Public Health
Paragraphs

Shorenstein APARC's annual report for the academic year 2023-24 is now available.

Learn about the research, publications, and events produced by the Center and its programs over the last academic year. Read the feature sections, which look at the historic meeting at Stanford between the leaders of Korea and Japan and the launch of the Center's new Taiwan Program; learn about the research our faculty and postdoctoral fellows engaged in, including a study on China's integration of urban-rural health insurance and the policy work done by the Stanford Next Asia Policy Lab (SNAPL); and catch up on the Center's policy work, education initiatives, publications, and policy outreach. Download your copy or read it online below.

All Publications button
1
Publication Type
Annual Reports
Publication Date
Authors
1
Asia Health Policy Postdoctoral Fellow, 2024-2025
mai_nguyen.jpg
Ph.D.

Mai Nguyen joins the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as Asia Health Policy Postdoctoral Fellow for the 2024-2025 academic year. She holds a PhD in health services and health policy from Queensland University of Technology (QUT), Australia, and a Master of Science from Heller School for Social Policy and Management, Brandeis University.

Her doctoral research focused on how the expanding private healthcare sector can be managed more effectively to better supplement public health services to achieve universal health coverage in Vietnam. The study analyzed large and complex national health datasets from two consecutive Household Living Standard Surveys, clinical hospital data at national levels and in-depth interviews with key stakeholders of Vietnam's health system to investigate consumers' choice for private and public health care services in Vietnam. Her research findings have implications for policy change in terms of harnessing and regulating private health services in Vietnam and other Asia-Pacific countries, especially low and middle-income countries.

Dr. Nguyen has worked as a senior health specialist at Vietnam Ministry of Health. Her research interest stems from her professional experience in health policy and program management, including health policy and management, health services, private healthcare and health equity. Her works have been published in many Q1-international journals such as BMC Public Health, BMC Health Services Research, Human Resources for Health and International Journal of Health Policy and Management.

At APARC, Dr. Nguyen will extend her research on the roles of private healthcare to supplement the public health sector to address the growing burden of chronic diseases and conditions in Vietnam.

Date Label
0
Lazear-Liang Postdoctoral Scholar, Stanford Graduate School of Business
hanmo_yang.jpg
PhD

Hanmo's research fields include labor and health economics, development economics, and population studies, with a particular focus on China's fertility, healthcare, and elderly care systems and policies. She primarily conducts empirical research to explore the principles of how various interventions affect caregiving practices, fertility behaviors, and other health or economic outcomes by utilizing data from surveys and hospital records. In 2022, Hanmo received her Ph.D. in economics from Peking University. Building on her doctoral work on health and economic development, she broadened her research to include aging and health systems as a postdoctoral scholar at the Harvard T.H. Chan School of Public Health from 2022 to 2023.

Date Label
Authors
Beth Duff-Brown
News Type
News
Date
Paragraphs

The 2020 murder of George Floyd in Minneapolis highlighted the harms of racially discriminatory policing and inspired global protests against police brutality. For many, Floyd’s death and the live courtroom trial of the officer charged with his murder was their first real exposure to police killings.

Not for J’Mag Karbeah, PhD, a health services researcher at the University of Minnesota School of Public Health. She had already begun to ask herself how these police killings of Black men were affecting the mental and physical health of Black people — particularly among mothers and adolescents. 

“As a maternal and child health researcher, after each event, I found myself asking: `How do these traumatic events impact the health of the community, especially mothers and people who can get pregnant? How do you steel yourself to bring children into this world knowing what potential harms might happen to them?’”

Police Brutality Not New

Police brutality has been part of the American fabric since its beginnings, from the slave patrols of the early 1700s to the advent of television bringing racialized police attacks on Blacks into American homes during the civil rights movement. In the last decade, bodycams and social media have put a spotlight on police killings, with Eric Garner’s death by police chokehold in 2014 going viral due to his friend catching the homicide on his smartphone.

J'Mag Karbeah speaks at Stanford Health Policy

 

According to the Washington Post’s police shootings database, as of March 7 there have been 8,283 people killed by the police in the United States since Garner’s death. Last year alone, 1,098 Americans were killed by officers — the deadliest year for civilian killings by police. 

