Robert A. Aronowitz, M.D.Expertise:
Health Risks; Public and Population Health; Public Health Strategies | The Construction of Health Risk and the Demand for Disease Prevention, 1945-2000
Award Year: 2000 Show AbstractWhile many newly defined health risks have elicited major societal and biomedical responses such as screening tests and risk-reducing drugs, others have not. Dr. Aronowitz examines how values and interests of various stakeholders influence how we recognize, name, define, and respond to health risks. His project traces the history of these risks in the U.S. since World War II and seeks to explain how they have been discovered, promoted, and made the object of prevention practices. Case studies on cancer cluster investigations, in situ cancers, Lyme disease vaccines, lung cancer screening, and the association between homocysteine and coronary heart disease will be compiled. Findings should inform and provoke societal debate over new ways to better manage research on health risks as well as the demand for interventions to reduce them. |
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Tamara Awerbuch, Ph.D.Expertise:
Health Risks | Why New and Resurgent Infectious Diseases Caught Public Health by Surprise and a Strategy to Prevent This
with Richard Levins, Ph.D.
Award Year: 1995Show Abstract This study investigates why the public health community was caught by surprise by the resurgence of diseases that were in decline such as malaria, TB, cholera and rabies, and the appearance of apparently new diseases including AIDS, legionnaire's disease, hantavirus, and Lyme disease. It looks at the results of: fragmentation of knowledge among disciplines; isolation of evolutionary ecology and social science from public health; the urgency to meet immediate human need; and institutional and philosophical biases in setting research priorities. A review determines the overlap in public health journals with ecology, biogeography, population genetics, veterinary and plant pathology literature. An analysis of health programs identifies major gaps in the epidemiology framework due to the prevailing fragmentation of knowledge. Several integrative case studies are developed for particular diseases, and a research and educational strategy for an integrative epidemiology is proposed. |
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Laurie J. Bauman, Ph.D.Expertise:
Child Health; Health Risks | Development of a Typology of Risk for Child Health: The Intersection of Social and Medical Factors
with Ruth E. Stein, M.D.
Award Year: 1999Show Abstract Social and environmental factors have powerful effects on health status, utilization, and costs of care among children. Child health policy in the U.S., however, has focused primarily on biomedical determinants of health, ignoring most social risks. This project augments traditional biological risk factors such as previous access to health services and chronic illness used by policymakers. Drs. Stein and Bauman consider social risk factors, like poverty and parental mental illness, which contribute to child morbidity and the cost of delivering care. Their goal is to improve the ability of policymakers to predict short-term health outcomes (cost and utilization of care) and long-term health outcomes (health status and functioning). They: 1) conceptualize and define social and biomedical risks of children; 2) create independent measures for social and biomedical risk; 3) combine these into a typology that describes the risk experienced by children from the combination of biomedical and social factors; and 4) apply the typology to existing child health data sets. |
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Phil Brown, Ph.D.Expertise:
Health Risks; Mental Health | Contested Illnesses: Disputes over Environmentally Induced Disease
Award Year: 1998Show Abstract Dr. Brown examines contested illnesses that involve major scientific disputes and extensive public debates over environmental causes. Because medical experts often fail to identify environmental diseases, these illnesses are frequently brought to light by victims and their advocates, scientists, and the media. The project focuses on three areas of major dispute - Gulf War Syndrome, small air particles and asthma, and environmental causes of breast cancer - and looks at how each condition became a social problem. Dr. Brown explores: 1) how victims and their lay allies identified diseases and organized to seek redress; 2) the roles played by government, professions, industry, advocacy/activist groups, and the media; 3) scientific and technological progress in disease detection and etiology and the development of less toxic products and processes; and 4) the effects of illness contestation on victims' health and on public health policy. Findings should demonstrate how environmental crises might lead to greater health protections and earlier treatment of disease. |
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Nicholas A. Christakis, M.D., Ph.D., M.P.H.Expertise:
Health Outcomes; Health Risks; Social Networks | Health in Marriage: Policy Implications of Spousal Illness and Death
Award Year: 2000Show Abstract There are major gaps in our understanding of how morbidity and mortality in one spouse affect the health and life of the other. Our rapidly aging population coupled with increased chronic disease, will likely result in serious health consequences for elderly individuals with ill or dying spouses. In his project, Dr. Christakis conducts an analysis based on observation, theory, and policy of the relationship between marriage and health. His conceptual framework draws on three related theories stress as a source of illness, the role of social support in mitigating disease and mortality, and social capital. Several health policy questions are addressed including: 1) when and how support services might best be delivered to newly-widowed individuals; 2) how to identify individuals at greatest risk; and 3) how marital health effects should be factored into the planning of health care services for the elderly. |
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David M. Gaba, M.D.Expertise:
Health Risks; Patient Safety | Organizational Structures, Cultures, and System Aspects of Safety in Tertiary Health Care: A Comparison with Other High Risk-Industries
Award Year: 1996Show Abstract Preventable accidents occur frequently in health care, especially in comparison with the rate of serious mishaps in commercial and military aviation, space flight, and nuclear power production. Dr. Gaba's systematic comparison of health care to these industries is guided by a synthesis of recent theoretical models of safety and error in complex organizations. Among the issues the project addresses are the structure of the health care industry, regulatory processes, and cultures of reliability concerning the care of hospitalized patients. The influence of malpractice litigation on safety, the connection between fatigued personnel and error in health care, and the effects of production pressure at work are also studied. By mapping features of health care to similar features of high-risk industries, Dr. Gaba formulates an integrated view of the implications for safety in health care. Project results provide recommendations for short and long-term policy changes to strengthen safety systems in health care. |
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David Hemenway, Ph.D.Expertise:
Health Risks; Public Health Strategies; Violence | Firearms and Public Health
Award Year: 1997Show Abstract Firearms are the second leading cause of injury-related death in the U.S. While attention to the problem has increased, the amount of research on the topic lags behind. This project provides new information about gun carrying, storage, brandishing, injuries, the use of guns in self-defense, and the connection between guns and suicide. It also synthesizes new public health literature relevant to firearms policy and analyzes private firearm surveys from college students and adults. Adopting a general public health framework, Dr. Hemenway develops beneficial and feasible firearm policy recommendations, seeking to alter the current social norm which accepts high levels of lethal violence as a part of American life. Findings will provide public health-oriented policy options for gun safety, firearm product oversight, collecting gun injury information, and the roles of the medical community and general public in firearm safety. |
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Lisa I. Iezzoni, M.D., M.Sc.Expertise:
Health Outcomes; Health Risks; Health Services Research; Mobility Impairment; Public Health Strategies | When Walking Fails
Award Year: 1996Show Abstract When walking fails, people lose easy movement essential to daily life as well as a fundamental sense of value. Available evidence suggests that about one-quarter of Americans age 55 and older have trouble walking, and almost 10 percent are unable to walk even a few blocks due to such chronic conditions as heart disease, osteoporosis, diabetes, and arthritis. The American health care system does little to identify or address the problem, although feasible ways exist to aid mobility and improve lives. Dr. Iezzoni's research focuses on three areas: 1) the epidemiology of walking impairments among adult Americans due to chronic illness; 2) the views of persons whose walking has failed, primarily concerning perceived barriers to mobility assistance and experiences with the health care system; and 3) the attitudes of health professionals and payers concerning services to assist mobility for chronically ill persons. Her results describe barriers experienced by those with walking impairments and policy options for overcoming them. |
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Eric Klinenberg, Ph.D.Expertise:
Health Risks; Media and Health; Neighborhood Health; Urban Health | Social Isolation in American Life
Award Year: 2003Show Abstract More Americans live and die alone than at any time in our nation's history. The common problems they suffer — depression, strained or severed family ties, minimal contact with friends, and difficulties navigating the health care system — often go undetected or are ignored by health care professionals. Eric Klinenberg, Ph.D. offers a new approach to understanding the emergence of social isolation and its effects on health, especially among the elderly and disadvantaged in American cities. His project, Social Isolation in American Life, examines how people experience isolation, using multiple research methods to build a knowledge base about living and dying alone. Dr. Klinenberg recently published book, Going Solo: The Extraordinary Rise and Surprising Appeal of Living Alone (Penguin Press, 2012) explores the impact that living alone is having on U.S. culture, business, and politics. |
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Lucian L. Leape, M.D.Expertise:
Health Risks; Organization of Care; Patient Safety | Toward Error-Free Medicine: New Policies for Health Care
Award Year: 1998Show Abstract Accidental injury due to errors in medical treatment is the most serious quality problem in health care delivery in the U.S. Errors cause 1 million injuries and 120,000 deaths annually, and the health care system's reliance on punishing individuals to ensure safety rather than designing safer systems has played a central role. This project develops a series of conceptual essays to alter how hospitals, doctors, regulators and society think about health care delivery. Dr. Leape engages a broad audience of policymakers, legislators, bureaucrats, regulators, health system designers, lawyers, judges, researchers, providers, patients, and the media. He aims to inform and provoke the kind of debate that can lead to sweeping policy changes at all levels of government and throughout the health care system. Topics include: why punishment doesn't work; designing error-free systems; the role of regulation; admitting mistakes to patients; accountability; and mandatory reporting. |
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Richard Levins, Ph.D.Expertise:
Health Risks | Why New and Resurgent Infectious Diseases Caught Public Health by Surprise and a Strategy to Prevent This
with Tamara Awerbuch, Ph.D.
