The Magazine of the Gerald R. Ford School of Public Policy
FA LL 2010
From Our Corner to the Four Corners of the Globe
Roads to Better Health Policy
Demand-side solutions ACA unfolding, shifting the landscape Social connectedness, disease, and development in rural Ecuador Skipping doses, splitting pills
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from the dean
ou hear it in the news all the time—our society is increasingly complex and the world is changing more rapidly than ever before. Some of those changes present opportunities. Cell phones, for example, are giving people in developing economies access to a world of information. Other changes present complex challenges. Health care costs continue to escalate, while too many go without care, and we spend increasing amounts of money treating problems rather than preventing them. What you hear less often—and what is perhaps our greatest strength and opportunity—is that our society is also becoming increasingly diverse and interconnected. If we can embrace it, that diversity—of experience, of knowledge, of opinion—will enable us to tackle today’s complex problems, and grasp the opportunities that present themselves. The University of Michigan recently celebrated the 50th anniversary of the Peace Corps. With colleagues from the Brookings Institution and the National Peace Corps Association, I had the honor of co-chairing an inspirational National Symposium on the Future of International Service. One of the many important themes that came out of that symposium was the sense that today’s generation— much more so than the generation that saw the launch of the Peace Corps five decades ago—doesn’t see strict divisions between domestic and international concerns, between domestic and international service.
State & Hill Dean: Susan M. Collins Associate Dean: Alan V. Deardorff Director of Communications/Editor: Laura K. Lee (MPP ‘96) Lead Writer: Erin Spanier Contributors: Katie Talik, Sarah Obed, Parvati Patil, Ryan W. Pretzer Design: Savitski Design Printer: Print Tech, Inc. Printed using vegetable-based inks with electricity offset by renewable energy wind credits. The paper is FSC certified and manufactured from 100% post-consumer waste using biogas energy.
Today’s young people think of themselves as citizens of the world. They fit service into their college experience, raising money for and awareness about pressing domestic and international issues. They spend their winter, spring, and summer breaks serving at home and abroad. They study urban policy issues and they study international policy issues. They merge what they’ve learned through these experiences into their careers in DC, Detroit, and Chicago, as well as in Vietnam, Berlin, and South Africa. They have multiple lenses for evaluating policy challenges, something that allows them to look beyond conventional perceptions and solutions, something that allows them to better understand complex issues. In this issue of State & Hill, we feature the work of 11 Ford School faculty members who bring diverse perspectives to a single complex issue: health policy. Mathematicians, economists, political scientists, sociologists, politicians, medical doctors, and more, these faculty members focus on different aspects of the issue to illuminate it, to teach students and policymakers about it, and to gather the data we need to craft effective policy solutions. The Ford School’s students benefit from exposure to this range of experience, and they apply their own passion and compassion to extend it out into the world as interns and volunteers. Inside this magazine, you’ll read about their experiences, and about the truly impressive work of the Ford School’s alumni, as well. We’re so proud of them—of you. Share your reactions to these articles. Tell us about your policy work. We hope these stories launch a dialogue about these and other important policy topics.
Let us know what you think:
firstname.lastname@example.org, or Editor, State & Hill, Ford School, University of Michigan, 735 S. State Street, Ann Arbor MI 48109-3091 Susan M. Collins ®
Regents of the University of Michigan Julia Donovan Darlow, Ann Arbor Laurence B. Deitch, Bingham Farms Denise Ilitch, Bingham Farms Olivia P. Maynard, Goodrich Andrea Fischer Newman, Ann Arbor Andrew C. Richner, Grosse Pointe Park S. Martin Taylor, Grosse Pointe Farms Katherine E. White, Ann Arbor Mary Sue Coleman (ex officio)
Joan and Sanford Weill Dean of Public Policy The University of Michigan, as an equal opportunity/affirmative action employer, complies with all applicable federal and state laws regarding nondiscrimination and affirmative action, including Title IX of the Education Amendments of 1972 and Section 504 of the Rehabilitation Act of 1973. The University of Michigan is committed to a policy of nondiscrimination and equal opportunity for all persons regardless of race, sex, color, religion, creed, national origin or ancestry, age, marital status, sexual orientation, gender identity, gender expression, disability, or Vietnam-era veteran status in employment, educational programs and activities, and admissions. Inquiries or complaints may be addressed to the Senior Director for Institutional Equity and Title IX/Section 504 Coordinator, Office of Institutional Equity, 2072 Administrative Services Building, Ann Arbor, Michigan 481091432, 734-763-0235, TTY 734-647-1388. For other University of Michigan information call 734-764-1817.
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& Peace Corps at Fifty 2 Volunteers Return to Serve at Home
Through the Lens of Social Science 4 Faculty Insights on Health Policy
Courtesy of Fred Shippey
Courtesy of David Giltrow
Health Care Reform Act Unfolding 12 Alumni Join the Debate
Of Roads and Rotovirus 18 Social Connectedness and Development
Skipping Doses in Southeast Michigan 20 National Poverty Center Research
Courtesy of Meredith Horowski and ONE
Leveraging Investments in Global Health 14 From Ann Arbor to the Blue Mountains 16 Bohnett Fellowship Strengthens Ties to Detroit 21 Alum Leads “Tough Nerd” to Victory 22 A Rwandan Journey with ONE 23
Departments Faculty News & Awards 24 Class Notes 26 The Last Word: Tom Ivacko 28
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P eac e Co rps 5 0
Returned Peace Corps volunteers serve abroad, serve at home As we celebrate 50 years of international Peace Corps service, the Ford School reflects on the impact of the Fellows/USA program—a fellowship for returned Peace Corps volunteers who agree to complete policy-related internships in underserved U.S. communities.
hen Alexis Guild finished her Peace Corps placement in Guatemala last year, where she served as a health facilitator for five rural primary schools, she was determined to continue her work in international development. “It was because of the Peace Corps that I chose to pursue a master’s in public policy,” says Guild, adding that U-M’s historic connection to the founding of the Peace Corps played a big part in her decision to pursue that degree at the Ford School. Skip this paragraph if you already know the story, but for the rest of you, that historic connection goes something like this. Fifty years ago, presidential hopeful John F. Kennedy visited the University of Michigan while on the campaign trail. Thousands of students crowded around the Michigan Union steps, waiting for him to arrive. When he did, his speech writers and campaign advisors went straight to bed (it was 2 a.m., after all), but Kennedy spoke to the crowd briefly, giving a speech that no one anticipated. In it, he shared some ideas he’d been mulling over about “a higher purpose” for universities and students, asking students if they would consider serving abroad—in nations like Ghana—in the interest of peace. Michigan students picked up the charge, circulating a petition that thousands signed, each pledging
to serve. Energized by their enthusiasm, Kennedy began to pitch the idea from the campaign trail, and founded the Peace Corps by executive order after winning the presidency by a narrow margin—a margin some attribute to the fervor he generated with that speech. Of course, Guild’s choice to attend the Ford School might also have been motivated by the fact that the school participates in the Peace Corps’ Fellows/USA program, offering generous financial assistance to returned volunteers who agree to intern in underserved communities in the states. International volunteer experiences, inspiring and informing domestic volunteer experiences—that’s the hallmark of this program. Since it was launched, more than 3,000 returned Peace Corps volunteers—including 31 from the Ford School—have completed meaningful internships in underserved American communities. For returned volunteers, the Fellows/USA program offers generous educational benefits: their application fees are waived, and, if accepted, they receive a $10,000 tuition fellowship for each of the program’s two years. For the Ford School, says Associate Director of Student and Academic Services Beth Soboleski, the program is a great way to connect with students who have a demonstrated commitment to Mahadevan making pizza with her 8th grade cooking club
“Tooth brushing time” at a school in Santa María Chiquimula, Guatemala Guild
The Peace Corps at Fifty S TAT E & H I L L
international service, who bring back interesting and relevant experiences to enrich discussions in the classroom, and who can have a deep impact on pressing domestic policy concerns in health, criminal justice, environmental regulation, economic development, and other policy arenas. Mahima Mahadevan, currently pursuing her MPP at the Ford School, spent her Peace Corps placement teaching English to 8th through 11th grade students in a tiny village in the Kyrgyz Republic. Unfortunately, the only time most of her students ever heard English spoken was during the two hours per week they spent in her course—something that made progress slow. To overcome that challenge, Mahadevan supplemented her traditional class sessions with after-school clubs focused on sports, arts and crafts, and cooking. Then she purchased a TV and DVD player for the school to show movies in English. Students had to complete their homework for the week to get a pass for movie club. Once there, Mahadevan would show a portion of the film in English, then watch it again with Russian subtitles. “The kids loved it.” When she returned to the U.S. in 2006, she spent twoand-a-half years in Detroit, applying her teaching skills there. Then she came to the Ford School, tapping into the Fellows/USA funding, to broaden her impact by learning more about domestic education policy. For her Fellows/USA internship, Mahadevan spent ten weeks at the Imagine Fund in Lansing, Mich., researching the impacts of Michigan’s recent affirmative action ban to find out how this law is affecting Black and Hispanic student enrollment and educational outcomes.
John F. Kennedy leaving campus via State Street the morning after his speech Photo courtesy of David Giltrow
2:00 am ceremony marked the 50th anniversary of Kennedy’s call to action
Susan M. Collins and Harris L. Wofford at international service symposium
Today, Mahadevan wants to apply her international and domestic skills and experiences to urban and education policy. “Being named a Peace Corps Fellow has been critical in my transition from international service to a career in education advocacy,” she says. At the Ford School, we just say “Thank you, Peace Corps, and happy birthday!” ■
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Issue Feature: Roads to Better Health Policy
Through the lens of social science: faculty insights on health policy When we thoughtfully apply scientific analysis to policy challenges, we discover new and sometimes surprising relationships. If our analysis is sound, sound policies can emerge from these discoveries. The Ford School faculty members featured in this article explore a broad range of health policy challenges by collecting and analyzing data from panel studies, surveys, interviews, and many other sources. Their discoveries—which find their way out into the world through books, articles, congressional hearings, policy consultations, and the popular press—offer rigorous social science data to help guide health policy decisions.
Polling parents on children’s health
ant to know what the nation thinks about childhood obesity, bullying, or genetic risk testing? Ask Dr. Matthew Davis , an associate professor at the Ford School and the Medical School. As director of the C.S. Mott Children’s Hospital National Poll on Children’s Health, he and his team have reported on dozens of timely and often policy-relevant topics to gauge parents’ experience with and opinions about current trends and issues in chil For Extra Credit dren’s health and health policy.
Davis collects a wealth of information from the adults he surveys, some of it surprising. For instance, while obesity, smoking, and drug use are the child health problems consisKaiser Family Foundation Polls, tently of greatest concern to (www.kff.org/kaiserpolls/ adults in the U.S., Internet safety index2.cfm). and bullying are also among the 10 most commonly identified problems in neighborhoods across the country. Asthma, autism, and cancer rank well below these issues in terms of overall levels of public concern. C.S. Mott Children’s Hospital National Poll on Children’s Health, (www.med. umich.edu/mott/npch).