As the Washington Post database notes, half the people shot and killed by police are white, but Black people are shot at a disproportionate rate. They account for less than 14% of the U.S. population — but are twice as likely to be gunned down and killed than whites.

Yet there is little research or discussion about the public health implications of police contact, whether it’s homicide, violence, racial profiling, or harassment.

Karbeah is working to change that. She recently gave the Health Equity Lecture at Stanford Health Policy, outlining the ways in which police contact is impacting the health and well-being of communities, from pregnant women to adolescents.

How do you steel yourself to bring children into this world knowing what potential harms might happen to them?
J'Mag Karbeah, PhD
Assistant Professor at the University of Minnesota School of Public Health

 

The Fourth Encounter

“In addition to fatal encounters, researchers often discuss police brutality associated with physical, emotional, or sexual abuse perpetrated by officers,” Karbeah said. “But there is a fourth type of police encounter that is much more common and sometimes overlooked: routine contacts such as stops, frisking and searches that don’t result in detainment.”

In a study published in JAMA Open Network in December 2021, Karbeah and coauthors found that greater police presence in Black vs. white neighborhoods appears to contribute to the persistent Black-white preterm birth disparity in Minneapolis. Their research found that of 1,059 Minneapolis residents who gave birth in 2016, the odds of preterm births for those living in a neighborhood with a high police presence were 10% greater compared to their racial counterparts in low-presence neighborhoods.

The paper notes that pregnant Black women nationwide experience preterm birth at rate approximately double that of whites and Black women are also twice as likely to experience the death of an infant younger than 1 year. SHP’s Maya Rossin-Slater also bore this out in a recent study that showed that wealthy Black mothers and infants fare worse than the poorest white mothers and infants in the United States.

“Black pregnant people who live in areas with high levels of racial segregation are more likely to give birth prematurely,” Karbeah writes in the study. “Residential segregation relegates Black people to neighborhoods disproportionately affected by poverty, violence, and crime. In lieu of policy solutions to address these issues, greater police presence has been the answer in many communities.”

Karbeah points to research showing that high police presence in neighborhoods is associated with adverse psychological outcomes for Black residents. Karbeah and colleagues suggest that pregnant people may experience these same psychological effects in ways that lead to increased stress — which in turn can lead to an increase in preterm births.

Image
J'Mag Karbeah speaks at Stanford Health Policy

Adolescent Health and Policing

Karbeah told the SHP lecture audience that adolescent health is another key area of her research as young people carry police encounters with them into adulthood. Their brains are still developing, and decisions made during this period can shape the rest of their lives. They are coming into their own, deciding where they fit in and who they can trust.

“An important aspect of policing that often gets lost when we start to think about police contact as a determinant of health is why people might come into to contact with the police,” Karbeah said. “Instinctively you might think, well, you usually do something bad and that is why you encounter law enforcement.”

But a cultural shift in policing, she notes, has gone from police focused on responding to crimes to a proactive model in which policing is attempting to prevent crime, leading to more officers in communities, turning more civilians into potential suspects and leading to more encounters.

“Research shows that stops are associated with stigma and shame,” Karbeah said, pointing to a study published in the Journal of Adolescent Health which shows that adolescents frequently stopped by police were more likely to report heightened emotional stress and PTSD symptoms.

“These stops are seen as unsettling or traumatic for young people and can alter a youth’s self-perception and their overall well-being,” she said. “The impact of these interactions accrues over time and becomes internalized.”

A young person may be stopped by police on the way home from school, for example, and might be left with feelings of shame, prompting them to turn away from family and friends. This can have life-course implications, she said, such as substance abuse, anxiety and depression, job loss and socioeconomic shifts.

“We were honored to host Dr. Karbeah at Stanford Health Policy for the Health Equity Lecture Series,” said Sherri Rose, a professor of health policy who leads the lecture series. “Her research on police encounters and health equity tackles challenging questions that have far-reaching implications across health policy.” 

