Regional Expertise

Key policy takeaways from Michael McFaul on Russia after Putin, Rose Gottemoeller on the New START talks, Nathaniel Persily on the midterm elections and U.S. democracy, Francis Fukuyama on democracy in America, Anna Grzymala-Busse on Hungary's Viktor Orbán and the GOP, Daphne Keller on the European Union's new cyber policies, and Marietje Schaake on Twitter and Elon Musk.

Importance  Statin-associated muscle symptoms (SAMS) are common and may lead to discontinuation of indicated statin therapy. Observational studies suggest that vitamin D therapy is associated with reduced statin intolerance, but no randomized studies have been reported.

Objective  To test whether vitamin D supplementation was associated with prevention of SAMS and a reduction of statin discontinuation.

We evaluated the protection conferred by mRNA vaccines and previous infection against infection with the omicron variant in two high-risk populations: residents and staff in the California state prison system. We used a retrospective cohort design to analyze the risk of infection during the omicron wave using data collected from December 24, 2021, through April 14, 2022. Weighted Cox models were used to compare the effectiveness (measured as 1 minus the hazard ratio) of vaccination and previous infection across combinations of vaccination history (stratified according to the number of mRNA doses received) and infection history (none or infection before or during the period of B.1.617.2 [delta]–variant predominance). A secondary analysis used a rolling matched-cohort design to evaluate the effectiveness of three vaccine doses as compared with two doses.

We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary nonmonotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution---who have the worst birth outcomes---have a death rate that is half that of infants of parents in the bottom ventile. When studying maternal health, we find a similar pattern of non-monotonicity between income and severe maternal morbidity, and a monotonic and decreasing relationship between income and maternal mortality. At the same time, these disparities by parental income are small when compared to racial disparities, and we observe virtually no convergence in health outcomes across racial and ethnic groups as income rises. Indeed, infant and maternal health in Black families at the top of the income distribution is markedly worse than that of white families at the bottom of the income distribution.Lastly, we benchmark the health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution.

We use linked survey and administrative data to document and decompose the striking differences across demographic groups in both economic and health impacts of the first year of the COVID-19 pandemic in the United States. The impacts of the pandemic on all-cause mortality and on employment were concentrated in the same racial, ethnic, and education groups, with non-White individuals and those without a college degree experiencing higher excess all-cause mortality as well as a greater employment loss. Observable differences in living arrangements and the nature of work – which likely affected exposure to the virus and to economic contractions – can explain 15 percent of the Hispanic-White difference in excess mortality, almost one-quarter of the non- Hispanic Black-White difference, and almost half of the difference between those with and without a Bachelor’s degree; they can also explain 35 to 40 percent of the differences in economic damages between these groups. These findings underscore the importance of non-medical factors in contributing to the disparate impacts of public health shocks.

Key policy takeaways from Michael McFaul on Russia after Putin, Francis Fukuyama on democracy in America, Daphne Keller on the global impact of the European Union's new digital policy, Marietje Schaake on Elon Musk's first days at Twitter, XXXXXX

An Asia Policy roundtable co-edited by Arzan Tarapore, including an essay by Oriana Skylar Mastro.

Putin's menacing rhetoric has alarmed the West, but lessons learned 60 years ago in the Cuban Missile Crisis provide some reassurance

This paper empirically investigates the labor market effects of China’s 2007 VAT reform, which significantly reduced the tax cost of capital investment. Employing city-by-year variation in the reform, we demonstrate that the tax cuts increased the earnings of skilled workers and left the earnings of the unskilled workers unaffected. Moreover, we find limited impacts of the reform on employment for both skill groups. These results suggest that the tax incentives increased the relative demand for skills, thus resulting in a higher income inequality between skilled and unskilled workers.

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Abstract

Professions play a key role in determining the division of labor and the returns to skilled work. This paper studies the productivity difference between physicians and nurse practitioners (NPs), two health care professions performing overlapping tasks but with stark differences in background, training, and pay. Using data from the Veterans Health Administration and quasi-experimental variation in the patient probability of being treated by physicians versus NPs in the emergency department, we find that, compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes. We find evidence suggesting mechanisms relating to lower human capital among NPs relative to physicians and worker-task assignment responding to the lower skill of NPs. Counterfactual analysis suggests a net increase in medical costs with NPs, even when accounting for NPs’ wages that are half as much as physicians’. Despite large productivity differences between professions, we find even larger productivity differences within professions and substantial productivity overlap between professions. Yet there is little overlap in wages between NPs and physicians and, within professions, no significant correlation between productivity and wages.

