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Maria Polyakova, an assistant professor of health research and policy at the Stanford School of Medicine, is this year’s recipient of the Ernst-Meyer Prize, which recognizes original research about risk and health insurance economics.

Polyakova, who wrote her thesis, “Regulation of Public Health Insurance,” while working on her Ph.D. in economics at MIT, was given the award by The Geneva Association, an international insurance economics think tank based in Switzerland.

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Christophe Courbage, research director of the health and aging and insurance economics programs at the association, made the announcement Tuesday. He called Polyakova’s work “an important and insightful thesis on a set of first order – but understudied – issues in insurance: namely the regulation of privately provided social insurance.”

Courbage said the topic not only had considerable academic interest, but also was “an important public policy issue in both the United States and Europe.

“This work makes extremely useful insights about an important area of public policy that has yet to get the attention it needs: the interaction of regulation with important demand and supply-side features of private insurance markets.”

Polyakova said she was honored to receive the award and thanked her thesis committee for their “unbounded support” of her work.

“I am especially grateful to Amy Finkelstein for inspiring my interest in social insurance in general, and health insurance, in particular,” she said. “I hope to continue my work in this area."

A summary of Polyakova’s thesis will be published in the July 2015 issue of The Geneva Association’s Insurance Economics newsletter.

 

 

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Beth Duff-Brown
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Stanford School of Medicine Dean Lloyd Minor told a distinguished group of visiting physicians, engineers, economists and businessmen from India that it was the perfect time to be collaborating with the world’s largest democracy.

As India’s economy heats up once again and biomedical research scales across the South Asian nation, Stanford intends to remain a key partner in this growth.

“India is on a journey to overcome its challenges,” Minor said. “Despite the substantial gaps in healthcare infrastructure and a shortfall of skilled healthcare workers, there’s enormous opportunity and enormously good work going on today – most of it being done by the people in this room.”

Minor was addressing a healthcare and policy panel during the two-day held on the Stanford campus on May 28-29. Reigniting India’s Growth: Perspectives from Business, Engineering, Medicine and Economics was sponsored by the Stanford Center for International Development, the Graduate School of Business, the schools of Engineering and Medicine, as well as the Office of the Vice Provost and Dean of Research.

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“I’m really eager to explore ways that we can deepen the collaboration and interactions between Stanford and India,” Minor said. “As I’m sure everyone here is aware, India is the world’s most populous democracy, one of the fastest growing major economies and a rising power with growing international influence – led by a prime minister who has great ambitions for the country.”

Prime Minister Narendra Modi has said his core mission is the revival of the Indian economy – once a powerhouse destined to rival that of China. Since taking office last year, when economic growth stood at 5 percent, the IMF forecasts India’s economy will grow to 7.5 percent by the end of this year.

Stanford has many partnerships with India, such as the Stanford-India Biodesign project to train the next generation of medical technology innovators in India. In 2007, Stanford joined with the nonprofit GVK Emergency Management Research Institute, based in Hyderabad, India, to train the country’s first corps of paramedics.

Minor noted that the Stanford-India Biodesign program has led to the founding of 37 biotech companies. “And the technologies that they have invented have been used in the care of over 300,000 patients – and that’s only the beginning,” he said.

Stanford physicians developed an educational curriculum and have trained thousands of paramedics and emergency instructors in India. EMRI says that since the training program began, more than 150,000 healthcare professions have been trained at its training center.

“These paramedics instructors have played a crucial role in the development of emergency medicine in India,” he said. “It’s been a true collaboration with a curriculum developed here in the U.S. and then standardized and implemented in a way that’s meaningful for people in India.”

Grant Miller, an associate professor at the School of Medicine and a senior fellow at the Freeman Spogli Institute for International Studies, is the director of the Stanford Center for International Development, which organized and co-hosted the India conference.

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“This year’s India Conference was new for SCID in that it was a cross-campus collaboration, partnering us with the business school and schools of medicine and engineering,” said Miller, also a core faculty member at CHP/PCOR.

“We feel that there is great potential for more campus-wide activity focused on India, enabling Stanford to develop new partnerships in India as well as across parts of our own university.”

Miller also launched the Stanford India Health Policy Initiative with another CHP/PCOR researcher, Nomita Divi. The initiative, connected with FSI’s International Policy Implementation Lab, joins Stanford with Indian health policymakers and professionals to design collaborative projects in India.

Last year the SIHPI fellows spent the summer investigating the factors that motivate formal and informal healthcare providers. This summer, three Stanford undergrads and a medical student will do fieldwork on the outskirts of Mumbai for seven weeks to document the impact of existing pharmaceutical networks on formal and informal provider practices.

