Global Health

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Global Health

Interdisciplinary research on global health problems through the lenses of economics, nutrition and politics.

Research Spotlight

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Tackling the Health of Women and Children in Global Conflict Settings

A new four-paper series in The Lancet exposes the far-reaching effects of modern warfare on women’s and children’s health. Stanford researchers, including SHP's Paul Wise and Eran Bendavid, have joined other academics and health-care experts in calling for an international commitment from humanitarian actors and donors to confront political and security challenges.
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Ethics and Governance of Digital Epidemiology

Many countries have taken digital epidemiology to the next level in responding to COVID-19. Focusing on core public health functions of case detection, contact tracing, and isolation and quarantine, the authors explore ethical concerns raised by digital technologies and new data sources in public health surveillance during epidemics.
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Does Diversity Matter for Health? Experimental Evidence from Oakland

African-American men have the lowest life expectancy of any major demographic group in the United States and live on average 4.5 fewer years than non-Hispanic white men. This paper finds that the mortality disparity is partly related to underutilized preventive healthcare services.

Featured Scholars

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Michelle Mello

Professor of Medicine
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Michelle Mello

Professor of Medicine
Professor of Law
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Doug Owns

Senior Fellow at the Freeman Spogli Institute for International Studies
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Doug Owns

Senior Fellow at the Freeman Spogli Institute for International Studies
Professor of Medicine
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Maya Rossin-Slater

Assistant Professor, Medicine
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Maya Rossin-Slater

Assistant Professor, Medicine
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Paul Wise

Senior Fellow at the Freeman Spogli Institute for International Studies
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Paul Wise

Senior Fellow at the Freeman Spogli Institute for International Studies
Professor of Child Health and Society

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Publications

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Journal Article

The Educational Gradient in Health in China

Qiulin Chen , Karen Eggleston, Wei Zhang, Jiaying Zhao
The China Quarterly , 2017

It has been well established that better educated individuals enjoy better health and longevity. In theory, the educational gradients in health could be flattening if diminishing returns to improved average education levels and the influence of earlier population health interventions outweigh the gradient-steepening effects of new medical and health technologies. This paper documents how the gradients are evolving in China, a rapidly developing country, about which little is known on this topic.

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Working Paper

Municipal Water Disinfection and Mortality Decline in Developing Countries: Evidence from Mexico’s Programa Agua Limpia

Sonia R. Bhalotra, Alberto Diaz-Cayeros, Grant Miller, Alfonso Miranda, Atheendar S. Venkataramani
National Bureau of Economic Research , 2017

Historically, improvements in the quality of municipal drinking water made important contributions to mortality decline in wealthy countries. However, water disinfection often does not produce equivalent benefits in developing countries today. We investigate this puzzle by analyzing an abrupt, large-scale municipal water disinfection program in Mexico in 1991 that increased the share of Mexico’s population receiving chlorinated water from 55% to 85% within six months.

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Journal Article

Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from the Essential Medications List under China’s 2009 Healthcare Reform

Brian K. Chen, Karen Eggleston, Y. Tony Yang
World Medical & Health Policy , 2017

Expanding access through insurance expansion can increase health‐care utilization through moral hazard. Reforming provider incentives to introduce more supply‐side cost sharing is increasingly viewed as crucial for affordable, sustainable access. Using both difference‐in‐differences and segmented regression analyses on a panel of 1,466 hypertensive and diabetic patients, we empirically examine Shandong province's initial implementation of China's 2009 Essential Medications List policy. The policy reduced drug sale markups to providers but also increased drug coverage benefits for patients.

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Book

Health Insurance and Chronic Disease Control: Quasi-experimental Evidence from Hypertension in Rural China

Karen Eggleston, M. Kate Bundorf, Margaret Triyana, Yan Wang, Sen Zhou
Cambridge University Press , 2017

"Health Insurance and Chronic Disease Control: Quasi-experimental Evidence from Hypertension in Rural China" is a chapter within the volume China's Healthcare System and Reform. The volume provides a comprehensive review of China’s healthcare system and policy reforms in the context of the global economy. Following a valuechain framework, the 16 chapters cover the payers, the providers, and the producers (manufacturers) in China’s system.

