Symposium 2015

Date: Friday, April 10, 2015
Symposium Theme: Social Determinants of Health: Non-medical Interventions that affect Population Health
Keynote Speaker: Dr. Robert K. Ross, President & CEO of The California Endowment
Location: RAND Corporation
Headquarters Campus
1776 Main Street
Santa Monica, California 90401-3208


Keynote Speaker Robert K. Ross

Robert K. Ross, M.D., is president and chief executive officer for The California Endowment, a health foundation established in 1996 to address the health needs of Californians. Prior to his appointment in July 2000, Dr. Ross served as director of the Health and Human Services Agency for the County of San Diego from 1993 to 2000, and Commissioner of Public Health for the City of Philadelphia from 1990 to 1993.

Dr. Ross has an extensive background in health philanthropy, as a public health executive, and as a clinician. His service includes: medical director for LINK School‐Based Clinic Program, Camden, New Jersey; instructor of clinical medicine, Children’s Hospital of Philadelphia; and faculty member at San Diego State University’s School of Public Health. He is a Diplomate of the American Academy of Pediatrics, served on the President’s Summit for America’s Future and as chairman of the national Boost for Kids Initiative. Dr. Ross received his undergraduate, Masters in Public Administration and medical degrees from the University of Pennsylvania in Philadelphia. Dr. Ross was a Robert Wood Johnson Clinical Scholar from 1988 to 1990, focusing on urban child health issues.

Dr. Ross has been actively involved in community and professional activities at both the regional and national level. He serves as a Member, President’s Advisory Commission on Educational Excellence for African Americans, a Board member of the California Health Benefit Exchange Board, Rockefeller Philanthropy Advisors; Co‐Chair, Diversity in Philanthropy Coalition; Board member, USC Center on Philanthropy and Public Policy; and has served as a Board member of Grantmakers in Health , National Vaccine Advisory Committee, the National Marrow Donor Program, San Diego United Way and Jackie Robinson YMCA.

He has received numerous awards and honors including the 2011 Public Health Champion award from the UCLA School of Public Health, 2011 Latino Health Alliance Champion Award, 2011 California Association of Human Relations Organization Civil Rights Award, 2009 Legal Aid Foundation of Los Angeles Access to Justice Award, and the Council on Foundations’ 2008 Distinguished Grantmaker of the Year Award. He has also been named by Capitol Weekly as one of California’s most influential civic leaders in health policy, and he was recently named by the NonProfit Times as one of the 50 Most Influential Non‐Profit Leaders in America. In 1999 he was named by Governing Magazine as a national Public Official of the Year for his leadership in innovative health and social services delivery.

During his tenure at The California Endowment, the foundation has focused on the health needs of underserved Californians by championing the cause of health coverage for all children, reducing childhood obesity, strengthening the capacity of community health centers, improving health services for farm worker and ex‐offender populations, and strengthening the pipeline for bringing racial and ethnic diversity to the health professions. In the Los Angeles region, he has provided leadership to support the re‐opening of the Martin Luther King Jr. Medical Center and the revitalization of Charles Drew University. In 2010, The California Endowment launched a 10‐year statewide commitment investing $1 billion to advance policies and forge partnerships to build healthy communities and a healthy California. Recently, he has helped bring greater philanthropic attention to the health and well‐being of young men of color across California and the nation. Dr. Ross and his wife Robin have four children, and he serves on the Vestry Board at the St. Mark’s Episcopal Church.


8:00 – 8:45 am

Check In
Light breakfast

8:45 – 10:00 am

Student Presentations
Part I

10:00 – 11:00 am

Dr. Robert Ross, President and CEO of The California Endowment

11:00 am – 12:00 pm

Student Presentations
Part II

12:00 – 1:30 pm

Presentation by head recruiter of the World Bank

1:30 – 2:30 pm

Panel 1
Impact of socioeconomic and political factors on population health (Click to watch video)

Moderator: Deborah Cohen (RAND)

  • Herb Schultz (Eisner Pediatric & Family Medical Center)
  • Rishi Manchanda (HealthBegins)
  • Gwendolyn Flynn (Community Health Councils)

2:30 – 3:30 pm

Panel 2
Impact of physical and environmental factors on population health (Click to watch video)

Moderator: Amy DeSantis (RAND)

  • Kathy Sanders-Phillips (RAND)
  • Bill Pitkin (Conrad Hilton Foundation)
  • Nancy Halpern Ibrahim (Esperanza Community Housing Corporation)
  • David Kennedy (RAND)

3:30 – 4:30 pm

Recruiter from United Nations Development Programme (UNDP)

4:30 pm &ndash close

Career Networking Reception: The Symposium will close with a Networking Reception and Mini-Career Fair.

