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Panelists

Michele Barry, MD: Medicine and Tropical Diseases; Center for Innovation in Global Health

Doug Owens, MD: Medicine; Center for Health Policy/Primary Care Outcomes Research

David Relman, MD: Medicine, Microbiology & Immunology; Center for International Security and Cooperation

Stephen J. Stedman: Center on Democracy, Development and the Rule of Law

Paul Wise, MD: Pediatrics; Center for Health Policy/Primary Care Outcomes Research

 

Co-sponsors:

Freeman Spogli Institute for International Studies

Stanford University School of Medicine

Center for African Studies

Center for Health Policy/Center for Primary Care and Outcomes Research

Center for Innovation in Global Health

Center for International Security and Cooperation

Center on Democracy, Development, and the Rule of Law

McCoy Family Center for Ethics in Society

Bechtel Conference Center

Encina Hall

Michele Barry Panelist

Encina Commons, Room 201
615 Crothers Way
Stanford, CA 94305-6006

Administrative Assistant:
Sharon Beckstrand
sbeckst1@stanford.edu
(650) 736-0815

(650) 723-0933 (650) 723-1919
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Henry J. Kaiser, Jr. Professor
Professor, Health Policy
Senior Fellow, Freeman Spogli Institute for International Studies
Professor, Management Science & Engineering (by courtesy)
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MD, MS

Douglas K. Owens is the Henry J. Kaiser, Jr. Professor, Chair of the Department of Health Policy in the Stanford University School of Medicine and Director of the Center for Health Policy (CHP) in the Freeman Spogli Institute for International Studies (FSI). He is a general internist, a Professor of Management Science and Engineering (by courtesy), at Stanford University; and a Senior Fellow at the Freeman Spogli Institute for International Studies.

Owens' research includes the application of decision theory to clinical and health policy problems; clinical decision making; methods for developing clinical guidelines; decision support; comparative effectiveness; modeling substance use and infectious diseases; cardiovascular disease; patient-centered decision making; assessing the value of health care services, including cost-effectiveness analysis; quality of care; and evidence synthesis.

Owens chaired the Clinical Guidelines Committee of the American College of Physicians for four years. The guideline committee develops clinical guidelines that are used widely and are published regularly in the Annals of Internal Medicine. He was a member and then Vice-Chair and Chair of the U.S. Preventive Services Task Force, which develops national guidelines on preventive care, including guidelines for screening for breast, colorectal, prostate, and lung cancer. He has helped lead the development of more than 50 national guidelines on treatment and prevention. He also was a member of the Second Panel on Cost Effectiveness in Health and Medicine, which developed guidelines for the conduct of cost-effectiveness analyses.

Owens also directed the Stanford-UCSF Evidence-based Practice Center. He co-directs the Stanford Health Services Research Program, and previously directed the VA Physician Fellowship in Health Services Research, and the VA Postdoctoral Informatics Fellowship Program.

Owens received a BS and an MS from Stanford University, and an MD from the University of California-San Francisco. He completed a residency in internal medicine at the University of Pennsylvania and a fellowship in health research and policy at Stanford. Owens is a past-President of the Society for Medical Decision Making. He received the VA Undersecretary’s Award for Outstanding Achievement in Health Services Research, and the Eisenberg Award for Leadership in Medical Decision Making from the Society for Medical Decision Making. Owens also received a MERIT award from the National Institutes on Drug Abuse to study HIV, HCV, and the opioid epidemic. He was elected to the American Society for Clinical Investigation (ASCI) and the Association of American Physicians (AAP.)

Chair, Department of Health Policy, School of Medicine
Director, Center for Health Policy, Freeman Spogli Institute for International Studies
CV
Doug Owens Panelist

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Stanford University
Encina Hall, E209
Stanford, CA 94305-6165

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Senior Fellow at the Freeman Spogli Institute for International Studies
Thomas C. and Joan M. Merigan Professor
Professor of Medicine
Professor of Microbiology and Immunology
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MD

David A. Relman, M.D., is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University, and Chief of Infectious Diseases at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California. He is also Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford, and served as science co-director at the Center for International Security and Cooperation at Stanford from 2013-2017. He is currently director of a new Biosecurity Initiative at FSI.

