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E R A C H T L A HE

SOLVING PUZZLE the

Racism and Health Reducing Dementia Risk Media Messaging and Firearms

In pursuit of universal, quality, affordable, and equitable care, the Fielding School is leading the way.


DEAN’S MESSAGE

MUCH OF OUR WORK IN PUBLIC HEALTH is devoted to keeping people from getting sick through health promotion and disease prevention strategies. But all of us will, at some point, experience an illness or injury that requires medical attention or hospitalization. In addition, a key element of prevention involves regular visits to a health care provider for important vaccines and disease screenings, monitoring and counseling on risk factors, and keeping chronic conditions under control, to name only a few. Thus, ensuring that everyone has access to affordable, quality, and timely health care is a vital role of public health. Unfortunately, too many people don’t get the health care they need, and whether they do depends to a great extent on factors such as income, education, race, ethnicity, and immigration status. Faced with this continuing challenge, public health can and must advance policies and practices that contribute to more equitable and effective health care systems. This issue of our magazine includes examples of the many ways in which the Fielding School is leading on these issues, building on a long tradition. FSPH’s UCLA Center for Health Policy Research (CHPR) is an essential resource for legislators and advocates seeking to improve health care access and quality, and for its analysis on the impact of proposed reforms; the center’s California Health Interview Survey, conceived and developed by the center’s founding director, the late E. Richard Brown, with current CHPR director Ninez Ponce, is routinely relied on to inform policies that have made California a national leader in expanding access to important health services. For decades, the Fielding School’s Department of Health Policy and Management has served as an invaluable partner for health care leaders — particularly in Southern California, where a number of the most dynamic and innovative health care organizations are based. So many of these leaders, in fact, are Fielding School alumni. The relationship between our school and health care management practitioners will only deepen with the recent establishment of FSPH’s Center for Healthcare Management, under the leadership of Laura Erskine and Leah Vriesman, and the newly established Paul Torrens Chair in Healthcare Management. This new center and endowed chair were made possible by the Sinaiko Innovation Fund for Healthcare Management, a gift from Richard and Patricia Sinaiko, and Greg and Marcie Sinaiko; and the Don S. Levin Trust and Edna and Tom Gordon, respectively. The new center and endowed faculty chair reflect the desire of California health care management leaders to not only give back to a school that has contributed to their profession, but to enhance the Fielding School’s ability to generate new knowledge and produce new generations of leaders for years to come. Whether we are academics or practitioners, we were all drawn to public health by the desire to contribute to the mission of improving the lives of countless people we may never meet through research, education, policies, and practices that result in better health. By continuing to lead the fight for health care access, quality, and affordability, the Fielding School is fulfilling a critical part of that mission.

Ron Brookmeyer, PhD Interim Dean


The UCLA Fielding School of Public Health Magazine

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CONTENTS 14

04

16

25

FEATURES

HEALTH CARE 04 Q&A Gerald Kominski on the U.S. health care system’s future 07 The Road to Better Primary Health Care Lessons from Brazil 08 State of Progress California bucks the trend 10 Left Behind Coverage gaps for Latinos 11 Health Essentials Documenting nursing’s role 12 Managing Partners FSPH’s new center advances health care management

13 Making the Connections New chair honors Torrens 14 Caring for All Communities Alum helps to build diverse health care workforce 16 Screen Test Preventing colorectal cancer in low-income populations 18 Prescriptive Paths Why these students and alums chose health care 21 Safe at Home In support of long-term care 22 Dose of Reality Countering vaccine myths

ADDRESSING DISCRIMINATION

23 A ‘Direct Threat to Health Equity’ New book explains how practitioners can address racism

REDUCING DEMENTIA RISK

MEDIA MESSAGING & FIREARMS

HEALTHY STORYTELLING

DEPARTMENTS 27 School Work 30 Grants & Contracts 32 Transformative Investments

24 Cognitive Pension Study suggests participation in the labor force may help women in later life 25 Unintended Consequences In wake of mass shootings, gun control coverage in news linked to rise in gun sales

Visit us online: ph.ucla.edu

26 Dramatic Improvement Assessing a popular TV series’ effect on health behaviors

PHOTOGRAPHY & ILLUSTRATION Kailah Ogawa: cover. Jane Houle Photography: Dean’s Message. iStockPhoto/San Giorgio: TOC: health jar; p. 4. Cazzie Burns: TOC: group photo; p. 15. NYU Tandon: Althea Labre, Shinnosuke Nakayama, Maurizio Porfiri: TOC: origami gun; p. 25. 123rf © Oksana Mironova: pp. 2-3. iStockPhoto/Niyazz: p. 7: stethoscope with Brazilian flag. Lisa Rau: p. 7: Macinko. Unsplash/Wil Stewart: p. 9. iStockPhoto/Juan Estey: p. 10. iStockPhoto/Martin Barraud: p. 11: nurse with chart. Owen Lei: p. 11: Needleman. Rawpixel © 123RF: p. 12. iStockPhoto/Fat Camera: p. 22. Abduallahi Abdulgader: p. 23: book. iStockPhoto/Serts: p. 24: construction worker. Noun Project/Pham Thanh Loc: p. 24: brain icon. Vincent Bloch: p. 26. Todd Cheney, UCLA Photography: p. 29. Alexandra Foley: p. 32. iStockPhoto/Orbon Alija: inside back cover. Margaret Molloy: back cover. COURTESY OF: Northeast Valley Health Corporation: TOC: health care provider with patient; p. 16. Gerald Kominski, UCLA Fielding School of Public Health: p. 5. Dr. Paul Torrens, UCLA Fielding School of Public Health: p. 13. UCLA Kaiser Permanente Center for Health Equity: p. 17. Sebastian Ramirez: p. 18: Ramirez. Michelle Keller: p. 18: Keller. Erik Coll: p. 19: Coll. Isomi Miake-Lye: p. 19: Miake-Lye. Petra Rasmussen: p. 20: Rasmussen. Hiroshi Gotanda: p. 20: Gotanda. United Domestic Workers of America: p. 21. Chandra Ford: p. 23: Ford. Elizabeth Yzquierdo, Alina Dorian, and Ninez Ponce: p. 27.

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HEALTH CARE The United States is among the world’s wealthiest countries, and the biggest health care spender, by far — an average of about $11,000 per person annually. But it’s hard to argue that we’re getting our money’s worth. In the 2019 Bloomberg Healthiest Country Index, the U.S. ranked 35th. In a nation that devotes approximately 18% of its GDP to health care — other high-income countries average 11.5% — an estimated 27.5 million people in the U.S. lack health insurance, leading many to skip regular visits to the doctor for health maintenance, preventive screenings, and control of chronic conditions. Among adults with insurance, more than a quarter are underinsured, with high deductibles and out-ofpocket medical expenses relative to their income, which raises the likelihood that they, too, won’t obtain important health services or fill needed drug prescriptions. A nation with some of the world’s most advanced medical technology remains an outlier among high-income countries in not providing universal health care. This issue of the Fielding School’s Public Health Magazine illustrates the wide-ranging ways in which Fielding School faculty, students, staff, and alumni are addressing a core public health concern — ensuring that quality health care is accessible, affordable, and equitable. From the FSPH experts who are shaping health care policies and health care systems to the students and recent graduates poised to parlay their FSPH education into future leadership roles, the Fielding School is on the front lines in bringing about change locally, statewide, and nationally so that everyone receives the care that can advance their health.

MAGAZINE STAFF Ron Brookmeyer, PhD Interim Dean

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Carla Denly Executive Editor & Asst. Dean for Communications

UCLA Fielding School of Public Health Website: ph.ucla.edu Manage Your Subscription: ph.ucla.edu/subscriptions

Dan Gordon Editor & Writer

Follow the Fielding School on Social Media: @UCLAFSPH

Rent Control Creative Design Direction

UCLA Public Health magazine is published by the UCLA Fielding School of Public Health for the alumni, faculty, students, staff, and friends of the school. Copyright 2019 by The Regents of the University of California. Permission to reprint any portion must be obtained from the school. Please send requests to communications@ph.ucla.edu.

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EDITORIAL BOARD Haroutune K. Armenian, MD, DrPH Professor in Residence, Epidemiology; Thomas R. Belin, PhD Professor, Biostatistics; Pamina Gorbach, DrPH Professor, Epidemiology; Moira Inkelas, PhD Associate Professor, Health Policy and Management; Marjorie Kagawa-Singer, PhD, MN Professor Emerita, Community Health Sciences; Cathy Lang, PhD Director for Research Administration; Adjunct Assistant Professor, Community Health Sciences; Michael Prelip, DPA Professor and Chair, Community Health Sciences; Beate Ritz, PhD Professor, Epidemiology and Environmental Health Sciences; May C. Wang, DrPH Professor, Community Health Sciences; Elizabeth Yzquierdo, EdD Assistant Dean for Student Affairs; Adjunct Assistant Professor, Community Health Sciences; Zuo-Feng Zhang, MD, PhD Associate Dean for Research; Professor, Epidemiology; Yifang Zhu, PhD Associate Dean for Academic Programs; Professor, Environmental Health Sciences; Frederick Zimmerman, PhD Professor, Health Policy and Management; Lori S. Pelliccioni, JD, MPH '96, PhD '02 President, Public Health Alumni Association

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HEALTH CARE

The Future of the U.S. Health Care System With a presidential election looming and the nation’s framework for health care at a crossroads, Fielding School professor Gerald Kominski assesses the possibilities.

ENACTMENT IN 2010 of the Patient Protection and Affordable Care Act, otherwise known as the Affordable Care Act (ACA) or Obamacare, represented a significant milestone in the effort to expand health coverage. But against the backdrop of political and legal challenges, the future contours of the U.S. health care system are far from settled. Gerald Kominski, a leading expert on health care policy, economics, and reform, has spent much of the last decade studying the expected and actual impacts of the ACA. Kominski, a professor in the Fielding School’s Department of Health Policy and Management and senior fellow at FSPH's UCLA Center for Health Policy Research, spoke with FSPH’s Public Health Magazine about the state of the U.S. health care system and the future directions currently under discussion. Q: From a public health perspective, what should be the goals of a national health system? A: The ideal health system provides high-quality care in a timely manner, in an equitable fashion, and in a way that is cost-effective — not necessarily at the lowest cost, but the lowest cost given all of the other objectives that we’re trying to achieve. We have to ensure that cutting costs doesn’t result in poorer quality or poorer access. Q: In what ways has the U.S. failed to meet these objectives? A: No country is ideal in all of those dimensions, but in the U.S., we certainly fall short on the issue of equity of access to health care. Despite the achievements of the Affordable Care Act, nearly 30 million Americans remain without health insurance. And we know from numerous studies over the last several decades