Read More

Alyce Adams, Stanford Health Policy
Q&As

Toward Equal Footing

In this Q&A, Stanford Health Policy's Alyce Adams talks about the devastating impact that chronic conditions like diabetes had on her own family members.
cover link Toward Equal Footing
Black Mother & Infant in Hospital
News

Striking Inequalities in Infant and Maternal Health Point to Structural Racism and Access Issues

Research by Petra Persson and Maya Rossin-Slater on health inequality finds wealthy Black mothers and infants fare worse than the poorest white mothers and infants.
cover link Striking Inequalities in Infant and Maternal Health Point to Structural Racism and Access Issues
Dr. Utibe Essien
News

Pursuing Equity in Pharmacology for Black Patients

Our recent Health Equity Lecture was given Dr. Utibe Essien, who is on a mission to ensure patients — regardless of race, ethnicity or socioeconomic status — have access to the highest-quality medications on the market.
cover link Pursuing Equity in Pharmacology for Black Patients
All News button
1
Subtitle

J'Mag Karbeah, an assistant professor at the University of Minnesota School of Public Health, gives Stanford Health Policy's latest health equity lecture, Her focus was on the public health implications for Black people who are exposed to police contact.

0
tom_kennedy_vert.jpg

Tom Kennedy is a project manager at the Stanford Center on China’s Economy and Institutions (SCCEI). He joined the team in Fall 2022 after spending three years working as a Software Engineer at Apple. Tom graduated from Stanford in 2019 with a B.S. in Mathematical and Computational Science. While at Stanford, he worked as a research assistant for SCCEI and multiple other FSI-affiliated researchers. Tom manages projects related to mental health and vision care, among other areas.

Project Manager, Rural Education Action Program
Date Label
0
screen_shot_2022-08-10_at_3.47.56_pm.png

Tara manages communications for the Cyber Policy Center, supporting its six programs with graphic design support, social media, print and digital publishing, special events, video editing and other communication needs. Prior to the Cyber Policy Center, Tara was the Communications Manager for the MBA Program at Stanford's Graduate School of Business. Previous to that, she worked at a number of start ups around the Bay Area. She has a Masters in Creative Writing. 

As Tara Cottrell, she is the co-author of Buddha's Diet (Hachette) that has been translated into eight languages, Portuguese, Spanish, Dutch, Italian, Czech, Vietnamese, German and Polish. Her fiction has appeared in print in ZYZZYVA, Missouri Review, Indiana Review, Zoetrope and others. 

Communications Associate,
Cyber Policy Center, Freeman Spogli Institute for International Studies
-
abstract blue image with text Trust and Safety Research Conference

Join us September 29-30 for two days of cross-professional presentations and conversations designed to push forward research on trust and safety.

Hosted at Stanford University’s Frances. C. Arrillaga Alumni Center, the Trust and Safety Research Conference will convene trust and safety practitioners, people in government and civil society, and academics in fields like computer science, sociology, law, and political science to think deeply about trust and safety issues.

Your ticket gives you access to:

  • Two days of talks, panels, workshops, and breakouts
  • Networking opportunities, including happy hours on September 28, 29 and 30th.
  • Breakfast and lunch on September 29 and 30th.

Early bird tickets are $100 for attendees from academia and civil society and $500 for attendees from industry. Ticket prices go up August 1, 2022. Full refunds or substitutions will be honored until August 15, 2022. After August 15, 2022 no refunds will be allowed.

For questions, please contact us through internetobservatory@stanford.edu

Frances C. Arrillaga Alumni Center
326 Galvez Street
Stanford, CA 94305

Conferences
-

 

Image
Stanford Department of Health Policy Health Equity Symposium Header

 

***

Stanford Medicine's new Department of Health Policy held its inaugural departmental symposium on October 6, convening thought leaders and experts in medicine, law, economics and data science. Speakers discussed innovative policy work and scalable solutions for improving health equity. Panelists addressed how to reduce persistent health disparities from three angles: social determinants of health, technology and innovation, and access and affordability.

Discover the powerful role health policy can serve in ensuring the health of all people, not just a privileged few.

 

***

Keynote Speaker: Kirsten Bibbins-Domingo, PhD, MD

Talk Title: Building Equity in the Research Enterprise

Editor in Chief, Journal of the American Medical Association (JAMA) and JAMA Network Professor of Epidemiology & Biostatistics and Medicine, University of California, San Francisco

 

 

 

 

 

Opening Remarks by Stanford Medicine Dean Lloyd Minor

Terrance Mayes, Associate Dean for Equity and Strategic Initiatives

 

 

Panel 1 — Social Policy: Strategies for Addressing Structural Determinants of Health

 

 

