Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Ryan McDevitt

Ryan McDevitt is a professor of economics at the Fuqua School of Business, Duke University, and a research associate at the National Bureau of Economic Research. T

Title: Comparing the Effects of Vertical Integration and Horizontal Consolidation: Evidence from the Dialysis Industry

Abstract: Health care markets have consolidated in recent decades, with increases in both horizontal and vertical ownership ties. We study the implications of shared ownership along both of these dimensions in the U.S. market for outpatient dialysis using a new dataset of mergers, acquisitions, and joint ventures between dialysis chains and local partners such as physicians. We first provide novel evidence of the growth and prevalence of joint ventures in dialysis facilities, which nearly tripled from 9.8% in 2005 to 29.8% in 2017. Using a difference-in-differences framework, we find that joint ventures result in much larger gains in market share compared to acquisitions but relatively similar changes in practices. We also provide evidence that these gains in market share stem largely from business stealing and that patient steering at joint ventures may serve as a barrier to potential entrants.

Stanford Health Policy

Conference Room 119

615 Crothers Way Encina Commons

 

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Slavery victimizes tens of millions of people worldwide. In 2016, 40 million people were identified as slaves, an estimated 25% percent of them children. Given a broader definition of slavery that includes child labor and child servitude, 152 million children between the ages of 5 and 17 were child laborers as of 2016, and many millions more were involved in some form of slavery-like practice.

Stanford PhD candidate Vincent Jappah, MD, notes in his new article published in the journal Medicine, Conflict and Survival, that the gray area surrounding the acceptance of child servitude in many cultures makes formulating the correct number of victims difficult. Call it servitude or slavery, the practice diminishes the health and social well-being of children and causes harmful ripple effects in their communities as well as to the rest of the world.

Jappah notes that policies to address child servitude and other slavery-like practices are fundamental to global health policy and development. Using a health equity framework can help mitigate the negative impacts of child servitude, in that it requires addressing the diverse factors that impact a person’s ability to meet key health milestones. Irrespective of a person’s race, socio-economic status, financial and physical ability, all global citizens have the right to a healthy life.

The study, “The political economy of child service in Liberia, West Africa,” co-authored by Jappah and Danielle Taana Smith, a professor of African American Studies at Syracuse University, notes that modern slavery is often centered around alleviating one’s own personal poverty and gaining power, even if that means exploiting the children of your own community.

Both Liberian natives, the researchers note that Liberians — like those of other countries including the United States — will often target those from low socioeconomic backgrounds and indigenous peoples.

This often takes place “within groups that in many instances share similar racial identities and physical features,” Jappah said. “Today, the child next door in a neighbor’s home may be deprived of going to school and coerced into performing endless hours of chores, with poor food and living conditions, the inability to leave the house, and the constant fear of violence.”

Jappah notes child servitude can potentially have devastating health consequences, and poses a major health challenge for individuals and their communities. Many victims typically live in unsuitable and unsanitary environments often littered with mosquitos, flies, lice, and other transmitters of disease. These children may also face poor mental health outcomes such as depression, social anxiety and social dysfunction, low self-esteem and failure to meet critical developmental milestones.

These children, as all children do, internalize and, to some extent, normalize their living conditions, and society becomes more acquiescent to such practices, despite their detrimental effects.
Vincent Jappah, MD, MPH
PhD Candidate, Stanford Heath Policy

Liberia is one of the poorest countries in the world, having suffered years of civil war and regional conflict. Its human development indicators rank 175 out of 189 countries on the 2019 Human Development Index. The child malnutrition rate is 15% among 5-year-olds and younger and many Liberians lack access to basic needs such as food, water, shelter, education, and health care.

In fact, the authors note, nearly 63% of the people in the West African nation established by freed American slaves live in poverty; 69% of the country’s 5 million people live on less than $3.20 a day.

“A functional economy that ensures that most citizens can earn a living wage does not exist,” the authors wrote. “Extreme poverty in some families, high levels of illiteracy and unemployment, and suboptimal economic activities contribute to child servitude and other forms of child exploitation.”

The children of Liberia are not alone. In societies with inherent instability and ongoing conflict, the practice of child servitude can become accepted as a normal way to make money and centralize power when opportunity and resources are scarce.

Jappah notes that for young children and adolescents, this is the period of forming personality, critical reasoning and developing relationships outside of the home, as well as forming opinions about the world around them. Living in such dehumanizing conditions can result in shame and trauma and often have intergenerational effects. They also have lower levels of education and higher dropout rates, contributing to an ongoing cycle of intergenerational poverty.

“These children, as all children do, internalize and, to some extent, normalize their living conditions, and society becomes more acquiescent to such practices, despite their detrimental effects,” Jappah said.  “These practices are widespread in places where laws are not adequate to address them, or if there are laws, few enforcement mechanisms are in place, or they are not enforced.”

Jappah said Liberians must address their cultural history of exploitation if they want to abolish the practice of child servitude. In addition, addressing the larger issues of inequity and the exclusion of marginalized groups is necessary.