“Health improvement is of course a critical objective of broad-based social and economic development, and we are very excited to see Stanford’s potential to make interdisciplinary contributions to health improvement in India,” Miller said on the sidelines of the India conference.

The conference featured four panel sessions in which perspectives from economics, business, engineering and medical sectors were debated. Discussions focused on how best to combine these to ensure sustained high growth in the Indian economy.

Each session featured a distinguished panel of speakers, and was followed by a lengthy floor discussion. Among the speakers were Nandan Nilekani, the co-founder of Infosys, one of India’s most successful IT services companies; Stanford President John Hennessy; Montek Ahluwalia, former deputy chairman of India’s Planning Commission, and Mr. K. Ram Shriram, managing partner at the venture capital firm, Sherpalo Ventures.

Ashok Alexander, former founding country director of the Bill and Melinda Gates Foundation in India, said too many India observers tout the incredible growth of its economy and highly educated and skilled technology innovators. Yet they ignore the majority of the country’s 1.2 billion people still lack adequate public healthcare and that 70 percent of medical spending comes out of pocket.

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“We cannot ignite India nor can we sustain India unless we think about the ways to fix public health problems,” Alexander said. “The solution to most public health problems in India are absurdly simple; it’s all about scaling up of well-known solutions.”

Only 1.3 percent of India’s GDP was devoted to public health in 2014, according to the World Bank. That is one of the world’s lowest rates. The risk of dying during childbirth is one in 43, whereas the rate in developed countries is one in 4,000.

“While India is making such great strides in its energy and business sectors, how come there is no great debate on public health?” he asked.

Amit Sengupta, a senior biomedical consultant at Tata Memorial Center and adjunct professor at ITT/AIIMS in New Delhi, told the medical panel that modern medicine is still not the first preference in rural Indian and the urban slums.

“Health is not only a biomedical issue, but also sociocultural issue,” he said. “Fifty percent of the world’s tribal population lives in India; it’s a rich heritage but they eschew Western medicine.”

Sengupta said rural India is plagued by physical and psychological stress, alcoholism and domestic violence. Meanwhile, he said, the government continues to cut the healthcare budget – a cycle that always leads back to poverty.

And, he said, remember Gandhi’s memorable saying: “Poverty is the worst form of violence.”

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Avik Roy

Avik Roy is a Senior Fellow at the Manhattan Institute and the Opinion Editor at Forbes. His research interests include the Affordable Care Act, universal coverage, entitlement reform, international health systems, veterans' health care, and FDA policy. In 2012, Roy served as a health care policy adviser to Mitt Romney. He is the author of Transcending Obamacare: A Patient-Centered Plan for Near-Universal Coverage and Permanent Fiscal Solvency and How Medicaid Fails the Poor, published by Encounter Books in 2013.In addition, Roy writes regularly for National Review Online on politics and policy. He is a frequent guest on television news programs, including appearances on Fox News, Fox Business, NBC, MSNBC, CNBC, Bloomberg, PBS, CBS, and HBO. His work has also appeared in The Wall Street Journal, The Atlantic, USA Today, Health Affairs, and National Affairs, among other publications. Roy is a member of the Advisory Board of the National Institute for Health Care Management, and co-chairs the Fixing Vertans Health Care Policy Taskforce. At the Manhattan Institute,  Roy is the founder of Roy Healthcare Research, an investment research firm in New York. Previously, he served as an analyst and portfolio manager at Bain Capital, J.P. Morgan, and other firms.

Avik Roy
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In this session of the Shorenstein APARC Corporate Affiliate Visiting Fellows Research Presentations, the following will be presented:

Yoshihiro Kaga, Ministry of Economy, Trade & Industry, Japan, "The Roles of University-Industry Collaboration for Promoting Innovation"

The existence of top class universities, especially those ties with industry, is regarded as one of the key characteristics of the Silicon Valley ecosystem, where the most successful innovation-based economic growth in the world is observed today.  Kaga has conducted a literature review of previous research on this topic and research on Stanford organizations facilitating university-industry ties.  Kaga will present his findings and share implications for policies in Japan.  His research is in cooperation with Shingo Nakano.