Relman was an early pioneer in the modern study of the human indigenous microbiota. Most recently, his work has focused on human microbial community assembly, and community stability and resilience in the face of disturbance. Ecological theory and predictions are tested in clinical studies with multiple approaches for characterizing the human microbiome. Previous work included the development of molecular methods for identifying novel microbial pathogens, and the subsequent identification of several historically important microbial disease agents. One of his papers was selected as “one of the 50 most important publications of the past century” by the American Society for Microbiology.

Dr. Relman received an S.B. (Biology) from MIT, M.D. from Harvard Medical School, and joined the faculty at Stanford in 1994. He served as vice-chair of the NAS Committee that reviewed the science performed as part of the FBI investigation of the 2001 Anthrax Letters, as a member of the National Science Advisory Board on Biosecurity, and as President of the Infectious Diseases Society of America. He is currently a member of the Intelligence Community Studies Board and the Committee on Science, Technology and the Law, both at the National Academies of Science. He has received an NIH Pioneer Award, an NIH Transformative Research Award, and was elected a member of the National Academy of Medicine in 2011.

Stanford Health Policy Affiliate
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David Relman Panelist
Stephen J. Stedman Panelist
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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
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MD, MPH

Dr. Wise is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics and Health Policy at Stanford University School of Medicine.  Dr. Wise is also a Senior Fellow in the Center for Democracy, Development and the Rule of Law and the Center for International Security and Cooperation, in the Freeman-Spogli Institute for International Studies, Stanford University. He is also co-Director of the March of Dimes Center for Prematurity Research at Stanford University.

Dr. Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston.  His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, and Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School.  He served as Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, and currently is a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH. 

Dr. Wise’s research focuses on health inequalities, child health policy, and global child health.   He leads a multidisciplinary initiative, Children in Crisis, which is directed at integrating expertise in political science, security, and health services in areas of civil conflict and unstable governance.

Core Faculty, Center on Democracy, Development and the Rule of Law
Affiliated faculty at the Center for International Security and Cooperation
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Paul Wise Panelist
Panel Discussions
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Teal Pennebaker
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Andres Moreno is not just unearthing the genetic backgrounds of many Latin Americans and Caribbeans. He’s also making sense of the history of this region, and piecing together a clearer genetic medical history of understudied populations. By looking at the genetic history of Mexicans, Cubans, Puerto Ricans, Dominicans, Hondurans and Colombians, Moreno’s research unearths these populations’ ties to Europe, native tribes and Africans, and serves as a way to understand the waves of migration in these populations.

And he’s able to do much of this work because of the Dr. George Rozenkranz Prize for Health Care Research in Developing Countries, given out by the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) to a promising young researcher.

“The Rosenkranz Prize is such a unique opportunity to promote the work of some of Stanford’s most promising young investigators,” CHP/PCOR Director Douglas K. Owens, also a senior fellow at the Freeman Spogli Institute for International Studies and a professor of medicine, said. “We’ve had researchers from within our centers, and with Andres we have a Rosenkranz recipient who’s thinking about international health from a completely new angle for CHP/PCOR.”

The $100,000 prize is given to young Stanford researchers focusing on how to improve health care access in developing countries. The award’s namesake, George Rozankranz, first synthesized cortisone in 1951, and later progestin (the active ingredient in oral birth control pills). He went on to establish the Mexican National Institute for Genomic Medicine, and his family created the Rosenkranz Prize in 2009.

“The Rosenkranz Prize has allowed me to build research independence upon original ideas and collaborative efforts initiated in different regions throughout Latin America and the Pacific,” Moreno said. “These efforts are paving the way to conduct population and medical genomics research in populations from developing regions traditionally underrepresented in large-scale genetic projects.”

Moreno continued: “This is only the beginning though. There is much to do to bridge the gap between developed and developing countries in terms of biomedical research, so funding opportunities like the Rosenkranz Award are essential to tackle this problem.”

As part of this work, Moreno published article in PLOS Genetics in November 2013, with two more anticipated in 2014.

“In this publication we especially wanted to focus on people in the Caribbean,” Moreno said. “We felt that this region has been understudied in terms of genetic complexity, and wanted to know which part of Africa, Europe and a Native American tribal genes existed. And its implications for medicine.”

