Stanford University

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.

SCPKU faculty fellow speaks on innovation in mobile healthcare

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Robert Chang, Assistant Professor of Ophthalmology at Stanford University Medical Center and SCPKU Faculty Fellow, gave a public talk at the center earlier this month focused on mobile healthcare innovation and the growing adoption of smartphones as medical devices.

Life expectancy worldwide made huge gains in the last century alone which has created an increasingly heavier burden on our health systems.  The world has seen a rise in age-related chronic illnesses, unique challenges for less developed nations, an increased need for specialized health care workers, and alarming health care cost increases.  These challenges have created opportunities which have spurred innovation in mobile healthcare solutions and the use of smartphones as medical devices to improve the delivery and cost of healthcare.

Chang highlighted Apple’s plans to penetrate the mobile healthcare market including rumors that the company will be releasing a new “iWatch” in October.  At its Worldwide Developer Conference in early June, the company also announced a new iOS 8-based health app and HealthKit framework for tracking personal health and fitness data.  Chang believes these represent important steps in digital health, signaling strong interest in major high-tech players to develop digital healthcare “hubs” and solutions for effective disease monitoring and management.

The current trend within the healthcare technology space is the general population’s use of smartphone sensors to self-track health and fitness data including heart rate, sleeping patterns, activity level and calorie consumption.  Over time, Chang sees the industry moving towards more wearable devices that are more fashionable, invisible and intuitive. 

Within the field of ophthalmology, eye disease diagnoses have typically been done with expensive, bulky equipment.  This limits the ability to deliver effective and efficient eye care in remote patient situations and/or where eye specialists aren’t readily available.  Ophthalmology is well-suited for telehealth and the use of mobile devices to facilitate remote triage. As mobile medical devices, smartphones are ideal given their broad market adoption and processing power and the ubiquity of the Internet.  Currently,  however, cost-effective adapters are needed to accompany a smartphone solution as the smartphone alone is insufficient to capture enough detail inside the eye for effective diagnoses.  As an ophthalmologist with a special interest in healthcare startups, Chang is working with a Stanford-based team to develop the EyeGo, a custom iPhone attachment and adapter coupled with a HIPAA-secure app to facilitate taking pictures of both the front and back of the eye to support remote triage and more efficient physician to physician communication.  While his initial platform is iPhone-based due to the phone’s ubiquity in the Silicon Valley, he eventually plans to port his solution to an open systems platform.

Chang closed his talk by re-emphasizing his point about wearable mobile healthcare becoming more invisible and intuitive.  “The lines are blurring between man and machine,” he said. He cited the “Turing Test,” an experiment developed by famed mathematician Alan Turing to create an artificial intelligence (AI) design standard for the tech industry.  “Can you design an AI where the AI can talk to a person but you can’t tell the difference between the computer and the human?” he challenged.  In order to pass the test, one must fool at least 33% of the judgment panel into thinking the AI is the real person.  Chang believes that mobile health technology can be successfully integrated into the medical field and that we will get to the point where people are completely comfortable interacting with the technology   “This is the next level in the wearable healthcare revolution  -- it will be like you’re talking to your doctor and you won’t be able to tell the difference,” he said.

Chang is a clinician-scientist with an active surgical practice and an interest in early stage medical device development and healthcare IT startups. He has received numerous grants and fellowships In recognition of his focus on patient care, physician innovation, biodesign, and design thinking.  Chang’s clinical research revolves around understanding the association between myopia and glaucoma.  

 

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USING SMARTPHONES AS MEDICAL DEVICES: INNOVATION IN MOBILE HEALTHCARE

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More patients are living longer and developing chronic diseases, often managed with increasingly expensive technology.  Both healthcare providers and hospital systems are struggling to keep up.  Modern smartphones can be converted into powerful, inexpensive portable medical devices to improve the delivery of healthcare, particularly in low- and middle-income countries. 

 

Professor Chang will talk about his experience in developing a simple adapter to turn an iPhone into an “Eye-Phone” Camera. Chang is an ophthalmologist with a special interest in healthcare startups and online medical education. His clinical research focus revolves around understanding the association between high myopia and glaucoma. He is currently co-developing “EyeGo,” an iPhone imaging adapter system for remote eye care triage.

Stanford Center at Peking University

Robert Chang Assistant Professor of Ophthalmology Speaker Stanford University Medical Center
Lectures

Fisheries and Food Security in China - 2014 Symposium

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From May 13-15, the Center on Food Security and the Environment and the Lenfest Ocean Program welcomed leading Chinese and international scientists to the Stanford Center at Peking University in Beijing, to share research and insights on the role of ocean fisheries, aquaculture, and marine ecosystems for improving food security in China.