Moderator

Alyce Adams, Stanford Health Policy

Alyce Adams, Stanford Medicine Innovation Professor, Professor of Epidemiology and Population Health, Professor of Health Policy

 

 

 

Panelists

Jeremy Goldhaber-Fiebert

Jeremy Goldhaber-Fiebert, Professor of Health Policy

 

 

 

Gilbert Gonzales, Vanderbilt

Gilbert Gonzales, Assistant Professor at the Center for Medicine, Health & Society at Vanderbilt University

 

 

 

Adrienne Sabety, Stanford Health Policy

Adrienne Sabety, Assistant Professor of Health Policy

 

 

***

Panel 2 — Technology: Optimizing Innovation for Health Impact and Equity

 

 

Joshua Salomon of Stanford Health Policy

Moderator: Josh Salomon, Professor of Health Policy, Director of the Prevention Policy Modeling Lab

 

 

 

 

Panelists

Joshua Makower, Stanford

Joshua Makower, Boston Scientific Applied Biomedical Engineering Professor, Director of the Stanford Byers Center for Biodesign

 

 

Grant Miller Stanford Health Policy

Grant Miller, Henry J. Kaiser, Jr. Professor, Professor of Health Policy

 

 

 

Sherri Rose Stanford Health Policy

Sherri Rose, Associate Professor of Health Policy, Co-Director of the Health Policy Data Science Lab

 

***

 

Panel 3 — Access & Affordability: How to Finance and Deliver Health Care Innovations Equitably

 

 

Michelle Mello

Moderator: Michelle Mello, Professor of Health Policy, Professor of Law

 

 

 

Panelists

Nicole Cooper, UnitedHealth

Nicole Dickelson Cooper, Senior Vice President at UnitedHealth Group 

 

 

 

Stacie B. Dusetzina, Vanderbilt

Stacie Dusetzina, Associate Professor of Health Policy at Vanderbilt University Medical Center

 

 

 

Maria Polyakova Stanford University

Maria Polyakova, Assistant Professor of Health Policy

 

 

 

 

Vindell Washington Verily Life Sciences

Vindell Washington, Chief Clinical Officer of Verily Health Platforms and CEO of Onduo

 

 

 

 

 

#StanfordHealthEquity

WATCH ENTIRE EVENT HERE

Learn More about Stanford Health Policy

Our People, Our Reserch and Our Mission to Improve Health

 

Accreditation

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this live activity for a maximum of 4.0 AMA PRA Category 1 CreditsTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

***

McCaw Hall, Arrillaga Alumni Center

Symposiums
Date Label
Authors
Beth Duff-Brown
News Type
News
Date
Paragraphs

The Supreme Court ruling eliminating the constitutional right to an abortion could also result in women’s personal reproductive health data being used against them, warns Stanford Health Policy’s Michelle Mello.

The Dobbs v. Jackson Women’s Health Organization ruling could, for example, lead to a woman’s health data in clinician emails, electronic medical records, and online period-tracking platforms being used to incriminate her or her health-care providers, Mello said.

“Ultimately, broader information privacy laws are needed to fully protect patients and clinicians and facilities providing abortion services,” writes Mello, a professor of health policy and law in this JAMA Health Forum article with colleague Kayte Spector-Bagdady, a bioethicist from the University of Michigan. “As states splinter on abortion rights after the Dobbs Supreme Court decision, the stakes for providing robust federal protection for reproductive health information have never been higher.”

Eight states banned abortions on the same day the Dobbs ruling came down, and 13 states that had “trigger bans” that, if Roe v. Wade were struck down, would automatically prohibit abortion within 30 days. Other states are considering reactivating pre-Roe abortion bans and legislators in some states intend to introduce new legislation to curb or ban the medical procedure.”

Three Potential Scenarios

The authors note these new abortion restrictions may clash with privacy protections for health information, laying out three scenarios that could impact millions of women. And, they note, “despite popular misconceptions about the breadth of the Privacy Rule of the Health Information Portability and Accountability Act (HIPAA) and other information privacy laws, current federal law provides little protection against these scenarios.”

The first scenario is that a patient’s private health information may be sought in connection with a law-enforcement proceeding or civil lawsuit for obtaining an illegal abortion. HIPAA privacy regulations and Fourth Amendment rights against unreasonable searches and seizures won’t help physicians and hospitals resist such investigative demands, the authors write. And though physician-patient communications are ordinarily considered privileged information, the scope of that privilege varies greatly from state to state. “In many cases medical record information has been successfully used to substantiate a criminal charge,” the authors write.