In understanding a person’s genetic history, a doctor can determine whether a patient has gene variants that correlate with a disease. For example, because Ashkenazi Jewish women have an increased likelihood of having breast and ovarian cancer, their health providers are more likely to monitor for these cancers. 

Moreno’s advisor and co-author on the PLOS papers, Stanford Genetics Professor Carlos Bustamente, described Moreno’s work on this project: “Andres was extraordinary in putting the data all together, developing algorithms and doing simulation work,” he said. Moreno would seek to understand the implications of their findings, think through how this would affect their design of the next round of experiments and  “translate it into future genetic studies and interpretation of genomes that come into the clinic.”

The findings also tell a historical story of the region. In the Caribbean, Moreno and his co-authors were able to pinpoint where in Africa particular segments of the population had come from and when they contributed to the genetic pool. The first wave of Africans came from the western tip of Africa (present day Senegal and Gambia), a region that was an original contributor for all African slaves. But another strand of African heritage also emerged in their studies—from Africa’s gold coast (Nigeria and the Gulf of Guinea). Moreno explained, “We can now genetically pinpoint when and where ancestry came from in Africa.”

Moreno said in looking at the populations, a major difference was between the genetic heritage of the island and mainland populations. In the case of the four islands, there were very consistent results of roughly the same date of European genes—about 500 years ago, which, Moreno pointed out, is exactly when colonization happened.

But in the mainland areas, Moreno and colleagues didn’t find European lines until two generations later, meaning Europeans first settled in the islands and then moved to the mainland.

Similarly, the Native American strands are distinct. Moreno and his co-authors believe that the Native American genes among the Caribbean populations are from inland Amazon tribes—a completely different Native American background than what’s typically found among Native American descendants in the United States.

Bustamente said Moreno has great breadth, commanding the whole operation—sampling in the field, collecting the data in the lab, doing the data scrubbing and analysis. Each of these tasks is typically undertaken by a different person. “He does all of this—and it gives him a real edge,” Bustamente said. “He thinks in a very integrated fashion. Plus he’s an MD!”

Kathryn McDonald, executive director for CHP/PCOR, said Moreno’s work represents the essence of the Rosenkranz Prize. “We really wanted this award to reach all angles of the Stanford health policy research community, and Andres embodies this. He’s expanding our understanding of health care and predisposition for diseases in a host of developing countries. It’s exciting—and such important—work.”

Teal Pennebaker is a freelance writer.

 

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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.

Design, Setting, and Participants  Using person-level data from the Demographic and Health Surveys, we conducted cross-country and within-country analyses of adult mortality (annual probability of death per 1000 adults between 15 and 59 years old) and PEPFAR's activities. Across countries, we compared adult mortality in 9 African focus countries (Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia) with 18 African nonfocus countries from 1998 to 2008. We performed subnational analyses using information on PEPFAR's programmatic intensity in Tanzania and Rwanda. We employed difference-in-difference analyses with fixed effects for countries and years as well as personal and time-varying area characteristics.

Main Outcome Measure  Adult all-cause mortality.

Results  We analyzed information on 1 538 612 adults, including 60 303 deaths, from 41 surveys in 27 countries, 9 of them focus countries. In 2003, age-adjusted adult mortality was 8.3 per 1000 adults in the focus countries (95% CI, 8.0-8.6) and 8.5 per 1000 adults (95% CI, 8.3-8.7) in the nonfocus countries. In 2008, mortality was 4.1 per 1000 (95% CI, 3.6-4.6) in the focus countries and 6.9 per 1000 (95% CI, 6.3-7.5) in the nonfocus countries. The adjusted odds ratio of mortality among adults living in focus countries compared with nonfocus countries between 2004 and 2008 was 0.84 (95% CI, 0.72-0.99; P = .03). Within Tanzania and Rwanda, the adjusted odds ratio of mortality for adults living in districts where PEPFAR operated more intensively was 0.83 (95% CI, 0.72-0.97; P = .02) and 0.75 (95% CI, 0.56-0.99; P = .04), respectively, compared with districts where it operated less intensively.