Feng Lin, ACON Biotechnology, "Innovations in China Primary Healthcare Reform: Development and Characteristics of the Community Health Services in Hangzhou"

One of the five major tasks for China’s health reforms launched in 2009 was to promote the development of a primary healthcare system.  Hangzhou is one of the cities with a long history in China for developing community health services.  Lin has studied the model of community health services in Hangzhou, which is characterized as government-led, guaranteed with enough funding, personnel, space and regulation; supported by a unified information platform; and the assigned central role of general practitioners as health “gatekeepers”.  His data collection and analysis have indicated that the basic health status of residents in Hangzhou is comparable to that in Western developed countries.  Based on these findings, Lin proposes that the primary healthcare level in Hangzhou will be further developed and promoted with the indexed performance evaluations and more effective implementation of additional measures.

Shingo Nakano, Ministry of Economy, Trade & Industry, Japan, "Policy Implications for Increasing the Number of Start-ups in Japan"

As mentioned in “Japan Revitalization Strategy (Revised in 2014),” it is critical for Japan to develop an environment where venture businesses are launched one after another.   The Japanese government has taken some measures to this end, but significant obstacles - such as institutional, human, financial, etc. - remain for venture businesses.  Nakano's research looks at how to eliminate these obstacles, while focusing on increasing the number of start-ups in Japan.  Based on his findings, Nakano will discuss some policy implications for improving the Japanese start-up ecosystem.  His research was conducted in collaboration with Yoshihiro Kaga. 

 

Philippines Conference Room

Encina Hall, 3rd Floor, Central

Yoshihiro Kaga Ministry of Economy, Trade & Industry, Japan
Feng Lin ACON Biotechnology
Shingo Nakano Ministry of Economy, Trade & Industry, Japan
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Abstract: Recent advances in synthetic biology are transforming our capacities to make things with biology. This bio-based manufacturing technology has the potential to be most disruptive around products for which existing material supply chains result in limited access. For example, broad access to medicines and the development of new medicines has been difficult to achieve, largely due to the coupling between material supply chains and these therapeutic compounds. We are developing a biotechnology platform that will allow us to replace current supply chains for already approved medicines with stable, secure, scalable, distributed, and economical microbial fermentation. Our initial target is the opioids, an essential class of medicines for pain management and palliative care, which are currently sourced through opium poppy cultivation. In addition, we will leverage this technology to access novel compound structural space that will open up tremendous opportunity for transforming the discovery and development of new drugs over a longer-time frame.

About the Speaker: Christina D. Smolke is an Associate Professor, Associate Chair of Education, and W.M. Keck Foundation Faculty Scholar in the Department of Bioengineering and, by courtesy, Chemical Engineering at Stanford University. Christina’s research program develops foundational tools that drive transformative advances in our ability to engineering biology. For example, her group has led the development of a novel class of biological I/O devices, fundamentally changing how we interact with and program biology. Her group uses these tools to drive transformative advances in diverse areas such as cellular therapies and natural product biosynthesis and drug discovery. Christina is an inventor on over 15 patents and her research program has been honored with numerous awards, including the NIH Director’s Pioneer Award, WTN Award in Biotechnology, and TR35 Award.

Encina Hall (2nd floor)

Christina Smolke Associate Chair for Education, Associate Professor, Bioengineering Speaker Stanford University
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Noncommunicable diseases (NCDs) have become the leading causes of death worldwide and China's increased NCD prevalence is of growing concern. Randall Stafford, Professor of Medicine in the Stanford Center for Research in Disease Prevention and SCPKU Faculty Fellow, led a symposium at the center last fall.  Entitled "Tackling China's Noncommunicable Diseases: Shared Origins, Costly Consequences, and the Need for Action," the symposium focused on China's NCD threats to public health and the urgent need for solutions.  The symposium summary was published earlier this month in the Chinese Medical Journal.

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A rapidly aging population poses serious challenges for many countries around the world, particularly in Asia, home to the most populous countries. China and India account for nearly 36% of the world’s population, and are expected to face social and economic complications from demographic change in the next decades.

A special issue of the Journal of the Economics of Ageing explores these trends in a comparative perspective, “The Economic Implications of Population Ageing in China and India” (December 2014), co-edited by David Bloom, a professor at Harvard University’s School of Public Health, and Karen Eggleston, a Center Fellow at the Shorenstein Asia-Pacific Research Center.

“Population ageing represents uncharted waters for China and India,” Bloom and Eggleston write in their coauthored introduction.

The special issue is a collection of 10 articles that examine the economic benefits and potential dilemmas arising from decreased fertility and increased life expectancy, two trends that will impact the development and future trajectories of China and India at the micro- and macroeconomic levels.

Dropping or continued low birth rates imply fewer young people to refresh the labor market. But will this cause the workforce to shrink to an unsustainable level? Demand will increase for health care, long term care, and other social services that support the elderly. What must the government do to ensure adequate access to care?

