Investigator Awards In Health Policy Research 53 Bay State Road
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Investigators And Their Projects » Awards by Year:
Section Info
This section contains information about all of the projects and researchers that have been funded through the Investigator Awards program since the first grants were made in 1993. The indexes in this section can be used to identify investigators by name, area of expertise, or year of award. Throughout the site, you will find that each investigator’s name links to details including contact and project information.
»List Projects awarded in
Projects Awarded in 2001:
Investigator names link to complete details.
Ronald Bayer, Ph.D.
Amy L. Fairchild, Ph.D., M.P.H.		Privacy and Surveillance: The History and Politics of Public Health Reporting
Award Year: 2001

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Although surveillance has long been a feature of public health practice, there has been no systematic and comprehensive analysis that meaningfully relates the history of surveillance to current public health policy and practice. Drs. Bayer and Fairchild will address the broad question of how shifting understandings of privacy, confidentiality and individual rights - as reflected in constitutional, ethical, and social norms - have affected our understanding and acceptance of public health surveillance. Through historical and contemporary analysis, the project will shed light on the core ethical and policy challenges posed by surveillance and provide key information for advancing public policy discussions. Case studies with both state and federal components - including infectious disease reporting, vaccine, cancer and birth defect registries, and occupational health reporting - as well as study of the Model State Public Health Privacy Act - will contribute to the development of public policy that is sensitive to privacy and confidentiality and the demands of research and public health.
Scott Burris, J.D.
Zita Lazzarini, J.D., M.P.H.		Human Subjects Protection as Regulation: A Comparative, Empirical View
Award Year: 2001

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Since 1991, most of the studies conducted on human subjects in U.S. research institutions have been regulated by the Department of Health and Human Services under Title 45, Part 46 of the Code of Federal Regulations, known as The Common Rule. Although the goal of protecting human research subjects is unquestionably valid, it is not clear that the regulatory approach codified in The Common Rule is the most sensible or effective option. This project will redefine the issues and propose effective and efficient regulation. Using implementation and socio-legal research methods, the investigators will consider how successfully the Rule works and how alternative approaches would provide improvement. They will examine the current system: the problem of harm and abuse in research, the costs and benefits of institutional review boards, and tools such as informed consent. In exploring alternatives, the investigators will consider other models of risk assessment and regulation as well as human subject protection systems in other countries.
George Davey Smith, M.D., D.Sc.
John W. Lynch, Ph.D., M.P.H.		An Individual and Population Lifecourse Approach to the Determinants of Health
Award Year: 2001

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Drs. Lynch and Smith will develop an individual and population lifecourse framework to better understand the two dominant features of population health - widening disparities existing simultaneously with overall improvements. Through analyses conducted at the individual, regional (states and regions within the U.S. and U.K.), and international levels, the investigators will examine how lifecourse influences affect a particular cohort, different cohorts over time, and disease trends among populations in wealthy nations and between the rich and poor within these countries. A range of exposures and health outcomes will be studied including low birth weight and such cause-specific morbidity and mortality indicators as CHD, stroke, COPD, asthma, TB, suicide, cirrhosis, accidental/violent deaths, and lung, breast, and stomach cancer. Findings should clarify those poor starts in life that can and cannot be overcome and assist in identifying targets for interventions.
Jeffrey A. Fagan, Ph.D.Social Contagion of Adolescent Violence
Award Year: 2001

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While the 1985-1998 epidemic of adolescent violence in U.S. cities has generated intense scholarly and policy interest, spatial and temporal diffusion of the epidemic have been largely overlooked. This project will explore whether current models of infectious disease epidemics can be adapted to explain the spread of youthful violence - particularly its onset, spread, peak, recession and cessation. It will also examine the resilience of some neighborhoods to epidemics of violence, despite social similarities to "infected" communities. Dr. Fagan will construct a conceptual model integrating elements of disease and injury epidemiology with sociological theories of diffusion and contagion. He will apply the model to data on violence morbidity and mortality derived from New York City's 2,220 census tracts. He also will integrate data from life history interviews with young men involved in interpersonal violence to construct a model of social interaction that illustrates the mechanisms of transmission. The project hopes to identify and help resolve competing perspectives on the control of social epidemics as well as leading to more sophisticated strategies for addressing them.
Beatrix R. Hoffman, Ph.D.A History of the Right to Health Care
Award Year: 2001