Given China’s demographic changes, evolving nutritional requirements, and dominant role in global fisheries, the key question of the symposium was whether marine ecosystems can be managed adequately to support the country’s future vision for domestic food security.

Nearly 30 participants from around the world shared research on the provision of wild fish for direct human consumption and for animal feeds. Participants also shared insights on China’s aquaculture sector, including the tradeoffs involved in using wild fish in aquaculture feed.

Agenda

Session I – Food security and marine ecosystems

Session II – Aquaculture, feeds and fisheries

Session III - Coastal fisheries & impacts on marine ecosystems

Session IV – Economies of the global marine fish trade

Session V - Critical issues and challenges 

Stanford Center at Peking University

Rosamond L. Naylor

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Senior Fellow, Stanford Woods Institute and Freeman Spogli Institute for International Studies
William Wrigley Professor of Earth System Science
Senior Fellow and Founding Director, Center on Food Security and the Environment
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Rosamond Naylor is the William Wrigley Professor in Earth System Science, a Senior Fellow at Stanford Woods Institute and the Freeman Spogli Institute for International Studies, the founding Director at the Center on Food Security and the Environment, and Professor of Economics (by courtesy) at Stanford University. She received her B.A. in Economics and Environmental Studies from the University of Colorado, her M.Sc. in Economics from the London School of Economics, and her Ph.D. in applied economics from Stanford University. Her research focuses on policies and practices to improve global food security and protect the environment on land and at sea. She works with her students in many locations around the world. She has been involved in many field-level research projects around the world and has published widely on issues related to intensive crop production, aquaculture and livestock systems, biofuels, climate change, food price volatility, and food policy analysis. In addition to her many peer-reviewed papers, Naylor has published two books on her work: The Evolving Sphere of Food Security (Naylor, ed., 2014), and The Tropical Oil Crops Revolution: Food, Farmers, Fuels, and Forests (Byerlee, Falcon, and Naylor, 2017).

She is a Fellow of the Ecological Society of America, a Pew Marine Fellow, a Leopold Leadership Fellow, a Fellow of the Beijer Institute for Ecological Economics, a member of Sigma Xi, and the co-Chair of the Blue Food Assessment. Naylor serves as the President of the Board of Directors for Aspen Global Change Institute, is a member of the Scientific Advisory Committee for Oceana and is a member of the Forest Advisory Panel for Cargill. At Stanford, Naylor teaches courses on the World Food Economy, Human-Environment Interactions, and Food and Security. 

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Symposiums

Mobile Health in Ophthalmology: A View From Silicon Valley

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Mobile medical applications and portable medical devices are increasingly entering health care delivery systems as they push the limits of big data acquisition, secure cloud storage, and automated analysis of medical information. Smartphone technologies have advanced rapidly and are now in the hands of a large number of physicians and other healthcare workers, including individuals in low- and middle-income countries. Professor Chang will talk about the exploding mobile health space, his experience in developing a simple adapter to facilitate image capture of the eye, and emerging trends in wearable tech.

Dr. Chang is a clinician-scientist with special interest in mobile health development and healthcare IT startups. His clinical research focus revolves around understanding the association between high myopia and glaucoma. He is currently co-developing “EyeGo,” an iPhone imaging system for remote eye care triage.

Stanford Center at Peking University

Robert Chang SCPKU Faculty Fellow and Assistant Professor of Ophthalmology Speaker Stanford University Medical Center
Lectures

Why the United States Spends So Much More on Health Care than Other Countries: Economic, Institutional and Political Perspectives

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Abstract:

The United States spends over 17 percent of GDP on health care; the next six highest countries spend over 11 percent. This six percent differential indicates an excess spending of approximately one trillion dollars per year. Depending on the benefit from the extra spending, this suggests the possibility of a huge misallocation of resources. Also, because the federal government funds almost half of total health care spending, there are significant effects on the deficit and the debt. The main reasons for the excess are (1) the U.S. pays higher prices for drugs, devices, and equipment and higher fees to specialists and sub-specialists; (2) higher administrative costs; and (3) a more expensive mix of medical care. The seminar will focus on institutional and political explanations for the three proximate reasons.

 

Speaker Bio:

Victor R. Fuchs is the Henry J. Kaiser Jr Professor Emeritus at Stanford University, in the Departments of Economics and Health Research and Policy.  He is also a Research Associate of the National Bureau of Economic Research and a Senior Fellow at SIEPR.  He applies economic analysis to social problems of national concern, with special emphasis on health and medical care.  He is author of nine books, the editor of six others, and has published over two hundred papers and shorter pieces.  His current research focuses on male-female differences in mortality, reform of medical education, and the future of U.S. health care.

