The Institute for Public Policy at Hong Kong University of Science and Technology (HKUST) is soliciting papers for a workshop, “Reforming Public Hospitals in China: Emerging Models and Policy Options,” held in Hong Kong from Aug. 24-25, 2017. The workshop, led by an organizing committee with Shorenstein APARC’s Karen Eggleston, will result in an edited volume or a special issue of China Policy Journal, a new open access journal by the Policy Studies Organization.
Both quantitative and qualitative papers are welcomed; priority will be given to research that focuses on policy intervention of a specific locality or compares practices of multiple local initiatives. Selected paper presenters will receive economy airfare and accommodation paid for by HKUST’s Institute for Public Policy.
Abstract submissions should be 300 words in length and provide a summary of the paper’s main arguments and conclusions. The deadline for submission is April 15, 2017, to Eliza Tang at eliza@ust.hk.
For more information, please click to view the PDF below.
In a shack that now sits below sea level, a mother in Bangladesh struggles to grow vegetables in soil inundated by salt water. In Malawi, a toddler joins thousands of other children perishing from drought-induced malnutrition. And in China, more than one million people died from air pollution in 2012 alone.
Around the world, climate change is already having an effect on human health.
In a recent paper, Katherine Burke and Michele Barry from the Stanford Center for Innovation in Global Health, along with former Wellesley College President Diana Walsh, described climate change as “the ultimate global health crisis.” They offered recommendations to the new United States president to address the urgently arising health risks associated with climate change.
Bangladeshi children make their way through flood waters.
The authors, along with Stanford researchers Marshall Burke, Eran Bendavid and Amy Pickering who also study climate change, are concerned by how little has been done to mitigate its effects on health.
There is still time to ease — though not eliminate — the worst effects on health, but as the average global temperature continues to creep upward, time appears to be running short.
“I think we are at a critical point right now in terms of mitigating the effects of climate change on health,” said Amy Pickering, a research engineer at the Woods Institute for the Environment. “And I don’t think that’s a priority of the new administration at all.”
Health effects of climate change
Even in countries like the United States that are well-equipped to adapt to climate change, health impacts will be significant.
“Extremes of temperature have a very observable direct effect,” said Eran Bendavid, an assistant professor of medicine and Stanford Health Policy core faculty member.
“We see mortality rates increase when temperatures are very low, and especially when they are very high.”
Bendavid also has seen air pollutants cause respiratory problems in people from Beijing to Los Angeles to villages in Sub-Saharan Africa.
“Hotter temperatures make it such that particulate matter and dust and pollutants stick around longer,” he said.
In addition to respiratory issues, air pollution can have long-term cognitive effects. A study in Chile found that children who are exposed to high amounts of air pollution in utero score lower on math tests by the fourth grade.
“I think we’re only starting to understand the true costs of dirty air,” said Marshall Burke. “Even short-term exposure to low levels can have life-long effects.”
Low-income countries like Bangladesh already suffer widespread, direct health effects from rising sea levels. Salt water flooding has crept through homes and crops, threatening food sources and drinking water for millions of people.
“I think that flooding is one of the most pressing issues in low-income and densely populated countries,” said Pickering. “There’s no infrastructure there to handle it.”
Standing water left over from flooding is also a breeding ground for diseases like cholera, diarrhea and mosquito-borne illnesses, all of which are likely to become more prevalent as the planet warms.
On the flip side, many regions of Sub-Saharan Africa — where clean water is already hard to access — are likely to experience severe droughts. The United Nations warned last year that more than 36 million people across southern and eastern Africa face hunger due to drought and record-high temperatures.
Residents may have to walk farther to find water, and local sources could become contaminated more easily. Pickering fears that losing access to nearby, clean water will make maintaining proper hygiene and growing nutritious foods a challenge.
Climate change will affect health in all sectors of society.
All of these effects and more can also damage mental health, said Katherine Burke and her colleagues in their paper. The aftermath of extreme weather events and the hardships of living in long-term drought or flood can cause anxiety, depression, grief and trauma.
Climate change will affect health in every sector of society, but as Katherine Burke and her colleagues said, “….climate disruption is inflicting the greatest suffering on those least responsible for causing it, least equipped to adapt, least able to resist the powerful forces of the status quo.
“If we fail to act now,” they said, “the survival of our species may hang in the balance.”
What can the new administration do to ease health effects?
If the Paris Agreement’s emissions standards are met, scientists predict that the world’s temperature will increase about 2.7 degrees Celsius – still significant but less hazardous than the 4-degree increase projected from current emissions.
The United States plays a critical role in the Paris Agreement. Apart from the significance of cutting its own emissions, failing to live up to its end of the bargain — as the Trump administration has suggested — could have a significant impact on the morale of the other countries involved.
“The reason that Paris is going to work is because we’re in this together,” said Marshall Burke. “If you don’t meet your target, you’re going to be publicly shamed.”