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that having access to insurance improves access to health care, and ultimately improves health. Our nation also does poorly on the issue of cost. We spend more than any other country on health care, both per capita and as a percentage of GDP — and yet, we are far from being the healthiest country. We have access issues, and although we have some of the highest quality of care in the world, it’s not equitably distributed. Additionally, our system is fragmented both in how we provide coverage and how people get health care. The employmentbased insurance system serves the majority of Americans and their families, and for the most part it serves them relatively well, although there are issues in that system. We have two large public insurance programs, Medicare and Medicaid. And we now have the ACA for people who fall through the cracks — those who don’t qualify for these public programs and can’t get insurance through their job. But the way those systems pay for health care varies, and our health system performs differently depending on the insurance card you have in your wallet. Q: What has been the impact of the Affordable Care Act? A: The Affordable Care Act [ACA] is the second most important piece of health legislation that’s been enacted in the last 60 years, after the Medicare and Medicaid programs in 1965. It’s been very successful in providing a safety net, filling in the gaps in our current system. Millions of Americans who were employed but didn’t have health insurance through their place of employment can now obtain health insurance through the ACA. Millions more have benefited from the expansion

of Medicaid to include everyone under 139% of the federal poverty level, which works out to approximately $16,750 for an individual, or about $34,640 for a family of four. In that regard, the ACA has been a major success in providing health insurance coverage to approximately 15 million Americans who didn’t have it, and has made health insurance more affordable for some who previously had it, because of the subsidies or the expansion of Medicaid. The major shortcomings are that the Medicaid expansion became voluntary rather than mandatory for states because of the initial U.S. Supreme Court challenge to the law, and as a result, today 14 states have not expanded their Medicaid programs, despite the availability of significant federal funding to subsidize those expansions. But even if those 14 states tomorrow agreed to expand their Medicaid programs, approximately 25 million Americans would remain uninsured because they don’t qualify for benefits under the ACA or the other programs that provide coverage. So the Affordable Care Act was a major step in the right direction, but it was never intended to provide universal coverage, and that is where we stand today. Q: What could make the ACA more effective? A: There are several avenues for strengthening the ACA. States like California run their own marketplaces — in our case, Covered California functions well as an active purchaser, providing health insurance for approximately 1.2 million Californians. Operationally, that means we have an infrastructure and a mechanism for building upon it. The ACA has been effective because of the federal tax dollars flowing to the states to either expand their Medicaid programs

“We spend more than any other country on health care … and yet, we are far from being the healthiest country.”

GERALD KOMINSKI

or provide subsidies for people above Medicaid eligibility to buy insurance in the exchanges. Those subsidies could be made more generous, and could be made available without any limit on income. Currently the limit is four times the federal poverty level; you could lift that cap and say we’re going to make subsidies available to any family that qualifies, regardless of income. But the most important step to take in terms of building on the ACA would be to identify some default mechanism that would enroll everyone unless they opted out. This is the only way we’re going to get to universal coverage in the United States — ensuring that if you don’t have any other form of insurance, you are automatically enrolled unless you choose not to. Q: Why is that so important? A: Millions of Americans who qualify for benefits under the ACA

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have not enrolled. It’s easy for people to sit on the sidelines and say, “I’ve been healthy for a while; maybe I can go without health insurance right now, save on premiums and take my chances.” The problem is that if those individuals do get sick, they can’t immediately buy a policy, and if they’re hospitalized, they can’t afford the cost and that gets spread across everyone with insurance. Q: What would be the impact of Medicare for All and other alternative proposals currently being advanced? A: There are a couple of variations on that theme. The Medicare for All approach proposed by Senator Bernie Sanders places everyone in a new Medicare program — not the existing Medicare program — that is more comprehensive than any insurance that’s currently offered. Everything is covered without any copayments or deductibles, and it’s publicly financed. “Medicare for All Who Want It” is the idea of a Medicare

universal coverage. Again, unless there is a default requirement or a default assignment in the bill, we won’t get to true universal coverage, but these proposals go much further than where we are today in terms of covering the entire U.S. population. Q: Critics of Medicare for All have argued that it is too expensive. Can such a system be affordable? A: Based on figures that are available from the U.S. Department of Health and Human Services, we are expected to spend $45 to $47 trillion over the next decade on health care in this country. So the real question is, how does total health care spending under a comprehensive system like Medicare for All compare with what we’re going to spend anyway? Several studies have looked at this, and have concluded that overall spending would be lower. But that does come at a political cost. For one, this becomes the sole source of insurance, and for people with

“The main advantage [of a single-payer system] is that … you remove the incentive to select patients based on the profitability of the insurance that they have.” buy-in. Other proposals would create a separate new public insurance option that would be available, for example, through the insurance exchanges under the Affordable Care Act, and would compete with the private insurance currently available through the state exchanges. All of these options would go a long way toward getting us to 6

employment-based insurance who are accustomed to having a choice of insurers, that might feel like something is being taken away. The other significant political barrier is that the system would be totally publicly financed and managed. Depending on your political beliefs, that either is not a problem, or is a serious problem.

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Q: What direction do you expect the U.S. health care system to take if opponents of the ACA and Medicare for All prevail? A: We have been hearing “repeal and replace” since as early as a month after enactment of the ACA. There were two bills that Republicans introduced and could not get passed during 2017. If we use those as an indication of where the party might go in the future, there appears to be some recognition that providing protections for people with preexisting conditions is an important issue across the political spectrum, as well as acknowledgement that subsidies are necessary to help people afford insurance in the private market. Some Republicans have stated that the subsidies can be much smaller, and that they should not be tied to income. A flat subsidy — a tax credit — would be available to anybody, as opposed to treating people differently based on their economic need. Q: Many in public health have advocated for a system such as Medicare for All in which all health care is financed by the same source — a single-payer system. What are the merits of such a system? A: The main advantage is that because everyone is in the same system — providers as well as the population — you remove the incentive to select patients based on the profitability of the insurance that they have. It gives government the authority not only to set prices, but to control the rate of growth in health care spending in a much more direct way than it does today. Medicare has been doing this for decades, successfully, and that is what most other countries do to keep their health care spending from growing as rapidly as ours has.


HEALTH CARE

the world’s best-documented success stories of nationally scaling access to primary health care,” says James Macinko, an FSPH professor of health policy and management and community health sciences. “It has become a reference for the world.” In the FHS, all health services are public, freely available, close to home, and based on a strong primary care orientation. Comprehensive care is provided by multidisciplinary community-based health teams, each of which includes a physician, nurse, and several community health workers who make monthly home visits. Macinko began studying the impact of Brazil’s FHS in 2002, and has conducted research in partnership with local Brazilian universities and health authorities ever since; two FSPH doctoral students, Natalia Woolley and Brayan Seixas, are currently conducting their own studies on Brazil under his mentorship. Macinko and his Brazilian colleagues have focused on outcomes that are particularly indicative of primary health care’s impact. Their research, published in The Lancet and other ven-

THE ROAD TO BETTER PRIMARY HEALTH CARE

ues, has concluded, among other things, that the FHS has resulted in lower infant mortality rates, fewer deaths from heart disease and stroke, lower rates of avoidable hospitalizations, and enhanced equity in access to care and health outcomes. For all of its success, the SUS is now at a crossroads, with Brazil introducing austerity measures in 2016 to freeze increases in health and education spending for the next 20 years in spite of the proven cost-effectiveness of the system. Such a move would likely cripple the continued expansion of the Family Health Strategy, which currently covers 130 million people, or 63% of

Research by an FSPH professor concludes we can learn much from Brazil.

AS THE U.S. GRAPPLES with how to achieve

the population. Macinko notes that the poten-

universal access to quality primary health care, a

tial cutbacks are particularly ominous at a time

Fielding School faculty member who has studied

when Brazil has one of the world’s most rapidly

the experience of Brazil suggests there is much to

aging populations, and remains among the most

be learned from Latin America’s largest country.

unequal societies. “The SUS has provided ser-

In 1988, as part of its return to democracy,

vices for people who had very little, and austerity

Brazil enshrined in its constitution the notion that

is cutting many of these benefits,” says Macinko,

health care is a universal right and state respon-

who is working with his Brazilian colleagues on

sibility. Two years later, the government estab-

studies projecting the impacts of the austerity

lished a national health system known as the

measures, both on the general population and on

Sistema Único de Saúde (SUS), anchored by what

a cohort of aging Brazilians.

came to be known as the Family Health Strategy

JAMES MACINKO

Although its future is uncertain, the SUS con-

(FHS). The FHS was pilot-tested beginning in the

tinues to serve as an important model for other

mid-1990s and expanded nationwide by the end

countries. “In the U.S., we have a very fragmented

of the decade.

health system with a weak primary care orienta-

Over the next two decades, a nation with

tion,” Macinko says. “Brazil’s experience, while far

relatively limited economic resources and mas-

from perfect, is a testament to how a system with

sive inequalities experienced remarkable results.

a strong primary care focus can be cost-effective,

“The Family Health Strategy in Brazil is one of

efficient, and equitable.” ph.ucla.edu

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HEALTH CARE

S TAT E OF PROGRESS As California continues to counter the national trend by seeking new ways to expand health insurance coverage and benefits, the Fielding School serves as an invaluable resource.

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THE PERCENTAGE OF PEOPLE IN THE UNITED STATES without health insurance rose from 7.9 in 2017 to 8.5 in 2018 — the first year-to-year increase since 2009, just before the Patient Protection and Affordable Care Act (ACA) became law. But at a time when the ACA has been weakened federally, California has bucked the national trend. Between 2013 and 2018, the uninsured rate for Californians under age 65 was nearly halved, according to a recent analysis by FSPH’s UCLA Center for Health Policy Research (CHPR), which noted that despite the national increase in 2018, the state’s uninsured rate remained at a historic low. That’s thanks to bold steps taken by California lawmakers. Among other things, the most recent state budget included funding to increase the subsidies in Covered California (the health insurance exchange established by the ACA), making health insurance more affordable for a wider swath of the population. California also became the first state to extend Medicaid coverage to undocumented young adults, building on legislation from 2016 that made undocumented immigrant children Medicaid-eligible. “These are significant initiatives to stabilize the ACA and expand coverage in the absence of federal support,” says Gerald Kominski, FSPH professor of health policy and management and a senior fellow at CHPR. In these and other efforts by the state to expand health insurance coverage and benefits, the Fielding School has been a vital resource. During the run-up to ACA implementation, Kominski worked with colleagues at UC Berkeley to create the California Simulation of Insurance Markets (CalSIM) program, a micro-simulation model to estimate eligibility and enrollment under the law, along with the impacts of proposed policy changes on coverage. Covered California, which helped to fund CalSIM, relied heavily on the model at a time of great uncertainty about the volume of people who would enroll when the state exchange opened for business in October 2013. CalSIM proved highly accurate in projecting that 1.2 million would sign up in the initial enrollment period — the final number was 1.22 million subsidized enrollees. Kominski, who continues to serve as CalSIM’s principal investigator, says that the model’s role in guiding Covered California has evolved. “It’s one thing to estimate the potential eligibility of the population, but Covered California wants to know who are the remaining eligible uninsured and who is most likely to sign up, demographically and geographically, so that they can target their advertising and outreach,” Kominski says. In the last year, he adds, the CalSIM group has been among those asked to model the potential effects of ACA expansions that were considered and ultimately enacted by the state. Both CalSIM and the CHPR-administered California Health Interview Survey have been critical sources of information fueling the work of another key player in the state’s ongoing efforts to expand health insurance benefits. The California Health Benefits Review Program (CHBRP) responds to requests from the state Legislature to provide

independent, nonpartisan analyses of the medical effectiveness, cost, and public health impacts of proposed health insurance benefit mandates and repeals. CHBRP draws from experts throughout the University of California system, who work with actuarial consultants to complete each analysis during a 60-day period. Nadereh Pourat, FSPH professor of health policy and management and CHPR associate director, oversees the cost group as vice chair, a position previously held by Kominski. “Frequently, policymakers have to rely on back-of-theenvelope calculations and anecdotal evidence to make policy decisions,” says Pourat, whose group focuses on the impact of proposed benefit expansions on premiums, out-of-pocket costs, and overall insurance coverage. “CHBRP has been tremendously important in providing the California governor and Legislature with a rigorous analysis of the potential impacts of proposals based on existing evidence, as well as any unintended consequences, so that there can be an informed debate leading to the best possible determinations.” Originally authorized in 2002, CHBRP carries a sunset date but has been reauthorized each time it has come up for renewal — a testament to how highly it is valued by the state’s lawmakers and health plans alike, Pourat says. Assemblymember Jim Wood, chair of the California Legislature’s Assembly Health Committee, praised the work of Pourat’s team and CHBRP in general. “The California Health Benefits Review Program is an invaluable resource for legislators like me,” Wood said in a statement. “When we need the independent actuarial talents and expertise of its analytic staff to assess the impact of proposed legislation on health insurance benefit mandates and repeals, we accept their analysis with a high level of confidence.” ph.ucla.edu

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Left Behind HEALTH CARE

California’s uninsured rate is at a historic low, but an FSPH study finds that the state’s Latino population isn’t enjoying the same benefits as other racial/ethnic groups.