Davis and his colleagues frequently share this data with lawmakers and opinion leaders in an effort to provide public perspectives on timely issues. In the past, policymakers have used the poll findings to inform their legislative plans—dropping a requirement to vaccinate middle- and high-school girls against the relatively lowrisk human papillomavirus (HPV) and electing to regulate electronic cigarettes that provide nicotine in an aerosol form, for example.
S T A Tpolicies E & HILL Knowing how to treat or prevent an illness isn’t enough. Well-crafted can bridge the gap between knowledge and action-improving health outcomes. Economists, political scientists, sociologists, medical doctors, and analysts— working collaboratively—build roads to better health policy.
Poll findings also regularly contribute to the broader public dialogue on children’s health and health policy. In the last year alone, Davis’s poll has been referenced in USA Today, TIME, the Los Angeles Times, the New York Times, the Washington Post, Health Daily, Reuters, WebMD, and National Public Radio broadcasts. “It’s absolutely critical to hear and consider what the public is thinking about children’s health issues,” says Davis. “Experts are smart. Policymakers can be well-intentioned.
But I believe that knowing what the public thinks and what initiatives they would support is an important element in crafting sound public policy.” Upcoming surveys will focus on gun safety and violence, teen pregnancy, and opinions about the perceived reliability of a variety of health information sources. Ideas for future polls? Email Davis and his poll team at npch@med. umich.edu.
Legislators, lobbyists, and health care reform
lmost every month a new book comes out that impugns the integrity of lobbyists and legislators,” says professor of public policy and political science Rick Hall , “that they’re in bed together, that there’s a corrupt conspiracy, that members are beholden to special interests, that they sell their votes for campaign contributions…” The reality—in health care legislation and other policy areas—isn’t quite as racy. In almost 200 interviews conducted over several years, Hall has surveyed lobbyists and legislators around substantive policies—about half of these in the health arena. Through these interviews, he can quantify their contacts and characterize their relationships. His discovery: lobbyists don’t spend much time talking to the legislators who are undecided or who disagree with them; they invest their time in supporting friends. For these likeminded legislators, lobbyists offer data and anecdotal evidence, they gather information for speeches, they craft legislative language, they provide political intelligence. They become, in the words of Lester Milbrath, a scholar who published on the topic five decades ago, adjunct staffers. Hall disagrees with Milbrath, however, on the consequences of this behavior. “Milbrath described the same patterns but came to the wrong conclusion. He thought that because they mainly lobby their congressional allies, lobbyists are ineffective, they are singing to the choir. I find that lobbyists are effective because they lobby their allies.” In the main, lobbyists don’t buy votes or quietly bribe legislators with fancy meals or long weekends in the Hamptons (although there will always be a few corrupt ones who do). Lobbyists gain influence because legislators don’t have time to take action on every issue they care about and are more likely to propose legislation or amendments if they have a reliable source of support. “To influence legislation, a legislator has to work at it,” Hall summarizes. “Lobbyists help them do that work, but only on issues that also serve the lobbyist’s interests.”
In one sense, Hall explains, “this strengthens the democratic process by allowing legislators to become involved in more issues, support more constituency interests, give voice to more problems.” In another, more important sense, he says, it creates problems. Because interest groups don’t have equal resources, some are, in the proverbial words of George Orwell, “more equal than others.” They have more staff to support their proposals, thereby enabling more legislators to work on their common interests. But that also takes time and attention away from other constituent For Extra Credit matters. Resource-rich interest groups may not influence legislators’ positions, but The DeMarco Factor: they do influence their priTransforming Public Will into orities, says Hall. As a result, Political Power, by Michael resource-poor interests are Pertschuk, (2010). pushed down, perhaps off, “Lobbying and Legislative the legislator’s “to do” list.
Strategy,” by Katharine W.V.
This summer, Hall did the Bradley and Richard L. Hall. research for his last case Burdett Loomis, ed., CQ Guide study—interviewing health to Interest Groups and Lobbying, care reform lobbyists from (forthcoming 2011). health provider groups, the insurance industry, public interest groups, business groups, and others involved in the 2010 Patient Protection and Affordable Care Act. Those interviews, and others he’s conducted around the Medicare prescription drug act, the Patients’ Bill of Rights bill, and other health legislation, continue to support his theory. “I do not think it’s a very complicated story,” says Hall, “but as far as I can tell, nobody has told it, nobody looks at it this way.”
Roads to Better Health Policy
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Demand-side solutions to health disparities FEAT URE
rofessor Jim House is on a research leave this year as a visiting scholar at the Russell Sage Foundation in New York City. From his office on the Upper East Side of Manhattan, he’s writing a new book, tentatively titled Beyond Sicko and Health Care Reform, which explores the connections between education, income, employment policies, and public health. An extension For Extra Credit of a conference and edited volume supported by the Russell Sage Foundation and the Sicko, directed by Ford School’s National Michael Moore, (2007). Poverty Center several years “Beyond Health Care: New ago, House’s book will take an Directions to a Healthier America,” integrative look at how policies Robert Wood Johnson Foundation. designed to address social and economic concerns can have a Unnatural Causes: Is Inequality big impact on the health of the Making Us Sick? PBS series. people they touch.
“The best-known fact about American health care and health policy is that we spend way more than anyone else in the world on health care and insurance—increasingly so since the mid-20th century,” says House, one of 96 Distinguished University Professors at U-M since 1947, and one of three currently on the Ford School faculty. The problem is that our returns on these investments (as measured by indicators like longevity and infant and maternal mortality) have diminished relative to all other comparably developed countries, and even some developing ones. “Health has been getting better in the overall population,” says House, “and this is true around the world. But we’re getting a relatively poor return compared to what we’re spending.” What’s the fix? What can we do about it? Health care reform is intended to tackle this problem, but it can’t do it alone.
“The people doing health care reform, in the most extensive way it’s been done in the last half century, would like to believe that what they’re doing will change all that,” says House. But while House agrees that efforts to control and manage a program that consumes close to 20 percent of the GDP are worthwhile, he points out that these are supply-side solutions that aim to control the amount, type, price, accessibility, and quality of care and insurance. The other side of the equation—the demand side—needs to be addressed, as well. On the demand side, there’s a clear consensus that health care is not the only or main determinant of population health, and probably never has been, House explains. Rather, health is also a result of a wide range of life and work conditions, including health behaviors, environmental exposures, stress and resources for adapting to stress, and more. Exposure to and experience with all of these (and of biomedical risk factors as well) are also heavily influenced by race, ethnicity, and socioeconomic position. For example, explains House, “People who are better educated have considerably better trajectories of health over their entire life course, increasingly so over the last quarter century. And education also improves economic wellbeing and job competitiveness. Thus, investing in education improves long-term health, probably more than investing in health care at and beyond the levels that we do now.” Foundations like Russell Sage and, especially, Robert Wood Johnson are beginning to study and promote this demandside approach. The Obama Administration is showing an interest as well. House’s book—which he hopes to complete this year—will be a strong addition to the available literature on using social and economic policies to boost public health, and ultimately reduce the need for and expense of health care and insurance.
Health economics and public policy
nother faculty member on loan from the University of Michigan this year is research professor Helen Levy , who was appointed this August to serve a one-year term as a senior economist for the Council of For Extra Credit Economic Advisers (CEA)—an agency that provides the U.S. President with economic advice “The Taxes of Sin: Do Smokers related to the formulation of and Drinkers Pay Their Way?” domestic and international Journal of the American economic policy. Over the next Medical Association, (1989). year, Levy will serve with other CEA appointees at the White As Good as it Gets, directed by House to analyze economic James L. Brooks, (1997). research and empirical evidence, with the goal of formulating and recommending
national economic policies designed to promote employment and economic growth. At the Ford School, Levy recently taught “Health Economics and Public Policy,” a course designed to introduce graduate students to the economics of health and medical care— offering instruction in the analytic tools needed to evaluate policies. Levy has also led major research initiatives for the Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation, the National Institute on Aging, the Michigan Retirement Research Center, and many other foundations and agencies seeking to understand how low-income families adapt to loss of health insurance, the persistence and impact of high health spending, health literacy and health disparities among the elderly, and the effects of specific government-sponsored health insurance programs on household wellbeing.
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Blame it on the rain: early rainfall impacts health, wealth, and education
heir country straddling the equator, Indonesians know two basic seasons: dry and wet. However, the length of the rainy season can vary widely across this archipelago comprised of thousands of islands. Village farmers are used to this, and have adapted their agricultural practices over generations to accommodate the local climate and topography. But, when rainfall is unusual compared to normal levels in that village—for example when a drought strikes—crop yields can suffer dramatically. Interestingly, rainfall affects more than a single season’s crops, explains economist and Ford School lecturer Sharon Maccini . For Indonesian women born in the 1950s through the 1970s, she’s found that early life rainfall impacts health, wealth, and education far into the future. Inspired by the “Barker Hypothesis,” which posits a connection between nutrition in utero and long-term health, Maccini wanted to test how men and women born into rural farming communities, where livelihoods are dependent on rain, were impacted by the “luck factor”—how much it happened to rain during their first year of life. Maccini and her co-author, associate professor Dean Yang, combined decades of data from hundreds of rainfall stations across the Indonesian archipelago with results from a rich RAND panel study that tracked dozens of well-being measures for thousands of representative families over a decade. Their careful analysis revealed that higher than
average rainfall didn’t impact boys, but girls born in years with higher than average rainfall fared significantly better than peers born in drier years. In later life, they were taller, had more years of schooling, and were better off financially.
For Extra Credit
Sharon Maccini Origins: How the Nine Months Before Birth Shape the Rest of Our Lives, by Annie Murphy Paul, (2010). “Side Effects of 1918 Flu Seen Decades Later,” by Adi Narayan. Time Magazine, (www.time.com/ time/health/article/0,8599, 1929814-1,00.html).
“There’s some new evidence that, during times of hardship, girls feel it more,” says Maccini. “Girls, who may get second dibs on things, may do well only when there are extra resources around.” Maccini, who regularly teaches “Public Health in Developing Countries” at the Ford School, says the research underscores the need for stronger social safety nets in developing countries. “A broader health safety net would help support people at any time—not just a drought,” Maccini explains. “If mothers and children can get enough nutrients when there’s a crisis, it will reduce long-term health problems and increase their prospects for economic wellbeing later in life.”
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Roads to Better Health Policy
Genetic gold rush hinders competition, innovation FEAT URE
ven before we had mapped the human genome, American entrepreneurs had begun to stake claims to it. Over the last two decades, the U.S. Patent Office has issued more than 5,000 patents on parts of the human genome, leaving an alarming 20 percent of our genes under the ownership of corporations, individuals, and universities. While some argue that this practice gives patent holders an incentive to pour money into research and develop genetic risk tests and disease interventions, many others, including For Extra Credit Ford School assistant professor Shobita Parthasarathy , argue that patent ownership stifles innovation, decreases consumer Gattaca, directed by options, and makes health care Andrew Niccol, (1997). prohibitively expensive.
Shobita Parthasarathy The Immortal Life of Henrietta Lacks, by Rebecca Skloot.