During the reception, students will have the opportunity to meet with representatives from the following organizations:

  • World Bank (Recruiter)
  • United Nations Development Programme (Recruiter)
  • U.S. Department of State (Foreign Service Officer)
  • Claremont Graduate University (School of Community & Global Health; School of Social Science, Policy & Evaluation)
  • RAND Corporation (Human Resources)


Panel 1 Participants

Deborah Cohen

Deborah Cohen (RAND) — Moderator

Deborah Cohen is a senior natural scientist at the RAND Corporation. She is the author of A Big Fat Crisis: The Hidden Influences Behind the Obesity Epidemic—and How We Can End It. Her areas of interest include how structural environmental factors—social and physical—influence health. She has studied how neighborhood parks influence physical activity and how community characteristics affect health disparities and health. She is working on interventions to promote healthier diets and more physical activity at the population level. Cohen has directed numerous projects on sexually transmitted diseases, HIV screening and prevention, and alcohol policy. She has served on technical and advisory panels for the National Institutes of Health, the Centers for Disease Control and Prevention, and the Robert Wood Johnson Foundation. Cohen received her M.D. from the School of Medicine, University of Pennsylvania.

Herb Schultz

Herb K. Schultz (Eisner Pediatric & Family Medical Center)

Herb Schultz is the President and CEO of Eisner Pediatric & Family Medical Center (EPFMC). He is committed to strengthening Federally Qualified Health Centers, community clinics, and community health centers, such as EPFMC, in their quest for resources to expand quality health care to millions of Americans regardless of their ability to pay. Passionate about serving vulnerable and underserved communities, Schultz has built coalitions and worked closely with a wide array of public officials and thousands of non-governmental organizations and leaders across California and Los Angeles County.

Before coming to EPFMC, Schultz was appointed by President Obama and served as Regional Director of the U.S. Department of Health and Human Services, Region IX. In this role, he represented more than 50 million people across four states, Pacific jurisdictions, and more than 160 federally recognized tribal nations. Prior to his position with the U.S. Department of Health and Human Services, Schultz was Senior Advisor to Governor Arnold Schwarzenegger and the Director of the California Recovery Task Force. In the latter role, he was responsible for the oversight and implementation of the American Recovery and Reinvestment Act of 2009. Previously, he served as the Senior Health Policy Advisor to the Governor during California’s 2006–2008 state debate on comprehensive health care reform.

Schultz also served in former Governor Gray Davis's cabinet as Acting Secretary and Undersecretary of the California Labor and Workforce Development Agency. Prior to this cabinet-level appointment, he served as Deputy Director of the then-new Department of Managed Health Care. Schultz came to Los Angeles in late 1998 to serve as Director of Government Affairs for AIDS Project Los Angeles after 18 years in Washington, DC.

Rishi Manchanda

Rishi Manchanda (HealthBegins)

Dr. Rishi Manchanda is President and Founder of HealthBegins, a startup that transforms the health of vulnerable communities through innovative education, technology, and consultancy services.

As an ‘upstreamist’ physician and public health innovator, his work and expertise focuses on systems design to improve primary care, the social and environmental conditions that make people sick, and health and human rights.

Dr. Manchanda serves as the medical director of a clinic for high-utilizer homeless veterans in Los Angeles. He is also the founder of RxDemocracy, a nonpartisan healthcare coalition that supports civic engagement and that has registered 30,000 voters in clinics nationwide. He previously served as the founding Director of Social Medicine at St.John’s Well Child and Family Centers, a community clinic in South Central Los Angeles.

His first book The Upstream Doctors, in which he coins the term “Upstreamists” to describe an essential yet underdeveloped segment of the healthcare workforce, was released by TEDBooks in June 2013. Upstreamists are clinic-based practitioners who have the skills, tools, and authority to drive internal healthcare innovation that improves care and local social determinants of health.

Dr. Manchanda completed training at Tufts (BS, MD, MPH) and was the first graduate of UCLA’s Combined Residency in Internal Medicine and Pediatrics. He serves on the board of the National Physicians Alliance and Physicians for Social Responsibility – Los Angeles.

Gwendolyn Flynn

Gwendolyn Flynn (Community Health Councils, Inc.)

Gwendolyn Flynn is Nutrition Resources Development Policy Director with Community Health Councils, a non-profit community-based, health policy education organization in Los Angeles, California.

Her background includes more than twenty years’ experience addressing social justice issues in various capacities.

She joined the staff of Community Health Councils, Inc. in 2001 working with the Centers for Disease Control and Prevention’s national REACH initiative to eliminate chronic disease disparities in racial and ethnic populations. Flynn directs development and promotion of strategies that transform the community infrastructure for more healthful decision-making.

As Policy Director, she oversees efforts that improve nutrition access and quality through polices that change institutional practices, and promote local investment.

Flynn earned a BSc degree in Community and Human Services from SUNY Empire State College. She represents Community Health Councils on various committees and boards including California Convergence, the Los Angeles Food Policy Council, and is an American Public Health Association member.

