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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Abstract
The scope and complexity of global health can be overwhelming, making it difficult to form an inspiring and unified vision for the future. Mired in this complexity, the international community defines success disease by disease‹without a clear picture of what fundamental reform would actually look like. If the aspiration of global health with justice is the right goal, then answering three simple questions may pierce the haze.

First, what would global health look like? That is, given optimal priority-setting, funding, and implementation, to what level of health should we aspire, and with what provision of health-related services? Posing these three elementary questions, of course, oversimplifies a field that is fraught with tensions and trade offs. But I want to imagine a more ideal future for world health, with bold proposals to get there. After thinking about these three basic questions, I turn to an idea for innovative global governance for health‹a Framework Convention on Global Health.

Second, what would global health with justice look like? Global health seeks to improve all the major indicators of health, such as infant and maternal mortality and longevity. Global health with justice, however, requires that we look beyond improved health outcomes for the population as a whole. Although overall population health is vitally important, justice requires a significant reduction in health disparities between the well-off and the poor. Societies that achieve high levels of health and longevity for most, while the poor and marginalized die young, do not comport with social justice.

Third, what would it take to achieve global health with justice? That is, once we clearly state the goal, and meaning, of global health with justice, what concrete steps are required to reach this ambitious objective? This raises fundamental challenges, intellectually and operationally, as the response cannot be limited to ever-greater resources, but must also involve improved governance‹at the country and international level and across multiple sectors.

Lawrence O. Gostin is University Professor, Georgetown University’s highest academic rank conferred by the University President. Prof. Gostin directs the O’Neill Institute for National and Global Health Law and was the Founding O’Neill Chair in Global Health Law. He served as Associate Dean for Research at Georgetown Law from 2004 to 2008. He is Professor of Medicine at Georgetown University, Professor of Public Health at the Johns Hopkins University, and Director of the Center for Law & the Public’s Health at Johns Hopkins and Georgetown Universities.

 Prof. Gostin holds a number of international academic professorial appointments: Visiting Professor (Faculty of Medical Sciences) and Research Fellow (Centre for Socio-Legal Studies) at the University of Oxford, United Kingdom; the Claude Leon Foundation Distinguished Scholar and Visiting Professor at the University of Witwatersrand, Johannesburg, South Africa; and the Miegunyah Distinguished Visiting Fellow and Founding Fellow of the Centre for Advanced Studies (Trinity College), University of Melbourne. Prof. Gostin serves as Secretary and a member of the Governing Board of Directors of the Consortium of Universities for Global Health.

Building 200 (History Corner)
Room 205
Stanford University

Lawrence O. Gostin O'Neill Professor in Global Health Law Speaker Georgetown University
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Abstract:
The peoples of Burma/Myanmar have faced military rule, human rights violations, and poor health outcomes for decades. The country Is now undergoing a political liberalization, and multiple changes in political, social and economic life. The human rights and health situation of the country's many ethnic nationalities remain challenging, and represent one of the clearest threats to the prospect of successful transition to peace, and to democracy. We will explore the current health and human rights situation in the country, the ongoing threats to peace, and ways forward for this least developed nation as it emerges from 5 decades of military rule.

Chris Beyrer MD, MPH, is a professor of Epidemiology, International Health, and Health, Behavior, and Society at the Johns Hopkins University Bloomberg School of Public Health. He is the founding Director of the University¹s Center for Public Health and Human Rights, which seeks to bring the tools of population-based sciences to bear on Health and rights threats. Dr. Beyrer also serves as Associate Director of the Johns Hopkins Centers for AIDS Research (CFAR) and of the Center for Global Health. He has been involved in health and human rights work with Burmese populations since 1993. Prof. Beyrer is the author of more than 200 scientific papers, and author or editor of six books, including War in the Blood: Sex, Politics and AIDS in Southeast Asia, and Public Health and Human Rights: Evidence-Based Approaches. He has served as a consultant and adviser to numerous national and international institutions, including the National Institutes of Health, the World Bank, WHO, UNAIDS, the Open Society Foundations, the Walter Reed Army Institute for Research, amfAR The Foundation for AIDS Research, Physicians for Human Rights and Human Rights Watch. Dr. Beyrer received a BA in History from Hobart and Wm. Smith Colleges, his MD from SUNY Downstate in Brooklyn, NY, and completed his residency in Preventive Medicine, public health training, an MPH and a Infectious Diseases Fellowship at Johns Hopkins University in Baltimore. He received an honorary Doctorate (PhD) in Health Sciences from Chiang Mai University in Thailand, in 2012, in recognition of his 20 years of public health service in Thailand