Empirical data and commentary presented in the special issue seek to inform stakeholders about emerging patterns, and to provide insight on how to best address related policy challenges going forward.

“By adopting responsive behaviors and consultative institutions that address the challenges of population ageing in ways that are appropriate to their unique circumstances, China and India could reap the full economic and social benefits of longer, healthier lives,” they write.

The special issue includes an introduction by Bloom and Eggleston, a feature interview with Richard Suzman, and additional analysis by noted global health experts following each article. The titles and authors of the 10 original research articles are listed below:

  • Intergenerational co-residence and schooling (Anjini Kochar)
  • Regional disparities in adult height, educational attainment, and late-life cognition: Findings from the Longitudinal Aging Study in India (LASI) (Jinkook Lee, James P. Smith)
  • Healthy aging in China (James P. Smith, John Strauss, Yaohui Zhao)
  • Gender differences in cognition in China and reasons for change over time: Evidence from CHARLS (Xiaoyan Lei, James P. Smith, Xiaoting Sun, Yaohui Zhao)
  • Reprint of: Health outcomes and socio-economic status among the mid-aged and elderly in China: Evidence from the CHARLS national baseline data (Xiaoyan Lei, Xiaoting Sun, John Strauss, Yaohui Zhao, Gonghuan Yang, Perry Hu, Yisong Hu, Xiangjun Yin)
  • Should China introduce a social pension? (Bei Lu, Wenjiong He, John Piggott)
  • China’s age of abundance: When might it run out? (Yong Cai, Feng Wang, Ding Li, Xiwei Wu, Ke Shen)
  • The macroeconomic impact of non-communicable diseases in China and India: Estimates, projections, and comparisons (David E. Bloom, Elizabeth T. Cafiero-Fonseca, Mark E. McGovern, Klaus Prettner, Anderson Stanciole, Jonathan Weiss, Samuel Bakkila, Larry Rosenberg)
  • Economic development and gender inequality in cognition: A comparison of China and India, and of SAGE and the HRS sister studies (David Weir, Margaret Lay, Kenneth Langa)
  • Comparing the relationship between stature and later life health in six low and middle income countries (Mark E. McGovern)

The special issue of the Journal of the Economics of Ageing, vol. 4, pages 1-154 (December 2014) is available through Elsevier’s online platform ScienceDirect.

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China and India account for nearly 36% of the world’s population. The two countries are expected to see an unprecedented, accelerated rate in elderly populations, a shift that has already begun and will continue in the years ahead as life expectancy continues to increase and fertility to decrease or remain below replacement levels. Examining demographic changes can offer a unique opportunity to enrich the theoretical and empirical understanding of the economic aspects of population ageing. This special issue of the Journal of the Economics of Ageing, coedited by David E. Bloom, the Clarence James Gamble Professor of Economics and Demography at Harvard University, and Karen Eggleston, a Center Fellow at the Shorenstein Asia-Pacific Research Center at Stanford University, is a diverse collection of micro- and macro-economic research on ageing in China and India. This introduction, co-written by Bloom and Eggleston, provides background context to demographic trends in China and India, connections between demographic and economic changes and possible behavioral and policy responses. The introduction also gives a preview of the main contributions of the 10 articles featured in the special issue, which cover topics such as the impact of non-communicable diseases in China and India, how parents’ expectations of co-residence with their children affects educational outcomes, and the prevention of cognitive decline in China.

 

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China’s State Council has put forth draft legislation that would ban smoking in public spaces, part of the government’s larger advocacy efforts to help curb tobacco use nationwide. Matthew Kohrman, a professor of anthropology at Stanford University, said it’s a step forward but the ban’s long-term success would depend on local enforcement.

Despite popular belief, global cigarette production has tripled worldwide since the 1960s. Leading the surge has been China.

“China has become the world’s cigarette superpower,” said Kohrman, in an interview on National Public Radio’s program, Marketplace.

Moreover, local governments in China have become dependent on tax revenues generated from tobacco sales, thus reinforcing the cigarette’s ubiquity and ease of access.

China has implemented smoking bans in the past, but with varied success. Now rising healthcare costs caused by tobacco-related diseases are creating urgency for new regulations.

“Whether or not these new regulations will be enforced will, in the end, come down to local politics,” he said.

Matthew Kohrman is part of the Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center, and leads the project, Cigarette Citadels, a peer-sourced mapping project that compiles more than 480 cigarette factories globally.

The full audioclip is available on the Marketplace website.

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Pregnant women with a recent diagnosis of post-traumatic stress disorder were 35 percent more likely to deliver a premature baby than were other pregnant women, a study of more than 16,000 births found.