The Trump administration has also discussed repealing the Clean Power Plan, Obama-era legislation to decrease the use of coal, which has been shown to contribute to respiratory disease.
“Withdrawing from either of those will likely have negative short- and long-run health impacts, both in the U.S. and abroad,” said Marshall Burke.
Scott Pruitt, who was confirmed today as the head of the Environmental Protection Agency (EPA), is expected to carry out Trump’s promise to dismantle environment regulations.
Despite the Trump administration’s apparent doubts about climate change, a few prominent Republicans do support addressing its effects.
Secretary of State Rex Tillerson, the former chairman and CEO of Exxon Mobile, supports a carbon tax, which would create a financial incentive to turn to renewable energy sources. He also has expressed support for the Paris Agreement. It is possible that as secretary of state, Tillerson could help maintain U.S. obligations from the Paris Agreement, though it is far from certain whether he would choose to do so or how Trump would react.
More promising is a recent proposal from the Climate Leadership Council. Authored by eight leading Republicans — including two former secretaries of state, two former secretaries of the treasury and Rob Walton, Walmart’s former chairman of the board — the plan seeks to reduce emissions considerably through a carbon dividends plan.
Already an issue, malnutrition will increase with droughts in Sub-Saharan Africa.
Their proposal would gradually increase taxes on carbon emissions but would return the proceeds directly to the American people. Americans would receive a regular check with their portion of the proceeds, similar to receiving a social security check. According to the authors, 70 percent of Americans would come out ahead financially, keeping the tax from being a burden on low- and middle-income Americans while still incentivizing lower emissions.
“A tax on carbon is exactly what we need to provide the right incentives and induce the sort of technological and infrastructure change needed to reduce long-term emissions,” said Marshall Burke.
Pickering added, “This policy is a ray of hope for meaningful action on climate.”
It remains to be seen whether the new administration and congress would consider such a program.
What can academics do to help?
Meanwhile, academics can promote health by researching the effects of climate change and finding ways to adapt to them.
“I think it’s fascinating that there’s just so little data right now on how climate change is going to impact health,” said Pickering.
Studying the effects of warming on the world challenges traditional methods of research.
“You can’t create any sort of experiment,” said Bendavid. “There’s only one climate and one planet.”
The scholars agree that interdisciplinary study is a critical part of adapting to climate change and that more research is needed.
“If ever there was an issue worthy of a leader’s best effort, this is the moment, this is the issue,” said Katherine Burke and her colleagues. “Time is short, but it may not be too late to make all the difference.”
The Trump administration’s reinstatement of a policy that bans U.S. foreign aid to agencies that provide abortion counseling abroad was a predictable move that could have unintended consequences, Stanford researchers say.
The move freezes funding to nongovernmental organizations that provide abortion services or discuss abortions as a legitimate family-planning option. It revives what is known as the “Mexico City Policy,” so called because it was announced by President Regan in 1984 during a U.N. population conference in Mexico City. It’s a highly partisan policy, which has been implemented under Republican administrations and suspended by Democratic presidents.
From that standpoint, the move to revive the policy was no surprise, said Grant Miller, PhD, an associate professor of medicine at Stanford and core faculty member at Stanford Health Policy. But Miller’s research has shown that the policy actually appears to have the unintended effect of increasing, not decreasing, abortions in the developing world.
“The bottom line is that it doesn’t matter what you think about abortion and the morality and ethics of it,” Miller told me. “I don’t think either side of the disagreement would think a good policy is one that leads to an increase in abortions. Neither side wants to see more abortions.”
In 2011, Miller published a study with Eran Bendavid, MD, on the impact of the policy between 1994 and 2008 in sub-Saharan Africa, a region in which family planning services are heavily financed by U.S. foreign aid. Family planning agencies provide a range of family planning services, including contraception, so when their funding is cut, the availability of contraception declines, said Bendavid, the study’s lead author and another faculty member at Stanford Health Policy. This results in declining use of safe contraception and an increase in abortion rates, the researchers found.
“Sure enough, where you see this relative decline in use of contraception is where you see this uptick in abortion,” said Bendavid, an assistant professor of medicine. “Our theory of what is underlying this is this notion that when women have more restricted access to modern contraception, they rely on abortion. If the intention was to curb abortion, then what we observe is that cutting support to family planning organizations led to the opposite effect.”
Miller followed that up with another study published in 2016 that focused on Nepal during the period when the government legalized abortion, making it more widely available. The policy change gave him the opportunity to test the idea of abortion and contraception as substitutes — i.e. that use of one method to limit family size reduces use of the other. In fact, as the number of abortions rose, use of contraception declined, he found.
“What is remarkable is that this is clear evidence on this interchangeable use that women make in use of contraceptives and abortion services,” Miller said.