Award Year: 1995Show Abstract This study investigates why the public health community was caught by surprise by the resurgence of diseases that were in decline such as malaria, TB, cholera and rabies, and the appearance of apparently new diseases including AIDS, legionnaire's disease, hantavirus, and Lyme disease. It looks at the results of: fragmentation of knowledge among disciplines; isolation of evolutionary ecology and social science from public health; the urgency to meet immediate human need; and institutional and philosophical biases in setting research priorities. A review determines the overlap in public health journals with ecology, biogeography, population genetics, veterinary and plant pathology literature. An analysis of health programs identifies major gaps in the epidemiology framework due to the prevailing fragmentation of knowledge. Several integrative case studies are developed for particular diseases, and a research and educational strategy for an integrative epidemiology is proposed. |
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Gerald Markowitz, Ph.D.Expertise:
Health Risks; Occupational Health; Public and Population Health; Urban Health | The Un-Natural History of Public Health: From Epidemics and Injuries to Chronic Illness and Bio-Terrorism
with David Rosner, Ph.D., M.P.H.
Award Year: 2002Show Abstract Since September 2001, America's public health infrastructure has received more attention than at any time since the polio vaccination campaigns of the 1950s. David Rosner, Ph.D., M.P.H. and co-principal investigator Gerald Markowitz, Ph.D. address the effects on the field of public health of new mandates and resources aimed at protecting Americans from bioterrorism. Their project, The Un-Natural History of Public Health, takes a fresh look at the history of public health and examines the U.S. experience with crises, disease, and mortality from the 1900s to the present. The investigators will consider the physical, political, and social changes that have affected the American experience of illness and death and the structure of public health services. Their work will provide a broad historical perspective and new insights for future public health policymaking. |
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David Rosner, Ph.D., M.P.H.Expertise:
Health Risks; Occupational Health; Public and Population Health; Urban Health | The Un-Natural History of Public Health: From Epidemics and Injuries to Chronic Illness and Bio-Terrorism
with Gerald Markowitz, Ph.D.
Award Year: 2002Show Abstract Since September 2001, America's public health infrastructure has received more attention than at any time since the polio vaccination campaigns of the 1950s. David Rosner, Ph.D., M.P.H. and co-principal investigator Gerald Markowitz, Ph.D. address the effects on the field of public health of new mandates and resources aimed at protecting Americans from bioterrorism. Their project, The Un-Natural History of Public Health, takes a fresh look at the history of public health and examines the U.S. experience with crises, disease, and mortality from the 1900s to the present. The investigators will consider the physical, political, and social changes that have affected the American experience of illness and death and the structure of public health services. Their work will provide a broad historical perspective and new insights for future public health policymaking. |
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Ruth E. Stein, M.D.Expertise:
Child Health; Health Risks | Development of a Typology of Risk for Child Health: The Intersection of Social and Medical Factors
with Laurie J. Bauman, Ph.D.
Award Year: 1999Show Abstract Social and environmental factors have powerful effects on health status, utilization, and costs of care among children. Child health policy in the U.S., however, has focused primarily on biomedical determinants of health, ignoring most social risks. This project augments traditional biological risk factors such as previous access to health services and chronic illness used by policymakers. Drs. Stein and Bauman consider social risk factors, like poverty and parental mental illness, which contribute to child morbidity and the cost of delivering care. Their goal is to improve the ability of policymakers to predict short-term health outcomes (cost and utilization of care) and long-term health outcomes (health status and functioning). They: 1) conceptualize and define social and biomedical risks of children; 2) create independent measures for social and biomedical risk; 3) combine these into a typology that describes the risk experienced by children from the combination of biomedical and social factors; and 4) apply the typology to existing child health data sets. |
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Kenneth E. Warner, Ph.D.Expertise:
Health Risks; Public Health Strategies | The Nature, Evolution, and Implications of Tobacco Policy in the United States
Award Year: 1994Show Abstract Dr. Warner produces a detailed history of the rise and fall of cigarette smoking in the U.S. in the 20th century both as a social phenomenon and as a major determinant of trends in health and health care. Special attention is devoted to the roles of tobacco-control research and policy. Synthesizing the leading work in this field, he provides a comprehensive analysis of the nature, origins, and consequences of tobacco policy in the U.S. Lessons are drawn relevant to tobacco-control activists, policymakers, and the broader health promotion community as to what matters in health promotion policy and what affects its emergence in social discourse. The role of tobacco-control policy, its origins and uses, and the integration of policy research findings into policy advocacy, are also examined. The project makes a valuable contribution as interpretive social history and to understanding the development and analysis of health policy in the domain of self-affecting health behaviors. |
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