Stanford Health Policy is a joint effort of the Freeman Spogli Institute for International Studies and the Stanford School of Medicine
FSI researchers consider international development from a variety of angles. They analyze ideas such as how public action and good governance are cornerstones of economic prosperity in Mexico and how investments in high school education will improve China’s economy.
They are looking at novel technological interventions to improve rural livelihoods, like the development implications of solar power-generated crop growing in Northern Benin.
FSI academics also assess which political processes yield better access to public services, particularly in developing countries. With a focus on health care, researchers have studied the political incentives to embrace UNICEF’s child survival efforts and how a well-run anti-alcohol policy in Russia affected mortality rates.
FSI’s work on international development also includes training the next generation of leaders through pre- and post-doctoral fellowships as well as the Draper Hills Summer Fellows Program.
This project studied the patterns of health and health care disparities across elderly and non-elderly in China, including the impact of earlier educational and public health interventions on contemporary elderly.
Urbanization and obesity-related chronic diseases are cited as threats to the future health of India's older citizens. With 50% of deaths in adult Indians currently due to chronic diseases, the relationship of urbanization and migration trends to obesity patterns have important population health implications for older Indians. The researchers constructed and calibrated a set of 21 microsimulation models of weight and height of Indian adults. The models separately represented current urban and rural populations of India's major states and were further stratified by sex.
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Neesha Joseph is Program Manager for the Stanford Center on the Demography and Economics of Health and Aging (CDEHA) and the Stanford Center on Advancing Decision Making in Aging (CADMA). In this capacity she oversees center operations, including coordinating pilot projects and center conferences and activities. She also conducts policy research on health care topics, such as the impact of age on innovation in health research, the cost and disease management implications of patient comorbidity in Medicare populations, and the impact of of health care reform on physician human capital.
She brings with her experience in health research and management. Previously Neesha worked as a Research Analyst specializing in health economics at the Milken Institute, where she was involved with various aging initiatives. She received a master's degree in public policy from the USC Price School of Public Policy, and her areas of interest include health economics and international development.
Eugene Lewit, PhD, is an Adjunct Lecturer in the Department of Health Policy, Stanford University. His current research interests focus on implementation of the ACA and it’s impact on children and families. He also consults with philanthropies on strategy and evaluation.
From 2009 to 2013, Lewit was Program Officer and Manager in the Children, Families, and Communities Program at the David and Lucile Packard Foundation where he managed a multimillion-dollar grant program designed to help bring health insurance to all children. From 1999 to 2008, Lewit was Senior Program Manager for Heath and Economic Security and from 1991- 1999, Director, Research and Grants, Economics at the Packard Foundation. He managed large grant programs focused on children’s health care quality, poverty, welfare reform, and family economic security. In this capacity, he helped launch and develop key organizations working on children’s health care quality including the Vermont Oxford Network and the National Institute for Children’s Health Care Quality as well as seeding the dissemination of the California County Children’s Health Initiatives from Santa Clara County to 28 other counties in California.
Lewit is trained as a health economist and until 2010 was a Research Associate at the National Bureau of Economic Research. With his NBER colleagues, he published several seminal articles on tobacco taxation and other tobacco control policies. He has consulted with the WHO and World Bank on tobacco policy in developing countries. Lewit has also published on grantmaking, children’s health and health care policy, and poverty and income security for children and families and was an editor and regular contributor to The Future of Children.
In 2013, Lewit received the Academy Award from the National Academy for State Health Policy for “outstanding national leadership in improving health coverage for children,” and the Champion for Children award from the First Focus Campaign for Children. From 2011 to 2014, Lewit served on the Board of Directors of Grantmakers In Health.
Background: Pediatric liver transplant patients are at increased risk of post transplant lymphoproliferative disease (PTLD) from Epstein Barr virus (EBV) infection or reactivation after transplantation. The goal of this study was to determine the impact of induction and immunosuppression levels on the development of EBV viremia post transplantation. Methods: A retrospective chart review was performed on 104 patients less than 18 years of age who underwent isolated liver transplantation (LT) between 2000-2008 at Lucile Packard Childrens Hospital at Stanford University. Induction regiment, immunosuppression levels, and EBV viremia, as noted by any positive value of EBV polymerase chain reaction testing, was documented for one year post transplantation. Fixed-effects logistic regression models were constructed to determine associations between induction therapy, immunosuppression levels, and EBV viremia. A P-value < 0.05 was considered to be statistically significant. All statistical analyses were performed using STATA 11 (College Station, TX). Results: 56% of patients developed EBV viremia within one year of LT. Patients were more likely develop EBV viremia if they had received either anti-thymocyte globulin [ATG (73%)] or daclizumab (63%) for induction versus neither (39%), though the trend was not statistically significant (ATG: Odds ratio (OR) 0.19; 95% CI 0.024 1.58; p = 0.125; daclizumab: OR: 1.07; 95% CI 0.270 4.23; p=0.925). Tacrolimus immunosuppression levels were supratherapeutic 37% of the time within the first three months of transplant; however, only supratherapeutic tacrolimus levels between 0-2 weeks after transplant impacted the development of EBV viremia at 2-4 weeks post LT (OR 1.80; 95% CI 1.10-2.94; p=0.02). Only one patient developed PTLD during the study period. Conclusion: The type of induction used in isolated pediatric LT may play a role in the development of EBV viremia, with ATG and daclizumab leading to a higher incidence of EBV viremia, though it was not statistically significant. Supratherapeutic immunosuppression tacrolimus levels 0-2 weeks post LT impacted the development of EBV viremia at 2-4 weeks, but the effect was not seen at other time intervals. The incidence of PTLD in our study was low, suggesting better EBV and immunosuppression monitoring has played an important role in the reduction of complications associated with EBV viremia post pediatric LT.
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.