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Despite current talk of "patient rights," healthcare as a right remains an elusive concept. In this study of assertions and denials of the right to health care in the U.S., Dr. Hoffman will focus on four major topics. They include: legal challenges to the denial of health care; debates over indigent care; rights in the private insurance system including clashes among policyholders, providers, and insurance companies; and the role of race and citizenship in the shifting interpretations of health care rights. By moving discussions from the abstract to the concrete, the project will provide a basis for more effective debate on the role of rights in health care reform. Dr. Hoffman's findings will highlight philosophical and practical contradictions in the health care system that work against equity in access and outcomes.
Stephen J. Kunitz, M.D., Ph.D.Nation-States and Population Health
Award Year: 2001

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This project will explore how the standard of living debate and the consequences of modernization on traditional communities affect our understanding of the determinants of mortality. Improvements in the health of populations over the past few centuries have frequently been attributed to the rising standard of living, even though mortality in Europe began to decline before socioeconomic status had risen appreciably. Dr. Kunitz will examine the role of local and national governments in the decline of mortality and the relationship between national sovereignty and international governance. Other areas of study may include: environmental change, quarantine, drug pricing and production, use of sweated labor, emergence of infectious diseases, effects of free trade agreements, and the emergence of supra-national organizations. Dr. Kunitz' work should contribute to a greater understanding of the role government plays in reducing mortality and equalizing the life chances of its citizens.
Ira Moscovice, Ph.D.
George E. Wright, Ph.D.		Rural Models for American Health Care: Is Our Problem the Solution?
Award Year: 2001

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Rural health care is often viewed solely as a perennial problem and the object of special needs. This study takes a different perspective—many rural communities have also developed cost-effective, primary care-oriented, high-quality models that deserve careful attention. They represent America's homegrown alternative to the consolidation of health services and institutions, and to what patients often perceive as increasingly impersonal care. The investigators will test these assertions by reviewing the evidence on cost, quality, and system performance across rural areas from the viewpoint of strengths rather than weaknesses. By using small area analysis of rural health care to re-examine existing surveys, Drs. Wright and Moscovice will identify high performance systems and examine their generally lower costs. Three detailed case studies of successful models will be developed to help policymakers and administrators better understand the sources and small-scale difficulties of effective rural health care. Findings will enable the investigators to highlight lessons for improving service delivery in rural as well as urban America.
Keith A. Wailoo, Ph.D.Pain as Policy: The Social Negotiation of Pain in Medicine, Culture, and Public Policy in Post WWII America
Award Year: 2001

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There are wide disparities in the treatment of pain, and options for managing it have long been entangled with ideological debates over addiction and dependence. Dr. Wailoo will analyze and describe the complex evolution of pain policy and management practices as well as the principles underlying pain management in America since World War II. Using historical and sociological methods, he will examine increasing disparities in pain recognition and treatment by race, age, gender, class, disease, and region. The project will document the diverse ways in which cultural values have shaped the manner in which pain is understood and managed. It will trace the evolution of disparities in assessment and treatment and address why pain management has differed by community, clinic, state, and region. The roles of key policymakers (politicians, pharmaceutical companies, medical specialists, courts, and patient advocates) will also be assessed.
Timothy M. Westmoreland, J.D.Rules Over Policy: The Impact of the Federal Budget Process on the Modernization of American Public Health
Award Year: 2001

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Individuals working to improve public health and health care are often stymied by the federal budget process. This project will illuminate the arcane nature of federal budgeting, its unintended impact on formulation of health policy, and the absence of health-based measures to balance the process. Mr. Westmoreland will study the origin and development of the formal budget process, assessing the ostensible neutrality of budgeting principles and how they actually drive health policymaking. He will focus on mandatory spending programs (usually reserved for health insurance) and how they are treated differently from discretionary spending programs (typically used for public health activities, clinic- and population-based services) and examine financing disparities. The results will describe how health-related proposals are scrutinized and recommend ways that health-oriented measures might be used to advance federal policymaking.