His best known work, Who Shall Live?  Health, Economics, and Social Choice (1974; expanded edition 1998, 2nd expanded edition 2011), helps health professionals and policy makers to understand the economic and policy problems in health that have emerged in recent decades.  Other books include The Service Economy (1968), How We Live (1983), The Health Economy (1986), Women’s Quest For Economic Equality (1988), and The Future of Health Policy (1993).  He is the editor of Individual and Social Responsibility: Child Care, Education, Medical Care, and Long-term Care in America (1996).

Professor Fuchs was elected president of the American Economic Association in 1995.  He has also been elected to the American Philosophical Society, the American Academy of Arts and Sciences, the Institute of Medicine of the National Academy of Sciences, and is an Honorary Member of Alpha Omega Alpha.  He has received the John R. Commons Award, Emily Mumford Medal for Distinguished Contributions to Social Science in Medicine, Distinguished Investigator Award (Association for Health Services Research), Baxter Foundation Health Services Research Prize, and Madden Distinguished Alumni Award (New York University).  ASHE’s (American Society of Health Economists) Career Award for Lifetime Contributions to the Field of Health Economics and the RAND Corporation prize for the Best Paper published in the Forum for Health Economics and Policy are named and awarded in honor of Professor Fuchs.

This event is sponsored by the Stanford Center on Democracy, Development and the Rule of Law and the Center for Health Policy/Center for Primary Care and Outcomes Research.

 

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Victor Fuchs the Henry J. Kaiser Jr Professor Emeritus Speaker Stanford University
Seminars

Public health leaders address global challenges

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In a recent discussion, Dr. Gro Brundtland, former director-general of the World Health Organization, and Dr. Helene Gayle, president and CEO of Cooperative for Assistance and Relief Everywhere (CARE USA), address some of the underlying causes of extreme global poverty and their linkages to global public health challenges.
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Air Pollution and Short-Term Mortality in Beijing

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Little empirical evidence exists on the health costs of air pollution in China, one of the most polluted countries in the world. Unsurprisingly, the lack of reliable data on pollution levels and health outcomes impede research. Because the pollution-health relationship is likely non-linear, it is difficult to extrapolate from existing high quality studies in developed countries to ascertain health costs. We address this deficiency by obtaining new data on Beijing’s daily mortality April 2008-April 2013 from the Chinese Center for Disease Control and Prevention. We combine these data with daily pollution measures from the US Embassy in Beijing, which records particulate matter of 2.5 microns or less in width (PM 2.5). We find that after controlling for weather conditions, year, month, and day of week fixed effects, daily PM2.5 indeed predicts daily mortality, particularly deaths from cardiovaslular disease. A 100 μg/m3 increase in daily PM2.5 is associated with 7 deaths daily, among them 4 cardiovascular deaths, and 0.8 respiratory deaths. Furthermore, deaths among less-educated and outdoor workers show a stronger relationship to PM2.5 levels. Notably, the relationship is robust to controlling for the official measure of Beijing’s air pollution, the average daily air pollution index (API), despite the fact that PM2.5 is measured by 1 monitor at the US embassy whereas API (and mortality) combine data from across the Beijing metropolitan area. Indeed, Beijing’s API does not have a significant relationship to mortality once AQI at the Embassy is accounted for. Our finding supports previous research arguing for measuring PM 2.5 and reporting it promptly to the public. 
 
Shuang Zhang is an assistant professor in the Department of Economics at University of Colorado Boulder. She works on various topics in development, including health, education, environment, political economy, etc,. with a focus on China. She holds a PhD in Economics from Cornell University and was a postdoctoral fellow in SIEPR of Stanford University in 2012-13.

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Shuang Zhang assistant professor in the Department of Economics Speaker University of Colorado Boulder
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Health care aid for developing countries boosts life expectancy, study finds

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Foreign aid for health care is directly linked to an increase in life expectancy and a decrease in child mortality in developing countries, according to a new study by Stanford researchers.

The researchers examined both public and private health-aid programs between 1974 and 2010 in 140 countries and found that, contrary to common perceptions about the waste and ineffectiveness of aid, these health-aid grants led to significant health improvements with lasting effects over time.

Countries receiving more health aid witnessed a more rapid rise in life expectancy and saw measurably larger declines in mortality among children under the age of 5 than countries that received less health aid, said Eran Bendavid, MD, an assistant professor in Stanford Medical School's Division of General Medical Disciplines and lead author of the study. If these trends continue, he said, an increase in health aid of just 4 percent, or $1 billion, could have major implications for child mortality.

“If health aid continues to be as effective as it has been, we estimate there will be 364,800 fewer deaths in children under 5,” he said. “We are talking about $1 billion, which is a relatively small commitment for developed countries.”