MILLIONS OF CALIFORNIANS have gained health insurance coverage under the Patient Protection and Affordable Care Act (ACA), reducing the state’s uninsured rate to a historic low. Implementation of the ACA has led to significant increases in coverage for all racial/ ethnic groups in California, according to the FSPH-based UCLA Center for Health Policy Research (CHPR), which reported the findings in October 2018 using data from the 2017 California Health Interview Survey (CHIS). But despite these important gains, the state’s large Latino population continues to lag behind other racial/ethnic groups in coverage and access to health care. A subsequent CHPR study, released in August 2019, found that Latinos are less likely to have health insurance than other racial/ethnic groups, due to lower rates of coverage through employers as well as barriers such as citizenship restrictions on access. This lack of coverage means less access to health care services, ultimately resulting in poorer health outcomes, the study authors note. Using 2015 and 2016 data from CHIS — the nation’s largest state health survey, based in CHPR — the researchers found that 13.7% of California’s nonelderly Latinos remain uninsured, compared with 6.4% of African Americans and 5.3% of non-Latino whites. Although Latinos have one of the highest rates of enrollment in Medi-Cal, the state’s Medicaid program (44.9%), more than one-fifth of uninsured nonelderly Latinos are also eligible for the program but not currently enrolled. The study also found that more than three-fourths of the state’s Latino children are eligible for Medi-Cal but not currently enrolled. In 2016, California extended Medi-Cal eligibility to all undocumented

was expanded to these groups, because some would have incomes above the qualifying threshold for the program. “These findings show that expanding Medi-Cal access to non-

residents under the age of 19. In July 2019, California became the

citizens would substantially reduce, but not eliminate, the gap in

first state to extend Medicaid coverage to undocumented young

uninsured rates between Latinos and other Californians,” says Tara

adults by making all low-income residents ages 19-25 eligible for

Becker, the study’s lead researcher and senior public administration

Medi-Cal, regardless of immigration status. Medi-Cal eligibility is

analyst at CHPR. “Despite high employment rates, many California

particularly important for California’s Latinos given that they have

Latinos lack access to affordable coverage through an employer and

the lowest job-based coverage rates among all racial/ethnic groups,

must purchase more expensive individual coverage on the private

with just 31.6% reporting being insured through an employer, the

market. Eliminating the gap in coverage will require reducing health

study authors note.

care costs and expanding access to subsidies to purchase coverage.”

California legislation allows the state to fund health care through

Robert Ross, president and CEO of The California Endowment,

Medi-Cal for residents regardless of citizenship status, but the state

which supported the research, said upon the release of the findings:

needs to obtain a federal waiver to implement the program, which

“We hope the data from the study can be used to inform health care

allows only some Latino adults to enroll. Not all noncitizens and

policies that expand and promote access to care for such an import-

nonpermanent residents would qualify for Medi-Cal if eligibility

ant segment of California’s population.”

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HEALTH CARE

Health Essentials In influential studies over the last two decades, professor and department chair Jack Needleman has shown the critical role of registered nurses in hospital outcomes.

JACK NEEDLEMAN was reading The Boston Globe one morning in 1998 when he came across an article that would alter the course of his career. The story was about nursing organizations and others in Massachusetts decrying the levels of staffing in hospitals — arguing that low staffing, implemented to save hospitals money, was endangering patients. “Labor is the largest component of hospital costs, and nursing is the largest component of labor,” notes Needleman, the Fred W. and Pamela K. Wasserman Chair of the Department of Health Policy and Management at the Fielding School. The argument that nurse staffing would influence patient outcomes seemed logical, but there was a problem: Little research had been done to support the claim.

JACK NEEDLEMAN

Needleman wasn’t a nurse, nor had he studied nursing. “I just recognized that this was an important question — what effect did nurse staffing have on patient outcomes? — and, with data, I could begin to address it,” he says. “So I started what turned into a 20-year research program.” The journey began with a three-year study in which Needleman and his colleagues analyzed data from nearly 800 hospitals in 11 states, culminating in a widely cited 2002 New England Journal of Medicine article. Needleman’s group found that facilities with lower nurse staffing levels — defined by both nursing hours and the proportion of registered nurses on the staff — were associated with longer lengths of stay and higher rates of death, hospital-acquired infections,

cardiac arrest, and gastrointestinal bleeding. “This made a powerful case for keeping nurse staffing levels high,” Needleman says. “But it left unanswered the question of cost: Is it affordable?” His research group made the business case for nurse staffing in a 2006 study published in the journal Health Affairs. The study found that when considering the higher costs of longer length of hospital stay and adverse events, increasing the proportion of nursing staff who are RNs — as opposed to cutting costs by hiring less-skilled nursing support staff — saved money. Because these studies had compared low- with highstaffed hospitals, Needleman next asked whether something other than staffing might explain the results. He addressed that concern in a 2011 study, which found that within a single hospital, patients exposed to lowstaffed shifts had higher death rates than patients on sufficiently staffed shifts. Needleman has continued to validate and extend these findings through subsequent ph.ucla.edu

studies, including one published in 2019. The work has had wide-ranging impact. “Jack Needleman’s studies have been utilized by policymakers across the United States to establish staffing rules for nurses working in acute-care settings,” says Linda Burnes Bolton, senior vice president and chief health equity officer for Cedars-Sinai, and past president of the American Academy of Nursing (AAN). “His research on quality and nurse staffing has also served as the basis for other studies on the impact of nurse staffing on desired patient-care outcomes.” Less than a decade after the fateful newspaper article, Needleman was inducted into the AAN as an honorary fellow. “I recently told a prospective student that you have to have a passion for research, but it can either be a specific topic or simply a desire to better understand the world,” Needleman says. “My passion is understanding, and I discovered a topic that was worth investing 20 years in.” AU T U M N /W I N T E R 2 0 1 9 –2 0

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Managing Partners At the Fielding School’s new Center for Healthcare Management, academics from wide-ranging disciplines collaborate with leading practitioners to advance knowledge and practice.

AMID A RAPIDLY CHANGING LANDSCAPE, the only certainty for health care management professionals is that the future is fraught with uncertainty. As the policy debate rages and new rules and regulations emerging from Washington, D.C., Sacramento, and other state capitals constantly shift how health care is delivered, where it’s delivered, and how it’s paid for, the Fielding School has established a center designed to bring together top academic researchers, students, and established health care executives and practitioners to explore critical issues in the management of health care organizations, while improving the state of knowledge and practice. FSPH’s Center for Healthcare Management — made possible by the Sinaiko Innovation Fund for Healthcare Management, a $1 million gift from Richard (MPH ’77) and Patricia Sinaiko, and Greg (MPH ’01) and Marcie Sinaiko (see page 32) — will leverage the Department of Health Policy and Management’s close ties with 12

alumni and other leading health care management practitioners in Southern California to ensure that the focus of its research, as well as the curriculum for students in the department’s executive, traditional, and customized degree and nondegree programs, are informed by on-the-ground health care management expertise. “Our family is thrilled to be able to provide this support in recognition of the benefits received from the Fielding School and our longstanding relationship with Paul Torrens and Leah Vriesman,” says Richard Sinaiko. “Engaging health care organizations as active collaborators with Fielding School faculty will ensure that our center produces practical, relevant knowledge,” says Laura Erskine, the center’s co-director, who is an adjunct professor and director of the Department of Health Policy and Management’s MPH degree program. The center has also enlisted the participation of experts from outside the Fielding School, including medical,

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nursing, dentistry, engineering, law, and business school faculty. “Health care management is not a standalone field,” explains Richard Sinaiko, who, with his son Greg, established and ran two nationally recognized companies, Sinaiko Healthcare Consulting and The Coding Source. “Increasingly, people in the field are interacting with many different sectors in order to be effective. Bringing in all of this expertise from the UCLA campus is a huge benefit.” In encouraging more hands-on involvement with health care management practitioners, the new center starts from a position of great strength. Graduates of FSPH’s Department of Health Policy and Management include some of the most influential leaders in Southern California, as well as statewide and nationally. In addition to a passionate and loyal alumni network, the center benefits from well-established ties with the community of health care management employers. Those ties have long been on display


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at the Paul Torrens Health Forum at UCLA, an established gathering that the center now presents, along with the Fielding School, where practitioners and academics discuss timely public health issues affecting the entire industry. “In a sense, this forum is a precursor to the center — a regular event where we have rich content, but also provide an opportunity for the practitioner community and UCLA faculty and students to come together to network and discuss what’s going on in real-world settings,” says Leah Vriesman, co-director of the center as well as an FSPH associate adjunct professor and director of the Executive Programs in Health Policy and Management. The new center is taking a number of additional steps to ensure that the education and scholarship within the Fielding School are geared toward finding solutions to the everyday challenges health care management professionals face. Along with a collection of fieldbased case studies created for classroom discussion and the dissemination of UCLA-generated scholarship to the practitioner community, a centerpiece of this effort is an annual health care management case competition. The first such competition, sponsored by UCLA Health, invited teams of graduate students from across the country to solve a management challenge faced by the UCLA Health system, with the finalists invited to Los Angeles to present their solutions to executive judges at UCLA Health in January. Building on the strong ties with the practice community will also influence the way health care management students in the school’s executive and traditional programs are educated and will afford more opportunities for alumni and other leaders in the field to provide mentorship. In recent years, the health care management curriculum has been revised in response to feedback from employers about the skills they need from graduates. “Our community partners have a great stake in the next-generation workforce,” Vriesman says. “They are turning to us, as a leading school of public health, to connect them with the people who will become future leaders.”

Making the Connections The Paul Torrens Chair in Healthcare Management honors a professor whose mentorship has influenced countless careers.