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Journal Article

The Epidemiologic Challenge to the Conduct of Just War: Confronting Indirect Civilian Casualties of War

Paul H. Wise
Daedalus , 2017

Most civilian casualties in war are not the result of direct exposure to bombs and bullets; they are due to the destruction of the essentials of daily living, including food, water, shelter, and health care. These “indirect” effects are too often invisible and not adequately assessed nor addressed by just war principles or global humanitarian response.

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Journal Article

Sources of variation in under-5 mortality across sub-Saharan Africa: a spatial analysis

Marshall Burke, Sam Heft-Neal, Eran Bendavid
The Lancet Global Health , 2016

The ongoing decline in under-5 mortality ranks among the most significant public and population health successes of the past 30 years.

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Journal Article

Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care

C. Jason Wang, Skye H. Cheng, Jen-You Wu, Yi-Ping Lin, Wen-Hsin Kao, Chia-Li Lin, Yin-Jou Chen, Shu-Ling Tsai, Feng-Yu Kao, Andrew T. Huang
Journal of the American Medical Association (JAMA) Oncology , 2016

Importance:

Value-driven payment system reform is a potential tool for aligning economic incentives with the improvement of quality and efficiency of health care and containment of cost. Such a payment system has not been researched satisfactorily in full-cycle cancer care.

Objective:

To examine the association of outcomes and medical expenditures with a bundled-payment pay-for-performance program for breast cancer in Taiwan compared with a fee-for-service (FFS) program.

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Journal Article

The weaker sex? Vulnerable men and women's resilience to socio-economic disadvantage

Mark R. Cullen, Michael Baiocchi, Karen Eggleston, Pooja Loftus, Victor R. Fuchs
SSM - Population Health , 2016

Sex differences in mortality vary over time and place as a function of social, health, and medical circumstances. The magnitude of these variations, and their response to large socioeconomic changes, suggest that biological differences cannot fully account for sex differences in survival. Drawing on a wide swath of mortality data across countries and over time, we develop a set of empiric observations with which any theory about excess male mortality and its correlates will have to contend.

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Journal Article

Abstinence Funding Was Not Associated with Reductions in HIV Risk Behavior in Sub-Saharan Africa

Nathan Lo, Anita Lowe, Eran Bendavid
Health Affairs , 2016

The President’s Emergency Plan for AIDS Relief (PEPFAR) has been the largest funder of abstinence and faithfulness programming in sub-Saharan Africa, with a cumulative investment of over US $1.4 billion in the period 2004–13.

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Book

The Economics of Women’s Health in Low- and Middle-Income Countries: A Life Cycle Approach

Marcella Alsan, Afsan Bhadelia, Patricia Foo, Corinna Haberland, Felicia Knaul
World Scientific Handbook of Global Health Economics and Public Policy: The Economics of Health and Health Systems , 2016

This chapter highlights evidence that links women’s health challenges in LMICs to economics at every stage of life. It advances the notion that discrimination against women persists for sociocultural and economic reasons and is embodied in ill health and disability across the life span.

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Commentary

The Grand Divergence in Global Child Health: Confronting Data Requirements in Areas of Conflict and Chronic Political Instability

Paul H. Wise, Gary Darmstadt
Journal of the American Medical Association (JAMA) Pediatrics , 2016

There is something deeply troubling about a death that goes unnoticed. Beyond the humane impulse to provide solace through collective acknowledgment and community support lies the recognition that an unnoticed death implies an unnoticed life. There can be no doubt that the accurate counting and causal attribution of morbidity and mortality provide technical information that is essential for public health planning, evaluation, and improvement in program performance.

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Journal Article

Improving the global health workforce crisis: an evaluation of Global Health Corps

Rajesh Gupta, Barbara P Bush, Jonny Dorsey, Emily Moore, Cassia van der hoof Holstein, Paul E Farmer
Lancet Global Health , 2015

Efforts to address the global healthcare workforce crisis focus heavily on traditional service providers such as physicians and nurses. Yet, improving health systems also necessitates involvement from a wide range of management and support workers.