In fall 2009, a coalition of patients, scientists, and physiImpure Science: AIDS, Activism, cians coordinated by the and the Politics of Knowledge, ACLU filed suit against Myriad by Steven Epstein. Genetics and the U.S. Patent Office to challenge patents on the genes that indicate increased risk for breast and ovarian cancer. The case was more than a challenge to one company’s patents, however: it called into question whether human genes should be patented at all. In the case of breast and ovarian cancer genetics, says Parthasarathy, who co-directs the University’s Science,
Technology, and Public Policy program, Myriad Genetics’ patent monopoly has led to inaccurate and prohibitively expensive genetic risk tests. She explored these issues and others in her MIT Press book, Building Genetic Medicine: Breast Cancer, Technology, and the Comparative Politics of Health Care, which analyzes the history and politics of genetic testing for breast and ovarian cancer in the United States and Britain. Based on the findings in her book, the ACLU asked Parthasarathy to work with them as they developed the lawsuit. She helped identify the list of plaintiffs in the suit; submitted an expert declaration in support of the ACLU position; and spoke to media representatives, including participating in an hour-long panel discussion at Washington, DC’s National Public Radio station, WAMU, about the implications. This spring, Judge Robert Sweet, the New York Federal Court Judge who presided over the case, cited Parthasarathy’s declaration extensively in his landmark ruling against Myriad. Myriad’s appeal on the ruling will be heard in the Federal Court of Appeals in DC. Regardless of the ruling by the appeals court, however, Parthasarathy notes that the final decision will likely come from the U.S. Supreme Court. “The case has such tremendous potential for transforming not only the patent system, but also the cultures of scientific research and health care in the United States,” Parthasarathy says. “The Supreme Court will certainly want to weigh in.”
Panel study tracks wellbeing over the lifecourse and across generations
o-director and principal investigator of the Panel Study of Income Dynamics (PSID), Professor Bob Schoeni is responsible for leading one of the most widely used social science data sets in the world— a longitudinal NSF-funded study that has collected 42 years of data on a vast, nationally representative sample of U.S. families. Recognized by the National Science Foundation in its “Sensational 60” publication, which highlights the 60 most significant NSF-funded advances in the organization’s 60-year history, PSID data sets are credited by the
NSF for their central role in illuminating “intergenerational relations; income, poverty, savings, and wealth; demographic events such as teen childbearing, marriage and divorce, living arrangements, and mortality; labor market behavior; and the effect of neighborhoods.” “For those studying family dynamics, investments in children, and wellbeing over the lifecourse and across generations,” says Schoeni, “the PSID is an unparalleled resource.” Last year alone, the free-access site had 5.2 million hits, and 13,000 registered users ran 27,000 customized data extracts. Since the study’s launch,
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more than 3,000 journal articles, books, book chapters, and dissertations have used its data sets to understand a broad range of questions about the dynamics of economic life of Americans, effects of childhood health on adult economic wellbeing, the reasons for massive black-white differences in lifetime wealth, and the interplay between social and economic policies and health trajectories, among other topics. In 2009, the Department of Treasury tapped into the PSID to gain a better understanding of the number of Americans who experience periods without health care coverage over time. President Obama’s weekly radio address on September 12, 2009 referenced that Treasury research, reporting that as many as 48 percent of nonelderly Americans and 57 percent of those under 21 years of age are uninsured at some point over a ten-year span. Schoeni is working now to add new modules to the PSID, expanding data about health status and behaviors, health
insurance coverage, and health care costs. With For Extra Credit outside funding, he also hopes to add data on psychological wellbeing, time President Obama Weekly Address: use, and cognition. “Each Saturday, September 12, 2009, year, the data archive (www.whitehouse.gov/ grows in scientific value, blog/2009/09/12/weekly-addressas more observations are losing-insurance-can-happenmade on the same famianybody). lies and their offspring Panel Study of Income Dynamics, and we expand the con(www.psidonline.org). tent,” explains Schoeni. “It’s satisfying to know that the PSID is a critical resource used by researchers and policy analysts across the globe—one that leads to more informed decisions by society and government.”
Uncertain funding, regulatory changes slow embryonic stem cell research innovation
n March 2009, just seven weeks after taking the oath of office, President Obama signed an executive order ending an eight-year ban on federal funding for virtually all human embryonic stem cell research. “Medical miracles do not happen simply by accident,” said Obama in his press announcement. “They result from painstaking and costly research—from years of lonely trial and error, much of which never bears fruit—and from a government willing to support that work.” Dr. John J.H. (Joe) Schwarz , a practicing otolaryngologist and one of the few medical doctors to serve in the Michigan Senate and the U.S. House of Representatives, openly praised Obama’s decision. Then this August, when a DC Federal District Court Judge ruled against Obama’s order, Schwarz predicted, “the inevitable (and correct) appeals precipitated by this ruling are going to be an ongoing public policy issue.” While an appeals court has temporarily suspended the ban on federal funding for embryonic stem cell research, Schwarz and others are concerned about the impact of uncertain funding on ongoing U.S.based research. Schwarz (R-MI) represented Michigan’s 7th Congressional District in the House from 2005-2007, and was there when H.R. 810, the Stem Cell Research Enhancement Act sponsored by Diana DeGette (D-CO) and Mike Castle (R-DE), passed with clear bipartisan support. But when President Bush vetoed the bill, he and other supporters couldn’t produce the two-thirds super-majority needed to override the decision. It wasn’t until Obama’s executive order that researchers could apply for National Science Foundation support for projects using discarded embryos to look for cures for a wide variety of diseases—from spinal cord injuries to neurodegenerative disease, sickle cell anemia, and much more.
In the state of Michigan, For Extra Credit restrictions on this research are equally stringent, says Schwarz, a lecturer at the Ford August 23, 2010 decision by DC School. In a Constitutional Federal District Court Judge Royce C. Amendment approved by Lamberth to suspend federal funding the Michigan electorate in for embryonic stem cell research, 2008, human embryonic (https://ecf.dcd.uscourts.gov/cgi-bin/ stem cell research became show_public_doc?2009cv1575-44). legal (it was once a felony Castle-DeGette Bill; HR 810, 109th offense), provided scienCongress. tists adhere to rigorous and appropriate regulaMichigan Constitutional Amendment tions by the Secretary of on embryonic stem cell research; Health and Human Services Article I, Section 27, (2008). and the National Institutes of Health. Schwarz, a leading Republican supporter of this research—one who is often contacted by the press to weigh in on the topic—has been involved at the state level as well. Several bills have been introduced in the Legislature which would mandate onerous and unnecessary reporting requirements on embryonic stem cell researchers, says Schwarz.
This past year, Schwarz was routinely contacted by the media to discuss another pressing health policy issue— health care reform. While in Congress, Schwarz served on the Armed Services, Science, and Agriculture Committees, each of which had oversight of some piece of federal health policy. His former colleagues on those committees— from both political parties—sought his advice both during the development of various elements of the health care reform legislation, and during the subsequent debate.
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Roads to Better Health Policy
Complex systems approach may offer new insights on health disparities
n the mid-1980s, Carl Simon—a professor of mathematics, economics, and public policy—became captivated by a medical and social crisis: the HIV epidemic. At the time, scientists knew very little about the transmission system of HIV, he explains, including how contagious it was, when it was most contagious, and the roles For Extra Credit of various sex acts in the transmission process. It was a complex problem.
HIV transmission, for example, they realized that the disease was especially contagious in the first month of infection—an idea that was received with skepticism by the scientific community initially, but is pretty well accepted now, he says. Their work received the 1995 Howard Temin Award for “scientific excellence in the fight against HIV/AIDS,” and its implications for the development of an HIV vaccine were highlighted in a two-page article, “Of AIDS and Altruism,” in the April 6, 1998, U.S. News & World Report.
As it happens, complex problems are Carl Simon’s métier. For ten “Of AIDS and Altruism: In Theory, A years, he directed the New Kind of Vaccine Could Halt the University’s Center for Epidemic,” by Chandler Burr. U.S. the Study of Complex News & World Report, (April 6, 1998). Systems, a center devoted Making Americans Healthier: Social to understanding comand Economic Policy as Health Policy, plexity wherever it exists in nature or society. (National Poverty Center Series on From economies, educaPoverty and Public Policy), edited by tion systems, and traffic Robert F. Schoeni, James S. House, patterns to ecosystems, George A. Kaplan, and Harold Pollack, immune systems, and (2008). epidemics—Simon and his peers identify the key variables and actors, match them to data on causal relationships and feedbacks, and build models to simulate and help illuminate the interactions and interdependencies.
These days, Simon works with the public health community to study other complex systems: influenza transmission, drug resistant staph infection in hospital settings, and more recently, non-contagious diseases related to population characteristics like social and economic status. Diabetes, obesity, heart problems, frailty, and loss of cognition—each of these diseases strikes hardest at specific segments of the population, implying a causal relationship between social and economic status and disease liability.
Harnessing Complexity: Organizational Implications of a Scientific Frontier, by Robert Axelrod and Michael D. Cohen.
The goal of a complex systems approach, he explains, is to avoid the unintended consequences that can result when we oversimplify complex relationships. “If you choose some policy problem and just focus on correcting it without worrying about how it’s connected to the other things, unexpected consequences can arise,” says Simon. Complex systems approaches can also produce surprising results and uncover promising avenues for future research. When Simon and his colleagues used this approach to explore
To tease out the interactions and interdependencies, Simon and his colleague, George Kaplan, have received funding from the Directorate for Social and Behavioral Sciences at the National Institutes of Health to build a network of scientists to look at the problem from a complex systems approach. Those scientists are among the world’s experts in modeling, segregation, diabetes, smoking, stress, policy, sociology, computer science, and population health, says Simon. At their first meeting in Ann Arbor this September, they discussed their charge: to break new ground in etiology (identifying the causes of disease) as well as policy (identifying actionable ways to address them). There’s homework, he explains, and regular meetings, and an obligation to produce results. But there’s also a charge to share inspiration, to build enthusiasm, to ask tough questions, to take risks, and to think outside the box. “Once we put it together, we can start thinking about what policies might work,” explains Simon, “so it’s pretty exciting.”
Can licensed health practitioners meet the gap?
ith 32 million previously uninsured Americans poised to receive coverage under the Affordable Care Act, some worry that this enormous influx of patients will overload the health care system—limiting access, driving up prices, and decreasing the quality of care. Still others are looking toward the growing population of licensed health practitioners, including Nurse Practitioners (NP) and Physician Assistants (PA), to fill the need. Since their origins in the 1960s, the number of NPs and PAs has grown dramatically. In the United States, these
professionals already outnumber family and general practice doctors, and are rapidly approaching equal footing with primary care physicians; in some areas, in fact, they are already the primary providers of care. Assistant Professor Kevin Stange ’s research seeks to understand how the health care system is responding to this growth. However, because most data sets on these practitioners are static, and aren’t connected with other community characteristics or population demographics, the first step in his research was to assemble the facts.