Panel 2 Participants

Amy DeSantis (RAND) — Moderator

Amy DeSantis is an associate behavioral/social scientist at the RAND Corporation. Prior to coming to RAND, she was a visiting assistant professor of human development and social policy at the Indian Institute of Technology, Gandhinagar. Her research interests include racial/ethnic and socioeconomic health disparities in the U.S. and internationally, social determinants of health, physiologic stress system activity, neighborhood influences on health, the developmental origins of health and disease, life course SES trajectories and health, and micro- and macro-level influences on health. DeSantis received her Ph.D. in human development and social policy from Northwestern University and completed postdoctoral research fellowships at the Center for Social Epidemiology and Population Health at the University of Michigan and the Cells to Society Center for Social Disparities and Health at Northwestern University.

Nancy Halpern Ibrahim

Nancy Halpern Ibrahim (Esperanza Community Housing Corporation)

Nancy Halpern Ibrahim, MPH, has led Esperanza Community Housing Corporation as the Executive Director since November 2006. She joined Esperanza in 1995 as the founding Director of Health Programs and designed Esperanza's model Community Health Promoters Program, which has graduated 438 bilingual Community Health Promoters/ Promotores de Salud over the past nineteen years. As Executive Director, she leads a staff of 30, addressing five major program areas: Affordable Housing, Health, Environmental Justice, Economic Development, and Art and Culture.

Ibrahim’s efforts have been central to pioneering environmental health strategies in the region, and to advancing the reputation of Mercado La Paloma, Esperanza’s economic development venue, as a cultural and culinary hub. Esperanza’s Community Health Promoters programs have engendered pioneering community health initiatives such as the South Los Angeles Healthy Homes Project, Better Neighborhood/Same Neighbors, the People Not Pozos campaign that struggles against oil and gas extraction activities in residential neighborhoods, and the South Los Angeles Health and Human Rights Coalition.

In May 2015, Ibrahim will be honored with the 2015 UCLA Community Service award for her dedication to improving the health of low-income families in Los Angeles. In March 2015 she received the Pioneer Woman of the Year award for Council District 9, from the City of Los Angeles Commission on the Status of Women. In 2011, Ibrahim was awarded a Durfee Foundation Sabbatical. In May 2006, she received the “Helen Rodriguez-Trias Award for Excellence in Community-Based Women’s Health Leadership” from the California State Office of Women’s Health. Since 2005, Ibrahim has been a founding Board Member of T.R.U.S.T South LA. In 2003, Ibrahim was welcomed into the UCLA School of Public Health’s Alumni Hall of Fame, recognizing “outstanding accomplishments in community-based health programs, including community health education and training.” Ibrahim received her Master of Public Health degree from UCLA, and has worked as a social justice activist in the field of women’s health and development for the past thirty years.

David Kennedy (RAND)

David Kennedy is a senior behavioral and social scientist at the RAND Corporation and professor at the Pardee RAND Graduate School. He has conducted research on the intersection of culture, social networks and health; and on various mental health topics, including depression, PTSD, and ADHD, other chronic and infectious illnesses including HIV/AIDS, diabetes, kidney disease, and abuse of substances such as tobacco, alcohol and drugs. For his research, he has examined a variety of populations, including international fieldwork in Latin America and Africa, homeless men, women and children in Los Angeles and civilian employees of an Air Force base.

As a methodologist, Kennedy specializes in the collection and analysis of qualitative data and in developing innovative research designs that integrate qualitative and quantitative methodologies. In particular, he specializes in innovative methods for collecting and analyzing social network data in conjunction with qualitative data and methods for partnering with community organizations in the collection and analysis of qualitative data. He has conducted research with both adolescents and adults on the effects of romantic relationships on health, including issues related to childbearing, sexually transmitted infections, substance use, and mental health. He has also developed innovative methods for targeting social network and romantic relationship factors in health interventions. He is also involved in training members of the Army's Human Terrain System in research methods.

Kennedy was trained as a medical anthropologist and received his Ph.D. in cultural anthropology from the University of Florida.

Bill Pitkin

Bill Pitkin (Conrad Hilton Foundation)

Bill Pitkin oversees the planning, development, implementation, and evaluation of the Conrad N. Hilton Foundation’s domestic priority areas. Prior to joining the Foundation, Pitkin was director of research and planning at United Way of Greater Los Angeles, where he oversaw the publication of research reports and led a strategic planning process resulting in that organization’s 10-year action plan to fight poverty in Los Angeles. Other past positions Pitkin has held include executive director at the Los Angeles United Methodist Urban Foundation and research director at the Advanced Policy Institute in the University of California, Los Angeles School of Public Affairs. Pitkin has published research articles and reports on topics including community and nonprofit technology, middle school education, homelessness, housing affordability, mortgage lending discrimination, participatory planning in Latin America, and urban planning history. He has taught in the UCLA Urban Planning Department and the Urban Studies and Planning Program at California State University, Northridge. He received his doctorate in urban planning from UCLA.