In other words, women are trying to control the number of children they have and will use one or the other, depending in part upon what is most available. “If contraception is available, they won’t have to resort to abortion,” Bendavid said.
He said these results have subsequently been corroborated in other studies in sub-Saharan Africa.
Hero Image
A woman sits by her stall in the Jorkpan market at Sinkor district in Monrovia, on May 2, 2016. Family planning services, like contraceptives and counselling are available in the markets in Liberia, an initiative that is aimed at tackling the high adolescent pregnancy rate in the younger population. | Marco Longari/AFP/Getty Images
Abstract: Globally, infectious diseases are emerging at an increasing rate. Vector-borne diseases in particular present one of the biggest threats to public health globally. Many of these diseases are zoonotic, meaning they cycle in animal populations but can spillover to infect humans. As a result, risk to humans of acquiring a zoonotic or vector-borne disease largely depends on the distribution and abundance of the reservoir hosts—the species of animals that pathogens naturally infect—as well as of the vector species. The ecology of many reservoir hosts and vectors is rapidly changing due to global change, which will fundamentally alter human disease risk in as yet unforeseen ways. In this talk, I will present and discuss three lines of research aimed at identifying drivers of disease emergence and risk at multiple spatial scales including 1) the ecological and environmental drivers of Lyme disease in California, 2) the roles of human behavior and land use in driving human Lyme disease in the northeastern US, and 3) effects of deforestation, land use policy and socio-ecological feedbacks in driving malaria in the Brazilian Amazon.
About the Speaker: Andrew MacDonald is a disease ecologist and a National Science Foundation Postdoctoral Fellow in Biology at Stanford University. He received his PhD from the Department of Ecology, Evolution and Marine Biology at the University of California, Santa Barbara in September 2016. His dissertation focused on the effect of land use and environmental change on tick-borne disease risk in California and the northeastern US. His current work focuses on coupled natural-human system feedbacks and land use change as drivers of mosquito-borne disease, with a focus on malaria in the Amazon basin.
Japan's population is old and getting older. "Japan has one of the highest total dependency ratios that's ever been seen," said Karen Eggleston, a senior fellow at the Freeman Spogli Institute for International Studies (FSI), "about one elderly dependent for every worker in the population." The country's aging population raises questions about how to provide for the elderly both socially and economically. Along with Professor of Medicine Jay Bhattacharya and other members of the Center on the Demography and Economics of Health and Aging (CDEHA), Eggleston developed the Japanese Future Elderly Model to project the health and functional status of the country's elderly.
The health gap between rich and poor children in developing countires is staggeringly high, but Assistant Professor of Medicine Eran Bendavid found that it is shrinking. In his pilot project, "Empirical Evidence on Wealth Inequality and Health in Developing Countries," Bendavid discovered that since the mid-2000s, life expectancies for children under five are starting to converge. How can we continue to close the gap? Watch to find out.
Consider the lowly worm. For some, it’s just a garden pest. But for more than a billion people in the developing world, parasitic worms can be a pernicious threat, causing disease, disability and sometimes death.
In a newly published perspective in the medical journal The Lancet, Stanford researchers, including Stanford Health Policy's Eran Bendavid and a host of distinguished colleagues, urge the World Health Organization to develop sweeping new guidelines to help end parasitic worm diseases, one of the world’s most prevalent health problems. They call for greatly expanded treatment of these diseases, which could save years of human suffering and an estimated $3 billion in lost productivity — similar to the impact of the Ebola and Zika epidemics of recent years, they say.
“Now everyone is coming together to say, ‘Now is the time, after more than a decade of new experience and data, to update the way we do things,’ said Nathan Lo, a Stanford MD/PhD candidate who is the first author of the commentary. “There is so much opportunity, whether it’s expanding treatment from children to the entire community or bringing in other strategies, such as sanitation, to strengthen the way we approach these diseases.”
The perspective is published today in Lancet Infectious Diseases and coincides with a WHO meeting in Geneva where officials, including many of the authors, are gathering to consider new treatment guidelines.
Health policy expert Bob Kocher likes to show a slide of the signature page of the Affordable Care Act, which he helped draft when he worked in the White House. The mottled page shows an official time stamp of March 23, 2010, and the choppy signature of President Obama, who had to use the 22 pens he would later gift each member of Congress who helped him pass the landmark health-care law.
“We thought it would be pretty simple,” Kocher recalled with a grin. “We had 60 Democrats in the Senate and a huge majority in the House, a popular president. But then you saw what happened.”
“Everything that you could imagine that would throw a monkey wrench into it, did,” said Kocher, a physician and partner at the Silicon Valley venture capital firm, Venrock, which invests in health-care and technology startups. Six years after its rocky start — and ongoing threats to repeal the law by Republicans — Kocher still believes the ACA has had a tremendously important impact on the nation.