THE 175 INDIVIDUALS IN ATTENDANCE at the Health Forum at UCLA FSPH in March 2016 included some of the most powerful health care professionals in the region. They were drawn to the UCLA campus both for the monthly gathering of public health leaders, faculty, staff, and students engaging on a key topic of the day, and for the renaming of the forum after Dr. Paul Torrens, the longtime Fielding School faculty member who, as part of his commitment to bridging the academic and practice worlds, had launched the forum years earlier. During the event, a speaker made a request. “If you were mentored by Paul Torrens and then went on to mentor someone else as a result, please stand up.” Almost no one remained seated. In September, the Fielding School announced the establishment of the Paul Torrens Chair in Healthcare Management, based within the school’s newly launched Center for Healthcare Management and the Department of Health Policy and Management. The chair, which will support the teaching and research activities of a faculty member with health care management expertise, was made possible by a gift of more than $1 million from the Don S. Levin Trust and Edna and Tom Gordon. “Paul Torrens has made a tremendous impact on health care management and policy in California — the state recognized as a national leader in transforming the U.S. health care system,” says Tom Gordon, who served as executive vice president of the Cedars-Sinai Health System and CEO of Cedars-Sinai Medical Network Services for 22 years and continues in an advisory role as consultant to the president. “It is my honor to play a role in furthering his legacy through the Paul Torrens Chair.” Initially trained as a physician, Torrens has had a long career in both health care management and health policy. But arguably his greatest impact has been as an FSPH faculty member, where his passion for teaching and ability to inspire have made a difference in the careers of countless health professionals, particularly in Southern California. “For decades, Paul Torrens has connected class after class with the health care community,” says Leah Vriesman, co-director of the Center for Healthcare Management and herself a beneficiary of Torrens’ mentoring when she was an FSPH doctoral student. “He has launched so many careers by saying, ‘Let me make a quick phone call,’ or ‘Let me have you talk to somebody.’ He was LinkedIn before there ever was a LinkedIn.” ph.ucla.edu

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Caring for All Dr. David Carlisle, a leader in bringing diversity to the health care professions, applies the lessons of his FSPH education. WHEN DR. DAVID CARLISLE (MPH ’88, PHD ’92) looks out the window of his office at Charles R. Drew University of Medicine and Science (CDU), where he serves as president and CEO, he is reminded of the urgency of CDU’s work in bringing more diversity into the health care professions. “I can see the 105 Freeway that divides Willowbrook from Watts in South Los Angeles, and you can’t find private practicing health professionals — doctors, dentists, psychologists, pharmacists, optometrists… — anywhere in this community,” Carlisle says. “The main sources of providers are federally qualified health centers, which are doing a great job, but that can’t be the only solution. We can’t improve our health care system if we don’t improve it in communities like South Los Angeles, where there is a crying need.” Carlisle has dedicated his career to advancing the health of under-resourced communities, a passion he traces to his own early experience with health care. He vividly recalls a childhood visit to a primary care clinic in northern Virginia, where the waiting room was packed with low-income African American patients with no other alternative but to spend hours awaiting their turn. “I thought that was normative until I started living in more affluent environments, where seeing the doctor didn’t involve crowded waiting rooms,” Carlisle says. “That’s when it occurred to me that health care wasn’t the same across different communities, and that it seemed to be correlated with both socioeconomic status and ethnicity.” A critical component to addressing these disparities involves diversifying the health care workforce. Carlisle notes that health care providers from under-resourced communities are most likely to return to those communities to

“Our most under-resourced populations are not able to participate fully in the best aspects of American health care.” — Dr. David Carlisle 14

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practice, and that a diverse health care workforce affects not only access, but also quality of care. “Concordance between patients and their providers is a critical factor in addressing health disparities,” Carlisle says. “We hear it from patients and we see it in the research.” Since 2011, Carlisle has led an institution that few can match when it comes to increasing the level of diversity in health care. CDU is a private, community-founded institution where more than 80% of the students and more than 71% of the faculty are from communities of color. In the five decades since the institution was incorporated in 1966, CDU has graduated more than 600 physicians, more than 1,200 physician assistants, and nearly 1,600 other health professionals, and trained more than 2,700 physician specialists through its sponsored residency programs. CDU’s nursing school has graduated more than 1,300 nursing professionals, including nearly 1,000 family nurse practitioners. More than 80% of CDU students report returning to practice and providing much-needed care in under-resourced communities after graduation. “This is a university that’s been delivering on its formative mission for our entire 53-year history, and we’re being recognized for it,” Carlisle says. Carlisle began addressing the issues of health disparities and health care workforce diversity long before he got to CDU. He spent 11 years as director of California’s Office of Statewide Health Planning and Development (OSHPD) in the administrations of three governors — Gray Davis, Arnold Schwarzenegger, and Jerry Brown. Under Carlisle’s leadership, OSHPD released its first-ever health disparities report, helped to draft a policy to develop a health workforce data clearinghouse, and increased scholarship and loan repayment opportunities for health providers committed to practicing in underrepresented, under-resourced, and underserved communities. Carlisle has also long devoted his medical practice to caring for people with the greatest need. For nearly three decades he served as a volunteer physician at the Venice Family Clinic, a nonprofit community health center, and currently serves on its foundation board. Carlisle was a staff physician overseeing the urgent care clinic at the Watts Health Center in the mid-1980s when he


Communities

DR. DAVID CARLISLE (FOURTH FROM LEFT) WITH STUDENTS FROM CHARLES DREW UNIVERSITY (CDU), WHERE CARLISLE IS PRESIDENT AND CEO. CDU HAS BEEN A LEADER IN CONTRIBUTING TO A MORE DIVERSE HEALTH CARE WORKFORCE.

began taking courses in the Fielding School’s Health Policy and Management Executive MPH program. The experience proved pivotal. “It totally changed my career orientation,” Carlisle says. “I was exposed to an entirely different perspective on health and health care — the population-based approach of taking care of the needs of thousands of people at a time instead of one patient at a time. I learned about managed care, health care economics, and what public health really meant. I felt like a kid in the candy shop — I just wanted to delve deeper and deeper into the subject area, which I found to be compelling and captivating.” Over the ensuing years, culminating with the completion of his PhD in 1992, Carlisle engaged in a constant dialogue with FSPH faculty mentors about the need for universal health insurance. Through those interactions, he began to

question why individuals from under-resourced communities couldn’t have access to the same quality of health care as those from more affluent communities. “When you look at health outcomes in the United States, we lag behind other industrialized nations on most measures, and I would argue that the reason is that our most under-resourced populations are not able to participate fully in the best aspects of American health care,” Carlisle says. “The result is the divergent quality of care, satisfaction with care, and health outcomes among those in under-resourced communities, many of which are communities of color. Effectively addressing the needs of these communities would go a long way toward bridging the health care gap between the United States and the rest of the industrialized world.” ph.ucla.edu

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SCREEN TEST An FSPH research team has partnered with a large federally qualified health center to study and implement strategies to increase colorectal cancer screening.

APPROXIMATELY 50,000 PEOPLE die from colorectal cancer (CRC) each year in the United States, making it the nation’s second-most deadly cancer — despite the fact that the disease is highly preventable. Screening can detect CRC at an early stage, when treatment is most likely to be successful. In addition, screening can prevent CRC by finding and removing abnormal cell growths or polyps before they can develop into cancer. But CRC screening is underutilized, particularly in low-resource settings and by low-income populations. 16

And among those who do get screened, many fail to follow up on abnormal results or to repeat the screening at the recommended time intervals. A new research program by the UCLA Kaiser Permanente Center for Health Equity at FSPH is addressing the problem from multiple angles by testing the effectiveness of strategies designed to increase screening rates, as well as identifying barriers to repeat screening and timely follow-up of abnormal results. Researchers at the center are conducting this work in partnership with

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the Northeast Valley Health Corporation (NEVHC), one of the nation’s largest federally qualified health centers (FQHCs), with 15 community-based facilities serving a low-income, uninsured, mostly Latino population in Los Angeles’ San Fernando and Santa Clarita valleys. FQHCs are community-based facilities that receive federal funds to provide primary care services to underserved patients. “This is a true universitycommunity collaboration, with all of the study interventions implemented by the NEVHC clinics, which

provide outstanding care to our most vulnerable populations and are always looking for ways to improve,” says Roshan Bastani, Fielding School professor and director of the UCLA Kaiser Permanente Center for Health Equity, who is leading the work along with two Fielding School alumni she trained: Dr. Folasade May (PhD ’15), who heads the study on follow-up of abnormal findings, and Narissa Nonzee (PhD ’18), who heads the repeat screening study. “The idea is to work with the clinics in developing effective interventions that take into consideration their real-world settings so that they will continue to be utilized long after the study has ended.” The partnership also includes efforts aimed at raising community awareness about the importance of colorectal cancer screening, in part through the training of Spanish-speaking promotoras (community health workers). The main screening study — which includes as co-principal investigators Alison Herrmann (PhD ’12) and Beth Glenn, FSPH faculty members and Kaiser center associate directors — will implement and evaluate a program focused on increasing CRC screening at NEVHC through strategies at the system, provider, and patient levels. The study will compare the results of two NEVHC clinics that implement the multilevel intervention with two clinics that provide standard care. The CRC screening test used most commonly by FQHCs, including NEVHC, is the fecal immunochemical test (FIT), which examines


the stool for microscopic early signs of colorectal cancer or polyps. Although colonoscopy is considered the gold standard for CRC screening, the FIT test is effective, noninvasive, and much more accessible to low-income patients. National guidelines call for annual FIT tests for averagerisk individuals between the ages of 50 and 75. To promote increased FIT screening participation by NEVHC patients, the main focus of the screening study is on workflow changes to ensure that providers are informed of patients who are due for screening; that all eligible patients receive a FIT kit along with a recommendation from their provider; that culturally and linguistically tailored education on the test is provided by staff; and that patients are issued follow-up reminders encouraging them to return the completed kit. Physicians and staff in the intervention clinics will receive training, clinical decision support, and feedback on screening rates and missed screening opportunities among their patients. “We’re trying to address missed opportunities,” explains Debra Rosen, NEVHC’s director of quality

and health education and the lead NEVHC investigator. “We have good tools in place that identify which patients are due for FIT screening, but many other steps need to occur to make sure the patients take home the test, complete it properly, and return it, and that everything is documented so that nothing falls through the cracks. We have made significant improvement in CRC screening, but are still well short of our goal and excited to work with the Fielding School team to determine what more we can do.” Even when patients complete and return the FIT test, they benefit only if they follow up on an abnormal finding. Between 5% and 14% of FIT results are positive, requiring a colonoscopy to assess for cancer or precancerous polyps. But May notes that in FQHCs, only about half of patients get a colonoscopy after a positive FIT. The study she leads will examine NEVHC’s electronic medical record data and interview providers and patients to learn about and ultimately address the factors that influence whether patients will follow up on a positive test with a colonoscopy. “Unlike at a large integrated health system like

“The idea is to work with the clinics in developing effective interventions that take into consideration their realworld settings.” — Roshan Bastani

TRAINED SPANISH-SPEAKING PROMOTORAS (COMMUNITY HEALTH WORKERS) PROMOTE COLORECTAL CANCER SCREENING, INCLUDING ENCOURAGING PEOPLE TO WALK INSIDE A GIANT “COLON.”

