Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Bioengineering researchers have recently constructed the final steps required to engineer yeast to manufacture opiates, including morphine and other medical drugs, from glucose, drawing significant interest, and concern, from the media and academics in the science and policy fields, including at the Center for International Security and Cooperation (CISAC).  

“Researchers are getting better at building biology based platforms to create a wide variety of compounds that are difficult, inefficient, or sometimes impossible to create by other means,” Dr. Megan J. Palmer told National Public Radio in the weekly Science Friday segment.

She highlighted how these platforms can enable production of potentially safer, cheaper and more effective drugs. “But one significant concern is if we create the full pathway to go from glucose to this intermediate and then all the way to things like morphine, this could feed into illicit markets and bolster new illicit markets.”

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Palmer is a William J. Perry Fellow in International Security at CISAC whose work focuses on developing best practices and policies for responsibly advancing biotechnology.

The media this week has focused on comments by researchers who pointed out that the modified yeast could be used to manufacture heroin, a synthesized version of morphine. The prospect of “home-brewed heroin” has been prominently featured in news coverage.

There are significant concerns, says Palmer, but she cautioned that focusing solely on that possibility could lead to bad policy outcomes.

“There is a big opportunity for researchers, policy makers, and industry to work together to figure out what controls they can put in,” she said in a separate interview. “We have time to get ahead of this problem. We now have choices in how we build and regulate the technology. The challenge for regulatory and technical communities will be to avoid reactive quick fixes. It’s encouraging to see researchers engaging in these issues early on.”

The challenge will be to find ways for researchers, law enforcers, and policy experts to work together to build safeguards into the biology itself as well as into organizations and institutions. 

“We really need to think about security as a design principle,” Palmer said. She hopes to foster thoughtful and rigorous analysis of how the design of biotechnology impacts future governance options.

“This issue highlights beautifully the nexus between public policy and science and technology, which is where CISAC has already, and will continue to make important contributions,” said CISAC Co-Director David Relman. Dr. Relman is also the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University. 

CISAC recently hosted a seminar led by Stanford’s Dr. Christina Smolke that discussed technology advances that are resulting in alternative supply chains for drugs, with particular attention to opiates.

Dr. Smolke is also troubled by the over-emphasis of the risks associated with the potential technology. “I believe it’s inflammatory, biased, and not grounded in an accurate representation of the technology. However, the commentary focuses on the risks of the supply chain and proposes regulations/governance for such a technology, without implementing a process to engage various parties in discussions to thoughtfully assess risks, opportunities, and regulatory needs in this context.”

“I think we need to frame this issue in the context of the larger systemic challenges involving the rearrangements of supply chains enabled through bio-manufacturing and how we spread responsible norms and practices,” Palmer said. “We need to think about governance options in terms of human capacities and technical capacities. What safeguards can we engineer into our technologies, and in turn what safeguards can we build into our organizations and institutions?”

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Stanford’s Asian Liver Center (ALC) held a press conference at SCPKU on April 17 to share progress on the ALC’s Hepatitis B education pilot program in China's Gansu and Qinghai provinces. In addition to media participants, there was representation from the Chinese Center for Disease Control, China’s National Health and Family Planning Commission, and the World Health Organization.  Dr. Samuel So, ALC Director, delivered the keynote address.  Targeting pregnant women and healthcare workers in Gansu and Qinghai provinces, the ALC has collaborated with local health departments to provide a series of classes, workshops, and public health services to enhance understanding and management of the disease.  The program has so far trained over 12,000 local healthcare workers and reached over 3 million residents in the two provinces.

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Beth Duff-Brown became the Communications Manager at Stanford Health Policy in May 2015. She was the editorial director at the Center for International Security and Cooperation for three years before joining the health policy and research centers at the Freeman Spogli Institute for International Studies and the School of Medicine. Before coming to Stanford, Beth worked in Africa and Asia as a foreign correspondent for The Associated Press, including as bureau chief for South Asia, based in New Delhi, and as the Deputy Asia Editor at the Asia-Pacific Desk in Bangkok, overseeing the daily news report from Afghanistan to Australia. She was a 2010-2011 Knight Journalism Fellow at Stanford, where she developed a digital platform to tell stories about women and girls in the developing world. Beth has a master's degree in journalism from Northwestern University and was a Peace Corps Volunteer in the Democratic Republic of the Congo.