Pregnant women with post-traumatic stress disorder are at increased risk of giving birth prematurely, a new study from the Stanford University School of Medicine and the U.S. Department of Veterans Affairs has found.

The study, which examined more than 16,000 births to female veterans, is the largest ever to evaluate connections between PTSD and preterm birth.

Having PTSD in the year before delivery increased a woman’s risk of spontaneous premature delivery by 35 percent, the research showed. The results were published online Nov. 6 in Obstetrics & Gynecology.

“This study gives us a convincing epidemiological basis to say that, yes, PTSD is a risk factor for preterm delivery,” said the study’s senior author, Ciaran Phibbs, PhD, associate professor of pediatrics and an investigator at the March of Dimes Prematurity Research Center at Stanford University. “Mothers with PTSD should be treated as having high-risk pregnancies.”

Spontaneous preterm births, in which the mother goes into labor and delivers more than three weeks early, account for about six deliveries per 100 in the general population. This means that the risk imposed by PTSD translates into a total of about two additional premature babies for every 100 births. In total, about 12 babies per 100 arrive prematurely; some are born early because of medical problems for the mother or baby, rather than because of spontaneous labor.

A piece of the prematurity puzzle

“Spontaneous preterm labor has been an intractable problem,” said Phibbs, noting that rates of spontaneous early labor have barely budged in the last 50 years. “Before we can come up with ways to prevent it, we need to have a better understanding of what the causes are. This is one piece of the puzzle.”

Doctors want to prevent prematurity because of its serious consequences. Premature babies often need long hospitalizations after birth. They are more likely than full-term babies to die in infancy. Many of those who survive face lasting developmental delays or long-term impairments to their eyesight, hearing, breathing or digestive function.

Phibbs’ team analyzed all deliveries covered by the Veterans Health Administration from 2000 to 2012, a total of 16,344 births. They found that 3,049 infants were born to women with PTSD diagnoses. Of these, 1,921 births were to women with “active” PTSD, meaning the condition was diagnosed in the year prior to giving birth, a time frame that the researchers thought could plausibly affect pregnancy.

The researchers examined the effects of several possible confounding factors. Being older, being African-American or carrying twins all increased the risk of giving birth prematurely, as extensive prior research has shown.

The researchers also looked at the effects of maternal health problems (high blood pressure, diabetes and asthma); possible sources of trauma (deployment and military sexual trauma); mental health disorders other than PTSD; drug or alcohol abuse; and tobacco dependence. However, these factors had little influence on risk for premature birth.

The effect of stress

In other words, although pregnant women with PTSD may have other health problems or behave in risky ways, it’s the PTSD that counts for triggering labor early.

“The mechanism is biologic,” Phibbs said. “Stress is setting off biologic pathways that are inducing preterm labor. It’s not the other psychiatric conditions or risky behaviors that are driving it.”

Stress is setting off biologic pathways that are inducing preterm labor.

However, if a woman had been diagnosed with PTSD in the past but had not experienced the disorder in the year before giving birth, her risk of delivering early was no higher than it was for women without PTSD. “This makes us hopeful that if you treat a mom who has active PTSD early in her pregnancy, her stress level could be reduced, and the risk of giving birth prematurely might go down,” said Phibbs, adding that the idea needs to be tested.

Although PTSD is more common in military veterans than the general population, a fairly substantial number of civilian women also experience PTSD, Phibbs noted. “It’s not unique to the VA or to combat,” he said, noting that half of the women in the study who had PTSD had never been deployed to a combat zone. “This is relevant to all of obstetrics.”

The VA has already incorporated the study’s findings into care for pregnant women by instructing each VA medical center to treat pregnancies among women with recent PTSD as high-risk. And Phibbs’ team is now investigating whether PTSD may also contribute to the risk of the mother or baby being diagnosed with a condition that causes doctors to recommend early delivery for health reasons.

The lead author of the study is Jonathan Shaw, MD, instructor in medicine at Stanford. The other co-authors are Steven Asch, MD, professor of medicine at Stanford and chief of health services research for the VA Palo Alto Health Care System; Rachel Kimerling, PhD, psychologist at VAPAHCS; Susan Frayne, MD, professor of medicine at Stanford and staff physician at VAPAHCS; and Kate Shaw, MD, clinical assistant professor of obstetrics and gynecology at Stanford.

The research was supported by the VA Office of Academic Affairs and Health Services Research & Development and by VA Women’s Health Services.

Stanford’s Department of Pediatrics also supported this research.

 

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