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In collaboration with Deborah Sampson from the Boston College School of Nursing, Stange recently finished a massive effort to construct a data set that tracks NP and PA growth at the county level from 1990-2008. To enrich this information, he has matched it to county characteristics including population, income, racial breakdown, educational achievement, and rural/urban status. He has also added information about whether the community has been designated a health provider shortage area, whether it has given NPs and PAs authority to write prescriptions, proximity to nursing and medical schools, and HMO penetration. With this information in hand, Stange is poised to begin exploring how growing numbers of NPs and PAs affect access to care, cost of care, and health care quality. “Just laying down some basic facts about where these changes in the health care workforce have been most significant
was a first step. Now we can begin exploring whether non-physician clinicians such as NPs and PAs are a cost-effective way of expanding high-quality primary care to more people. Physician groups have generally been reluctant to expand the independent practice authority of non-physicians, but there has been little research either supporting or refuting their concerns.”
For Extra Credit
Kevin Stange “Reinventing Primary Care,” Health Affairs (May 2010, Vol 29, No 5). Pages 880-905 pertain to the role of nurse practitioners and physician assistants. Is There a Doctor in the House? Market Signals and Tomorrow’s Supply of Doctors, by Richard M. Scheffler.
Health policy diffusion both horizontal and vertical
cross the nation, cities have been pioneers in restricting restaurant and workplace smoking, and making it harder for children to acquire cigarettes. As a political scientist, Professor Chuck Shipan’s work seeks to understand how these policies spread—both horizontally to other cities, and vertically to states—and to draw broader implications for those interested in policy diffusion. In collaboration with Craig Volden of The Ohio State University, Shipan has conducted a number of studies on this important health policy topic. In one, he investigates whether local antismoking policies increase the likelihood of state action through a snowball effect, or decrease it through a pressure valve effect. His conclusion? In states with legislative professionalism and strong health advocacy networks, these policies do bubble up. In another study, Shipan looks at mechanisms of diffusion in the largest U.S. cities over a 25-year period. His findings: that these policies diffuse as cities learn from the experiments of early policy adopters, seek to remain competitive with other large cities in their region, emulate larger cities, and adopt policies the state favors. Where cities imitated their larger peers rather than learning from early adopters, Shipan finds that antismoking policies tend to be short-lived. But, in general, Shipan’s research demonstrates that larger cities are better able to learn from others, less fearful of economic repercussions, and less likely to rely on imitation.
Shipan has also For Extra Credit explored a little-studied subset of policy diffusion: top-down diffusion from the federal government Inside the FDA: The Business and to the states. While Politics Behind the Drugs We Take and Congress and the the Food We Eat, by Fran Hawthorne. President are known The Cigarette Century: The Rise, to shape policies Fall, and Deadly Persistence of the through legal directives Product That Defined America, by and financial incentives Allan M. Brandt. (such as federal grants for states developing The Ghost Map: The Story of London’s policies in a particular Most Terrifying Epidemic—and How legislative area), Shipan It Changed Science, Cities, and the seeks to understand if Modern World, by Steven Johnson. they can also impact state-level policies simply by sharing information. Specifically, Shipan looks at Congressional legislative hearings—the public hearings Congress holds to collect and analyze information about a specific policy topic as they consider future legislation—as well as bills submitted to Congress that do not become law. Shipan’s finding will interest federal policymakers who seek to encourage policy solutions: even federal hearings and bills that fail can inspire state-level policymakers.
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Roads to Better Health Policy
Al um ni i m pac t
Health care reform act unfolding, shifting the field This September, the U.S. Census office announced that 14.3 percent of Americans are living in poverty, and 16.7 percent (50.7 million) are uninsured. The Patient Protection and Affordable Care Act signed into law eight months ago will welcome 32 million of these to the rolls of the insured. Whether you love it or hate it, this reform is shifting the landscape of the U.S. health system. Ford School alumni with health policy expertise share their insights on the landmark changes, and talk about how these policies are impacting their work in the field.
t the base of Capitol Hill, kitty corner to the United States Botanic Gardens, sits the Office of Legislation for CMS, the Centers for Medicare and Medicaid Services. Jennifer Boulanger (MPP ’87), deputy director of that office (where she has worked on and off for more than two decades), talks about the role her staff played in the Affordable Care Act, and what they’re working on now. During the health care reform debate, the Office of Legislation was a go-to organization, supporting legislators, their staff, and Congressional committee staff members by explaining Medicare and Medicaid policies and operations, and how proposed policies could be implemented by the organization. When lawmakers shared goals they wanted to accomplish, says Boulanger, CMS worked with them to ensure that those goals could be achieved by the agency. Tim Gronniger (MPP ’04), a professional staff member for the House of Representatives Committee on Energy and Commerce, is one of the Congressional staffers who worked with Boulanger’s office. Gronniger and his colleagues in Energy and Commerce have a single charge, he explains: to make sure the priorities of the committee are carried through. For the past two years, that meant shepherding through health reform. To do this, Gronniger and other staff worked with committee members to shape policies that would expand coverage and control costs, Boulanger’s office and other agencies to craft legal language, agency representatives to make sure the proposed policies could be successfully implemented, House leadership to ensure that members of Congress were satisfied with the content, and the Congressional Budget
Office (CBO) to make sure the policies would work from a budgetary perspective. While some critics suggest that this act will run up the deficit, CBO (the non-partisan government scorekeeper) tallied the health care reform bill’s savings at $143 billion over ten years. In the second decade, the CBO predicts even more dramatic savings—between one-quarter and one-half percent of gross domestic product (GDP). “That’s a much bigger number than it may sound, says Alan Cohen (MPP ‘75), senior budget advisor for the U.S. Senate Finance Committee. “A half-percent of GDP is estimated to be approximately $1.3 trillion, so the savings should be somewhere between $650 billion and $1.3 trillion in the second decade.” Boulanger confirms the Act will achieve cost savings. After insurance reforms and coverage, the law will leverage federal health care investments to control costs and get better quality care for the people who depend on these programs. To accomplish this, the ACA has provisions that incentivize better quality care including “value based purchasing” that rewards hospitals for meeting performance standards, reducing the number of avoidable hospital readmissions, and decreasing health care-acquired infections. The ACA also establishes new tools to make CMS more nimble, including creating a center for innovation to test new payment models and other ideas. “They see Medicare as a laboratory for figuring this stuff out,” says Boulanger, who points out that over time, Medicare payment and quality innovations have been adopted by other insurers. While Boulanger and Gronniger were busy assisting elected officials during the debate and subsequent legislation, they are no less busy today. “Congress was ambitious with the
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Affordable Care Act, setting high goals within tight timeframes,” says Boulanger. “So my agency is working hard to meet those deadlines.”
rom his office in Boston, across the street from the Massachusetts State House, Áron Boros (MPP ’06), director of federal finance for the Commonwealth of Massachusetts, talks about how the ACA will impact states. Massachusetts is a national leader in Medicaid coverage—providing free or subsidized coverage for anyone whose income is less than 300 percent of the federal poverty level. However, while Boros and his peers already meet and exceed many of the regulations imposed by the newly passed health care legislation, they still have
Beyond that, Boros points out, 49 of our 50 states have a Constitutional requirement to balance the budget each year. At the federal level, the government can maintain programs when there’s a deficit, catching up when financial conditions improve, but state-run Medicaid programs can’t do that. “So states are required to either increase taxes during a recession (which no governor wants to do), or limit Medicaid enrollment, services, or provider rates (which is also a terrible idea in the middle of a recession).” It’s a tight bind for any legislator.
President Obama signs the Affordable Care Act into law, March 23, 2010 Photo: Mandel Ngan / AFP / Getty Images
Ideally, Boros would love to see the Medicaid program fully paid for by the federal government. It’s not that he’s an advocate for big government;
When an economic recession strikes, massive numbers of people lose their jobs and benefits, increasing demand for need-based health programs. Unfortunately, that’s also when state budgets take colossal hits. work to do, and he is well aware of the amount of work other states are going to need to do to conform to the new regulations. In light of all this work—being duplicated by 50 states across the nation—why does the federal government oversee the Medicare program for elderly and disabled Americans, but give states the job of managing the need-based Medicaid program? The answer eludes him. When an economic recession strikes, massive numbers of people lose their jobs and benefits, increasing demand for need-based health programs. Unfortunately, that’s also when state budgets take colossal hits. The combination of pressures forces states to limit access to health programs just when people need them most.
it’s just that he thinks the shift would allow for improved efficiency, more rational quality improvement, a reduction of administrative expenditures, and an easy way for members to retain coverage even when they move from one state to another. “It’s just a spectacular idea from start to finish,” says Boros, who would be happy to move to Baltimore if they transferred his job down there. In the meantime, however, Boros advocates for states to be fearless in their expansion of Medicaid—even now. Beyond the obvious humanitarian reasons for doing so, Boros believes there are some sound fiscal reasons, too. To explain his rationale, he cites Michigan
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Al um ni i m pac t
as an example. In the cash-strapped Wolverine State, the federal government contributes 56 cents or more for every dollar the state spends on Medicaid. “If the Michigan legislature expands Medicaid in the state, and they pay a hospital 44 cents,” posits Boros, “that hospital is going to get another 56 cents from the federal government, and they’re going to spend that money in Michigan where the state will tax it. It’s a very effective way to stimulate the state economy.” Boros is quick to praise his state’s health care leadership, noting that some fundamental elements of the federal health bill are based on experiments piloted in Massachusetts—including the requirement for everyone to buy insurance, tax code enforcement of that requirement, government subsidies for people to buy their own health insurance programs, and the Connector program, which allows people to easily compare rates and coverage. Still, Massachusetts isn’t trouble-free, says Boros, who understands that the last two years have been difficult and the upcoming year will be no different. “Like all states, we’re facing financial challenges and we’ll likely be making changes to our program,” he says. “But unlike other states, even in these hard times we’ve maintained eligibility and the vast majority of our services.”
tates aren’t the only ones trying to adapt to changing health care legislation. Carol Kim (MPP ’99), spent eight-and-a-half years working with Los Angeles County Supervisor Zev Yaroslavsky to manage the county’s $4 billion health care system—the second largest in the nation. Today, she’s working on the issue from another angle—the corporate one—as manager of communications for HealthNet Inc.
Roads to Better Health Policy
A Fortune 200 publicly traded company with $16 billion in revenue and close to 10,000 employees, HealthNet provides all kinds of insurance—including HMOs and health insurance options for military families and Medicaid and Medicare recipients. Kim chose to work with HealthNet to approach the issue of health care from another, very important side. “Health care is very much a public-private partnership, whether we want to call it that or not,” says Kim. “It’s a symbiotic relationship between government and the public and private sectors on many different levels. We’re all linked in the delivery of services.” Today, Kim is working to navigate some of the early requirements of health care reform. One of the first of those expands parental coverage options for adult children to the age of 26. HealthNet, like many other insurance companies, now has to make that adjustment, notifying millions of plan members of the change. “Everyone in the health care industry—whether they’re insurers, doctors, pharmaceutical companies, or service providers—is trying to read the crystal ball and feel our way through this, with 2014 as the goal,” says Kim. Jim Hudak (MPP ’71), chair of the Ford School Committee, is looking to the future, as well. As chief administrative officer of CRC Health, a provider of behavioral health services, Hudak appreciates what the act will do for millions of uninsured Americans, and what it will do for his company, which focuses on treating those with drug and alcohol addictions, mental health problems, and other behavioral diseases.