“Throughout human history, we have witnessed clashes among social classes and groups,” Jappah said. “The more inequitable a society is, the more likely it is to be rife with social tensions.”

He concluded that those tensions are evident in developing countries as well as the industrialized nations such as the United States, a Western harbor of child trafficking and slavery. According to the Global Slavery Index, on any given day in 2016 there were 403,000 people living in conditions of modern slavery in the United States — or 1.3 victims of slavery for every thousand people in this country.

 “This phenomenon is universal; Liberia is not an exception,” Jappah said.

 

 

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Vincent Jappah, MD, MPH

PhD Candidate
He focuses on public policy, economics, global child and maternal health.
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Silhouette of Liberian Child, Photo Credit: Getty
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A new article co-authored by Health Policy PhD candidate Vincent Jappah reveals that the modern drivers of child servitude in Liberia are largely social vulnerability and cultural acceptance of the practice, rather than traditional factors based on race and ethnicity.

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Master's Student Alumni, Health Policy
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Beatrice Sun is a Master’s student in Health Policy at Stanford. She is a Stanford General Surgery resident currently in her Professional Development time. Prior to returning to the Bay Area, she obtained her BS from UCLA and MD from UC Irvine. She is interested in understanding the disparities and resource utilization of palliative and end of life care in cancer patients, with a particular focus on the resource needs of young adult cancer patients. After graduating residency, she plans on pursuing a fellowship in Surgical Oncology.

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Accountant
pamela_murarka_head-2023.jpg MBA

Pamela Murarka previously worked at Rensselaer Polytechnic Institute as a Senior Business Administrator. She received her bachelor's degree and MBA from Rensselaer Polytechnic Institute. She is originally from Cleveland and currently resides in upstate New York.

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PhD Student, Health Policy
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Jonatas Teixeira Prates is a PhD student in Health Policy. Born in Curitiba, Brazil, Jonatas attended Georgia State University, where he graduated with a BS and an MA, both in Economics. His main research interests are in how the environment – as composed of natural and cultural factors – can affect health, health-related behaviors, and healthcare delivery.

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Postdoctoral Research Fellow Alumni
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Victoria Ngo was a postdoctoral fellow in Health Policy at Stanford and in Health Services Research at the VA Palo Alto site of the Elizabeth Dole Center of Excellence for Veteran and Caregiver Research. She is a health informaticist with an extensive background in healthcare administration. Her research focuses on health equity and the optimization of information technology to improve the delivery and coordination of care in the community. Currently, she is utilizing participatory research methods to design and implement mobile and social technology-enabled interventions to improve veteran caregiving in the home. She holds a bachelor’s degree in Molecular and Cell Biology from UC Berkeley, and a PhD in Nursing Science and Health-Care Leadership from UC Davis.

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Amber E. Barnato is the Director of The Dartmouth Institute for Health Policy and Clinical Practice. She is a board-certified preventive medicine and public health physician with advanced training in decision science. Her research focuses on variation in end-of-life intensive care unit (ICU) and life-sustaining treatment use. Barnato earned a BA from the University of California at Berkeley, an MD from Harvard Medical School, an MPH from the University of California at Berkeley, and an MS from Stanford University.
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VA Medical Informatics Fellow
Global Health Postdoctoral Affiliate, Center for Innovation in Global Health (CIGH)
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Anu Ramachandran is a Medical Informatics Fellow affiliated with the VA's Center for Innovation to Implementation. She completed her medical degree at Johns Hopkins University and pursued a Masters degree in Public Health at the London School of Hygiene and Tropical Medicine as a Marshall Scholar. She recently completed her residency in Emergency Medicine at UC San Francisco/SF General Hospital. Her prior research has focused on the health needs of populations affected by humanitarian crisis. Broadly, she is interested in the intersection of informatics methodologies and health policy, with a focus on crisis preparedness and protecting medically vulnerable populations. She also hopes to use these tools to improve health system design and optimize the resiliency and equity of healthcare delivery in low-resource settings.

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Postdoctoral Research Fellow
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Robert Gallo is a medical informatics research fellow in the Department of Health Policy and the VA Palo Alto Health Care System’s Center for Innovation to Implementation. He obtained his medical degree at Washington University School of Medicine, and subsequently completed his residency training in Internal Medicine at Stanford. Dr. Gallo’s research focuses on inpatient health services delivery, particularly for diabetes and cardiovascular disease. He also has interest in the evaluation and implementation of prediction models.

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Postdoctoral Research Fellow
duncan_mcelfresh.jpeg PhD

Duncan is a Postdoctoral Fellow in Health Services Research and Development, with the VA Center for Innovation to Implementation (Ci2i) and the Stanford Department of Health Policy. Duncan uses methods from computer science and operations research for resource allocation and decision making in applied settings. To ensure that these systems meet appropriate standards of quality and safety, he is also developing processes for governing and monitoring deployed algorithms in healthcare settings. Duncan’s past projects have focused on blood donor recruitment (with Facebook), kidney exchange (with UNOS), and financial services (with FinRegLab). He holds a PhD in Applied Mathematics (AMSC) from the University of Maryland, College Park.

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