UCLA, FQHCs don’t have gastroenterologists, so patients have to be referred to a specialist outside of the system,” says May, an assistant professor in UCLA’s Vatche and Tamar Manoukian Division of Digestive Diseases. “We want to understand what can be done at the provider, patient, and system levels to overcome the challenges of ensuring follow-ups for these patients.” Nonzee, an FSPH postdoctoral fellow, is addressing the third piece — how to increase the likelihood that NEVHC patients will get repeat screenings. She points out that studies have found that even when patients are not required to pay, as many as 75% of those who complete an initial FIT test fail to repeat it, as recommended, the next year. “We have good tests that can screen for colorectal cancer, but the benefits of the tests aren’t being optimized ph.ucla.edu

unless they’re completed on a regular basis,” Nonzee says. “We want to understand what factors determine who gets repeat testing, as well as how those might differ from the factors influencing who gets their initial screening.” She will utilize NEVHC’s electronic medical records as well as interviewing providers and patients to find answers. For Bastani, this program is especially satisfying because of the involvement of so many former FSPH students whom she has mentored. “To see them building their own research programs makes me feel like a proud parent,” she says. “We are all working together toward the same public health goal — identifying successful strategies to increase CRC screening that can be widely disseminated to other similar settings, so that we can reduce the population-level burden of this very serious but highly preventable cancer.” AU T U M N /W I N T E R 2 0 1 9 –2 0

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Prescriptive Paths Three Fielding School students and three recent graduates share what compelled them to address health care through a public health lens, why they chose their area of focus, and what they hope to achieve.

Michelle Keller, MPH ’14, PhD ’19 Research Scientist

WHEN I WAS IN ELEMENTARY SCHOOL, my mother had an episode of debilitating back pain, which eventually morphed into chronic pain. As she shuttled from doctor to doctor with few answers, she was prescribed a medley of medications — some with potential for dependence and many of which weren’t helpful, despite their significant risks and side effects. My family’s experience in navigating the medical system for chronic pain highlighted the challenges that many patients and their families face. These experiences shaped my desire to study how clinicians make decisions about prescribing medications for pain as a doctoral student in FSPH’s Department of Health Policy and Management. For my dissertation, I interviewed clinicians at one health system to understand how they made

Sebastian Ramirez MPH Student

decisions about patients’ risk for opioid addiction or misuse, and about adding new patients to their practice who have been taking opioids for a long time. I also analyzed more than 20,000 patient records to see whether clinicians were prescribing opioids appropriately.

I ENTERED PUBLIC HEALTH AFTER RECOGNIZING the commonalities in my experiences with helping others. I earned my undergradu-

Today, I work as an embedded research scientist at

ate degree in medical imaging, then worked as an X-ray technologist

Cedars-Sinai Medical Center, where I apply findings

at large health care systems in Philadelphia. At the same time, I

from my research to inform patient care. My current

volunteered for community organizations that served Philadelphia’s

research focuses on helping to identify patients

LGBTQ+ population. Seeing and learning about the inequities experi-

who might be taking medications (such as opioids

enced by this population — and living some of them as a gay man

and benzodiazepines) that place them at high risk

of color myself — it became easy for me to see the same inequities

for addiction, dependence, or overdose, and who

within health care. That led me to seek ways to improve the cultural

could benefit from patient-centered medication

competency of health care professionals and promote inclusion in

management programs. I’m also working closely

health care practices, toward the goal of better serving not only

with pharmacists and physicians to develop com-

LGBTQ+ people, but any marginalized or underrepresented group.

munication tools that improve discussions about medications between patients and clinicians. My

To achieve this, I taught health care professionals about intercul-

goal is to reduce the use of inappropriate or unnec-

tural communication, intersectionality, and systems of oppression.

essary medica-

Attempting to do this while still an X-ray technologist, my reach was

tions, tests, and

limited. Additionally, helping one patient at a time, while important,

procedures in

wasn’t enough for me. I felt that I needed to do more, and I found

health systems

public health to lie at the intersection of my career and service expe-

while maintain-

rience. Public health can teach me effective ways to pursue social

ing empathetic,

justice within a broken U.S. system that can harm those who need

high-quality care

the most help. With that knowledge, I can create systemic changes

for patients with

to help entire communities. Following my Fielding School education,

chronic pain.

I hope to earn a position in strategic planning and operations at a health care institution, where I can work to create these changes. 18

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Erik Coll MPH Student

TWENTY YEARS AGO, I made a decision that shaped the person I am today: I chose to become a nurse. From that point forward, my goal was to further my education in the field of emergency medicine so that I could positively influence my family, community, and the health care system. Since those early days — working as an emergency medical technician running 911 calls, then going on to nursing school — I have lived my dream and accomplished many of my personal and professional goals. One that I cherish the most is working at UCLA as an assistant nurse manager in the emergency department. I applied to the Fielding School’s Executive Master of Public Health (EMPH) program so that I could obtain the key to unlock my future. I am an expert in the field of nursing and am learning the everyday joys and toils of front-line management. I seek to move beyond this and combine my experience and future education to become a transformational leader in the field of health care. I had done research on many programs and paths that could get me from point A to B, and there is little question in my mind that the EMPH program is the correct fit. I value the classroom format, along with the small, diverse cohorts where connections and relationships are fostered. The faculty and curriculum are directly in line with my goals. Finally, I enjoy working in the hospital and attending school on campus, which has allowed me to bring theory to work and work to theory while doing what I love: helping others.

Isomi Miake-Lye, PhD ’16 Researcher and FSPH Faculty Member

WHEN ANY ONE OF US STEPS OUT OF EVERYDAY LIFE and into the role of patient, we need support. For people who are sicker, being a patient means juggling a myriad of medications, appointments, and treatment plans and drawing upon a full slate of social workers, doctors, nurses, clerks, and professionals within the health care system. Failure to coordinate health care costs the United States tens of billions of dollars a year and has serious health implications — especially for complex patients like our veterans. Veterans have more physical and mental health comorbidities than the general population, and the veterans my work targets are some of the most high-risk, with complex needs. As a researcher at the Center for the Study of Healthcare Innovation, Implementation and Policy at the VA Greater Los Angeles Healthcare System, I take my organizational behavior theory and implementation science expertise and partner with clinicians and systems stakeholders to help troubleshoot where the system breaks down and implement solutions. The training I received while obtaining my PhD from FSPH’s Department of Health Policy and Management now feeds directly into the work I do — measuring organizational readiness for change initiatives, developing tailored implementation approaches, and investigating strategies for working with those places that are hard to engage. I am able to work directly in a real-world health care setting and be a part of an evolving health care system, learning how a massive and complex system can be responsive and provide the help veterans need. ph.ucla.edu

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Hiroshi Gotanda, PhD ’19 Physician

DURING MY CLINICAL TRAINING, I was astonished by how significantly health care providers’ practices are affected by state and federal health policies — in good and bad ways. After the introduction of financial penalties based on the rate of hospital-acquired condi-

Petra Rasmussen

tions such as infections and bedsores, we were strongly encouraged

PhD Candidate

However, I have seen cases in which diabetes is aggressively treated

to be vigilant about prevention and documentation, and rightly so. in patients who could be harmed by the treatment given their conditions, partly because of quality metrics to promote diabetes control.

EVERY DAY, THROUGHOUT THE DAY,

These experiences inspired me to pursue my PhD in health policy

people have to make decisions. Most

and management at FSPH so that I could learn about health systems

are simple and have minimal long-term

and methodologies for evaluating the effects of health policies.

consequences, such as deciding what to

While my interest as a clinician started from a desire to improve the

wear, which route to take to work, or what

quality of medical care for patients, studying at the Fielding School

TV show to watch at the end of a long day.

gave me a larger perspective that raised new questions: What about

But others are complicated, with poten-

people who don’t see medical doctors regularly? What about those

tially serious implications for an individual’s

who are uninsured? For my dissertation, I examined the national

well-being. These complex decisions are

impact of the Affordable Care Act’s Medicaid expansion on finan-

the type that people most often face when

cial and health outcomes among low-income populations, many of

interacting with the health care sector.

whom are uninsured and have limited access to health care.

In my dissertation research, I look at the

My ongoing goal is to produce clinically relevant and scientifi-

choices individuals make when enrolling in

cally rigorous evidence on health policies and programs that are

health insurance. While traditional eco-

intended to improve the

nomic theory suggests that having more

quality of care and expand

options to choose from is better, social

the outreach of health ser-

science research has found that people

vices, so that policymakers

often struggle to make the best decisions

and organizational leaders

for themselves, particularly when they are

can make sound decisions.

stressed, underinformed, and comparing

I am thrilled with my career

across several dimensions. Selecting a

path as a clinician and

health care plan meets all of these criteria.

health services researcher

People don’t like having to think about the

who can make a unique con-

possibility of getting sick or needing to

tribution to society.

see a doctor, they often have low health insurance literacy, and they have to figure out how to weigh plans’ premiums, co-payments, deductibles, provider networks, quality ratings, and covered benefits. By studying the health insurance choices that individuals make and their decisionmaking processes, I can evaluate how well people are able to navigate the enrollment process. Ultimately, the goal of my work is to gain insights into the types of challenges individuals face during enrollment so that we can better design improvements to the process that will benefit patients and consumers. 20

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HEALTH CARE

S A F E

A T

H O M E

A growing population depends on long-term care support and services, but such assistance is expensive and rarely covered by private insurance. An FSPH team is working with a coalition of advocates to produce data that can inform solutions. IN CALIFORNIA and nation-

the California Health Interview

ally, the health care system is

Survey (CHIS) that will begin

geared to meeting the immedi-

to produce the data needed to

ate needs of individuals when

help policymakers better under-

they’re sick, notes Kathryn

stand the use of, and demand

Kietzman, a research scientist at

for, LTSS in California. With Kietzman’s input, CHIS

FSPH’s UCLA Center for Health Policy Research (CHPR). But for

— the nation’s largest popula-

seniors and others with chronic

tion-based state health survey,

disabilities, the long-term

based in the CHPR — has added

services and supports (LTSS)

LTSS screening questions and

required for daily living often

in 2019 began administering a

go unaddressed.

15-minute survey to approximately 2,000 respondents with

“Many people assume that when they get older and

LTSS needs, with a follow-up

need some help in their home,

four years later. In between,

Medicare will cover that, but it

the CHPR team will conduct

usually doesn’t,” says Kietzman,

in-person, in-depth interviews

who has studied the health- and

with 100 Californians with LTSS

social-care needs of the most

needs to complement and con-

physically, socially, and finan-

textualize the findings from the

cially vulnerable older adults,

first survey and inform content

many of whom rely on LTSS to

for the follow-up. The survey

continue living independently

questions will be developed

at home. “Medicare covers a

with the input of a broad range

limited amount of post-acute

of stakeholders. “This is a different kind

care, but what it fails to address is where so much of health

of prevention than what we

happens, which is outside of

typically think about in public

the clinical setting.” Often, this

health,” Kietzman says. “Invest-

means paying LTSS costs out of

ing in LTSS can help to prevent dramatic declines that lead to

pocket, which can be exorbitant and result in medical bank-

transportation to medical and

ruptcy, Kietzman says.

other appointments. “We’ve

hospitalizations and the need

institutional care.” In response to this concern,

for institutional care. It can save

learned from our earlier studies

20 organizations dedicated to

money by allowing those indi-

are either 65-and-older or

that just a couple of hours a

finding affordable financing

viduals to stay at home, where

have disabilities — a population

day with a personal care worker

solutions to strengthen the

most people would rather be,

that’s expected to rise sub-

can make or break people’s

state’s LTSS system have joined

and with an increased quality of

stantially over the next decade.

ability to continue living in their

to form the California Aging and

life. But in order to come up with

That means a growing popula-

homes,” Kietzman says. “Minus

Disability Alliance. The alliance

a plan to change the way long-

tion requiring assistance with

those hours, at-risk individuals

was successful in securing $3

term services and supports are

activities such as household

are much more susceptible to

million in the state’s 2018-19

financed and delivered, we need

chores, obtaining groceries, and

needing emergency-room or

budget to develop content in

statewide data on this issue.”