Beyond that, he points out, the ACA will have huge benefits for society. In the case of drug and alcohol abuse, he explains, those who don’t receive treatment can miss out on
Leveraging investments in global health
hile the 2,000-page Affordable Care Act has dramatically changed the health policy landscape in the U.S., the Obama Administration’s new Global Health Initiative (GHI) is doing the same thing overseas. Unlike the Affordable Care Act, the GHI isn’t a new law, it’s more of a new approach and a recommitment to America’s investment in international health. GHI seeks to replicate and ramp up health initiatives, like President George W. Bush’s Emergency Plan for AIDS Relief (PEPFAR) program, that have proven effective; to focus on prevention and early intervention whenever possible; to complement services provided by other corporate, multilateral, and not-for-profit organizations; and to support countries as they develop self-sustaining health systems of their own. Andrew Schroeder (MPP ’07), director of
research and analysis for Direct Relief International (DRI), sees the Global Health
Initiative’s potential to multiply the impact of international health dollars. If you’ve heard of Direct Relief lately, it’s probably been in connection with emergency supplies they sent to Pakistan, Chile, or Haiti: DRI is one of dozens of governmental and non-governmental organizations that provide medical supplies in the wake of disaster, and that’s where the press attention flies. But the majority of what DRI does won’t make the evening news—the organization’s primary work is providing regular, ongoing donations of medicines, medical supplies, and medical equipment to free and low-cost clinics in the U.S. and around the world. Antibiotics, anti-diarrheal medicines, flu vaccines, diabetic test strips, life saving medicines and supplies—DRI actively solicits donations from pharmaceutical firms and medical suppliers and delivers those materials to the health clinics that provide front-line service to some of the neediest people on the planet. That small town clinic outside of New Orleans—the one that treated hundreds of Hurricane Katrina victims in the wake of the crisis—five years after the floods they’re still getting hundreds of thousands of
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“Like almost any legislation, ACA is going to cut both ways,” Hudak says. ”For us as a provider of health services, it’s a very good thing. For us as an employer, it’s not so good.” educational and employment opportunities, can acquire medical conditions directly or indirectly related to their addiction, and can turn to criminal activities to finance their habits, harming society and driving up the costs of incarceration. In recent testimony before the California legislature, CRC Health quantified some of the benefits of early intervention: according to a UCLA study, for every $1 spent on rehabilitation, states can realize as much as $7 in cost savings down the road; according to a Rutgers University study, untreated alcoholics incur general health care costs at least 100 percent higher than those of nonalcoholics. “These aren’t theoretical benefits and it’s not a do-good-humanitarian issue,” Hudak explains. Because he’s in charge of employee benefits at CRC Health, however, Hudak also sees the ACA from the employer perspective. “Like almost any legislation, ACA is going to cut both ways,” he says. “For us as a provider of health services, it’s a very good thing. For us as an employer, it’s not so good.” Hudak’s actuaries are predicting increased health care costs next year—perhaps as much as 12 percent. Senior budget advisor for the U.S. Senate Finance Committee, Ford School alumnus Alan Cohen explains that the cost-containment measures established by the ACA are just getting started, and we’ll begin to see their effects over the next few years. While the ACA contains dozens of measures aimed at lowering health care costs,
dollars of supplies each year from DRI. That diabetes clinic in Bolivia—the one that provided essential treatment during a series of massive mudslides several years ago—DRI continues to help them improve and grow their diabetes treatment and prevention programs. That medical center in Tanzania—where women go when they’re afflicted by obstetric fistula, a condition that develops from prolonged, unassisted obstructed labor and one that creates serious health problems that can plague these women for life—DRI regularly sends them the materials they need to conduct the fairly simple surgery that allows these women to heal. Where does Schroeder fit in? As an analyst and researcher, Schroeder’s job is to identify the areas where existing health resources—provided by the market, the government, and the nonprofit sector—don’t meet the full needs of the population: the place where the gaps are, or will be, most acute. By identifying these areas, Schroeder helps DRI maximize the impact of limited resources, directing aid to the places where it will do the most good. Medical packs being organized in advance of hurricane season Photo courtesy of Direct Relief International
Cohen offers a few examples to illustrate. First, Medicare payment reforms that tackle escalating costs, he explains, should help contain employer-provided health care costs, as well, because as the single-largest insurer in the nation, Medicare sets payment trends for the entire industry. Second, insurance premiums should decrease as more and more people become insured. “Premium costs for each American family are inflated by more than $1,000 per year because those with insurance cover the medical costs of those without. As more and more people carry health insurance, that hidden tax will shrink,” says Cohen. Third, moving to a system of electronic health records, he explains, will not only improve care coordination, but will also save money for everyone involved by reducing the cost of treatment, especially duplicative tests and procedures. “There are a lot of promises that this Act will control health care costs, and I hope that’s the case,” says Hudak, “but until I see it, I’m not going to believe it.” Ultimately, Hudak is in favor of the Act, in spite of the cost. “The political process isn’t perfect,” he says. “My hope is we’ll fix it as we go forward.” Carol Kim concurs. “While the dust won’t settle for several years, there are opportunities for us to address the health care problems we’ve faced— to meet the gap. This is a very exciting time.” ■ Reactions? Predictions? We’d love to hear your thoughts about the Patient Protection and Affordable Care Act: fspp-editor@ umich.edu.
DRI’s efforts—collecting and analyzing data to identify areas of need and help fill those needs efficiently—reflect on a smaller scale another Global Health Initiative thrust, that of increasing the impact of U.S. aid by both coordinating and integrating services with other agencies and monitoring and evaluating health needs and outcomes. Some businesses put together continuous quality improvement teams. Others focus on just-in-time manufacturing. Through the Global Health Initiative, the State Department is streamlining operations to improve efficiency and accountability, and, ultimately, to save more lives.
Roads to Better Health Policy
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Stud e nts
From Ann Arbor, Michigan to the Blue Mountains of Jamaica This spring, two Ford School students traveled to Jamaica’s Blue Mountains. Their goal: to improve the efficiency and effectiveness of a free clinic run by the Blue Mountain Project.
he Blue Mountain summit is the highest in Jamaica: the mossy trail leading up to it crowded with colorful wildflowers, clusters of ferns, towering stalks of bamboo, and fragrant Eucalyptus trees. Nestled in that peak, just outside the country’s capital in Kingston, is the community of Hagley Gap. Farmers here grow Blue Mountain coffee, a gourmet crop they ship to buyers as far away as Japan. But while the coffee provides income for some residents, many others struggle to thrive in an area where unemployment can reach as high as 50 percent, close to four times the national average. To make ends meet, Hagley Gap’s residents make seasonal treks to the United States to pick apples and harvest crops. Others travel to Kingston—only 10 miles away, but a three-hour drive along serpentine, unpaved, and sometimes flooded roads—to work in factory jobs. The community’s remote location and lack of roads cause other deprivations, too: in particular, poor access to health care. That’s why five years ago, a U.S.-based non-profit, the Blue Mountain Project, began operating a volunteer clinic in Hagley Gap, adding another in nearby Penlyne Castle a few years later. Together, these clinics provide a source of basic care services for the 3,000 men, women, and children in the district. In 2007, University of Michigan medical students began partnering with the Blue Mountain Project and traveling to Hagley Gap to provide free medical services. BlueLab, an engineering student group dedicated to sustainable development, joined them later, building an environmentally
friendly biosand water filter to provide clean drinking water for the clinic first, and later solar dryers and biosand filters for farmers and schools. This spring, with funding from the school’s Gilbert S. Omenn and Martha A. Darling Health Policy Fund, Ford School students joined the cause. In May 2010, Karen Tam, a dual MPP and MBA student, led a team of six students from Students Engaged in Public Health to Hagley Gap. Their mission? To improve clinic operations and offer follow up trainings on maintaining the water filtration system. Emmanuelle Ravat-Francoise, a dual MPP and MPH student, joined Tam, focusing on resource management, including managing staff, volunteers, and medical supplies. The group began by interviewing the two part-time nurses at the clinics to evaluate patient processes, staff concerns, medical records management procedures, and inventories. They then developed simple protocols to improve clinic operations and enhance efficiency, rehearsing them with the staff. Most important was the process for working with the short term medical volunteer groups who come in to serve the community 4-6 times annually. While the medical clinics are open twice a week, staffed by the part-time nurses, they are only at full capacity when the medical students arrive. This flood of patients and volunteers puts a strain on the staff, so Tam and her team worked with them to develop a handbook they could share with volunteers, explaining inventory procedures, medical record systems, and patient protocols.
unding for the Blue Mountain service trip was provided by the Gilbert S. Omenn and Martha A. Darling Health Policy Fund, a gift that has supported the school’s health policy initiatives and outreach activities. Gilbert Omenn is professor of internal medicine, human genetics, and public health at the University of Michigan and former executive vice president for medical affairs and chief executive officer of the University’s health system. He served as deputy science advisor to President Carter, policy
associate director of the Office of Management and Budget, and a White House Fellow for the Atomic Energy Commission. Martha Darling has served in a number of public policy leadership positions throughout her career, including as senior legislative assistant to U.S. Senator Bill Bradley and a White House Fellow in the Department of Treasury. She is a member of the White House Commission on Presidential Scholars and the Ford School Committee.
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After an overnight hike, Karen Tam watched the sun rise from the peak of the Blue Mountain
Emmanuelle Ravat-Francoise taking inventory of clinic supplies
Outside the Blue Mountain Project community clinic
Below: Karen Tam at Hagley Gap’s elementary school
The Green Mountains Photo courtesy of Veronika Aasvestad
While the medical clinics are open twice a week, staffed by the part-time nurses, they are only at full capacity when the medical students arrive. This flood of patients and volunteers puts a strain on the staff. “Through the Blue Mountain Service Learning Project, I was able to put my studies into real practice to help an organization effectively use the limited resources it receives to improve the quality of health in the community,” says Tam. Not everything they did there felt like work though. Living with host families gave them a strong sense of Hagley Gap’s close knit community. While the residents of Hagley Gap struggle financially, they retain a strong sense of community, and welcome visitors warmly. Tam and RavatFrancoise picked up a few Patois phrases while in the area. “Mi glad mi go ap de blue mountain,” says Tam. “I’m excited to go up the Blue Mountain.” ■
Roads to Better Health Policy
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P hD Researc h
Roads, roadlessness, and Rotovirus in southern coastal Ecuador Jonathan Zelner, just finishing his PhD in Public Policy and Sociology, reflects on the role of social connectedness in reducing risks of disease and the implications for the development of northern coastal Ecuador.
orldwide, one billion people lack access to clean water and almost 37 percent of the world’s population lacks access to basic sanitation. Every year about two billion people contract diarrheal disease, an affliction responsible for the death of 1.5 million children annually. “Like most of the developing world, rural Ecuador is a place where gastrointestinal illness and diarrheal disease are important public health problems,” says Ford School PhD student Jonathan Zelner, “—a place where people lack clean water and proper sanitation facilities.” Zelner’s research explores how gastrointestinal disease transmission in this rural South American region has been affected by recent government-sponsored development initiatives. In 1996 the Ecuadorian government began building roads to link the southern Colombian border with the Ecuadorian coast, and in 2001 a road spanning the southern end of the Chocô rainforest near the Pacific Ocean was completed. These roads provide faster and cheaper transportation to the region and link previously remote villages to urban centers. The construction of the new roads provided something of a “natural experiment,” notes Zelner—an opportunity to better understand how rapid development impacts infectious disease transmission. Zelner has been part of a multidisciplinary team—led by Dr. Joseph Eisenberg of the Department of Epidemiology at the U-M School of Public Health—studying disease, development, and community social connectedness in that once roadless area of northern coastal Ecuador. Zelner, who also earned a graduate certificate in Complex Systems during his time at Michigan, was tapped to join the research team because of his background in mathematical modeling of ecological and epidemiological systems.