Kathy Sanders-Phillips

Kathy Sanders-Phillips (RAND)

Kathy Sanders-Phillips is a Senior Behavioral/Social Scientist at the RAND Corporation. Prior to coming to RAND, she was a Professor of Pediatrics and Child Health at Howard University and an Associate Professor of Pediatrics at UCLA.

Her research interests include infant assessment and maternal and child health with an emphasis on the social determinants of drug use and violence in communities of color in the U.S. and South Africa. Much of her work has also focused on the impact of social hierarchies and political violence on perceptions of injustice and subsequent risk-taking in youth of color. Her most current projects have utilized transdisciplinary teams to examine the impact of exposure to violence, including social violence in the form of racial segregation and apartheid, on drug use and HIV/AIDS risks. A related line of research has focused on the impact of social inequalities on biological functioning, and the role of genetic factors on risk behaviors such as drug use.

Sanders-Phillips received her Ph.D. in developmental psychology from the Johns Hopkins University and completed an internship in pediatric psychology at the University of Maryland Hospital. She has served on several standing committee for NIH and CDC; provided technical assistance to the National Institute on Drug Abuse (NIDA) as well as the Medical Research Council (MRC) in South Africa on increasing the number of minorities in health disparities research; served as a member of the Technical Expert Panel (TEP) for the 2011 National Survey of Children’s Health conducted by the Maternal and Child Health Bureau, (DHHS/HRSA); and served as a member of the National Advisory Council for National Institute on Drug Abuse (NIDA) from 1995 – 2002.


Abstracts of Student Presentations

Watts and the Wind: A Spatial Statistical Analysis of Renewable Power in the Western US

Nicholas L. Cain (Claremont Graduate University)

What factors are associated with the development of utility-scale renewable power projects in the Western United States? The use of renewable forms of energy to generate electricity has been on the rise in the US and around the world. And, although the impact of different drivers has been studied, there is a lack of consensus in the research literature regarding the most important factors. My paper argues that to better understand the dynamics of energy development, researchers must account for geographic factors, including access to power transmission infrastructure. Starting with a novel dataset created in a geographic information system (GIS), wind power projects across the Western states are mapped. Then, using a spatial panel regression model, the impact of geographic, political and economic factors on the development of wind power is analyzed. Results show that although renewable portfolio standards have been effective in certain states, geospatial factors are also critical to consider. The results of this project point to alternative approaches to encourage renewable energy development and raise the possibility that it may be more efficient and effective to develop incentives to encourage the construction of shared regional infrastructure projects as opposed to relying on state-level incentives.

Assessing Potential and Impact on Bilateral Trade Expansion Between Indonesia and Argentina

Sulthon Sjahril Sabaruddin (Pomona College; Claremont Graduate University)

The paper attempts to analyze Indonesian and Argentinian export competitiveness and the impact of bilateral free trade (zero tariff) scenario. The analysis is performed based on the integrated world trade databases owned by United Nations Conference on Trade and Development (UNCTAD) and World Integrated Trade Solution (WITS). The current bilateral trade relations are still below their potentialities and with a relatively low trade intensity. The study reveals in general both countries’ exports are based on their comparative advantages, but limited products are within the top-ten strongest export competitiveness commodities. Meanwhile for the bilateral free trade scenario, the study reveals that Indonesia and Argentina‘s consumer surplus and trade creation are expected to increase as a result of bilateral FTA but however it does reduce the tariff revenues. Based on the results, it can be concluded that there are plenty room to further enhance their exports based on their strongest comparative advantage. The paper suggests the Argentinian government should reduce its protective measures, both tariffs and non-tariff barriers (including the current non-automatic import license regulation) as currently Indonesia is in the position of a widening trade deficit particularly over the last few years, thus a more balanced trade should be expected, and the study reveals by eliminating trade barriers both countries will reap higher welfare and fulfilling the objectives of both countries to intensify bilateral trade relations.

Intra-Action Report — A Dynamic Tool for Emergency Managers and Policymakers: A Proof of Concept and Illustrative Application to the 2014–2015 Ebola Crisis

Adeyemi Okunogbe (Pardee RAND)

Using the Ebola outbreak that surged in 2014 and continues into 2015 as an illustrative example, RAND developed a proof-of-concept tool that aims to track, synthesize, evaluate, and communicate lessons that are being learned during an ongoing response and recovery effort, so that these lessons can be applied to the same effort to mitigate a problem or replicate a success. In this perspective, we describe and then illustratively apply the proposed Intra-Action Report (IAR) — a label we coined to describe this proof-of-concept tool. The IAR offers unique value by (1) offering a structured framework to capture actions iteratively during an ongoing response and recovery effort related to public health emergencies and disasters that unfold over protracted time frames, (2) pointing to opportunities for addressing initial failures or challenges and for replicating and promulgating successes during the same event, and (3) supporting communication and dissemination of best practices about ongoing response efforts. Although we use the 2014 Ebola outbreak as an illustrative example, the IAR is applicable to any type of public health emergency. And while it has been designed to take advantage of periodic updates during an ongoing, protracted emergency response, the framework can also be used only once (to produce a snapshot rather than progress over time) or after an event (more closely resembling a traditional After-Action Report). We hope that this proof of concept will be a useful addition to the emergency management toolkit and that this perspective will spur further development of the IAR concept.