Nearly 8 million Californians

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HEALTH CARE

Dose of Reality

As ‘vaccine hesitancy’ threatens public health gains, an FSPH expert weighs in.

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IT’S ARGUABLY THE GREATEST PUBLIC HEALTH SUCCESS STORY of the modern era. Vaccination campaigns eradicated the scourge of smallpox from the planet and have nearly eliminated polio, a paralyzing infectious disease that once struck fear in every parent. In 2000, the World Health Organization (WHO) declared that the United States had eliminated measles, culminating a decades-long public health effort to promote childhood immunization against a disease that, prior to the vaccine’s introduction in 1963, annually infected 3 to 4 million U.S. children, of whom tens of thousands were hospitalized and several hundred died. But in 2019, during the largest U.S. outbreak in 27 years, the nation’s measles elimination status (defined not as zero cases, but as the disease no longer being constantly present) was nearly revoked. A primary cause, according to the U.S. Centers for Disease Control and Prevention: the declining vaccination rate. The WHO recently included “vaccine hesitancy” as one of the 10 biggest threats to global health. “This is an emerging problem,” says Annette Regan, an adjunct assistant professor in FSPH’s Department of Epidemiology, who previously served as the vaccine epidemiologist for Western Australia and has studied strategies for promoting recommended vaccines in community settings. Regan notes that although the overwhelming majority of U.S. parents follow the recommended immunization schedule for their children, a growing number either forgo the vaccines entirely, don’t complete the series on the schedule required for their child’s protection, or are selective about the vaccines they allow their children to receive. Many factors contribute, including religious objections and a distrust of government institutions and the pharmaceutical industry. As the immunization schedule for children has become more complex, some parents have worried that there are too many, too soon, although vaccines are rigorously studied and proven safe at current

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“For people who haven't seen these terrible diseases, it's harder to appreciate the importance of preventing them.” — Annette Regan

levels, Regan says. Reverberations also continue to be felt from a 1998 study that associated the measles, mumps, and rubella vaccine with autism, despite the study later being discredited and withdrawn by the journal that published it, and many subsequent studies showing no such connection. In Australia, Regan participated in efforts to overcome these and other barriers. She continues to study how immunizations can be better promoted in the community, with a focus on pregnant women — a high-priority population with relatively low rates of receiving recommended vaccines, including flu shots and the Tdap that will protect their infant against potentially deadly pertussis, or whooping cough. Educating primary care providers about the importance of counseling their patients on immunizations is a critical public health strategy, Regan contends; pregnant women, for example, are 10 times more likely to receive the pertussis vaccine if their doctor advises it. In general, Regan adds, many people simply need more and better information to overcome their concerns. “It’s easy to group vaccine attitudes into two categories — strongly for or strongly against — but it’s really more of a spectrum,” she says. Perhaps the biggest challenge is the diminishing societal memory of diseases vanquished by immunization campaigns. “In a sense, vaccines are cursed by their success,” Regan says. “For people who haven’t seen these terrible diseases, it’s harder to appreciate the importance of preventing them.”


ADDRESSING DISCRIMINATION

A ‘Direct Threat to Health Equity’ A new book co-edited by the director of FSPH’s Center for the Study of Racism, Social Justice & Health brings racism to the forefront as a public health problem requiring immediate attention.

“People don’t experience high rates of poor health because of how they look, but because of the unfair treatment they receive based on how they look.” — Chandra Ford

RESEARCHERS HAVE LONG DOCUMENTED HEALTH DISPARITIES — defined by the U.S. Centers for Disease Control and Prevention as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health” — that negatively affect racial and ethnic minority populations. Much less attention has been paid to the role of racism in fueling these disparities. In “Racism: Science & Tools for the Public Health Professional,” a new book co-edited by Chandra Ford, associate professor of community health sciences and founding director of FSPH’s Center for the Study of Racism, Social Justice & Health, academicians, students, and community organizers explain how experiencing racism can harm a person’s health, and how people who work in the field of public health should address the problem. The book includes contributions from Gilbert C. Gee, FSPH professor of community health sciences; four Fielding School doctoral students (Adrian M. Bacong, Natalie Bradford, Anna Hing, and Rebekah Israel Cross); and four alumni (Héctor E. Alcalá, MPH ’11, PhD ’15; Brittany N. Morey, MPH ’11, PhD

’17; Goleen Samari, MPH ’10, PhD ’15; and Mienah Z. Sharif, MPH ’09, PhD ’16). Ford notes that the peer-reviewed research literature on racism’s health impact has grown exponentially in recent years. The ways in which these health effects are felt vary. One of the most direct is the toll of chronic stress stemming from the mistreatment, which can compromise both mental and physical health. “Much of the media focus is on overt forms of racism, but the research is very clear that what really wears the body down over time and contributes to many health disparities is exposure to everyday forms of racism, such as being treated with less respect, being followed while shopping, and constantly having to wonder whether an interaction was racially motivated,” Ford says. Ford points to other ways in which racism leads to health disparities, from the disproportionately higher exposures to environmental hazards in racial and ethnic minority communities to discrimination in housing and employment — which, among other things, affects health insurance and access to care. “Race isn’t fundamentally a biological attribute,” Ford says. “People don’t experience high rates of poor health ph.ucla.edu

because of how they look, but because of the unfair treatment they receive based on how they look.” In the book, authors offer examples of how public health workers can confront racism, including naming it explicitly as a public health threat, recognizing their own biases, building community capacity in the course of research and interventions, collecting data on the lived experiences of populations exposed to various forms of racism, and prioritizing equity in assessments of health impacts. “For many years, we have heard that the problem is socioeconomic, or that by naming racism we were actually contributing to the problem,” Ford says. “The research is now clear that racism is a public health issue. Public health professionals need to remove their blinders and tackle this head-on as the direct threat to health equity that it is.”

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REDUCING DEMENTIA RISK

C GNITIVE N O I S N P E

An FSPH study finds that women who participate in the paid labor force during young adulthood and middle age experience slower late-life memory decline than women who don’t.

COULD WOMEN’S PARTICIPATION in the paid labor force during early adulthood and middle age bode well for their cognitive health later in life? A study led by Elizabeth Rose Mayeda, a Fielding School assistant professor of epidemiology, suggests it might. In an effort to better understand what role, if any, women’s work-family demands play in late-life memory decline, Mayeda and her colleagues analyzed data from the national Health and Retirement Study of more than 6,000 women born between 1935 and 1956. Women in the study reported on their waged-employment history as well as their marital and parenthood status between the ages of 16 and 50. Memory performance was measured using standardized tests approximately every two years starting when these women were 50 and older. Mayeda reported the findings at the 2019 Alzheimer’s Association International Conference in Los Angeles. Of the three work/family variables measured, participation in the paid workforce stood out when it came to later-life cognitive health. For example, compared with married mothers who participated in the paid labor force when of working age, average memory performance between ages 60 and 70 declined 61% faster among married mothers who did not engage in paid employment. Additionally, average memory performance of women who experienced a prolonged period of single motherhood without waged employment declined 83% faster than married mothers who participated in the paid labor force. Mayeda notes that women didn’t have to spend the entire period from 16 to 50 in the paid labor force to reap the later-life cognitive benefits — those who took time away from work when their 24

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children were young, for example, showed similar trajectories as those who did not. Two-thirds of people living with Alzheimer’s disease in the United States are women. Given that age is the biggest risk factor for Alzheimer’s and other dementias, it’s been widely assumed that this can be attributed to women’s average lifespan in the U.S. being approximately five years longer than men’s. But Mayeda’s research raises the possibility that other factors might also be involved. Although the study wasn’t designed to draw conclusions on the factors driving the differences in later-life cognitive health, Mayeda notes that previous research has found an association between participation in the workforce and higher levels of cognitive stimulation, along with increases in cognitive reserve. Mayeda also points to the potential financial and social benefits from paid labor-force participation. “For women born in the 1930s, ’40s and ’50s, working might have meant more financial independence and power to make decisions about their lives, including ways to promote their cognitive health,” Mayeda says. Other studies have suggested that social engagement positively influences later-life cognitive health. “Certainly, women living longer than men plays a significant role in the disproportionate number of women with Alzheimer’s dementia in the U.S.,” Mayeda says. “But even if that’s the only reason, it highlights the need to study the factors that influence dementia risk for women. Future research should evaluate whether policies and programs that facilitate women’s participation in the labor force are effective strategies to prevent memory decline.”


MEDIA MESSAGING AND FIREARMS

Unintended Consequences When news outlets mention gun control in the context of reporting about mass shootings, gun sales rise.

WHAT WAS LEARNED Print-media coverage of U.S. gun control policy in the wake of mass shooting events has resulted in increases in firearm acquisition, particularly in the states with the least restrictive gun laws.

HOW DO WE KNOW? A research team that included James Macinko, a professor of health policy and management and community health sciences at the Fielding School, along with colleagues at the NYU Tandon School of Engineering and Northeastern University, used a datadriven approach capable of going beyond mere correlations to reveal causal relationships. Theirs was the first study to quantify the influence of news-media stories on firearm prevalence. The researchers analyzed 69 mass shootings in the U.S. between 1999 and 2017, gathering data on the number of firearm background checks per month (a proxy measure for gun purchases), along with all print news coverage of firearm control policies appearing in the New York Times and Washington Post during the same period. Their findings of a causal link between the coverage and firearm sales were published in the journal Nature Human Behaviour.