A simulation model of an infectious disease outbreak.
The hub of the region that the team studied is the town of Borbón, which lies close to the coast just north of Quito. Borbón is at the center of trade and commercial activity, and is at the heart of three river basins that flow to surrounding rural villages. The new road connections meant rapid development for some villages in the region: more trade, transportation, communication, development and resources. But it also introduced problems,
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The new road connections meant rapid development for some villages in the region: more trade, transportation, communication, development, and resources. But it also introduced problems, including resource extraction, increased social instability, and increased exposure to new pathogen strains. at developing effective, high quality water treatment and sanitation systems, which prevent exposure to gastrointestinal pathogens in the first place. The research findings are expected to help policymakers predict—and shape—the potential impacts of rapid development on rural communities.
Although densely connected social networks are more likely to facilitate person-to-person transmission of diarrheal pathogens such as Cholera, Rotavirus, and Giardia, the dangers appear to be mitigated by the positives associated with high degrees of social connectedness. Why is that? The data suggest that these villages are also better
Next, Zelner discovered that it was in the remote communities—where residents were more socially connected with friends, relatives, and families—that the risks of gastrointestinal illnesses were minimized.
First, Zelner’s research extended earlier findings from the project, showing that the villages more accessible to Borbón by road were more socially fragmented than the remote villages: more people lived alone and had very few social connections than in the villages left untouched by the new roads.
In sociological terms, the “social connectedness” of a community is determined by the network of interpersonal relationships among community members: who a person spends time with and talks about important matters with, how many close relationships a person has.
Zelner’s dissertation includes his research in Ecuador along with two other papers about social connectedness and gastrointestinal infections, and he is set to defend in December. After graduation, he will start a joint postdoctoral fellowship at Princeton University and the Research and Policy for Infectious Disease Dyanmics (RAPIDD) program at the Fogarty International Center of the National Institutes of Health. This program is focused on developing models for the transmission and evolution of infectious diseases—models that can be used to help shape and implement effective policies and interventions for controlling those diseases. ■
So which villages were more susceptible to gastrointestinal illness and diarrheal disease in the wake of the development? Zelner’s research suggests that the answer lies to a large degree in the density of social connections within the communities.
including resource extraction, increased social instability, and increased exposure to new pathogen strains. Other villages, not connected to the road system, remained remote.
Among the first people Zelner met at the U-M was the Ford School’s own Professor Carl Simon, who until last year directed the U-M Center for the Study of Complex Systems (CSCS). Zelner was drawn to the interdisciplinarity of a complex systems approach. “What complex systems does is let you take something like infectious diseases and epidemiology and cross that with sociological perspectives on health,” he says.
Roads to Better Health Policy
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Reg i o nal In si g ht
Skipping doses, splitting pills in southeastern Michigan
etro Detroit residents have made difficult decisions to weather the “Great Recession” that began in December 2007—in some cases, to the detriment of their own health. That is one of the early findings from the Michigan Recession and Recovery Survey (MRRS), conducted by the Ford School-based National Poverty Center (NPC). Researchers found a correlation between economic hardship and behaviors to prolong prescription supplies. For example, 23 percent of unemployed persons did not adhere to their medication as prescribed by their doctors, compared with just 10 percent of those still working. Taking a less potent or less frequent dosage than prescribed not only adversely affects one’s health, said NPC faculty research affiliate and assistant professor of sociology Sarah Burgard, but has been documented to raise health care costs over time. “For chronic diseases like hypertension and diabetes, consistently skipping doses or splitting pills can lead to higher blood pressure and higher blood glucose,” said Richard Wong, who visited the NPC during a summer program sponsored by the Michigan Institute for Clinical and Health Research (MICHR). The MRRS survey, first conducted in late 2009 and early 2010, included a random sample of 915 adults between the ages of 18 and 64 who reside in the Detroit Metropolitan area. The study focuses on changes in employment and unemployment, debt and assets, and hardships such as housing instability, as well as health and
Metro Detroit residents have made difficult decisions to weather the “Great Recession” that began in December 2007—in some cases, to the detriment of their own health. mental health problems. A second wave of the survey will be fielded in spring 2011; a third wave is planned for fall 2012. “Our findings illustrate how the deep recession can compound problems for people under the current health care system,” said Tedi Castelli, NPC survey research assistant. Stressors such as experiencing a layoff or falling behind on housing payments had strong correlations with nonadherence. “We’re looking at very different sorts of factors
Photo Courtesy of Dave Hogg
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than people simply forgetting or choosing not to take their medications, and that’s going to change the type of policy options we consider down the road,” Castelli said. The first round of interviews documents that many families, not just low-income families, were negatively affected by the recession. At the time of the survey, 12.3 percent of respondents were unemployed. However, 31 percent had been unemployed for at least one month since the recession began, a number that surprised NPC director and Henry J. Meyer Distinguished University Professor of Public Policy Sheldon Danziger. “I obviously knew unemployment was high. I just hadn’t realized the extent to which it was so widespread,” Danziger said.
Photo Courtesy of Tom Laundroche / Metro Photo, LLC / Leaders & Best
Research is underway to examine how respondents coped with the rising unemployment and falling housing and stock prices. For instance, 18 percent of respondents who were unemployed for at least six months since January 2007 made early withdrawals or cashed out completely from their pension or retirement plan.
Schneider, Palazzola (L-R)
David Bohnett Public Service Fellowship strengthens ties between Ford School, City of Detroit The City of Detroit offers great opportunities for emerging policy leaders eager to learn about and be involved in urban revitalization. Now the Ford School has more students who will help make it happen. Julie Schneider and Elizabeth Palazzola are the
inaugural recipients of the David Bohnett Public Service Fellowship, which will provide two years of tuition support and a summer internship in the Detroit mayor’s office.
Subsequent analyses should give researchers an idea of how many respondents were able to stay in their homes, along with other housing-related outcomes. In the 12 months prior to the survey, seven percent of respondents moved in with others to cut expenses, while 14 percent had others move in with them to reduce housing costs.
The fellowship, made possible by a generous gift from the David Bohnett Foundation, will be offered to two students per year for the next two incoming MPP classes as well. The program is the first of its kind in the Midwest, joining David Bohnett Public Service Fellowships at New York University and UCLA.
MRRS is one of the few studies being carried out across the nation that will evaluate the full range of effects of the Great Recession on workers and families. Subsequent waves of the study will examine the extent to which the American Recovery and Reinvestment Act (the 2009 stimulus) offset some of the negative effects of the economic crisis. ■
“We are excited about our partnership with the Ford School at the U-M, to help provide much needed human capital to address our urban challenges,” said Foundation Chair David Bohnett (MBA ‘80). “The students who participate in these programs have the opportunity to improve local communities and learn from significant assignments in the public sector.”
Funding for the study has been provided by the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services, the Ford Foundation, the John D. and Catherine T. MacArthur Foundation, and U-M’s Office of the Vice President for Research.
Ford School students have interned in the Detroit mayor’s office often over the past several decades, including internships sponsored by the Ford Motor Company Fund between 1994 and 2005. The Bohnett Fellowship solidifies the Ford School’s commitment to the Motor City and adds critical tuition support for the students, enabling the school to attract top graduate students who have a deep interest in urban policy and in the revitalization of Detroit.
Read more about Schneider and Palazzola: www.fordschool.umich.edu/bohnett.
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Political novice leads “tough nerd” to victory Jeffrey Barnes and Rick Snyder (L-R)
(MPP ’09) had never run a political campaign before Michigan gubernatorial candidate Rick Snyder promoted him to campaign manager in August. The choice made sense for Snyder, a technology entrepreneur running for his first public office. He wanted voters to believe that political experience is not a prerequisite for leadership—and no one demonstrates that better than Barnes, a former Army captain. eff Barnes
“Jeff’s been a great asset,” said Snyder during a campaign stop at the Fox Run retirement community in Novi. “He’s just an outstanding individual. That’s the kind of leadership we need to grow and nurture in our state.” Barnes served 10 years in the Army, with 350 soldiers under his final command in Iraq before coming to the Ford School in 2007. Two years later, he chaired the annual Ford School charity auction, raising $12,000 for Operation Homefront, which provides emergency funds to military families. Barnes finds his Army experience more relevant everyday. “You learn to use the assets that you have available and employ them in a way that will benefit the mission the most. In a political campaign it’s very much the same,” he said. “You have to use your different assets—your communications department, your finance team—and leverage their expertise in a way to make informed decisions and good recommendations to the boss.” Interns are no exception, said John Lin (BA ’10). Barnes let Lin help write the health care policy as an intern two summers ago. “He’s very inclusive,” said Lin, whom Barnes later hired as his assistant. “Even if you might be on the very bottom rung of the campaign, you still feel like you had a part in it. You’re always welcome in his office.” Barnes’ engaging personality helped him make the transition from soldier to student. “It was funny because I’d been out of the classroom for 10 years,” he said. “To come back and see the technology in place and a beautiful new building, it was hard to hold back, so I jumped in.”
The Applied Policy Seminar with professor Liz Gerber gave Barnes his first engagement in Michigan state issues. He consulted for the Detroit Regional Chamber of Commerce, evaluating the proposal for a second bridge to Canada, known as the Detroit River International Crossing Project. In the classroom, Barnes shared his experiences but did not dominate the discussion. (He served in South Korea and Bosnia-Herzegovina as well as Iraq, with two Bronze Stars among his commendations.) His classmates must have liked what they heard; they elected him to speak on their behalf at the 2009 commencement ceremony. “He had a quiet charisma, a kind of leadership quality that really made people listen to him,” said Ambassador Mel Levitsky, who had Barnes in two classes at Weill Hall. “He was not the type to continually raise his hand and talk, but when he had something to say it was always very relevant and very useful.” Levitsky expressed surprise at Barnes’s foray into state politics after he had devoted much of his Ford School experience to national security. Upon graduation, Barnes did indeed have an offer to consult for the Department of Defense. The alternative was to join the Snyder campaign, which would allow Barnes and his wife, Taryn, to stay in Ann Arbor. Taryn, also an Army veteran, is a graduate student in the Ross School of Business. “One of the most difficult things in the military is that you move in and out of communities that you never really get to call home,” said Barnes, a Newark, OH, native. “When my wife and I decided to leave the military, we wanted to be a part of the community.” A meeting with Snyder convinced Barnes his national security aspirations could wait. He helped Snyder draft his initial policy platform—known as Rick’s 10-Point Plan to Reinvent Michigan. “He helped lead our policy effort, and if you go to our website, we have the finest white papers of any candidate in the country,” boasted Snyder, who beat out Democrat Virg Bernero by nearly 600,000 votes. Barnes then transitioned to operations manager, directing the daily activities of 50 campaign staff and volunteers. Life has been a whirlwind ever since, and he’s savored every minute. “It’s fun to be in this, to be able to see this stuff take place each and every day,” Barnes said. “You really feel like you’re in a defining moment in Michigan’s history. It’s an honor and a privilege to be a part of it.” ■
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Shouts across the Diag: a Rwandan journey with ONE
ord School undergraduate student Meredith Horowski’s concern for the poor helped earn her a spot on a journey to Rwanda this past June, where she observed both stark poverty and inspiring efforts to rebound from years of genocide and war.