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Journal Article

Why highly polluting methods are used to manufacture bricks in Bangladesh

Stephen P. Luby, Debashish Biswas, Emily S. Burley, Ijaz Hossain
Energy for Sustainable Development , 2015
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Commentary

Consensus Statement: Primary Health Care Reform & Community Health Service in China

ACON Primary Care Research Center and the Shorenstein Asia-Pacific Research Center , 2015

The conference report from the workshop, Community Health Services and Primary Health Care Reform in China, held on June 18, 2015 at the Stanford Center at Peking University. The report is written in both Chinese and English.

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Journal Article

Health Aid Is Allocated Efficiently, But Not Optimally: Insights From A Review Of Cost-Effectiveness Studies

Eran Bendavid, Andrew Duong, Charlotte Sagan, Gillian Raikes
Health Affairs , 2015

Development assistance from high-income countries to the health sectors of low- and middle-income countries (health aid) is an important source of funding for health in low- and middle-income countries. However, the relationship between health aid and the expected health improvements from those expenditures—the cost-effectiveness of targeted interventions—remains unknown. We reviewed the literature for cost-effectiveness of interventions targeting five disease categories: HIV; malaria; tuberculosis; noncommunicable diseases; and maternal, newborn, and child health.

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Journal Article

Searching for Public Health Law’s Sweet Spot: The Regulation of Sugar-Sweetened Beverages

David Studdert, Michelle M. Mello, Jordan Flanders
PLOs , 2015

David Studdert and colleagues explore how to balance public health, individual freedom, and good government when it comes to sugar-sweetened drinks. Over the last decade, many national, state, and local governments have introduced laws aimed at curbing consumption of sugar-sweetened beverages (SSBs), especially by children.

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Journal Article

Income Shocks and HIV in Africa

Marshall Burke, Erick Gong, Kelly Jones
The Economic Journal , 2015

We examine how variation in local economic conditions has shaped the AIDS epidemic in Africa. Using data from over 200,000 individuals across 19 countries, we match biomarker data on individuals' serostatus to information on local rainfall shocks, a large source of income variation for rural households. We estimate infection rates in HIV-endemic rural areas increase by 11% for every recent drought, an effect that is statistically and economically significant.

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Journal Article

Rethinking the development of Ebola treatments

Rajesh Gupta
The Lancet Global Health , 2014

In response to the current outbreak, the international community has endorsed the clinical use of unregistered treatments for Ebola. Even with this accelerated pathway to in-human testing and use, radically novel approaches to drug development will be needed to improve the likelihood that a treatment is realised.

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Working Paper

The Stanford-India Emergency Management and Research Institute (EMRI) Study: Early Findings

Grant Miller, Grant Miller, Kim Singer Babiarz, Nomita Divi, S.V. Mahadevan
Stanford University , 2014
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Journal Article

Girls' education and HIV risk: Evidence from Uganda

Marcella Alsan
Journal of Health Economics , 2013

Uganda is widely viewed as a public health success for curtailing its HIV/AIDS epidemic in the early 1990s. The period of rapid HIV decline coincided with a dramatic rise in girls’ secondary school enrollment. We instrument for this enrollment with distance to school, conditional on a rich set of demographic and locational controls, including distance to market center. We find that girls’ enrollment in secondary education significantly increased the likelihood of abstaining from sex.

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Journal Article

HIV Development Assistance and Adult Mortality in Africa

Eran Bendavid, CB Holmes, Jay Bhattacharya, Grant Miller
Journal of the American Medical Association , 2012

Context  The effect of global health initiatives on population health is uncertain. Between 2003 and 2008, the US President's Emergency Plan for AIDS Relief (PEPFAR), the largest initiative ever devoted to a single disease, operated intensively in 12 African focus countries. The initiative's effect on all-cause adult mortality is unknown.

Objective  To determine whether PEPFAR was associated with relative changes in adult mortality in the countries and districts where it operated most intensively.

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Journal Article

HIV Development Assistance and Adult Mortality in Africa

Eran Bendavid, Charles Holmes, Jay Bhattacharya, Grant Miller
Journal of the American Medical Association , 2012

Context  The effect of global health initiatives on population health is uncertain. Between 2003 and 2008, the US President's Emergency Plan for AIDS Relief (PEPFAR), the largest initiative ever devoted to a single disease, operated intensively in 12 African focus countries. The initiative's effect on all-cause adult mortality is unknown.

Objective  To determine whether PEPFAR was associated with relative changes in adult mortality in the countries and districts where it operated most intensively.

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