Ultimately, broader information privacy laws are needed to fully protect patients and clinicians and facilities providing abortion services.
Michelle Mello
Professor of Health Policy, Law

The second privacy concern is the potential use of health-care facility records to incriminate an institution or its clinicians for providing abortion services. Relevant records could include electronic health records, employee emails or paging information and mandatory reports to state agencies. Clinicians may not realize that if they are using an institutional email address or server, their institution likely has direct access to information and communications stored there, which can be used to search for violations. State Freedom of Information Act (FOIA) laws also allow citizens to request public records from employees of government hospitals and clinics.

“Additionally, state mandatory reporting laws for child abuse might be interpreted to cover abortions — particularly if life is defined as beginning at fertilization,” the authors note.

The third scenario is that information generated from a woman’s online activity could be used to show she sought an abortion or helped someone to do so. Many women use websites and apps that are not HIPAA-regulated or protected by patient-physician privilege, such as period-tracking apps used by millions of women that collect information on the timing of menstruation and sexual activity.

“There are many instances of internet service providers sharing user data with law enforcement, and prosecutors obtaining and using cellphone data in criminal prosecutions,” write Mello and Spector-Bagdady, adding commercially collected data are also frequently sold to or shared with third parties.

“Thus, pregnant persons may unwittingly create incriminating documentation that has scant legal protection and is useful for enforcing abortion restrictions,” they said.

The immediate problem, Mello notes, is in the states that have already banned abortion or passed restrictive laws.

“There could be a problem with states trying to reach outside their borders to prosecute people, but that could well be unconstitutional,” Mello said.

Some states’ laws sweep abortion pills into the definition of illegal abortions, she said, and there are legal obstacles to supplying the pills across state lines.

“There is a lot of energy going into figuring out a workaround right now, but it’s too soon to call,” Mello said.

Recommended Protections

So how can clinicians and health-care facilities protect their patients and themselves?

When counseling patients of childbearing age about reproductive health issues, clinicians should caution their patients about putting too much medical data online and refer them to expert organizations that will help them minimize their digital footprint.

When documenting reproductive health encounters, the authors said, clinicians should ask themselves: “What information needs to be in the medical record to assure safe, good-quality care, buttress our claim for reimbursement, or comply with clear legal directives?” For example, does information about why a patient may have experienced a miscarriage need to be recorded?

Patients and clinicians should be aware that email and texting may be seen by others, so conversations among staff about reproductive health issues may best be conducted by phone or in person.

Finally, if abortion-related patient information is sought by state law enforcement officials, a facility’s attorney should be consulted about asserting physician-patient privilege and determining whether the disclosure is mandated by law.

Michelle Mello

Michelle Mello

Professor of Health Policy, Law
Focuses on issues at the intersection of law, ethics and health policy.
Profile

Read More

Fake or Fact news on coronavirus
Q&As

Does Free Speech Protect COVID-19 Vaccine Misinformation?

While some might say making or spreading known false statements related to the COVID-19 vaccine should be criminalized, the First Amendment, which guarantees free speech, continues to provide protection for people who promulgate such faulty information. So, how can the spread of misinformation be stopped without quashing free speech?
cover link Does Free Speech Protect COVID-19 Vaccine Misinformation?
Health Law Illustration
Commentary

U.S. Public Health Law — Foundations and Emerging Shifts

The COVID-19 pandemic has focused attention on the complex and sometimes conflicting relationship between individual rights and public health protection.
cover link U.S. Public Health Law — Foundations and Emerging Shifts
Supreme Court
Q&As

A Look at the Supreme Court Ruling on Vaccination Mandates

Two Stanford law, labor and health experts explain the legal and health implications of the Supreme Court ruling that struck down the Biden administration's COVID-19 vaccine mandate for large companies, while upholding another federal regulation calling on health-care workers in federally funded facilities to be vaccinated.
cover link A Look at the Supreme Court Ruling on Vaccination Mandates
All News button
1
Subtitle

Michelle Mello writes that the overturning of Roe v. Wade — ending federal protection over a woman's right to an abortion — could also expose her personal health data in court.

Subscribe to Public Health