Note: This presentation is based on research conducted with the following RAND colleagues: Mashid Abir, Jonah Blank, Meg Chamberlin, Shira Efron, Bill Gelfeld, and Melinda Moore.

Is Natural Resources still an Important Determinant of Economic Growth? Or It has Already been Replaced by Economic Openness and Innovation?

Zhijun Gao (Claremont Graduate University)

In regard to the relationship between natural resources and economic development level, many people think that resource-abundant countries should be rich, because the resources provide raw material and energy for production. However, after looking into countries’ economic development level around the world, we found the relationship is opposite. Some scholars called this phenomena “Natural Resource Curse”. In this paper, I will analyze the relationship between natural resources and economic development level using multiple regression analysis and provide explanation for the curse. In the second section, I will analyze the other two determinants for economic development: economic openness and innovation, try to explore the reasons why some resource-scarce countries can achieve economic success. Several cases of resource-scarce countries’ economic success will be analyzed. The last section will provide policy recommendations for a resource-abundant country to avoid the curse and maintain stable economic growth.

Human Organs for Sale: An ethical solution to the organ shortage

Adam Crepelle (Pepperdine University)

In the United States, over 120,000 people are waiting for an organ, and the list keeps growing. The shortage of organs results in the death of 21 Americans each day. If there were a way to increase the supply of organs or a feasible organ substitute existed, these deaths could be avoided. This presentation examines the most controversial solution to the organ shortage: a market for human organs. The sale of human organs raises ethical issues and is banned by virtually every nation. Iran is the exception as it allows the sale of human kidneys. Iran is the only country that has eliminated its kidney waiting list. After discussing the Iranian kidney market, the presentation sets forth various human organ market designs with the hope of eliminating the organ shortage while addressing ethical concerns.

Limited Attention in the Residential Energy markets: A Regression Discontinuity Approach

Galib Rustamov (Claremont Graduate University)

It is well known that limited attention affects consumption decisions, in particular, when the decision environment is complex. The objective of this study is to determine whether or not, and to what extent, limited attention is prevalent in residential energy markets. We analyze how the tendency to focus on the left-most digit of a number affects how residential energy consumers incorporate their monthly bills into their energy usage decisions. We use data on more than 10 thousand randomly selected customers of a California based utility company and examine consumption responses when a previous bill crosses a salient threshold. Sharp regression discontinuity results indicate consumers use significantly less electricity when their previous bill crosses a threshold, such as $50 for lower-income households. As previous literature has found inattention to be related to income, we focus primarily on lower-income households. However, there is some evidence that higher income households have a similar response at higher thresholds. Considering the urgent need to reduce greenhouse emissions and increase the energy savings, our results may contribute to the design of more effective feedback mechanisms for energy-end-users.

Note: This presentation is based on research conducted with Quinn Keefer at California State University San Marcos.

The E-Water Gap: Examining Perceptions of E-Governance Participation in Public Management and Water Conservation.

Brandon De Bruhl, Yixue “Emily” Chen, Rhett Paranay (USC)

The economic and environmental implications of the ongoing California drought have created new pressures on water management agencies and staff. Highly constrained resources and ever-increasing demand have triggered investment and innovation into digital water management and E-governance strategies, which may have a transformative effect on how publics interface with water governance.

This study will examine how perceptions and realities of E-government and tech innovations compare across water agencies, municipal utility managers, and residents. Through survey instruments, network meta-analysis, and spatial demographic research, the study will investigate the future of E-government and digital technology in water management. This research will inform scholarship and practice of public leadership in the context of California’s drought and changing water ecology.

This project is supported by the Fels Institute of Government at the University of Pennsylvania, and is centrally based on a policy solution developed for the 2014 Public Policy Challenge national competition. Presenting authors were able to place as Finalists for a proposal to create community-based text and email messaging platforms in communicating water usage information and reduction strategies, which has since evolved into several research questions for this study.

As a report for the USC Schwarzenegger Institute for State and Global Policy, this research will provide leadership and administrative analyses to governance audiences for whom findings may be appreciated. This research is slated for completion in summer 2015, and will be circulated to California water policy and public leadership to spur dialogue and new awareness of digital technology in consumer-side utility management.