“Despite the single worst launch of a website in the history of the internet,” he said, 20 million more Americans now have access to health care; 13 million more are privately insured by their companies; and 7 million more are enrolled in Medicaid. “I believe the ACA is working better than expected by virtue of the fact that there’s nobody in the ecosystem who is not behaving differently,” Kocher said.
Bob Kocher's full talk
Stanford School of Medicine Dean Lloyd B. Minor shared what he called “some surprising statistics” with the 200 people at the symposium on Oct. 14. When looking at a pie chart representing the determinants of health, Minor said, only 5 percent are genetically based, 20 percent are based on health care and another 20 percent are due to behavioral factors. But a full 55 percent of the determinants of health are socially and environmentally determined, Minor said, and that presents challenges for academic medical centers. “I’m really excited in that I believe that we are beginning to come up with some ways we can address that need, as a leading academic medical center, to chart the future for how we can improve the delivery of health care in our country and then ultimately around the world,” Minor said.
“For us, that vision for how we fulfill that need begins with what we describe as precision health,” Minor said precision medicine, now embraced by the Obama administration, is about using genomics, big data science and personalization in order to individualize the treatment of acute diseases such as cancer, heart and neurological diseases. “It’s about understanding the determinants and predisposing factors of disease in being able to more effectively intervene earlier,” he said. “And of course there’s no better place to do that than at Stanford because our academic medical center is such an integral part of this great research university.”
Challenges in global health
Stanford Health Policy core faculty members Grant Miller, Marcella Alsan and Eran Bendavid discuss upcoming challenges and innovations in global health. Miller shows that the easiest way to improve health — particularly in middle- and low-income countries — is to change environments. One of his current projects provides free fortified rice to residents of Tamil Nadu, India, and vitamins to those in need without asking them to alter their behavior. Alsan connects history, health and development to understand why some populations are healthier than others and how to close the gap. Bendavid discusses his work with the President‘s Emergency Plan for AIDS Relief (PEPFAR) which has provided about $70 billion in HIV aid to significantly decreased mortality.
Reforming payment models
Stanford Health Care CEO David Entwistle, Lucile Packard Children‘s Hospital CEO Christopher Dawes and Stanford Health Policy‘s Jay Bhattacharya and Laurence Baker discuss payment reform in hospitals, through MACRA and in other health care organizations.
Patient safety and value
Stanford Health Policy‘s Douglas Owens, Kathryn McDonald and David Chan discuss the importance of value when assessing health care costs and reducing diagnostic errors.
Presidential candidates on health
Stanford Health Policy‘s Kate Bundorf discusses the effects the 2016 election could have on health if Hillary Clinton or Donald Trump were elected. This non-partisan panel examined both candidates‘ proposals for health care in the United States.
The ongoing decline in under-5 mortality ranks among the most significant public and population health successes of the past 30 years. Deaths of children under the age of 5 years have fallen from nearly 13 million per year in 1990 to less than 6 million per year in 2015, even as the world's under-5 population grew by nearly 100 million children. However, the amount of variability underlying this broad global progress is substantial. On a regional level, east Asia and the Pacific have surpassed the Millennium Development Goal target of a two-thirds reduction in under-5 mortality rate between 1990 and 2015, whereas sub-Saharan Africa has had only a 24% decline over the same period. Large differences in progress are also evident within sub-Saharan Africa, where mortality rates have declined by more than 70% from 1990 to 2015 in some countries and increased in others; in 2015, the mortality rate in some countries was more than three times that in others.
What explains this remarkable variation in progress against under-5 mortality? Answering this question requires understanding of where the main sources of variation in mortality lie. One view that is implicit in the way that mortality rates are tracked and targeted is that national policies and conditions drive first-order changes in under-5 mortality. This country-level focus is justified by research that emphasises the role of institutional factors in explaining variation in mortality—factors such as universal health coverage, women's education, and the effectiveness of national health systems. It is argued that these factors, which vary measurably at the country level, fundamentally shape the ability of individuals and communities to affect more proximate causes of child death such as malaria and diarrhoeal disease.
An alternate view has focused on exploring the importance of subnational variation in the distribution of disease. In the USA, studies on the geographical distribution of health care and mortality have been influential for targeting of resources and policy design. Similar studies in developing regions have shown the substantial variability in the distribution and changes of important health outcomes such HIV, malaria, and schistosomiasis—information that can then be used to improve the targeting of interventions. Nevertheless, the relative contribution of within-country and between-country differences in explaining under-5 mortality remains unknown. Improved understanding of the relative contribution of national and sub-national factors could provide insight into the drivers of mortality levels and declines in mortality, as well as improve the targeting of interventions to the areas where they are most needed.
Bangladeshi children make their way through flood waters.
Climate change will affect health in all sectors of society.
Already an issue, malnutrition will increase with droughts in Sub-Saharan Africa.