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Concerns about the quality of state-financed nursing home care has led to the wide-scale adoption by states of pass-through subsidies, in which Medicaid reimbursement rates are directly tied to staffing expenditure. We examine the effects of Medicaid pass-through on nursing home staffing and quality of care by adapting a two-step FGLS method that addresses clustering and state-level temporal autocorrelation. We find that pass-through subsidies increases staffing by about 1% on average and 2.7% in nursing homes with a low share of Medicaid patients. Furthermore, pass-through subsidies reduce the incidences of pressure ulcer worsening by about 0.9%.

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Yong Suk Lee
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SCPKU sponsored a Stanford graduate seminar entitled “Chronic Disease in China: Health Care and Public Health Challenges” March 16 to April 3.  Taught by Stanford Professor Randall Stafford from the Stanford Center for Research in Disease Prevention, the seminar focused on analyzing the multiple factors leading to China’s increasing non-communicable disease (NCD) burden and implications for health care services and policies – both within China and globally. In addition to Professor Stafford and his Teaching Assistant, seven Stanford students participated in the seminar along with students from Peking University and Zhejiang University.   

Two Stanford participants share some of their seminar experiences below. Ben Seligman is in the School of Medicine pursuing his MD and PhD and Daisy Zheng is working on her PhD in Civil and Environmental Engineering. Content from the interview has been edited for length and clarity. 

 

Qu: Why did you decide to apply for this SCPKU graduate seminar?

Ben:  The topic was relevant to my research interests and I am interested in doing more work involving China.

Daisy:  It aligned very well with my research and provided a chance for short-term study at a prestigious campus, Peking University. 

 

Qu: What did you hope to learn in China as part of the program and were your objectives met?

Ben:  I hoped to work on my Chinese, learn more about available datasets, and network with local faculty.  I would say I was mostly successful across the board.

Daisy:  I hoped to learn: 1) the differences in performing research abroad, 2) the difference between China’s healthcare system and that in other countries, and 3) the impact that environment has on quality of life in China.  What I found most surprising were the differences in male and female health factors in China (obesity and smoking), the issues with particular Chinese databases, and the categorization of disease treatment and diagnosis. 

 

Qu: Did the Chinese students from Peking University and Zhejiang University have an impact on your experience?

Ben:  Yes, having them present was a core part of what made the experience worthwhile.

Daisy:  Yes, I found working with them was most enlightening when discussing research habits.  The challenge was that the students were taking full loads at their universities while attending the seminar so they were extremely busy.  It would have been ideal to have Chinese students with lighter loads participating – perhaps students at the PhD level no longer taking classes or holding the seminar during the summer.

 

Qu: Was this your first time participating in an overseas course/field trip?  If not, please share some of the challenges that you may have encountered on your other trips and how you resolved them. 

Ben:    This was not my first trip.  Cross-cultural communication is always a challenge, particularly if the working language is English and many of the participants are not fluent.  Likewise, keeping on-schedule is a significant and important challenge.

Daisy:  No, I participated in a National Science Foundation International Research and Education in Engineering program in which I conducted research at Tsinghua University in Beijing.  The largest challenge was getting access to academic resources at Stanford.

 

Qu:  What are the first three words or thoughts that come to mind which best describe your experience at SCPKU?

Ben:  Exciting, informative and fun

Daisy: Fun, enlightening, bonding

 

Qu: Do you have future plans to travel to China? 

Ben:  I hope to return to SCPKU as a pre-doc fellow.  Longer-term, I hope to do some of my epidemiological and demographic research in China, building partly off of the contacts I have made.

Daisy: I would love to be able to go back and study air quality conditions in Beijing.

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In this session of the Shorenstein APARC Corporate Affiliate Visiting Fellows Research Presentations, the following will be presented:

Jaigeun Lim, Seoul Metropolitan Government, "A Study on the Influential Factors on Inbound Foreign Direct Investment and its Implications"

The global importance of Inbound Foreign Direct Investment (IFDI) continues to grow and each nation has made an effort to enhance its national competitiveness through IFDI.  Lim’s research targets 51 nations and 14  candidate variables to learn which factors have an influence on IFDI.

Statistically meaningful variables on IFDI include GDP, economic growth rate, dependency to trade, management of cities, small and medium-sized enterprises’ efficiency and investment incentive policy.  Particularly, the results from Outbound Foreign Direct Investment (OFDI)-oriented nations give evidence that influences of GDP, small and medium-sized enterprises’ efficiency and investment incentive policy are positive to IFDI.  However, Korea shows the lower level of performances in small and medium-sized enterprises’ efficiency and investment incentive policy.  Korea has also shown the lower performances in similar variables compared with other Asia-Pacific nations.  Lim’s research aims to find out what these results mean in terms of policy for Korea?