Reducing Obesity in Los Angeles County: Toward a Tax on Sugar-Sweetened Beverages

Rachel Horst (UCLA)

In recent years, policymakers across the country have looked to taxes on sugar-sweetened beverages (“SSBs”)—a class of drinks containing caloric sweeteners-- as a way to reduce total calorie consumption and, in turn, reduce obesity rates. The Greater Los Angeles region has high obesity rates and associated costs of several billion dollars per year. This report charts a path toward a tax on SSBs in order to drive down SSB consumption and reduce obesity rates in L.A. County, thereby partially mitigating its social and economic costs.

We discuss the economics of a tax on SSBs, outlining why and how a tax is expected to affect consumption and analyzing in detail its various design elements: definition of the tax subject (SSBs), tax type, tax level, and taxed unit. We also investigate the legal restrictions on instituting a new tax on SSBs in L.A. County, exploring the benefits and drawbacks of alternatives for revenue allocation. Based on this analysis, we find that a cent-per-ounce or two-cent-per-ounce excise tax on a broad class of beverages containing caloric sweetener would be effective at both reducing SSB consumption and raising revenue. We conclude that a general tax may be more politically feasible but could limit the opportunity to create and fund further anti-obesity interventions, while a special tax may be a harder sell but would allow for the creation of new anti-obesity interventions or the funding of exemplary existing programs. We identify some of these programs that could be the target of a special fund.

Note: This presentation is based on research conducted with UCLA colleagues Lenorre Clarke, Kene Izuchukwu, Chantal Lunderville, and Sandeep Prasanna.

UCLA Internal Medicine Service- Implementing a Screening, Brief Intervention Referral to Treatment (SBIRT) Program

Aleksandra van Loggerenberg, Danielle Janes, Amanda Ghattas, Rayek Nafiz (UCLA)

UCLA Internal Medicine Service is implementing a Screening, Brief Intervention Referral to Treatment (SBIRT) program. Alcohol use disorder and alcohol misuse are prevalent and expensive to society and the health system. There is some evidence to suggest that SBIRT can minimize these costs. We performed our an analysis to determine the most efficient screening methods and implementation recommendations. First, we created criteria to evaluate alcohol screening tools. Second, we performed a cost benefit analysis of screening all patients according to age, sex and drinking behavior to establish cutoffs for various levels of intervention. Our analysis reveals that it is beneficial to administer alcohol use screenings at the established cutoffs for both sexes and across all ages except for females sixty-five and above. For females over age sixty-five, a screening threshold one below the existing standard is required for the health system to benefit. Overall, the combination of AUDIT-C for males and AUDIT for females optimizes the clinical net benefit. Additionally, we provide time-sensitive recommendations for UCLA-IMS to implement SBIRT. Our recommendations address frequency of alcohol screening, technological programming, best practices, and programming a smart electronic health record for reimbursement and incorporating other important screenings.

Student Presentation Abstracts, Session 2

Should federal government have mandatory vaccination policy for children?

Yiming Shao (Pepperdine University)

Despite of the necessity and importance of vaccination for children, the argument has risen about whether parents should have choices on their children’s vaccination or not. There is no federal vaccination law exist, but all 50 states have mandatory policy on children’s vaccination against diseases such as diphtheria, tetanus, pertussis (usually in a DTaP Vaccine), polio (in a IPV vaccine), measles, mumps and rubella (generally in a MMR vaccine). All states allow medical exemption, there are 48 states allowing religious exemption, and 19 states allow philosophical exemption.

The paper will include two parts. The first part will talk about the rationale of federal government’s role in immunization policy for children. Furthermore, the paper will also discuss the problems existing in current policy environment. For example, pharmacies are billing free vaccinations under their customers’ insurance, and selling to other customers at market price. A more efficient immunization policy for children is needed to better allocate the budget for the best outcome.

How Can Knowledge Of Prior Criminal History Be Used To Reduce Harm Associated With Drunk Driving In Los Angeles County?

Jeremy Kauffman Ross Lenihan, Xiaoman Luo, Elizabeth Swain (UCLA)

We used a data set of DUI arrest records from 2008 to 2013, as well as arrest records for these individuals’ violent prior offenses that dated back to 2000. All of the arrests occurred in Los Angeles County. Our analysis of this data suggests that individuals with any type of violent prior are more likely to cause bodily injury when committing a DUI than non-violent prior individuals, and that they are disproportionately arrested for DUIs during the day. Moreover, our analysis suggests that individuals with a prior arrest for domestic violence (by far the most common violent prior type in our data), driving-related crimes, sex-related crimes, or simple assault/battery were more likely to commit a DUI that causes injury or death than individuals with other types of violent priors.