Horowski’s trip to Rwanda not only inspired her to become a better advocate, but also solidified international development and human rights as her career focus, she says. “As a result of this experience, I hope to be able to advocate more passionately and knowledgably for the fight against global poverty.”
Horowski, from Ludington, Michigan, also shook hands with the country’s president, Paul Kagame, at the 10th Anniversary Celebration of the National Youth Council in Amahoro National Stadium in Kigali, Rwanda.
The senior, who typically spends summers enjoying the Lake Michigan beaches near her hometown or riding her horse Kat, served the past year on the executive board of ONE’s U-M chapter. ONE is a grassroots campaign and advocacy organization backed by more than 2 million people committed to the fight against extreme poverty and preventable disease, particularly in Africa, according to the organization’s website. Cofounded by Bono and other campaigners, ONE is nonpartisan and works closely with African policymakers and activists.
While meeting the president was a special moment during her trip, Horowski’s most memorable experience in Rwanda came on her last day in the country.
That was when her fivemember group of college advocates, traveling with the anti-poverty advocacy organization ONE, met orphans of the 1994 genocide who are students at the National University of Rwanda in Butare.
Photo Courtesy of Meredith Horowski and ONE
“These students are some of the most intelligent and most dedicated I have seen. During our visit, they showed us their classrooms, dining halls, libraries, and group houses where they live together and support each other,” she recalls. At lunch they exchanged contact information and discussed everything from the World Cup to pop musician Lady Gaga. “And then on the bus ride back to drop these students off, ‘We Are the World’ came on the radio,” Horowski says. “Every one of us sang along, waving our arms in the air. I looked around that bus and saw remarkable Rwandan and American students, seated next to each other, singing of Africa’s hope. This was one of the most inspirational experiences of my life.”
“For the past year, I’ve read statistics about the 1 billion people who live on less than $1 per day, and shouted these same statistics across the Diag,” Horowski says. “As I learned, however, understanding the statistics does not remotely prepare one for encountering the reality.” She became eligible for the trip when her chapter took the top spot in ONE’s annual campus competition, the ONE Campus Challenge, a friendly competition between schools to help mobilize students to advocate on behalf of the world’s poor. Contestants rack up points by engaging in grassroots advocacy: recruiting other students to the cause, writing letters to Congress, hosting a speaker on campus, and more. The prize included a $10,000 grant that the group could donate to the charity of their choice; they chose Carolina For Kibera, an organization that fights poverty and helps prevent violence through community-based development in the Kibera section of Nairobi, Kenya, and beyond.
Health care workers train at a malaria clinic near Kigali, Rwanda
“After all our advocacy work on campus, I was eager to do more and learn more,” Horowski says. Any student at one of the top point-getting universities was eligible to apply for the trip to Rwanda. “I applied because I believe that the best advocates are those who have seen or experienced what they are advocating for first hand.” Upon arriving in Kigali, Horowski says she was struck by the city’s cleanliness and the friendliness of the people. Her week in Rwanda included field visits, meetings, and tours to provide an understanding of life in a developing country. Among the tour stops were a girls’ secondary school sponsored by the government, a genocide memorial, HIV and malaria clinics, and a coffee plantation where workers earn $1 per day. “We picked coffee cherries with local farmers and witnessed the complex washing and drying process. Coffee, as we learned, is Rwanda’s biggest export and requires much difficult labor,” Horowski says. “I will never again take my morning cup of coffee for granted,” ■
Read Meredith’s blog about her trip to Rwanda: www.one.org/campus/blog. Courtesy of Kevin Brown, University of Michigan Record Update
fac ult y
Faculty News & Awards Robert Axelrod and Scott Atran wrote an op-ed for the New York Times defending their right, as social scientists, to talk to U.S. classified terrorist organizations. The op-ed was a response to the recent Supreme Court decision, Holder vs. Humanitarian Law Project, which upheld a ban on the “material support” of foreign terrorist organizations. Material support includes talking to terrorists or the communication of expert knowledge and scientific information. A new book by
Susan M. Collins served as a session chair for the 2010 Economic Policy Symposium hosted by the Federal Reserve Bank of Kansas City in Jackson Hole, WY this August. In October, Collins co-chaired a national symposium on the future of international service, held to commemorate the 50th anniversary of the Peace Corps. Collins has also been named to the executive committee of the Association of Professional Schools of International Affairs (APSIA).
Scott Atran , Talking to the Enemy: Faith, Brotherhood, and the (Un)Making of Terrorists, is now available from HarperCollins.
Sandra Danziger and David
John Ciorciari was elected a term member of the Council on Foreign Relations, an independent, nonpartisan think tank that helps members and other interested citizens better understand foreign policy choices facing the United States. He also has a new book out from Georgetown University Press titled The Limits of Alignment: Southeast Asia and the Great Powers since 1975.
Harding were awarded funding from the Administration on Children and Families to examine the needs of several populations—low-income families with young children, low-income mothers, and former prisoners—who live within the Detroit Metropolitan area, are unemployed, and are disconnected from public assistance programs
H. Luke Shaefer, assistant professor of social work, and Sheldon Danziger received an award from the USDA to examine the effects of participation in food assistance programs on children in low-income families that have experienced job loss and divorce or separation. Danziger was also invited to deliver the keynote address at the 2010 Seoul Welfare Panel Study International Conference, held in October in Korea.
susan Dynarski and Brian Jacob
are co-principal investigators of a $5.9 million research initiative funded by the U.S. Department of Education’s Institute for Education Sciences to study the effects of the Michigan Merit Curriculum and the Michigan Promise Scholarship on student outcomes. Dynarski and Jacob will work in collaboration with researchers at the U-M and Michigan State University, as well as the Michigan Department of Education, to assess the impact of these reforms on college attendance and workplace success. Neel Hajra was selected as one of
twelve nonprofit professionals to receive an American Express-Aspen Institute Fellowship for Emerging Nonprofit Leaders. Mel Levitsky travelled to Vienna, Austria this May to attend the International Narcotics Control Board’s spring meeting. Following the meeting, Levitsky travelled to Zagreb, Croatia to meet with the Croatian Government concerning their responsibilities under international drug conventions.
Research by Sharon Maccini and Dean Yang was included in the New York Times Magazine’s ninth annual “Year in Ideas” feature. Maccini and Yang were recognized for their research on the effects of early-life rainfall on health, education, and economic well-being.
During U-M’s spring commencement address, President Obama encouraged graduates to remain committed to civic engagement and public service. In his Charge to the Classes of 2010, Michael Pan (MPP ’99), senior policy advisor to the U.S. Ambassador to the United Nations, told Ford School grads that “What ultimately sustains you in this profession is the conviction you bring into it…. Remember the boldness of your vision.”
jeffrey MacKie-Mason is the new
Carl Simon was tapped to co-
dean of the University of Michigan’s School of Information. MacKie-Mason, a Ford School alum (MPP ‘82), was a founding faculty member of the School of Information and is the Arthur W. Burks Collegiate Professor of Information and Computer Science.
chair a National Institutes of Health panel charged with studying the origins of health disparities using a complex systems approach. The 20-member panel, called the Network on Inequality, Complexity, and Health, has representatives from the health and medical fields, public policy, sociology, and computer science.
David Morse ’s first play, titled Quartet, is being performed at the University of Colorado this fall. The drama, directed by Ann Sandoe, explores the events surrounding Beethoven as he developed his late quartets. The play integrates Beethoven’s music with performances by Takács Quartet. Barry Rabe served on a National
Academy of Public Administration panel that co-authored a report for the U.S. Department of Commerce, the National Oceanic and Atmospheric Administration (NOAA), and the U.S. Congress. The report, “Building Strong for Tomorrow: NOAA Climate Service,” makes recommendations for the creation of a Climate Service line within NOAA. A new book edited by Rabe, Greenhouse Governance: Addressing Climate Change in America features a number of America’s preeminent public policy scholars examining some aspect of governance and climate change.
Robert Stern co-edited a new book, The Japanese Economy in Retrospect, published by World Scientific. The book, presented in two volumes, contains selected papers by Gary Saxonhouse. Saxonhouse, considered a leading expert on the Japanese economy, was a University of Michigan faculty member in the Department of Economics until his death in 2006, following a battle with leukemia. Carrie Walling and Susan Waltz
hosted a research conference, “Human Rights: From Practice to Policy,” this October. The conference focused on the role of the international human rights movement in developing what have become core concepts, norms, and methodologies of human rights research and advocacy. Participants included a select group of scholars and international practitioners with a wide range of experience in the international human rights movement.
Student Service Day Students volunteered at local nonprofits Growing Hope and Food Gatherers at annual fall Service Day.
Quidditch, anyone? BA student Emily Byl is the founder of U-M’s “muggle” Quidditch Team, a terrestrial sport adapted from JK Rowling’s Harry Potter novels. Photo courtesy of Ariel Bond/The Michigan Daily
Two new faces join the faculty
Associate Professor David Harding has been an assistant professor of sociology at the University of Michigan since 2006. Harding retains his sociology appointment along with his affiliations at the University’s Institute for Social Reseach. Harding’s research interests lie in inequality, poverty, urban studies, race, and qualitative and quantitative methodology. Assistant Professor Ashley Langer ’s research interests include environmental economics, energy economics, and industrial organization. Langer comes to the University as part of an effort to grow the University’s faculty expertise in energy and the social sciences. She received her PhD in economics from the University of California, Berkeley.
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alum n i
Class Notes Arthur Johnson III , MPA ’52, retired in 1992 after serving as Assistant Director of Budget and Finance for a Toledo, Ohio, agency managing programs such as Head Start. He previously held two city manager positions in Illinois and was city auditor (CFO) of Toledo for three years.
Susan McLaughlin , MPP ’93, has
Walter Braunohler , MPP ’02, and his
been appointed a Senior Policy Advisor in the Markets Group at the New York Federal Reserve. She will be focusing on lender of last resort and related crisismanagement issues.
wife, Loren, are happy to announce the birth of their first son, Logan Reece, in July. The family will be moving from Washington, DC, to Bangkok, Thailand, for new assignments with the U.S. State Department.
Michael Green , MPP ’93, is Executive
enjoying life in Korea as an Emeritus Professor and recently published the third edition of Administrative Ethics.
Director at the Center for Environmental Health. He and his wife, Melanie, married in New Orleans seven months after Hurricane Katrina and have two children, Dylan, 3, and Juliette, 1.