Building 200 (History Corner)
Room 205
Stanford University

Chris Beyrer Director Speaker Johns Hopkins Center for Public Health & Human Rights
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**** PLEASE NOTE CHANGE OF SPEAKER***

Dr. Susan Kasedde currently serves as Senior Advisor and Team Leader on HIV and Adolescents for UNICEF based in New York since November 2009. In this role, she has contributed towards global level evidence generation, technical guidance development, advocacy, global partnership development, and technical assistance towards the global response towards HIV prevention, treatment and care in adolescents aged 10 - 19. Since 2011, on behalf of UNICEF, Susan has coordinated a series of efforts including documentation of global practices in the care of adolescents living with HIV; mathematical modeling with the Futures Institute to assess the impact and cost of scale up of proven high impact HIV prevention, treatment and care interventions within a holistic response, on new HIV infections and AIDS deaths in adolescents; and a systematic review with the London School of Hygiene and Tropical Medicine to confirm evidence on effective approaches for programming to reduce HIV infection, illness and death in adolescents. This work has contributed to stronger advocacy and technical guidelines for programming for adolescents, a group of children previously largely neglected. In 2013, the documentation on adolescents living with HIV was a major contribution to the new WHO guidelines on HIV testing and counseling and care in adolescents. The impact modeling and systematic review are among a series of key papers that will be released in a special supplement on HIV prevention, treatment and care in adolescents at the International AIDS Society Conference in Melbourne, Australia in 2014.

 

 Susan joined UNICEF having served since 2007 as Regional Adviser with the UNAIDS Regional Office for Eastern & Southern Africa. In that role, she was responsible for coordinating analytic work on the epidemic and response and modes of HIV transmission in several high HIV burden countries, working extensively with government teams and partners in the highest HIV burden countries in the world to use an incidence model to predict the next 1000 new HIV infections and assess alignment of national strategies with the national epidemic. Susan has over 18 years of experience working on adolescents sexual and reproductive health of which 16 of those have been focused on HIV in adolescents. Susan holds a doctorate in Epidemiology and Population Health from the London School of Hygiene & Tropical Medicine, a Masters degree in Public Health from Boston University and Bachelors degrees in Biomedical Science and French. Susan is a national of Uganda and speaks English and French.

Building 200 (History Corner)
Room 205
Stanford University

Susan Kasedde Senior Advisor and Team Leader on HIV and Adolescents Speaker UNICEF
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Abstract
According to international human rights law, countries have to provide palliative care and pain treatment medications as part of their core obligations under the right to health. The failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may also result in the violation of the obligation to protect against cruel, inhuman and degrading treatment. The lecture will discuss Human Rights Watch’s research on this issue in India, Ukraine, Senegal, Kenya, and Mexico; our national and international advocacy efforts; and how we evaluate the impact of our work.

Joe Amon, PhD MSPH, is the Director of the Health and Human Rights Division at Human Rights Watch. Since joining Human Rights Watch in 2005, Joe has worked on a wide range of issues including access to medicines; discrimination, arbitrary detention and torture in health settings; censorship and the denial of health information; and the role of civil society in the response to infectious disease outbreaks and environmental health threats. Between January 2009 and June 2013 he oversaw Human Rights Watch's work on disability rights. He is an associate in the department of epidemiology at the Bloomberg School of Public Health at Johns Hopkins University and a lecturer in public and international affairs at Princeton University. In 2012 he was a distinguished visiting lecturer at the Paris School of International Affairs of SciencesPo.            