The Effects China’s Spatial Heterogeneity on Corruption

Nikhil Mathur, Jacob Meyer, Lisa Piergallini (Claremont Graduate University)

This paper investigates the effects of foreign investment, economic growth, and political capacity on corruption in China. Following Gordon Tullock, we hold that governance systems of states establish a political monopoly through political institutions in which individuals may “rent-seek.” This paper adds to the existing public choice literature and studies of China’s political economy with the use of expected utility modeling and estimation, supplemented by statistical data analysis. We use aggregated data from 1998 – 2008 and construct a profile for each sub-national province in China. Cross-sectional analysis using variable averages is most appropriate for this type of study, since the pertinent variation is observed across provinces rather than over time. The results highlight the provincial and regional differences across China as well as the peculiar nature of corruption on this rising star of the international system. We find that both real political capacity (RPC) and foreign direct investment (FDI) have a negative and statistically significant relationship with corruption, whereas gross domestic product (GDP) per capita has a positive and significant association with provincial corruption in China. These findings suggest that the horizontal discipline and accountability associated with greater political capacity works to effectively diminish the rent-seeking behavior of officials, particularly at the local level. Relatedly, FDI inhibits rent-seeking behavior by disrupting the political monopoly with the credible threat of capital flight. Our conclusion is therefore consistent with the current policy adopted by the central Chinese authorities, which seeks to minimize rent-seeking behavior, as the effects are shown to be detrimental to long-run social and economic welfare.

A Simple Approach to Assessing Potential Health Emergency Interventions: A Proof of Concept and Illustrative Application to the 2014–2015 Ebola Crisis

Meg Chamberlin (Pardee RAND)

During the response to the Ebola outbreak that surged in 2014 and continues into 2015, several new and largely untested interventions were suggested by various political and other authorities in both West Africa and the United States. When such public health emergencies arise, policymakers must assess and compare proposed interventions to determine the best way forward. Using Ebola as an illustrative example, RAND has developed a simple, practical, proof-of-concept policy analysis tool that aims to fill gaps in a decisionmaker's ability to systematically assess proposed interventions in a public health emergency, whether for planning and preparedness purposes or for decisionmaking during an ongoing response. The tool developed by RAND and described in this report is flexible enough to allow evaluation of a single intervention, multiple interventions with the same aim, and the entire landscape of interventions, as well as to be used to make decisions quickly when needed, or on the basis of more in-depth analysis and consultation when time permits.

Note: This presentation will discuss research conducted with the following RAND colleagues: Mashid Abir, Jonah Blank, Adeyemi Okunogbe, Shira Efron, Bill Gelfeld, and Melinda Moore.

Mitigating the Impact of Ebola in Potential Hot Zones

Bill Gelfeld (Pardee RAND)

The Ebola epidemic that surged in 2014 and continues into 2015 is the largest in history, primarily affecting three countries in West Africa—Guinea, Liberia, and Sierra Leone. A small number of cases were reported in Mali, Nigeria, Senegal, and Democratic Republic of the Congo, but these countries intervened early and effectively to limit disease transmission. The authors propose a two-phase approach as a proof of concept to help identify potential hot zones and explore concrete actions to mitigate the impact of Ebola in these potentially vulnerable countries. To determine what factors might indicate vulnerability to a future Ebola outbreak, the authors assess a number of widely available statistical indicators in four broad domains: political, economic, sociocultural, and health. For the exemplar countries used in the perspective, the authors establish criteria and, in progressively aggregating fashion, classify each indicator, domain, and country as high, medium, or low risk. Upon selecting three countries—Côte d’Ivoire, Ethiopia, and Pakistan—to examine further as potential Ebola hot zones, the authors describe both weaknesses and mitigating factors relevant to an Ebola outbreak. Finally, the perspective outlines a tabletop exercise for Ethiopia to highlight how a scenario might unfold and the questions, decisions, and challenges to be addressed along the way. The approach in this perspective is not inherently specific to Ebola—it can be applied or adapted to address other types of natural, accidental, or intentional health emergencies.

Note: This presentation will discuss research conducted by the presenter with the following RAND colleagues: Mashid Abir, Jonah Blank, Adeyemi Okunogbe, Shira Efron, Meg Chamberlin, and Melinda Moore.

A New Policy for Rural Emergency Water Supply

Eddy Waty (Pepperdine University)

This paper examines improving a vital life-saving function: the provision of clean water by the US to areas of the world during or after natural or manmade disasters. The present policy of waiting until after an emergency event occurs and then shipping in vast quantities of bottled water from a central source over long distances has saved many thousands, but has serious problems, including high costs and unnecessary loss of life due to late response and aid arrival, especially in the remote areas that are typically the hardest hit. An alternative policy is herein examined for feasibility, of providing US technology and training to enable local water purification and availability in vulnerable areas before a crisis occurs. Three cases are reviewed (Haiti earthquake, Indonesia tsunami, and US Hurricane Sandy) for lessons learned relevant to supporting this new policy. The conclusion is that the new approach appears feasible, could save many additional lives, would support community resilience, and could be implemented near-term within present cost constraints.