 

Ryuichi Ohta, Japan Patent Office, "Relationship Between Technical Standard and Patents"

Samsung and Apple have more than 50 cases of appeals to the courts against each other in more than 10 countries.  In these court battles, Samsung asserted injunction using essential patent which is related to telecommunication standards and committed RAND (Reasonable And Non-Discriminatory) commitment.  Injunction is one of the basic rights for patent, which means Samsung can assert this right.  However in this case, can Samsung assert injunction in spite of RAND commitment?  In normal circumstances, standard organizations require RAND licensing obligations for essential patents.  Ohta will address the question "Why do they require it and why do they consider these obligations are reasonable for essential patents?" through case studies.

 

Rajeev Prasad, Reliance Life Sciences, "Concept of Total Quality Management in Pharmaceutical Industries"

The pharmaceutical industry is profoundly regulated and the reasons are obvious;  the use of ineffective, poor quality, harmful medicines can result in therapeutic failure, exacerbation of disease, and resistance of medicines and sometimes death of the patients.  Also, the mistakes in product design or production can have severe, even fatal, consequences for patients which sometimes lead to recall of drugs from the market.  Total Quality Management (TQM) acts as an umbrella under which everyone in the organization can strive for customer satisfaction by producing better quality of product, reduce cost and wastage and increase the efficiency of services.  In his research, Rajeev has focused on the failures of TQM principles by evaluating the warning letters, case studies of pharmaceutical manufacturers and product recalls and also outlined about the implementation of robust quality management system by amalgamation of principles of TQM and pharmaceutical regulatory guidelines.

Philippines Conference Room

Encina Hall, 3rd Floor, Central

Jaigeun Lim Seoul Metropolitan Government
Ryuichi Ohta Japan Patent Office
Rajeev Prasad Reliance Life Sciences
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Abstract

Governance is exceptionally complex in health systems. Part of the complexity lies in the differences between these systems; especially across countries. Differences make it difficult to assess governance conditions in a comparative sense, and call for a framework to think about this issue. This talk discusses a potential framework based on the idea that governance mechanisms vary depending on relationships in systems and the problems that systems face. The framework is applied to different countries to show how different health sector governance regimes might be required for different contexts.

 

Speaker Bio

mattandrews Matt Andrews
Matt Andrews is Associate Professor of Public Policy at Harvard Kennedy School. A South African, he does research on governance in developing countries and also on implementation of reforms. His most recent work examines comparative governance arrangements as well as problem driven approaches to doing development differently.

 

 

**This event is co-sponsored by the FSI Policy Implementation Lab.** 

 

 

Governance Maps, Traps and Emergent Strategies
Matt Andrews Associate Professor of Public Policy, Harvard Kennedy School Associate Professor of Public Policy, Harvard Kennedy School
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The Shaanxi Daily issued a press release on REAP's ongoing Perfecting Parenting project.  This article was translated and reprinted with permission from The Shaanxi Daily.  Read the original article (in Chinese) here.

 

China’s First “Parenting Trainers” Will Be Born in Shangluo

March 19, 2015
 
Shaanxi Media Online
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In Shangluo, tucked away in the distant parts of the Qinling mountain range, 70 officials have already undertaken the assignment of “early child development parenting trainers.”

Yaojiang Shi, Director of the Center for Experimental Economics in Education at Shaanxi Normal University, was brimming with confidence as he received journalists, saying, “before long, they will pass the evaluations and become China’s first generation of parenting trainers.”

According to statistics, in 2013, 40 percent of 6- to 12-month-old children living in rural areas in Shaanxi province clearly lagged behind in cognitive ability and social-emotional development. Parents are only concerned that their children have enough to eat and warm clothes to wear, neglecting their mental health and development. Scientific research has proven that the first three years of a child’s life is a critical period for mental development. However, in China’s vast rural areas, there is still a blank space in place of education for 0- to 3-year-old children. In order to change this situation, China’s National Health and Family Planning Commission, Shaanxi Normal University, Stanford University in the United States, and the Chinese Academy of Sciences jointly established the “Perfecting Parenting” project. Following this project’s officially launch last November, 70 “parenting trainers” were recruited from among the family planning officials in 58 townships across Danfeng, Shangnan, Shanyang, and Zhenan counties, and 275 babies were randomly selected to take part in the project. After undergoing rigorous training, the “parenting trainers” will teach scientific child-rearing knowledge to children’s parents and caretakers through demonstration and guidance. By having parents interact more with their children through story telling, singing songs with them, playing games, and engaging in other parent-child activities, they aim to improve the babies’ cognitive abilities, motor development, and social-emotional development.