Building 200 (History Corner)
Room 205
Main Quad
450 Serra Mall
Stanford University

Joe Amon Director of Health and Human Rights Speaker Human Rights Watch
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Abstract
Preventing tobacco addiction is one of the leading ways to prevent fatal disease, yet many nations have declined to take steps against it. In recent years an international legal effort has begun to fill this void. In this lecture Professor Koh, formerly Legal Adviser of the U.S. State Department, will review the various dimensions of the legal campaign that is now underway.

Harold Hongju Koh is Sterling Professor of International Law at Yale Law School. He returned to Yale Law School in January 2013 after serving for nearly four years as the 22nd Legal Adviser of the U.S. Department of State.

Professor Koh is one of the country’s leading experts in public and private international law, national security law, and human rights. He first began teaching at Yale Law School in 1985 and served as its fifteenth Dean from 2004 until 2009. From 2009 to 2013, he took leave as the Martin R. Flug ’55 Professor of International Law to join the State Department as Legal Adviser, service for which he received the Secretary of State's Distinguished Service Award. From 1993 to 2009, he was the Gerard C. & Bernice Latrobe Smith Professor of International Law at Yale Law School, and from 1998 to 2001, he served as U.S. Assistant Secretary of State for Democracy, Human Rights and Labor.

Building 200 (History Corner)
Room 205
Stanford University

Harold Hongju Koh Sterling Professor of International Law Speaker Yale Law School
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Abstract
The most important post-Nuremberg health-related human right and bioethics principle is informed consent. A series of post-9/11 developments, including quarantine and forced vaccination proposals, "altered standards of care" for disaster responders, eliminating consent for "emergency research," the post-ACA rise of "standard of care research," whole genome screening guidelines for adults and children, and proposals for newborns, gene bank proposals for "broad" or no consent, and the force-feeding of hunger strikers at Guantanamo and in US prisons, all suggest that informed consent should be seen as optional, and judged by a physician-determined standard of care. It's time to kill these zombies, and save the life of informed consent, and thus of the individual person who retains dignity and human rights.

George Annas is the cofounder of Global Lawyers and Physicians, a transnational professional association of lawyers and physicians working together to promote human rights and health.  He has degrees from Harvard College (A.B. economics, '67), Harvard Law School (J.D. '70) and Harvard School of Public Health (M.P.H. '72).

Professor Annas is the author or editor of 18 books on health law and bioethics, including Worst Case Bioethics:  Death, Disaster, and Public Health(2010),Public Health Law (2007),American Bioethics: Crossing Human Rights and Health Law Boundaries(2005),The Rights of Patients(3d ed. 2004),Some Choice: Law, Medicine, and theMarket (1999), Standard of Care: The Law of American Bioethics (l993), and Judging Medicine (1987), and a play entitled Shelley's Brain, that has been presented to bioethics audiences across the U.S. and in Australia. Professor Annas wrote a regular feature on "law and bioethics" for the Hastings Center Report from 1976 to 199l, and a regular feature on "Public Health and the Law" in the American Journal of Public Health from 1982 to 1992 and since 1991 has written a regular feature for the NewEngland Journal of Medicine (“Health Law, Ethics & Human Rights”).

He  is a fellow of the American Association for the Advancement of Science, a member of the Institute of Medicine, a member of the National Academies’ Human Rights Committee, and co-chair of the American Bar Association's Committee on Health Rights and Bioethics (Individual Rights and Responsibilities Section). He has also held a variety of government regulatory posts, including Vice Chair of the Massachusetts Board of Registration in Medicine, Chair of the Massachusetts Health Facilities Appeals Board, and Chair of the Massachusetts Organ Transplant Task Force.