WHAT IT MEANS “Our study suggests that many people may purchase firearms not out of fear for their safety, but out of fear of new regulations,” Macinko says. “There is a clear need for dialogue around how mass shooting events are discussed by the press, in order to find ways to mitigate unintended consequences.” ph.ucla.edu

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HEALTHY STORY TELLING

DRAMATIC IMPROVEMENT An FSPH team is assessing the ability of a popular TV series in West Africa to change health-related norms and behaviors. PRODUCED IN SENEGAL and popular through much of West Africa, the TV series C’est la Vie (That’s Life) takes place in the fictitious Ratanga health clinic and features storylines about the lives of the midwives who staff it. But in addition to following the dating twists and office politics involving the main characters, viewers are exposed to a hefty dose of public health messaging on topics involving maternal and child health, sexuality and reproductive rights, gender violence, and female genital mutilation, to name a few. For Réseau Africain d’Education en Santé (RAES), a nongovernmental organization based in Dakar, Senegal, the compelling storylines of C’est la Vie are in the service of reaching viewers in ways that advance public health through changed knowledge, attitudes, and behaviors. A group of Fielding School faculty and an FSPH alumnus now at Drexel University have served as technical advisers to RAES and the program’s producer, Alexandre Rideau, and have begun evaluating the impact of C’est la Vie, two seasons in. The FSPH team, led by Deborah Glik, professor of community health sciences, has had a long association with Rideau — having collaborated with him on research to better understand the effective use of entertainment to communicate health messages, as well as connecting him with TV-industry professionals. “Alex is working closely with professional screenwriters, directors, and actors from French West Africa, where there is a burgeoning television industry,” says Glik, a longtime leader in working with the Hollywood community to use the medium as a vehicle to promote public health. “The result is a show that is carefully and thoughtfully produced, and we know from past research in Hollywood that this approach leads to storylines that res26

C’EST LA VIE FOLLOWS THE LIVES OF THE MIDWIVES WHO STAFF A FICTITIOUS HEALTH CLINIC.

onate with viewers and therefore have significant impact.” As they embark on studying C’est la Vie’s influence in Senegal and Côte d'Ivoire, Glik and her colleagues — including FSPH faculty members Michael Prelip, Jessica Gipson, and Roch Nianogo, along with Philip Massey (MPH ’09, PhD ’13), an associate professor in Drexel’s School of Public Health — are testing the hypothesis that communicating health messages through the popular series will prove more impactful than simply delivering them through a public service announcement or other traditional health-education venues. “The idea is that when the audience relates to the characters and receives these messages through a story that hooks them, the messages are better internalized,” Prelip says.

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With three years of funding from the Gates Foundation, the FSPH-led team is evaluating C'est la Vie’s impact through a combination of opinion polling, surveys, social media surveillance, and focus groups. “We have seen many examples in the U.S. of the power of popular media to effect societal change,” says Glik, who cites a late1980s initiative by NBC, in affiliation with Harvard’s School of Public Health, to insert storylines on the dangers of drinking and driving into its programming, which changed public attitudes and led to a significant reduction in drunk-driving deaths. Since that time, Glik notes, many health issues have been tackled by television, both in the U.S. and globally. “A program such as C'est la Vie has the potential to change social norms.”


SCHOOL WORK FSPH AT AMERICAN PUBLIC HEALTH ASSOCIATION ANNUAL MEETING AND EXPO

THE 2019 AMERICAN PUBLIC HEALTH ASSOCIATION (APHA) annual meeting in Philadelphia was attended by Fielding School faculty, students, staff, and alumni, many of whom had their work featured. The meeting’s theme was “Creating the Healthiest Nation: For science. For action. For health.” The APHA Food & Nutrition Section chose professor of community health sciences May Wang as the winner of the 2019 Excellence in Dietary Guidance Award. Dawn Upchurch, professor and

STAY CONNECTED WITH UCLA FSPH Visit us online: ph.ucla.edu

vice chair of the community health sciences department, was elected to serve as section councilor for the Integrative, Complementary and Traditional Health Practices Section of APHA. Department of Community Health Sciences professors Chandra Ford and Gilbert C. Gee were unanimously chosen as co-recipients of the 2019 Paul Cornely Award for their work, individually and together, on the impact of racism on health. Ford and Gee accepted their awards at the annual Health Activist Dinner in Philadelphia.

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WELCOMING NEW FACULTY The Fielding School welcomes the following new faculty members. To learn more about their work, please visit ph.ucla.edu/faculty

DEPARTMENT OF BIOSTATISTICS

DEPARTMENT OF HEALTH POLICY AND MANAGEMENT

ZHE FEI, assistant professor-in-residence

JULIE ELGINER, adjunct assistant professor

Fei develops statistical methods to analyze big data and has applied

Elginer is an expert in health care advocacy who has drafted legisla-

these methods to data related to cancer survival, epigenetics and

tion and testified before the California State Legislature and Office

aging, and quality measures for health care providers. He is part of

of the Governor on issues related to perinatal mental health, human

several research collaborations, including one with the UCLA Luskin

trafficking, categorical eligibility for food stamps, and microbicide

School of Public Affairs and the Los Angeles Unified School District

funding. In 2010, the California State Assembly bestowed her with an

that aims to improve the mental health of students in Los Angeles.

Individual Member Resolution for her “lifetime of achievements and meritorious service.”

DEPARTMENT OF COMMUNITY HEALTH SCIENCES DR. JOANN ELMORE, professor JENNIFER WAGMAN, assistant professor

Elmore is a primary care physician who conducts research into

Wagman collaborates with researchers at the Rakai Health Sciences

the accuracy of cancer screening tests and other medical tests.

Program in Uganda to investigate intimate partner violence, hazard-

She also studies how patients benefit from accessing their

ous alcohol use, and HIV infection. She also leads UC Speaks Up, a

doctors’ office notes via the OpenNotes project and is using AI/

project aimed at preventing sexual assault and dating violence on

machine learning to help improve diagnostic accuracy in radiol-

three University of California campuses, and is director of Violence

ogy and pathology.

Prevention Research with the UC Global Health Institute Women’s Health, Gender and Empowerment Center of Expertise.

RISHA GIDWANI-MARSZOWSKI, adjunct assistant professor Gidwani-Marszowski's research focuses on both the costs and health

DEPARTMENT OF ENVIRONMENTAL HEALTH SCIENCES

outcomes associated with health care services, especially cancer care and end-of-life care. Gidwani-Marszowski is currently a health

JIAN LI, professor

economist with the Veterans Affairs Health Economics Resource

Li conducts research about how work stress can affect a person’s

Center and a core investigator at the Veterans Affairs Center for

health and investigates which interventions can help. Li’s contri-

Innovation to Implementation.

butions to the field of occupational health have been recognized with awards from the National Institute for Occupational Safety and

ISOMI MIAKE-LYE, adjunct assistant professor

Health and other research societies.

Miake-Lye is a researcher with the Veterans Affairs Greater Los Angeles Healthcare System whose research focuses on how the

DEPARTMENT OF EPIDEMIOLOGY

organization of health systems affects doctors’ and other health care providers’ approaches to applying evidence from scientific research

MARISSA SEAMANS, assistant professor

to their work.

Seamans analyzes large health care databases to learn about patterns related to substance use and mental health. Most recently,

WARREN SCOTT COMULADA, associate professor-in-residence

she led a study that found that people who live in households with

Comulada designs and analyzes studies that use cell phone apps to

prescription opioid users are at higher risk for taking the drugs

help people engage in healthy behaviors. He is currently the lead

themselves.

statistician on two large studies funded by the National Institutes of Health that are investigating HIV prevention and treatment in adults

ANNETTE REGAN, adjunct assistant professor

and teens.

Regan studies the maternal and child health impacts of vaccination during pregnancy as well as strategies for promoting vaccines to

DR. YUSUKE TSUGAWA, assistant professor

parents and pregnant women. She is currently working on several

Tsugawa studies variations in quality of care and costs of care

projects that aim to improve flu vaccination among pregnant women

among physicians. According to the research analytics website

and children, and is leading a study involving more than 700,000

Altmetric, Tsugawa's paper comparing the quality of care between

Australian mothers and their infants to learn the best time to vacci-

male and female physicians was the third-most widely circulated

nate against pertussis and the flu during pregnancy.

scholarly article in 2017.

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Center for Healthcare Management and t h e Pa u l To r r e n s C h a i r i n H e a l t h c a r e M a n a g e m e n t Established at the UCLA FSPH THE FIELDING SCHOOL RECENTLY ANNOUNCED the establishment of the Center for Healthcare Management. The center — made possible by the Sinaiko Innovation Fund for Healthcare Management, a $1 million gift from Richard (MPH ’77) and Patricia Sinaiko, and Greg (MPH ’01) and Marcie Sinaiko — will leverage the Department of Health Policy and Management’s close ties with alumni and other leading health care management practitioners in Southern California to ensure that the focus of its research, as well as the curriculum for students in the department’s executive, traditional, and customized degree and nondegree programs, are informed by on-the-ground health care management expertise. See pages 12 and 32 to learn more. The establishment of the Paul Torrens Chair in Healthcare Management, based within the newly launched center and the Department of Health Policy and Management, will support the teaching and research activities of a faculty member with health care management expertise, and was made possible by a gift of more than $1 million from the Don S. Levin Trust and Edna and Tom Gordon. See page 13 to learn more.

STUDENTS, FACULTY, STAFF, AND ALUMNI gathered to ring in the new academic year and welcome new students at the seventh annual Fielding Fall Fest.

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GRANTS & CONTRACTS

This section includes new grants and contracts awarded in 2018-19. Due to space limitations, only funds of $50,000 or more are listed, by principal investigator.

UC Tobacco-Related Disease Research Program, $89,996 for two years DENA HERMAN Partners in Excellence for Leadership in Nutrition Health Resources and Services Administration, $1,208,323 for five years JODY HEYMANN Amplifying Efforts to Advance Women’s Economic Empowerment With Actionable Data

RICHARD AMBROSE

RYAN COOK AND PAMINA GORBACH

on Accountability

Fighting Drought With Stormwater

The Effects of HIV, Substance Use, and Obesity on

William and Flora Hewlett Foundation,

UC Office of the President & University of

the Gastrointestinal Microbiome of Young Men of

$750,000

California, Santa Barbara, $116,020

Color Who Have Sex With Men National Institute on Drug Abuse, $52,960

HAROUTUNE ARMENIAN

MICHAEL JERRETT Health on the High Street

American University of Armenia Corporation/

ROGER DETELS

Robert Wood Johnson Foundation & Royal

American University of Armenia Funds for

National Center for AIDS/STD Control and

Society for Public Health, $170,688 for one-and-

Dr. Armenian

Prevention, China CDC/China-U.S. HIV/TB

a-half years

American University of Armenia Corporation,

Multidisciplinary Training Program

Powering Healthy Lives Through Parks

$87,605

National Health and Family Planning

Urban Institute & Prevention Institute, $65,000

Commission-PRC & Chinese Center for Disease SUDIPTO BANERJEE

Control and Prevention (China), $355,732

DVORA JOSEPH DAVEY

Flexible Bayesian Hierarchical Models for

Los Angeles Clinical Research Site for the

Evaluation of Pre-Exposure Prophylaxis Cascade

Estimating Inhalation Exposures

Multicenter AIDS Cohort Study/Women’s

in Pregnant and Breastfeeding Women in Cape

National Institute of Environmental Health

Interagency HIV Study Combined Cohort Study

Town, South Africa

Sciences, $1,605,606 for four years

National Heart, Lung and Blood Institute,

Fogarty International Center, $698,291 for

$27,050,000 for seven years

five years

Addressing Obesity in Early Care and Education

PATRICIA GANZ

LEEKA KHEIFETS

Settings

A Model Clinical/Translational Research Program

Exploring Distance and Magnetic Fields

National Institute of Child Health and Human

for Breast Cancer Survivors: A Focus on Cognitive

Association in California Power Line Study:

Development, $2,836,257 for five years

Function After Breast Cancer Treatment

Replication of Draper Study of Childhood

Implementation Research to Reduce Colorectal

The Breast Cancer Research Foundation, $250,000

Leukemia, Brain Tumors and Distance to Power

ROSHAN BASTANI

Lines in California - Trend in Risk

Cancer Disparities UC Tobacco-Related Disease Research Program,

BETH GLENN

$910,175 for three years

Within Our REACH (Racial and Ethnic

Electric Power Research Institute, $50,000

Approaches to Community Health)

KATHYRN KIETZMAN

ALEXANDRA BINDER

Centers for Disease Control and Prevention &

California Health Interview Survey (CHIS)

Epigenetic Age as a Marker of Reproductive Age

Public Health Advocates, $425,000 for five years

Long Term Services and Supports Content Development

and Modifier of Invasive Breast Cancer Risk Among Postmenopausal Women

PAMINA GORBACH

California Department of Health Care Services,

National Cancer Institute, $463,150 for three years

Understanding the Effects of Opioid and Stimulant

$2,999,832 for eight years

Injection Among HIV-Positive and Negative Men RONALD BROOKMEYER

Who Have Sex With Men (MSM) of Color

GERALD KOMINSKI

Clinical, Pathological, and Imaging Studies in the

National Institute on Drug Abuse, $165,675

California Simulation of Insurance Markets

Oldest Old, The 90+ Study

Collaborating Consortium of Cohorts Producing

California Healthcare Foundation & University of

National Institute on Aging & University of

National Institute on Drug Abuse (NIDA)

California, Berkeley, $218,786 for two years; The

California, Irvine, $302,608 for five years

Opportunities (C3PNO)

California Wellness Foundation & University of

National Institute on Drug Abuse, $155,569

California, Berkeley, $65,000 for two years

EMMELINE CHUANG

Demographic Analysis and Microsimulation

Qualitative Research, Project Management and

DI HE AND JULIA HECK

Model Comparisons

Statistical Analysis - Task Order 2

Study on Maternal Smoking During Pregnancy

California Health Benefit Exchange, $955,895 for

Department of Veterans Affairs, $755,000

and Childhood Metabolic Outcomes

two years

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ANNETTE MAXWELL

$650,000 for three years; County of San Diego,

ANDRE ROGATKO AND PATRICIA GANZ

Colorectal Cancer Control Program (CRCCP)

$1,480,000 for five years; City and County of San

Advancing Analysis and Interpretation of Adverse

Grantee Survey

Francisco, $1,052,000

Events and Patient Reported Outcomes in Cancer

Centers for Disease Control and Prevention &

CHIS Child and Adolescent Redesign Pilot

Clinical Trials

University of Washington, $112,000 for two years

Expansion

National Cancer Institute, $3,395,793 for five years

California Department of Health Care Services, FOLASADE (FOLA) MAY

$750,000

ANNETTE STANTON

Follow-Up of Abnormal Findings on Colorectal

Medi-Cal Monitoring With CHIS

Understanding and Improving the Experience of

Cancer Screening in a Federally Qualified Health

California Healthcare Foundation, $132,981

Breast Cancer

Center: The Role of System-Level Clinical

Advancing the Disaggregation of Ethnic/Racial

The Breast Cancer Research Foundation, $250,000

Care Processes

Data Through Technical Assistance, Training, and

National Cancer Institute, $157,606 for two years

Case-Making

ONDINE VON EHRENSTEIN

Robert Wood Johnson Foundation, $789,887 for

Risks, Early Markers, and Prevention of Metabolic

ELIZABETH ROSE MAYEDA

three years

and Cardiovascular Disease in Adolescents in

The Inverse Link Between Incidence Rates of

Preserving Health Coverage for Immigrants:

Bangladesh: Pilot Study

Cancer and Alzheimer’s Disease: Comparing

Economic & Health Implications of Proposed

National Institute of Child Health and Human

Spurious and Causal Explanations to Illuminate

Public Charge Rules on California and Local

Development, $342,350 for two years

the Causes of Alzheimer’s Disease

Jurisdictions

National Institute on Aging & University of

California Healthcare Foundation, $161,045

STEVE WALLACE

California, San Francisco, $218,400 for

California Tribal Epidemiology Center (CTEC)

Resource Centers for Minority Aging Research

four years

Building Health Infrastructure Initiative

(RCMAR) National Coordinating Center at UCLA

Closing the Gap Between Observational Research

Centers for Disease Control and Prevention &

National Institute on Aging, $1,184,741 for five years

and Randomized Trials for Prevention of

California Rural Indian Health Board, INC.,

Alzheimer’s Disease and Dementia

$600,000 for one-and-a-half years

National Institute on Aging & University of

MAY WANG Assessing Impact of Federal Nutrition Programs

NADEREH POURAT

on Health Outcomes

Evaluation of Health Home Program

National Institute of Child Health and Human

CORINNA MOUCHERAUD

California Department of Health Care Services,

Development, $171,191 for two years

Implementation and Clinical Effectiveness of

$1,000,000 for five years

Cervical Cancer Prevention in Malawi: A Critical

Toward Universal Coverage: Understanding

YIFANG ZHU

Evaluation to Bring Screening and Treatment

Health and Other Characteristics of

Linking E-Cigarette Aerosol Characteristics to

to Scale

Undocumented Californians Based on CHIS Data

Mechanisms of Pulmonary Toxicity

National Center for Advancing Translational

California Healthcare Foundation, $151,522 for

National Heart, Lung and Blood Institute,

Sciences & UCLA Clinical and Translational

two years

$1,872,000 for four years

California, San Francisco, $169,028 for five years

Science Institute, $389,318 for three years

Air Quality Management Training Program: MICHAEL PRELIP

40-Year Lessons From Los Angeles

EZINNE NWANKWO AND MAY

UCLA FSPH-Jackson State University Pathways

Energy Foundation China, $55,000

SUDHINARASET

to Graduate Programs

Impacts of Residential Gas Appliances on Air

Health Policy Research Scholars Cohort

University of California Office of the President,

Quality and Population Health in California

Three – 2018

$268,772 for three-and-a-half years

Sierra Club, $65,000

Robert Wood Johnson Foundation, $120,000 for five years

ANNE RIMOIN Ebola Virus Immunogenicity in the Democratic

ANNE PEBLEY

Republic of the Congo

Social Disparities in Physical Functioning by

Bill and Melinda Gates Foundation, $1,260,822 for

Race, Ethnicity, and Immigration Status

two years

National Institute on Aging, $1,631,962 for four-

Continuation of Digitization and Support for

and-a-half years

Development of Human African Trypanosomiasis

STAY CONNECTED WITH UCLA FSPH

(HAT) Information and Decision Support System NINEZ PONCE

in Democratic Republic of the Congo

California Health Interview Survey (CHIS)

Bill and Melinda Gates Foundation, $104,783

California Department of Health Care Services, $2,974,500 for three years; California Department

BEATE RITZ

of Public Health, $4,226,669 for four years;

Environment, Metabolomics, and Parkinson’s Disease

California Health Benefit Exchange, $1,350,000

National Institute of Environmental Health

for two years; The California Wellness Foundation,

Sciences, $443,000 for two years ph.ucla.edu

AU T U M N /W I N T E R 2 0 1 9 –2 0

31


TRANSFORMATIVE INVESTMENTS

PAY I NG I T F OR WA R D

The Fielding School was integral to the Sinaikos’ success in health care management. Their gift will pave the way for countless others to follow a similar path.

RICHARD SINAIKO (MPH ’77) believes his successful career in health care management would have been impossible without his Fielding School education. With that in mind, Richard and Patricia Sinaiko, and Greg (MPH ’01) and Marcie Sinaiko, decided to further elevate FSPH’s health care management program in a way that would allow others to enjoy the same opportunities. The family’s $1 million gift through the Sinaiko Innovation Fund for Healthcare Management helped to establish the Fielding School’s Center for Healthcare Management (see page 12). “We wanted to give back, and felt that we were in a position to help create something that would elevate the outstanding health care management program at the school,” Richard Sinaiko says. Richard Sinaiko came to the Fielding School in the mid1970s after deciding to change careers. He was immediately enthralled by the health care management program, then under the leadership of Fielding School professor Dr. Paul Torrens, who would become Sinaiko’s mentor. Through the insights he gained, Sinaiko quickly ascended up the ranks of the health care management field, holding senior executive positions that included five years as chief financial officer of UCLA Medical Center before forming Sinaiko Healthcare Consulting in 1991. Joined by both of his sons, Sinaiko grew the company into one of the nation’s most successful health care consulting firms, offering a personalized approach and bringing his expertise in managed care — then a relatively new phenomenon outside of California — to other parts of the country. When Medicare instituted complex new coding requirements in 2002, the Sinaiko family spun off a separate company, The Coding Source, under Greg Sinaiko’s leadership — significantly 32

U C L A F I E L D I N G S C H O O L O F P U B L I C H E A LT H M AG A Z I N E

expanding the business. The Sinaikos’ association with UCLA predates Richard’s enrollment in the EMPH program. Patricia Sinaiko recalls regularly roaming the halls of UCLA Medical Center as a child in the 1950s; her father, the late Dr. David Solomon, was recruited to UCLA in 1952 and became the first board-certified endocrinologist in Los Angeles. He went on to become chairman of the Department of Medicine and establish the Division of Geriatric Medicine and the UCLA Center on Aging. Through all of his years as a busy executive and consultant and now in retirement, Richard Sinaiko has remained an active supporter of the Fielding School and the program that helped to launch his career — teaching Healthcare Financial Management and Healthcare Financial Applications in the EMPH program, serving on the Dean’s Board of Advisors, and always making sure to find time to meet with students looking for career opportunities or advice. When students ask about the benefits of a career in health care management, Sinaiko doesn’t hesitate to offer his unqualified endorsement. “It’s always going to be challenging and you’re always going to have the satisfaction of knowing you are contributing to society,” he says. “In addition, you will be working with similarly motivated people. To me, that adds up to a rewarding work experience.” For information on how you can join the Sinaikos in supporting the Fielding School’s Center for Healthcare Management, please contact Tal Gozani at tgozani@support.ucla.edu, or call (310) 267-0447.

ABOVE, FROM LEFT TO RIGHT: GREG, MARCIE, PATRICIA, AND RICHARD SINAIKO.


BETTER TOGETHER

Solving the growing challenges in today’s health care environment requires a partnership among the best minds in the academic and practice communities. The Fielding School’s new Center for Healthcare Management leverages the strong connections between the school, experts across the campus, and leading practitioners to improve health care management research, knowledge, and practice.

JOIN US

By supporting the center you will help to strengthen this dynamic partnership between the Fielding School and health care management practitioners.

To become a partner in advancing health care management, please contact publichealth@support.ucla.edu or call (310) 825-6464.


Box 951772 405 Hilgard Avenue Los Angeles, CA 90095-1772 ph.ucla.edu Address Service Requested

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.” — Dr. Martin Luther King Jr.

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Profile for UCLA Fielding School of Public Health

UCLA Public Health Magazine - Autumn/Winter 2019  

This issue of the Fielding School’s Public Health Magazine illustrates the wide-ranging ways in which Fielding School faculty, students, sta...

UCLA Public Health Magazine - Autumn/Winter 2019  

This issue of the Fielding School’s Public Health Magazine illustrates the wide-ranging ways in which Fielding School faculty, students, sta...

Profile for uclafsph