Background

A population health approach to depression screening using patient portals may be a promising strategy to proactively engage and identify patients with depression.

In this JAMA Forum article by Stanford Health Policy's Michelle Mello, the professor of health policy and law writes that reports are mounting of pregnant patients being denied potentially lifesaving care in emergency departments.

Key policy takeaways from Rose Gottemoeller on why the U.S. should avoid a nuclear arms race, Michael McFaul on how Putin may try to end the war in Ukraine, Oriana Skylar Mastro on China's intentions toward Taiwan, Francis Fukuyama on political realignment in America, Renée DiResta and Samantha Bradshaw on Russian propaganda in cyberspace, and Gil Baram on the cyber war between Israel and Iran.

ABSTRACT

Child servitude is a form of economic exploitation of children around the world. We examine this phenomenon with local specificity, in Liberia, where it represents a perennial failure of the government to protect children, who are among its most vulnerable citizens. Despite its persistence and high prevalence, child servitude has not been the focus of academic research on Liberia. This paper explores the interplay of transmuted American chattel slavery and indigenous specific Liberian cultural practices of human subjugation against a backdrop of socio-economic inequalities, and their linkages to contemporary child servitude in postwar Liberia. We discuss the impacts of child servitude on victims and recommend policy measures to protect the rights of Liberian children. If postwar Liberia is to achieve its pro-poor developmental agenda, policies must be formulated that address child servitude and other forms of exploitation against Liberian children.

Graham Webster has authored a chapter in the forthcoming book from Harvard University Press, The China Questions 2: Critical Insights into US-China Relations

A chapter in The China Questions 2: Critical Insights into US-China Relations, edited by Maria Adele Carrai, Jennifer Rudolph, and Michael Szonyi.

Key policy takeaways from Rose Gottemoeller on NATO’s new strategic concept, Francis Fukuyama on the Jan. 6 connection with the war in Ukraine, Michael McFaul on the West arming Ukraine, Amy Zegart on future U.S. cyber policy, Daniel Sneider on Japan after Shinzo Abe, and Riana Pfefferkorn on abortion and data collection.

An essay in a Hudson Institute report, Defending Guam, edited by Rebeccah Heinreichs

The U.S. Centers for Disease Control and Prevention (CDC) is responsible for preventing the introduction, transmission, and spread of communicable diseases into the United States. It does this primarily through the Division of Global Migration and Quarantine (DGMQ), which oversees the federal quarantine station network. Over the past two decades, the frequency and volume of microbial threats worldwide have continued to intensify. The COVID-19 pandemic, in particular, has prompted a reevaluation of many of our current disease control mechanisms, including the use and role of quarantine as a public health tool.

The emergence of COVID-19 prompted CDC to request that the National Academies of Sciences, Engineering, and Medicine convene a committee to assess the role of DGMQ and the federal quarantine station network in mitigating the risk of onward communicable disease transmission in light of changes in the global environment, including large increases in international travel, threats posed by emerging infections, and the movement of animals and cargo. The committee was also tasked with identifying how lessons learned during COVID-19 and other public health emergencies can be leveraged to strengthen pandemic response. The report's findings and recommendations span five domains: organizational capacity, disease control and response efforts, new technologies and data systems, coordination and collaboration, and legal and regulatory authority.

Abstract

Decision models can combine information from different sources to simulate the long-term consequences of alternative strategies in the presence of uncertainty. A cohort state-transition model (cSTM) is a decision model commonly used in medical decision making to simulate the transitions of a hypothetical cohort among various health states over time. This tutorial focuses on time-independent cSTM, in which transition probabilities among health states remain constant over time. We implement time-independent cSTM in R, an open-source mathematical and statistical programming language. We illustrate time-independent cSTMs using a previously published decision model, calculate costs and effectiveness outcomes, and conduct a cost-effectiveness analysis of multiple strategies, including a probabilistic sensitivity analysis. We provide open-source code in R to facilitate wider adoption. In a second, more advanced tutorial, we illustrate time-dependent cSTMs.