 

Building 200 (History Corner)
Room 205
Stanford University

George J. Annas, JD, MPH Professor Speaker Boston University Schools of Public Health, Medicine, and Law
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Children in rural Kenya are more susceptible to disease and death the farther away they live from clean drinking water, according to Stanford researchers.

In a survey of families in Asembo – a small farming community at the edge of Lake Victoria that has high rates of chronic diarrhea, child malnutrition and child death – a research team from the Center on Food Security and the Environment found that most people live just over a quarter-mile from clean water sources. About 200 feet closer to home are ponds and springs contaminated with E. coli bacteria. Sixty-six percent of families primarily use this contaminated surface water for drinking.

A child in Asembo, Kenya sits next to her family's water storage containers.

A child in Asembo, Kenya sits next to her family's water storage containers.
Photo Credit: Amy Pickering

While water is essential for farming, collecting it is time-consuming and physically exhausting in remote places like Asembo. Previous research has shown that when families must travel long distances for water, child health suffers. The harder it is to collect, the less of it a family will use. A shortage of water for cooking and drinking compromises children’s nutrition and hydration. And it limits hand washing and bathing, making children more susceptible to disease. Quality and availability of water also varies widely from source to source, and the time required to collect water can force families to use dirtier, unimproved water sources that are closer to home. 

In 2011, the FSE researchers partnered with the Centers for Disease Control Kenya Medical Research Institute (CDC-KEMRI), which was already conducting an extensive survey of household-level health indicators in the region. Combining resources with CDC-KEMRI allowed the team – led by FSE Director Rosamond Naylor, a professor of environmental earth system science, and Jenna Davis, an assistant professor of civil and environmental engineering – to use a robust set of data. The information covered about 3,000 households in a five kilometer radius and was collected on a bi-weekly basis for six months. In exploring the links between water, food and health in Asembo, FSE researchers first expanded the definition of water “access” to account for both physical distance and the quality of water sources.

Researchers take a child's measurements in Asembo, Kenya.

Researchers take a child's measurements in Asembo, Kenya.
Photo Credit: Amy Pickering

Researchers then mapped the distance of each household from its nearest water source, and recorded whether the source was improved (such as a deep borewell) or unimproved (surface water like a pond, spring or shallow well). To get the most precise possible data on local water quality, the research team collected samples from each household’s water source and sent them to a local hospital lab for testing. Surveyors then collected data on each household’s water management practices, including water treatment. They measured agricultural output, dietary diversity, and perceived food insecurity, then recorded the weight and height measurements of each child in the household. Respondents also reported the frequency of recent cases of diarrheal disease among children of the household.

Results of the initial survey highlight sobering realities about water access in Asembo. Households in the survey reported average per capita water consumption of only 31 liters per day, including water used for cooking, drinking, hygiene and agriculture. The average walk time to the nearest water source was approximately 15 minutes. The average distance to the nearest improved source was 428 meters, whereas the average distance to unimproved surface water was 374 meters. Water quality tests confirmed that these sources, used by the majority of families, were highly contaminated with E. coli bacteria, while improved water sources were significantly cleaner. Thirty percent of children showed stunted growth, and 11 percent were underweight for their age.

A researcher collects a sample of stored water at a household in Asembo, Kenya.

A researcher collects a sample of stored water at a household in Asembo, Kenya.
Photo Credit: Amy Pickering

Researchers found that close proximity to an abundant water source, regardless of quality, correlated with an increase in food production and diversity, as well as a lower hunger score. Having enough extra water for crop irrigation clearly improves children’s diets – particularly their access to the micronutrients essential for normal physical and cognitive development – and helps them resist disease. Households further from water sources reported lower and less diverse crop yields, as well as poorer child health indicators. Quality was also an important factor, as households with access to clean, improved water reported better child health outcomes than those relying on contaminated surface water.

The ultimate goal of the project, “Rural health and development at the food-water nexus” is to design interventions and policy incentives that help people absorb nutrients in environments where food and water are limited and disease is prevalent. In the next stage of the project, researchers will focus on links between water access and the progression of HIV, and will also investigate how improved diets from better water access can impact household income.

