Paul Wise explores and discusses the challenges of wartime pediatrics on the Stanford Radio show.

As millions marched against gun violence across the country on Saturday, research by Stanford Health Policy experts about the impact of gun ownership on public health was also in the spotlight.

The Washington Post published an in-depth story about how the work of gun researchers is finally getting attention — an unfortunate consequence of the recent mass shootings in the United States.

David Studdert — a professor of medicine and law — and Yifan Zhang, a biostatics and data analyst with Stanford Health Policy, along with seasoned gun researcher Garen Wintemute of UC Davis’s Violence Prevention Research Program, are trying to answer the question: Are you more or less likely to die if you own a firearm?

“The explosion of national interest in the problem of gun violence since the Parkland shooting has been remarkable,” said Studdert, who is also a core faculty member at Stanford Health Policy.  “And it is inspiring to hear students’ voices — that is definitely a new twist in the politics around this issue. I think there is momentum for change, but I remain pessimistic that we will see the enactment of any substantial reforms at the federal level.”

The Post wrote:

Studdert’s group is using a data set unique to California because of the state’s strict gun laws. Every time a gun is sold in California, a background check logs the purchase and purchaser with California authorities, who also have been unique in their willingness to share such politically fraught data with academic researchers.

Using a sample of 25 million people (taken from California’s voter registration records), Studdert’s team plans to identify handgun owners with the firearm sales records, then compare that against state death records.

The resulting data in theory will help them determine the relationship — whether good or bad — between gun ownership and death.

They call the project LongSHOT, a nod to the project’s scale and ambition.

Academic researchers who were studying the impact of gun violence on public health were dealt a huge financial and political blow in 1996, when the so-called Dickey Amendment was passed by Congress under pressure from gun lobbyists. The law forbids the Centers for Disease Control and Prevention to fund research that might be seen as advocating for gun control. This choked off federal grant money and essential data-gathering on gun violence.

But tucked into the government spending bill in Congress last week was language that indicates the CDC now has the authority to conduct research on the causes and effects of gun violence. Though gun researchers are skeptical that the change in tone will lead to any significant support or funding, some believe that it’s a start. The $1.3 trillion government funding measure also includes efforts to improve state compliance with the national background check system, as well as funding for school counseling and safety programs.

Again, from The Post story:

Yifan Zhang was finishing her PhD in biostatistics at Harvard five years ago when news broke of the Sandy Hook Elementary School shooting.

As a graduate student from China, specializing in highly technical design of clinical drug trials, she had little connection to America’s long-running debate over gun violence. But even now, she said, the anguished faces of those parents she saw on television remain seared in her memory.

So when she heard about a gun-violence research project at Stanford University that could use the statistical skills she had honed on pharmaceuticals, she jumped at the chance.

“I have a son who just turned 1,” said Zhang, 31. “When I think about what I will need to teach him about protecting himself, I think about that school shooting.”

Zhang hopes the Stanford team can one day have an impact.

“I think there are going to be some big decisions that the whole country has to make together, and I’m hoping that our research can help provide evidence and information for the decision making,” she said.

Health care has become the largest sector of the global economy, now accounting for more than 10 percent of Gross World Product, or $7.5 trillion. And it’s only going to get bigger as economists expect that figure to approach $18 trillion in two decades.

And yet, the quality of care and health outcomes are not keeping pace.

Ashish K. Jha — a leading expert on health policy and director of the Harvard Global Health Institute — calls this a “critical moment” in health care as the standard of care increasingly becomes more important than the number of people who have health coverage around the world.

“The point is, coverage is not coverage is not coverage. All health financing schemes are not the same,” said Jha, noting that China and Canada have universal coverage for its citizens, but many still receive inadequate health care or are going broke due to the high cost of special medical needs.

“In many places, the problem is the shallowness of the coverage.  Everyone may be covered — but if you get really sick, shallow coverage gets people into trouble,” said Jha, a keynote speaker at the annual Global Health Economics Colloquium, which brings together health economists and policy experts from University of California San Francisco, UC Berkeley and Stanford Health Policy to discuss recent developments in their fields.

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The fifth colloquium identified the health needs of vulnerable populations and developing cost-effective and scalable interventions to improve the health of socially and economically disadvantaged people here in the United States and in low- and middle-income countries.

“Our hope for the day is that our speakers will remind us why we do what we do, remind us why we support evidence-based policies, and most of all to inspire us at a time of this geopolitical craziness and why we must continue to persist,” Dhruv Kazi, a cardiologist and health economist at UCSF, who opened the daylong event.

Rising cost of global health care

Global health-care spending is so massive due to several key factors, Jha told the audience: the unprecedented rapid expansion of people moving into the middle class and the rise in treatments, drugs and medical technologies.

And while these are all positive movements, he said, as the world becomes more interdependent, it “behooves us to act” quickly so that health coverage and quality keep up.

At the end of 2016 there were 3.2 billion people in the global middle class; on average 160 million will join the middle class annually for the next five years, heavily concentrated in Asia.

So the two goals of universal health care should be financial protection and improved health.

But Jha noted that while 90 percent of China’s 1.4 billion people are covered by its national health care system, some 18 percent of Chinese are still thrown into poverty by the incidence of catastrophic health spending above and beyond what the government provides. That is nearly 8 percent higher than the global incidence of catastrophic spending, which stands at 11.7 percent.

India, by contrast, does not have a universal health-care system and only 20 percent of it 1.3 billion people have some form of health insurance. But it also has a 17-percent incidence of catastrophic health spending.

“Catastrophic payment incidence cannot be inferred from the fraction of the population covered by health insurance schemes or public health services,” Jha said, quoting a recent Lancet study.

It stands to reason that the health outcomes of those in countries with universal health care should have improved. But most studies show that that is not the case; the reason?  The quality just isn’t there.

Unsafe medical care top cause of deaths

Nearly 43 million injuries are caused in hospitals each year around the world, leading to 23 million years of healthy living that is lost among the world’s population.

“Unsafe medical care is probably one of the top 10 causes of death and disability in the world,” Jha said.

Jha wondered if quality of care isn’t a bigger problem than access to care.  For example, in one of India’s poorer rural states, Madhya Pradesh, there are 11 health-care providers within walking distance of every village, a fairly large number of private providers.

“Yet half of them have no formal training, they didn’t go to any school but they call themselves doctors,” Jha said.

And in the capital of India, New Delhi, public-sector physicians who are well trained are so overworked they spend an average of 2.5 minutes and ask one question per patient.

Ideally, universal health care must be effective and consistent with best professional practices while meeting the needs of the individual patient.

“Global health policy leaders have made universal health coverage an overarching priority.  This is a good thing.  But in order for UHC to improve the health of the world’s poor, we need to ensure people get good care. And that is the biggest challenge of all.”

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