The study was published online April 21 in JAMA Internal Medicine. The study’s co-author, Jay Bhattacharya, MD, PhD, is an associate professor of medicine.

Bendavid and Bhattacharya are core faculty members at Stanford’s Center for Health Policy and Center for Primary Care and Outcomes Research at the university's Freeman Spogli Institute for International Studies.

Does it work?

Bendavid noted that there is much debate around foreign aid. Critics question whether it’s used effectively and reaches its intended recipients. They often argue that it discourages local development and displaces domestic resources that might otherwise be devoted to health. So the researchers devised a statistical tool to address the basic unanswered question: Do investments in health really lead to health improvements?

Bendavid said there are many reasons to suspect the answer would be no, though the findings proved just the contrary, with health-related aid leading to direct, beneficial outcomes.

“I think for many people, that will be surprising,” he said. “But for me, it fits with other evidence of the incredible success of public health promotion in developing countries.” In a previous study, for instance, he found that hundreds of thousands of lives were saved through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, in which the U.S. government invested billions of dollars in antiretroviral treatment and other AIDS-related prevention and treatment initiatives.

In the latest study, the two investigators used data from the Creditor Reporting System of the Organization for Economic Cooperation and Development, the world’s most extensive source of information on foreign aid. While aid programs for health grew during the 36-year study period, the largest period of growth occurred between 2000 and 2010, they found.

Stepped-up investments

It was during this decade that many governments and private groups stepped up their investments in health, including PEPFAR; the World Bank; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Gates Foundation; and the GAVI Alliance, among others, he said.

As a result, while health aid in 1990 accounted for 4 percent of total foreign aid, it now amounts to 15 percent of all aid, he said. And it’s become an important part of health budgets in recipient countries, accounting for 25-30 percent of all health-care spending in low-income countries, Bendavid said.

The researchers found that these funds were used effectively, largely because of the targeting of aid to disease priorities where improved technologies — such as new vaccines, insecticide-treated bed nets for malarial prevention and antiretroviral drugs for HIV — could make a real difference.

They observed the greatest health impacts between 2000 and 2010, when donor investments were at their peak. During the decade, under-5 child mortality declined from a mean of 109.2 to 72.4 deaths per 1,000, or 36.8 fewer deaths among those children in the countries that received the most health aid, the researchers found (a 34 percent reduction). In the countries receiving the least, under-5 mortality fell from 31.6 to 23.2 deaths per 1,000, or 8.4 fewer deaths per 1,000 live births (a 26 percent reduction), the researchers reported.

Life expectancy increases

During that period, life-expectancy figures also grew faster in countries with a greater infusion of health aid, Bendavid said. Life expectancy rose from 57.5 to 62.3 — an increase of 4.8 years — among the countries receiving the most aid. Among the countries receiving the least health aid, life expectancy increased by 2.7 years, from 69.8 to 72.5 years.

Bendavid said previous experience has shown that, on average, life expectancy has increased by nearly one year every four years in developed countries. But health-aid programs literally cut in half the time it took to reach this goal in developing countries. “In that same four-year span, they increased life expectancy by two years, rather than one year,” he said.

He said the results are not surprising if one considers some of the new health technologies made available to developing nations as a result of foreign aid. Childhood vaccines, including those for diphtheria, tetanus, polio and measles, have all but wiped out what used to be among the top killers of young children in the developing world. Health aid directed to providing insecticide-treated malarial bed nets also has been credited in recent studies with reducing malarial deaths among young children, he noted.

Among both adults and children, aid that has expanded the availability of antiretroviral drugs in the developing world has had a major impact on reducing deaths and improving overall life expectancies, he said. For instance, in a study published in 2012, Bendavid and colleagues found that PEPFAR’s health aid resulted in more than 740,000 lives saved between 2004 and 2008 in nine countries.

The researchers also found that the benefits of aid have a lasting effect: The telltale signs of aid’s relationship to reducing under-5 mortality were detectable for three years following the distribution of aid. The correlation between health aid and longer life expectancy overall was detectable for five years after the aid was distributed.

With aid commitments flattening amid the economic downturn, Bendavid said donors will have to be that much smarter in how they invest future dollars, focusing on the most cost-effective interventions and technologies.

“To date, there has been little consideration of how to use development aid in the most cost-effective manner,” he said. “That will have to change now that the funding level has reached a plateau.”

The study was funded by the George Rosenkranz Fellowship for Health Policy Research in Developing Countries and by the National Institutes of Health (grant K01AI084582).

Information about Stanford’s Department of Medicine, which also supported the work, is available at http://medicine.stanford.edu.

Ruthann Richter is the director of media relations at the Stanford School of Medicine.

 

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n Afghan child receives polio vaccination drops during an anti-polio campaign in Kabul March 24, 2014.
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