About the Stanford Research Team:

Jenna Davis is Associate Professor of Civil and Environmental Engineering, Higgins-Magid Faculty Senior Fellow at the Stanford Woods Institute for the Environment, and an affiliate of the Center on Food Security and the Environment.
Rosamond Naylor is the Director of the Center on Food Security and the Environment, Professor of Environmental Earth System Science, and the William Wrigley Senior Fellow at the Stanford Woods Institute.
Eran Bendavid is an infectious diseases physician and Assistant Professor of Medicine in the Division of General Internal Medicine, as well as an affiliate of the Center on Food Security and the Environment and the Stanford Health Policy center.
Amy Pickering is a lecturer in the School of Earth Sciences, and a research associate in Civil and Environmental Engineering, the Woods Institute for the Environment, and the Center on Food Security and the Environment.
Glwadys Gbetibouo is a postdoctoral scholar at the Center on Food Security and the Environment.
Katrina ole-MoiYoi is a Ph.D. student at the Center on Food Security and the Environment.

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Researchers take a child's measurements in Asembo, Kenya.
Amy Pickering
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CISAC Honors Student Mailyn Fidler has been awarded a Marshall Scholarship to continue her studies in international technology policy. She investigates security implications of the global trade in "zero-day" software exploits. Fidler has also worked as a consultant for Google Glass, autonomous vehicles and Internet access through atmospheric balloons, and was the co-founder and co-editor-in-chief of the Stanford Journal of Public Health.

Marshall Scholarships are named for former U.S. Secretary of State and U.S. Army General George Marshall, and are given to intellectually distinguished Americans to study in Britain.

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Abstract:

Nipah virus lives in large fruit bats in South and Southeast Asia. When people become infected with Nipah virus over half of them die. Nipah virus can also be transmitted from person to person. This talk will describe how this bat virus occasionally infects human populations and causes outbreaks through person-to-person transmission. It will explore the risk of a global pandemic of Nipah virus and consider appropriate policy responses.

Speaker bio:

Stephen Luby is Professor of Medicine in the Division of Infectious Diseases and Geographic Medicine; Deputy Director for Research at the Center for Global Health Innovation; Senior Fellow at the Woods Institute for the Environment and Senior Fellow at the Freeman Spogli Institute for International Studies at Stanford University.

Dr. Luby studied philosophy and earned a Bachelor of Arts summa cum laude from Creighton University. Dr. Luby earned his medical degree from the University of Texas Southwestern Medical School at Dallas and completed his residency in internal medicine at the University of Rochester-Strong Memorial Hospital. He studied epidemiology and preventive medicine at the Centers for Disease Control and Prevention.

Dr. Luby's former positions include leading the Epidemiology Unit of the Community Health Sciences Department at the Aga Khan University in Karachi, Pakistan for 5 years and working as a Medical Epidemiologist in the Foodborne and Diarrheal Diseases Branch of the Centers for Disease Control and Prevention exploring causes and prevention of diarrheal disease in settings where diarrhea is a leading cause of childhood death.  Immediately prior to his current appointment, Dr. Luby served for eight years at the International Centre for Diarrheal Diseases Research, Bangladesh (ICDDR,B), where he directed the Centre for Communicable Diseases. Dr. Luby was seconded from the US Centers for Disease Control and Prevention (CDC) and was the Country Director for CDC in Bangladesh.

Dr. Luby's research has focused on clarifying the burden of several communicable diseases in low income countries and developing and evaluating practical strategies to mitigate their impact. He is currently exploring circumstances where economic and political forces encourage environmental degradation that exerts substantial disease burden in low income countries, with a view to developing and evaluating interventions.

CISAC Central Conference Room

Stephen Luby Senior Fellow, Stanford Woods Institute for the Environment; Sr. Fellow, Freeman Spogli Inst. for International Studies; Research Deputy Director for the Stanford Univ. Center for Innovation in Global Health; Prof. of Medicine, Infectious Diseases Speaker
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