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This is a time at which the global movement for universal health coverage (UHC) is under intense review.  As an isolated country which recently opened up to the world, Myanmar has endorsed the goal of achieving UHC by 2030. However, current evidence has shown that there will be significant challenges for Myanmar to achieve this target.  The Myanmar health system comprises a pluralistic mix of public and private systems both in financing and provision. It was ranked the second worst in terms of ‘overall health system performance’ by the WHO in 2000. According to World Bank (2012), the country’s out-of-pocket payment burden is one of the highest in the world, at 81% of total health expenditures, resulting in high levels of catastrophic health expenditure. About three-quarters of Myanmar’s citizens, including the poorest and most marginalized communities, find themselves with very limited access to essential health services. And too many of these same populations suffer a further burden of being pushed, or kept, in poverty because they have to pay for their health care. Recognizing the fragility of its health system, Myanmar launched some transformations in the health sector in 2011. The most significant changes were increasing the health budget four-fold since 2011, launching some health insurance programs in some areas, starting to collaborate with a diversity of actors in the health sector, and major structural changes in the Ministry of Health, Myanmar. This colloquium will reflect upon these transformations and discuss how the changes will shape Myanmar’s future health system, drawing upon comparisons with health reforms in other South East Asian countries.

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Phyu Phyu Thin Zaw is currently a visiting scholar at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC). Her research interests are reproductive health, equity, health policies and gender issues.  

After receiving her MBBS degree from the University of Medicine (Mandalay), Phyu Phyu worked for two years at a public hospital. In 2009, she became an active researcher at the Department of Medical Research (Upper Myanmar). As a researcher, she participated in various clinical and public health researches and presented papers at national and international conferences. She was also actively involved in the welfare of underprivileged groups in Myanmar. She earned her PhD in Epidemiology from the Prince of Songkla University, Thailand in 2013. After her PhD, she continued her work at DMR (Upper Myanmar) as a research officer as well as a member of the secretariat of the Academic Committee. She was also as a field supervisor in two national surveys on HIV and RH commodities and services in Myanmar. She has also published journal articles on equity, gender differences and RH services utilization among the poor.

At APARC, Phyu Phyu will study the current trends of Myanmar health policies in general, as well as the specific sex education programs of the country. She will investigate how Myanmar/Burmese culture affects the objectives of the current sex education programs at schools based on the perceptions of adolescent students, teachers and parents.

 

The Philippines Conference Room

Encina Hall 3rd Floor Central

616 Serra Street

Stanford, CA 94305

Phyu Phyu Thin Zaw 2014-2015 Walter H. Shorenstein Asia-Pacific Research Center Visiting Scholar
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China has a relatively weak primary healthcare system as well as the highest absolute disease burden of diabetes in the world, accounting for almost one in three diabetes patients globally. An estimated 74.2% of the 114 million Chinese patients with diabetes are untreated. Extending treatment will add a heavy burden on the health care system. As the most developed Chinese city that spends a modest 5.1% GDP on health with excellent outcomes, Hong Kong may serve as a cost-effective model for strengthening primary  care for chronic disease management, with diabetes care as an example.

In this seminar, Professor Leung will discuss the health system in Hong Kong, the importance of primary care, and recent research assessing the ‘value for money’ of care for all 631,469 patients with diabetes who attended the public sector in Hong Kong between 2006 and 2013.  He argues that the publicly funded and provided integrated model of Hong Kong may serve as a useful value-for-money reference as mainland China scales up to address the national epidemic of chronic disease like diabetes.  

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Gabriel Leung became the fortieth Dean of the Li Ka Shing Faculty of Medicine in August 2013. Leung, a clinician and a respected public health authority, concurrently holds the Chair of Public Health Medicine. Previously he was Professor and Head of Community Medicine and served as Hong Kong’s first Under Secretary for Food and Health and fifth Director of the Chief Executive's Office in government.

Leung specialises in the field of public health medicine, a statutorily accredited specialty that covers the full range of public health sciences and their constituent disciplines.

Within the broad scope of public health medicine, his major interests revolve around topics that 1) have major population health impact locally, 2) where Hong Kong is a reliable and unique epidemiologic sentinel for mainland China, or 3) where Hong Kong is particularly endowed and best placed to address the fundamental science at hand. As such his research crosses the traditional boundaries of individual disciplines or fields of enquiry.

Philippines Conference Room

Encina Hall 3rd. Floor Central

616 Serra Street,

Stanford, CA 94305

Gabriel M. Leung Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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