Changes in the Calorie Content of Menus of the Top 200 U.S Chain Restaurants from 2010 to 2014

Cameron Wright (RAND Corporation)

The Affordable Care Act of 2010 required chain restaurants to list calories on menus, although the enforcement of the law was not finalized until 2014. Menu-labeling laws could prompt industry changes, such as reduced portions, reformulation, or the addition of healthier menu items. We examine changes in calories of menu items available in U.S. chain restaurants from 2010 to 2014. We used data collected by our group for 2010 merged into New York State Department of Health’s MenuStat data system for later years and matched menu items for 124 restaurant chains operating in both 2010 and 2014.

Generalized linear models were used to examine the change between 2010 and 2014 of three measures: The change in mean calories in all menu items, the change in mean calories of menu items on menus in both years, and the difference in mean calories between menu items appearing in 2014 only and items that appear in 2010 only. To examine trends in calories across the distribution, we also used quantile regression.

The mean calories of all menu items increased by 11 calories (2% increase) from 2010 to 2014. There was no significant change in mean calories of items that were on menus in both 2010 and 2014. New menu items added in 2014 had 13 more calories (2% increase) than menu items that were only present in 2010. In contrast to several claims, we find little change in menus over time and no evidence of widespread item reformulation or additions of healthier items.

Note: This presentation is based on research conducted with Roland Sturm (RAND Corporation) and with Helen Wu (Institute for Population Health Improvement, UC Davis Health System), a Pardee RAND alumna.

Social Policy Formulation of Systematic Alerts for Emergency Response (S.A.F.E.R.) Through Amber Alerts & Social Media Applications

Robert Cira, Tristan Hall, Huayuan Huang, Desmond Jeffries, Sarah Mirembe, Taofik Oladip (Pepperdine University)

This policy paper addresses the safety of individuals from Pandemic and Epidemic Diseases (PEDs), such as the Ebola virus; quarantine and other preventive measures need to be explored. The major concern is the virus is not immediately detectable; the public is left susceptible to unsuspected infected people. Forming public-private partnerships addresses the biosafety of individuals from PED exposure; governmental measures, including civic engagement, not limited to: citizens, families, churches, nonprofit organizations should act in a concerted effort to educate and communicate the control of PEDs.

Systematic Alerts for Emergency Relief (SAFER) is the response to PEDs; central to S.A.F.E.R is communication. S.A.F.E.R. policy requires telecommunication companies to disseminate emergency biosafety alerts via; sms message, emails, television and radio PSA to inform citizens as a federal and FCC mandate. S.A.F.E.R implements the use of the Amber alert system to issue biosafety alerts city or state-wide and calls for the CDC and CDPH to issue alerts and put information in the hands of the individual via mobile app of biosafety emergency.

S.A.F.E.R is an effective and low cost solution with quick modes of communication, informing companies to integrate health alert features in their technology plans. The best policy is to provide useful information to protect the public from catastrophic virus outbreak.

Perceived heat stress and health effects on construction workers

Gulrez Shah Azhar (Indian Institute of Public Health Gandhinagar; Public Health Foundation of India; Pardee RAND)

Introduction: Spurt in construction activity coupled with frequent heat waves highlights a need for heat exposure assessment of construction workers. This study aims to highlight the effects of heat on construction workers from a site in Gandhinagar, Gujarat and to identify possible intervention points at both worker and policy levels.

Methods: This study involved a mixed methods approach consisting of a cross sectional survey with anthropometric measurements (n=219) and focus groups (4), and onsite environmental measurements of heat stress exposure. Survey data was collected in summer and winter, and heat illness symptoms were compared between the two time periods. Thematic coding of focus group data was used to identify vulnerability factors and coping mechanisms. WBGT Heat stress was compared to international safety standards.

Result: Heat-related symptoms increased in summer; 59% of all reports in summer were positive for symptoms compared to 41% in winter. Focus groups revealed four dominant themes: 1) non-occupational stressors compound work stressors; 2) workers were particularly attuned to the impact of heat on their health; 3) workers were aware of heat-related preventive measures; and 4) few resources were available to protect workers. Working conditions often exceed international heat stress safety thresholds.

Conclusion: This study suggests significant health impacts on construction workers from heat stress exposure, showed that heat stress levels were higher than those prescribed by international standards and highlights the need for revision of work practices, increased protective measures, and possible development of indigenous heat exposure work safety standards.

Note: This presentation is based on research conducted with Priya Dutta, Ajit Rajiva, and Abhiyant Tiwari (Indian Institute of Public Health Gandhinagar), Dileep Andhare (Indian Institute of Public Health Gandhinagar; Public Health Foundation of India), Perry Sheffield (Icahn School of Medicine at Mount Sinai), and the Ahmedabad Heat and Climate Study Group.


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