Conclusions  Between 2004 and 2008, all-cause adult mortality declined more in PEPFAR focus countries relative to nonfocus countries. It was not possible to determine whether PEPFAR was associated with mortality effects separate from reductions in HIV-specific deaths.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
Journal of the American Medical Association
Authors
Eran Bendavid
Eran Bendavid
CB Holmes
Jay Bhattacharya
Jay Bhattacharya
Grant Miller
Grant Miller
Paragraphs

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.

Design, Setting, and Participants  Using person-level data from the Demographic and Health Surveys, we conducted cross-country and within-country analyses of adult mortality (annual probability of death per 1000 adults between 15 and 59 years old) and PEPFAR's activities. Across countries, we compared adult mortality in 9 African focus countries (Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia) with 18 African nonfocus countries from 1998 to 2008. We performed subnational analyses using information on PEPFAR's programmatic intensity in Tanzania and Rwanda. We employed difference-in-difference analyses with fixed effects for countries and years as well as personal and time-varying area characteristics.

Main Outcome Measure  Adult all-cause mortality.

Results  We analyzed information on 1 538 612 adults, including 60 303 deaths, from 41 surveys in 27 countries, 9 of them focus countries. In 2003, age-adjusted adult mortality was 8.3 per 1000 adults in the focus countries (95% CI, 8.0-8.6) and 8.5 per 1000 adults (95% CI, 8.3-8.7) in the nonfocus countries. In 2008, mortality was 4.1 per 1000 (95% CI, 3.6-4.6) in the focus countries and 6.9 per 1000 (95% CI, 6.3-7.5) in the nonfocus countries. The adjusted odds ratio of mortality among adults living in focus countries compared with nonfocus countries between 2004 and 2008 was 0.84 (95% CI, 0.72-0.99; P = .03). Within Tanzania and Rwanda, the adjusted odds ratio of mortality for adults living in districts where PEPFAR operated more intensively was 0.83 (95% CI, 0.72-0.97; P = .02) and 0.75 (95% CI, 0.56-0.99; P = .04), respectively, compared with districts where it operated less intensively.

Conclusions  Between 2004 and 2008, all-cause adult mortality declined more in PEPFAR focus countries relative to nonfocus countries. It was not possible to determine whether PEPFAR was associated with mortality effects separate from reductions in HIV-specific deaths.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
Journal of the American Medical Association
Authors
Eran Bendavid
Eran Bendavid
Charles Holmes
Jay Bhattacharya
Jay Bhattacharya
Grant Miller
Grant Miller
Paragraphs

Abstract

Background

Survival to old ages is increasing in many African countries. While demographic tools for estimating mortality up to age 60 have improved greatly, mortality patterns above age 60 rely on models based on little or no demographic data. These estimates are important for social planning and demographic projections. We provide direct estimations of older-age mortality using survey data.

Methods

Since 2005, nationally representative household surveys in ten sub-Saharan countries record counts of living and recently deceased household members: Burkina Faso, Côte d'Ivoire, Ethiopia, Namibia, Nigeria, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. After accounting for age heaping using multiple imputation, we use this information to estimate probability of death in 5-year intervals (5qx). We then compare our 5qx estimates to those provided by the World Health Organization (WHO) and the United Nations Population Division (UNPD) to estimate the differences in mortality estimates, especially among individuals older than 60 years old.

Findings

We obtained information on 505,827 individuals (18.4% over age 60, 1.64% deceased). WHO and UNPD mortality models match our estimates closely up to age 60 (mean difference in probability of death -1.1%). However, mortality probabilities above age 60 are lower using our estimations than either WHO or UNPD. The mean difference between our sample and the WHO is 5.9% (95% CI 3.8–7.9%) and between our sample is UNPD is 13.5% (95% CI 11.6–15.5%). Regardless of the comparator, the difference in mortality estimations rises monotonically above age 60.

Interpretation

Mortality estimations above age 60 in ten African countries exhibit large variations depending on the method of estimation. The observed patterns suggest the possibility that survival in some African countries among adults older than age 60 is better than previously thought. Improving the quality and coverage of vital information in developing countries will become increasingly important with future reductions in mortality.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
PLoS One
Authors
Eran Bendavid
Eran Bendavid
Seligman B
Kubo J
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