Aaron Adams , MPP ’03, is an Operations Analyst for the U.S. Department of Treasury in the Office of Financial Stability in Washington, DC.
Alan Miller , MPP/JD ‘74, is proud of
John Kaczor , MPP ’95, started his own
his daughter, Joanna, who is now a freshman in U-M’s College of Music, Theatre, and Dance.
consulting firm, Municipal Analytics, earlier this year to provide financial analysis and decision-making support to local government officials. His oldest son, Noah, is now a high school senior and hopes to study art and marketing at U-M next fall.
founding executive director for Education Trust-Michigan, the Midwestern affiliate of the Washington DC-based Education Trust, which addresses the urban-suburban student achievement gap. She is hiring staff with a wide range of career experience in the coming months, and would love to hear from interested Ford Schoolers at aarellano@edtrustmichigan. org.
Jong-Hae Yoo , MPA ’65, PhD ’68, is
Joel B. Smith , MPP ‘82, has been selected by the Intergovernmental Panel on Climate Change to be a coordinating lead author for the IPCC’s Fifth Assessment Report. He will address the North America chapter of the “Impacts, Adaptation and Vulnerability” report. He contributed in a similar capacity to the Third and Fourth Assessment Reports in 2001 and 2007, respectively.
As of press time, Steve Moss , MPP ’85, was running for the San Francisco Board of Supervisors, with the election to be held in November. His web site is www. mossfordistrict10.com. Laura Walter Perna , MPP ’92, has
been promoted to Professor at the University of Pennsylvania, where she also received the 2010 Christian R. and Mary F. Lindback Foundation Award for Distinguished Teaching.
Sophia Drossos , MPP ’97, has taken a
new position on the Global Macro and Asset Allocation team at Morgan Stanley Investment Management. She was previously Morgan Stanley’s Co-Head of Global Currency Strategy. Carol Kim , MPP ’99, recently joined Health Net, Inc., as a Manager in Corporate Communications and Public Affairs. For more than eight years she had served as the health care policy advisor to Los Angeles County Supervisor Zev Yaroslavsky. Michael Chapnick , MPA ’00, recently left the U.S. Trade Development Agency to rejoin the Asia-Pacific Economic Cooperation (APEC) Secretariat in Singapore as Director of Communications and Public Affairs.
Class of 20?? Pictured are Ellery Violet Engle and Leor Yakira Adelsky (L-R)
Amber Arellano , MPP ’03, is the
Philip Maxwell , MPP ’03, JD ’05, married the former Christine Donaldson in St. Louis, MO, on March 6, 2010. Fellow Ford alums Brian Pappas and Stuart Heiser were in attendance. A U.S. Army JAG officer, Philip has been assigned to Seoul, South Korea, where he handles Operational Law for the UN Command/ U.S. Forces Korea (USFK). Bulbul Gupta , MPP ’04, recently relocated to Boston, where her husband, Aman, is now the CFO for Sonos.com. Bulbul will continue working for The Asia Foundation remotely, and is looking forward to welcoming a baby into the family in 2011.
Eric Hesse , MPP ’06, was named to the “Top 40 Under 40” list by Mass Transit, the only magazine dedicated to public transportation. Eric works for TriMet, the public transportation service in Portland, Oregon.
Jon Hill , BA ’10, is a Research Fellow at the Harvard Kennedy School. His work on evidence based international development has allowed him to spend significant time in Lahore, Pakistan, and northern Columbia.
Nate Engle , MPP ’07, PhD ’10 (SNRE),
Jonathan Newman , BA ’10, has started his first year at the University of Pennsylvania Law School.
and Sarah (Haradon) Engle , MPP ’07, welcomed their daughter, Ellery Violet Engle, into the world on June 18, 2010. The family also recently moved to the Washington, DC, area. Brian Tremblay , MPP ’07, married Connie Elliott in 2008, had baby girl Ellie in 2009, moved to Berkeley and bought a house in 2010, and was promoted to Senior Analyst, International Affairs and Trade, GAO in 2010. Brian was working in Haiti when the earthquake hit earlier this year. John Chin , MPP ’08, started to pursue his doctorate in Politics from Princeton University this fall. He spent the past two years as an International Affairs Analyst at the Congressional Budget Office in Washington, DC. Sol Adelsky , MPP ‘08, and his wife,
Dina (BA, MA from U-M ‘07), are happy to announce the birth of their first child, a little girl, Leor Yakira. She was born on July 30, 2010. They currently live in Providence, RI, where Sol is a secondyear medical student at Brown. Abigail Newcomer , MPP ’09, moved to
Washington, DC, in March to join the Center for Law and Social Policy (CLASP). She is a policy analyst working on income and work support issues. Jonathan Shepard , MPP ’09, recently
joined USAID as an evaluation specialist in its new Office of Learning, Evaluation, and Research. His documentary chronicling the plight of chicken farmers in the southern U.S., The Share Croppers, is being screened at eight film festivals. The film’s website is thesharecroppers.blogspot.com.
Gareth Collins , BA ’10, received a
two-year teaching fellowship through Princeton in Asia to work for an education non-profit operating in China’s southwest Yunnan province. The nonprofit, China Education Initiative, specializes in closing the achievement gap between rural and urban schools using a model based on Teach for America. Greg Mandelman , MPP ’10, has joined Pacific Gas and Electric Company (PG&E) as a Senior Regulatory Analyst in San Francisco, where he is working alongside
three 2008 Ford School alums—Jomo Thorne (MPP/MBA ‘08), Brooke Reilly
(MPP/MBA ‘08), and Sara Margaret Gilbert (MPP ‘08). Greg will be leading
portfolio optimization and evaluation for the firm’s Demand Response programs.
In Memoriam Dana Tindall , MPP ‘85, 48, died in a plane crash with her beloved daughter Corey, 16, on August 9.
As one of Alaska’s most influential businesswomen and public policy leaders, and as a remarkable mother, wife, friend, artist, and leader, Dana Tindall had a profound impact on the people she touched and the issues she championed. A visionary and brilliant advocate, she shaped Alaska’s telecommunications policies and structure for decades. Dana graduated from the University of Michigan, where she earned a BA in Economics with High Distinction, a master’s degree in Public Policy, and many honors. She is survived by her husband, Virgil Peachey, her son Connor Tindall, her parents, Grant and Sandra Russell, her sister, Linda Steidtmann, her brother, Ryan Russell, and nieces and nephews. Photo courtesy of GCI
Harold Ford, Jr., chairman of the Democratic Leadership Council and former member of Congress, shared his thoughts about the future of bipartisanship. He was accompanied to the Ford School by Sandy Weill (background.)
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The Last Wo rd
Bullish on Michigan A Conversation with Tom Ivacko (MPA ’93) from the Center for Local, State, and Urban Policy (CLOSUP)
LOSUP Program Manager Tom Ivacko played a key role in designing and implementing the center’s Michigan Public Policy Survey (MPPS)—an innovative effort to query elected and appointed officials from every jurisdiction in Michigan. Tom spoke with State & Hill about the survey and prospects for the Next Great Michigan. S&H: What’s been learned lately from the MPPS? TI: Our most recent report was on “economic gardening”—a relatively new concept in economic development that is picking up steam here in Michigan. The idea is that cities can nurture existing local businesses, rather than simply hunt for new ones with tax incentives and so forth. We asked city and county officials whether they were doing things like fostering networks among business leaders, developing infrastructure, or providing market information to existing businesses.
instead of extending a housing subdivision, suddenly there’s an industrial site right next to it, polluting the subdivision— that’s not effective, sound policy. S&H: You’ve involved external partners with the MPPS. Why? TI: Bringing academic research to bear on the real world has been a key goal for us. Well before we launched, we went to the Michigan Association of Counties, the Michigan Municipal League, and the Michigan Townships Association. We asked them to be involved from the beginning—so that it wouldn’t be just “the ivory tower” asking what we thought were interesting questions. We’ve gone even further now and convened advisory panels of stakeholders on upcoming waves of the survey. We want to make sure that the survey design and the questions asked are relevant, so that when we come out with the results, they’re useful and actionable and won’t just sit on the shelf.
It turns out that there’s more of it happening and more support for it than we would have expected.
S&H: You’re a Michigan lifer (and a loyal fan of the
S&H: Is that a good thing?
TI: You know, I am really bullish on the state of Michigan! I think that the future is bright for the state. It’s going to be a slog before that unfolds, although some experts think we may have already hit the bottom. I think we’re close, and when the national economy picks up steam, then Michigan will finally start to grow.
TI: Economic development is probably most effective as a basket approach where you want to incorporate lots of strategies. Yes, you have to “hunt”—everyone else is doing it and you can’t not be in that game. But economic gardening seems to really work, in part because entrepreneurs who are in your community now want to be there, so it makes sense to build on that spirit. S&H: What’s next for the survey? TI: The next wave will focus on intergovernmental cooperation—one of the really hot policy domains facing the state. For local officials, cost-savings are far and away the biggest motivator for cooperating: nobody wants to raise taxes, and budgets have been tight for a long time, so the cuts that are coming up next would represent serious service cuts. So what other options are there? One is to cooperate with neighboring jurisdictions to reduce redundancies.
But saving money isn’t the only motivation. It could also be about providing a service that you couldn’t do on your own, such as economic development, a regional parks system, or a library system. Or, it could be a route to better policy: if each little jurisdiction is doing its own land use planning, for example, you could hit the boundary and
Wolverines). Where do you see Michigan in 10 years?
Michigan has always been a boom and bust state. If you go all the way back to the very first economy based on animal pelts—furs were a massive resource! But the trappers became so successful that they depleted the reserves. It was the same thing later with timber. Both times, people thought the boom would last forever. Agriculture boomed next, but technology led to employment declines in that sector. And of course now we’re living in a post-industrial bust. But there’s an incredible amount of activity across the state from talented, committed people who are laying the framework for our economic future. I really think—and I don’t know when—that the state will bounce back and we’ll see the Next Great Michigan. The talent of the Ford School students is one of the things that make me optimistic. I hope we can find a way to keep more of them around after graduation. ■
To learn more about the MPPS, visit www.closup.umich.edu.
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What do Amnesty International, the U.S. Government Accountability Office, the City of Warren, Michigan, and the Safer Pest Control Project have in common?
A: They put the skills of Ford School graduate students to work. Could your organization use the analytic, problem-solving, and communication skills of top-notch MPP students? We are currently accepting project proposals for our Fall 2011 Applied Policy Seminar (APS). The APS enables our MPP students to serve as consultants to real-world policy organizations, developing key professional skills as they tackle significant policy challenges in the public, private, or non-profit sectors. For more information, contact Tom Phillips, Associate Director of Graduate Career Services, at 734-615-6454 or email@example.com.
Ford School Annual Fund The Ford School is a leader in professional education, research, and public service. Be a leader, support the Annual Fund. To find out more about the Annual Fund and other giving opportunities, please contact the Alumni Relations and Development Office. 734-615-3892 or visit www.fordschool.umich.edu/giving
Joan and Sanford Weill Hall 735 S. State Street Ann Arbor, MI 48109-3091
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Twitter: Follow us on Twitter to get brief, real-time updates on news and information. Video Library: Visit our new video library for public lectures, faculty research news segments, and more.