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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Frances Butcher is a Ph.D. candidate at University of Oxford’s Ethox Centre and the Wellcome Centre for Ethics and Humanities. She is supported by a Wellcome Trust Fellowship for Health Professionals in Humanities and Social Science. Her research, which utilizes empirical ethics methodologies and explores ethical dimensions of global health security, looks at the definition and limits of what should be included in the global health security regime, and how this might effect good practice. Frances is also a Specialty Registrar (physician) in Public Health undertaking dual clinical-research training. During her training in the UK, she has worked in various roles including in clinical medicine and public health for Public Health England, the UK Health Security Agency, and NHS England. Frances has a medical degree from Brighton and Sussex Medical School, an MA in Bioethics and Society from King’s College London, and an MSc in Global Health Science from the University of Oxford. She was a 2022 Pre-Doctoral Fellow at CISAC and a 2019 Fellow on the Johns Hopkins Emerging Leaders in Biosecurity Program.

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This article was first published by the social and political economy portal IndiaSpend.


Women from poor households made about 235,000 fewer hospital visits compared to men for seven gender-neutral disease categories between January 2017 and October 2019, a new study analyzing a Rajasthan state health insurance scheme has estimated. The Bhamashah Swasthya Bima Yojana aims to provide health insurance to about 46 million persons living below the poverty line, as a step towards universal and equitable access to healthcare in the state, per the study.

Pascaline Dupas and Radhika Jain of Stanford University studied data of insurance claims from 4.2 million hospital visits under the Bhamashah scheme from its launch in December 2015 till October 2019, and the study was published as a National Bureau of Economic Research working paper. The study was conducted in partnership with the Rajasthan state government.

Women made up 45% of hospital visits under the Bhamashah scheme between January 2017 and October 2019, though their share in the population is 48%, per the study. The gender gap is starker for girls and older women. The share of girls in children aged under 10 years who visited the hospital under this insurance program was 33%, though their share of this age group's population is 47%; among those aged above 50 years, women are 51%, yet their share of hospital visits under this insurance program was 43%.

"We were struck by this discrepancy in the data. We were not expecting such a large [gender] difference," Dupas, an economist and professor at Stanford University, told IndiaSpend. In most other developed countries for which such data have been analyzed, subsidized healthcare usually caters to those who otherwise don't have access to it, added Jain, a postdoctoral fellow in Asia Health Policy at Stanford University, US.

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A new study of the Rajasthan government's Bhamashah health insurance program for poor households has found that just providing health insurance cover doesn't reduce gender inequality in access to even subsidized health care.

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This opinion piece was first published in the economics and policy portal Ideas for India.


Equity in healthcare is a key goal of health policy in India. Analyzing administrative data from Rajasthan, this article highlights substantial gender gaps in the utilization of subsidized hospital care under the state health insurance program. These disparities persist despite substantial program expansion and seem to be driven by households being less willing to allocate resources to female vis-à-vis male health.

Over the past 15 years, India’s central government and numerous state governments have put in place health insurance programmes that entitle low-income households to free healthcare at public and empanelled private hospitals. Health equity and universal health coverage are explicit goals of these programs. In new research, we study gender equity in the Bhamashah Swasthya Bima Yojana (BSBY)1 health insurance program, which was launched in the state of Rajasthan in 2015, and is similar in design to the national Pradhan Mantri Jan Arogya Yojana (PMJAY).

Our starting point is a dataset of insurance claims filed for all 4.2 million hospital visits between 2015 and 2019, including patient age, gender, residence address, hospital visited, dates of admission and discharge, and service(s) received. We geo-coded hospital locations and patient addresses, which allowed us to calculate proximity to hospitals and the distance traveled for every hospital visit. Finally, we linked the insurance data to the 2011 Census and data on three rounds of village-level (gram panchayat) elections. To our knowledge, the dataset we compiled from these various sources is the first dataset of its type in India and allows us to study care-seeking under insurance with unusual granularity.

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Stanford University researchers' study of Bhamashah Swasthya Bima Yojana reveals that just expanding geographical access and reducing the cost of healthcare won't reduce gender disparity.

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Using administrative data on over 4 million hospital visits, we document striking gender disparities within a government health insurance program that entitles 46 million poor individuals to free hospital care in Rajasthan, India. Females account for only 33% of hospital visits among children and 43% among the elderly. These shares are lower for more expensive types of care, and far lower than sex differences in illness prevalence can explain. Almost two-thirds of non-childbirth spending is on males. We combine these data with patient survey, census, and electoral data to show that 1) the program is unable to fully offset the costs of care-seeking, which results in disparities in hospital utilization because some households are willing to allocate more resources to male than female health; 2) lowering costs does not reduce disparities, because males benefit as much as females do; and 3) long-term exposure to village-level female leaders reduces the gender gap in utilization, but effects are modest and limited to girls and young women. In the presence of gender bias, increasing access to and subsidizing social services may increase levels of female utilization but fail to address gender inequalities without actions that specifically target females.

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Gender Disparities in Utilization of Government Health Insurance in India
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Working Paper 28972
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Melissa De Witte
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This interview was first published by the Stanford News Service.


The 2020 Summer Olympics have begun this week but public support among the Japanese public for the games has been generally low and their mood can be articulated through the succinct question: “Why are we doing this now?” says Stanford sociologist and Japan Program Director Kiyoteru Tsutsui.

 
Here, Tsutsui discusses how the various challenges posed by the COVID-19 pandemic and other national scandals related to the games have led to a general dissatisfaction among the Japanese public towards their government and the International Olympic Committee. Despite low morale, the country’s mood may change once the Summer Games commence – barring any further complications or disruptions. But given that the games are pared down this year, it still may be hard to generate the same levels of excitement as in previous years, Tsutsui said.
 
Tsutsui is the Henri H. and Tomoye Takahashi Professor and director of the Japan Program at the Walter H. Shorenstein Asia-Pacific Research Center, which is part of the Freeman Spogli Institute for International Studies. Tsutsui is also a professor of sociology and his research focuses on social movements, globalization, human rights and Japanese society. He is the author of Rights Make Might: Global Human Rights and Minority Social Movements in Japan (Oxford University Press, 2018).
 

Polls among the Japanese public show mixed support for the games and meanwhile, major advertisers in the country are pulling out. As a sociologist, how do you see this mixed public sentiment affecting overall mood and morale?

There is no question that there is a strong headwind against the Olympics in the lead-up to the opening ceremony. Opinion polls are still against the games, although the numbers improved a little in recent weeks. The general public sentiment can be summed up as “Why are we doing this now?”

The road to the Tokyo Olympics has been a long and winding one complicated by COVID-19, first and foremost, and various scandals. The Japanese public has been fed up with the COVID-19-related emergency declarations and other restrictions as well as the slower pace of vaccination compared to other developed countries. The perception, right or wrong, is that the government is making decisions based on whether they help in hosting the Olympics successfully, when the focus should be on public health and economic rescue in the COVID environment.

Morale is low, but many are hoping that things will change quickly once the games begin. Whether that happens or not depends on a whole host of factors, most importantly whether major public health incidents and other unfortunate accidents happen or not, how Japanese athletes fare, who might emerge as global stars, and so on.

To what extent has the International Olympic Committee (IOC) helped or hindered support for the games among the Japanese public?

The Japanese public sees the IOC as simply pushing its economic interest without the proper regard for their safety and health. Many people do not understand that the Japanese government does not have the authority to cancel the Olympics and could have faced a lawsuit with a huge compensation at stake if it tried to do so. The IOC looks like the IMF/World Bank during the Asian economic crisis in affected countries or the EU in some European countries – an international entity that pushes its agenda without accountability to the citizens. The frustration has nowhere to go but to the Japanese government, which combined with overall COVID-19-related dissatisfaction, has led to the most recent polls showing the lowest approval rating for the government under Prime Minister Yoshihide Suga.

For Japan, hosting the 2020 Olympic Games initially symbolized the country’s rebound from the devastating Tōhoku earthquake, tsunami and Fukushima Daiichi nuclear accident in 2011 and was poised to boost their economy. Then COVID hit, and meanwhile, Olympic expenses ballooned. Are there any opportunities for the Olympic Games to help the country bounce back? 

The 2020 Olympics was initially framed as a symbol of recovery from the triple disaster in 2011, but that slogan is no longer central. The expenses were justified as a way to develop infrastructure for foreign visitors and increase inbound tourists, and the government’s goals for the number of visitors from abroad have been met already. With no spectators allowed, Japan will lose money on hosting the Olympics, but the economic damage is not irrecoverable. Once the world gets out of COVID-19, the Japanese economy will likely rebound and tourists will come back.

It will be interesting to follow how socially, in terms of the national psyche and its unity, Japan will respond to the Tokyo Olympics. Even when the games take place in other countries, the Olympics often serve as a moment of national unity, especially in Japan. With Japan being the host, many thought that it would serve as an enormous booster towards national confidence and unity. We have yet to see how the games will turn out, but these psychological impacts will likely be lessened as the games are scaled down and may not get as much global attention as typical Olympics do.

There’s still a chance for a better outcome though if the games go smoothly and offer many compelling moments. People in many countries are still more homebound than usual and the contents that the games offer could be attractive. And the Japanese public is known to swing from one side to the other very quickly and on a massive scale, so once the games begin, TV personalities who were questioning whether the games should happen will likely quickly turn around and support Japanese athletes and tout their accomplishments. That is, if no serious outbreak incidents occur.

The Olympics are often celebrated as a nonpolitical event that can unite the world. In a globally turbulent world, what do you make of that assessment? Can the Olympics be nonpolitical?

The Beijing Winter Olympics in 2022 is a case in point. Boycott of the games seems unlikely, but House Speaker Nancy Pelosi has already floated an idea of diplomatic boycott. There’s a lot at stake for the host country, and the Olympics will likely be politicized when countries like China, Russia or even the U.S. host it.

Another problem is that not many democracies would be eager to host the games anymore. Public support is needed for democracies to host the Olympics, but the growing cost of the games, combined with increasingly less clear benefits of hosting, has made it difficult to find democracies that are eager to be the host country. Meanwhile, non-democracies like China and Russia, and even smaller countries like Kazakhstan or Azerbaijan campaign to become host nations. The pattern of dictatorships hosting the Olympics and the world demanding a change in their human rights practices and, threatening a boycott, might be a recurring pattern in the coming decades.

 
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Kiyoteru Tsutsui

Senior Fellow at FSI, Professor of Sociology, Director of the Japan Program
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While public support in Japan has been lackluster for the 2020 Tokyo Olympic Games, the mood may change once the games start – provided no major public health incidents and other unfortunate accidents occur, says Stanford sociologist Kiyoteru Tsutsui.

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Scott Rozelle, Yuqing Zheng, and Chengfang Liu were the guest editors of this special issue on agriculture, the rural economy and China's growth in the 21st century. Scott Rozelle also authored a publication in this issue.
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July 15 Surgeon General

Join the Stanford Internet Observatory for a conversation with US Surgeon General Vivek H. Murthy, MD, MBA, where he will discuss slowing the spread of health misinformation, both during the COVID-19 pandemic and beyond. 

Health misinformation is a major threat to public health because it can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts. Although health misinformation is not a recent phenomenon, the COVID-19 pandemic has exacerbated an already growing issue. While information has enabled people to stay safe and informed throughout the pandemic, it has also led to confusion. The rising use of technology platforms, such as social media companies, online retailers, and search engines, can helped connect and inform people, but at the same time, many platforms can also drive misinformation to users.

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CDDRL Postdoctoral Scholar, 2021-22
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I am a political scientist (PhD degree expected in July 2021 from Harvard) working on political parties, social welfare policies and local governance, primarily in the Middle East and North Africa. My dissertation project focuses on secular parties in the region and explores why they could not form a robust electoral alternative to the Islamist parties in the post-uprisings period. In other projects, I explore voters' responses to executive aggrandizement (focusing on Turkey), and social welfare in the context of ethnic and organizational diversity (focusing on Lebanon). Prior to PhD, I worked as an education policy analyst in Turkey, managing several research projects in collaboration with the Ministry of Education, World Bank and UNICEF. I hold a BA degree in Political Science from Boğaziçi, and Master's degrees from the LSE and Brown. 

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