Structural Racism and the People’s Health: History and Context Matters

Abstract: In this presentation on “Structural racism & the people’s health: history & context matters,” I commence with a brief reminder as to our current societal and ecological context, after which I introduce the ecosocial theory of disease distribution, which guides my work, including conceptualization and measurement of structural injustice. I then offer empirical examples of my research on structural racism and health inequities, in relation to Jim Crow and both past and present residential segregation, as measured using the Index of Concentration at the Extremes for racialized economic segregation and also historical redlining (as delineated by the 1930s federally-sponsored maps produced by the Home Owners Loan Corporation (HOLC)). Health outcomes addressed include: preterm birth; infant mortality; child mortality; cancer incidence, stage at diagnosis, and mortality; and breast cancer estrogen receptor status. The presentation concludes with reflections on embodied histories, health inequities, and the people’s health.
*Co-sponsored with the Center for the Study of Racism, Social Justice & Health

Beyond Life Expectancy—The Case for Monitoring Lifespan Variation

Abstract: Human population health is generally monitored by average mortality levels, typically in terms of life expectancies or age-standardized death rates, which belie substantial variation in length of life. Variation in ages at death, captured by a metric of lifespan variation, should be used to supplement measures of average longevity when comparing or monitoring societies and population subgroups. Although lifespan variation has historically been strongly inversely correlated with life expectancy, we are beginning to see this relationship reversed, resulting in positive correlation in some countries or subnational populations. Often these changes reflect midlife mortality crises with roots in stratified education and wealth. In this talk I will present empirical examples from around the developed world, pressing the case to monitor lifespan variation.

Race, Millennials and Wealth in the Aftermath of the Great Recession
Abstract: As America becomes more plural, it is critical to view race as a pillar and not just an issue in our economy. Despite the narrative that with hard work, resilience, grit, and personal responsibility – people can pull themselves up, and achieve economic success; high achieving black Americans, as measured by education, still exhibit large economic and health disparities relative to their white peers, especially in the domain of wealth. This may be worsening, in the aftermath of the great recession, the homeownership gap for young adult black Millennials is larger than any other generation in over 100 years. This talk will examine these issues, and present a political economy and policy apparatus that can bring about a racially and economically inclusive America.
*Co-sponsored with the Center for the Study of Racism, Social Justice & Health

"Hospital Productivity and the Misallocation of Healthcare Inputs"

Abstract: There is growing evidence for wide variation in total factor productivity across hospitals, with large differences in risk-adjusted health outcomes as well as expenditures. In this paper, we consider the additional contribution of misallocation in input choices – the underuse of effective inputs and overuse of ineffective ones -- to explain why some hospitals get better outcomes at lower cost. The sample is of 1.7 million patients in the Medicare fee-for-service population with acute myocardial infarction (AMI), or heart attacks, during 2007-17. The problem of confounding health factors is addressed in several ways, including the use of tourists, whose assignment to hospitals resembles random assignment (Doyle, 2011), and ZIP-code fixed effects. Briefly, we find strong evidence for input misallocation across hospitals; greater use of highly effective inputs, such as beta blocker, statin, and ACE/ARB drug treatments, primary care support, and stenting are predictive of highly-productive hospitals, while an excess of multiple physicians, scans, and potentially fraudulent excess home health care billings are predictive of low-productivity hospitals.
Co-Sponsored with the Dept. of Economics 

Improving Emergency first Response and Follow-up for Individuals Who Experience Behavioral Crisis
Abstract: Men and women who experience serious mental illness and other challenges face increased risk of violent encounters with police officers and other first-responders. This talk describes person-, place-, and event-based strategies to improve emergency response to such incidents. It also discusses promising strategies of prevention and follow-up to reduce the risk of such violent encounters from occurring or re-occurring.
Co-sponsored with the California Policy Lab
Location: Presented remotely via Zoom

Aging Among the Homeless in the time of COVID: A crisis upon a crisis
Abstract: In this talk, Margot Kushel will explore the aging of the homeless population, including causes, consequences and solutions. She will end the conversation with implications for the COVID-19 crisis.
Co-sponsored with the California Policy Lab
Location: Presented remotely via Zoom

"The political context and infant health in the United States"
Florencia Torche, Stanford University
Abstract: Political factors could have substantial consequences for the health and wellbeing of populations. In the United States, an important political factor is the party of the president. The two main parties differ in their ideologies and policy agendas, and these differences have sharpened since the 1960s. We examine the effect of prenatal exposure to the political party in office at the national level (president’s party) and the state level (governor’s party) on infant health between 1971 and 2018, considering the heterogeneity and timing of these effects. Fixed effects models show a beneficial effect of a Democratic president but no effect of a Democratic governor on birth outcomes. The benefit of in-utero exposure to a Democratic president is much stronger for Black infants than White infants. The effect of the president’s party does not materialize immediately after the inauguration. Rather, it takes approximately two years to fully emerge, and it remains elevated until the end of the party’s tenure in office. The effect is robust across specifications and only partially mediated by a battery of measurable social policies. Our findings suggest that the party in power is an important determinant of infant health, particularly among vulnerable populations.

"Challenges with Using Simulation Models to Plan and Refine COVID Testing for High-risk Populations"
Sanjay Basu, Harvard University
Abstract: Simulations models are frequently used during infectious disease outbreaks to guide policy and practice. This talk will discuss the use and refinement of COVID simulation models to help develop a testing network, define testing plans and refine them for high-risk populations--including homeless shelters, nursing homes, meat-packing plants, and similar congregate worksites--and address limitations and uncertainties presented by those models that were informed by implementation of their results.

Bio: Sanjay Basu, MD, PhD, is a primary care physician at Tenderloin Health Services—an integrated primary care, behavioral health, and substance use treatment clinic in San Francisco—and Director of Research at Collective Health.

"How Deep is the COVID-19 Recession? Evidence from Kenya and Beyond"
Edward Miguel, UC Berkeley
Abstract: Despite numerous journalistic accounts, systematic quantitative evidence on the evolution of economic conditions during the ongoing COVID-19 global pandemic remains scarce for most low and middle income countries, in part due to the limitations of official economic statistics in environments with large informal sectors and subsistence agriculture. I will focus on novel evidence from a detailed and large-scale panel data collection effort in rural Kenya, documenting the evolution of living standards over time as well as the effects of an earlier cash transfer program. I also discuss results from over 30,000 respondents in an ensemble of 16 original household survey samples collected in nine countries in Africa, Asia, and Latin America. The data documents declines in employment and income across socioeconomic strata beginning in March 2020, resulting in widespread food insecurity and the risk of persistent adverse effects, especially among children and other vulnerable groups.
Bio: Prof. Miguel's research focus is African economic development, including work on the economic causes and consequences of violence; the impact of ethnic divisions on local collective action; interactions between health, education, environment, and productivity for the poor; and methods for transparent social science research.

Giovanni Peri, UC Davis

Bio: Giovanni Peri has expertise in labor economics, urban economics and the economics of international migrations. In addition to his appointment in the Department of Economics, he is a Research Associate at the National Bureau of Economic Research in Cambridge, Massachusetts, and the founding director of the UC Davis Migration Research Cluster.

Voting after Shelby: Did pre-clearance matter?
Ariel White, Massachusetts Institute of Technology
Abstract: Nearly five decades after the passage of the Voting Rights Act, the law was dramatically changed by the Supreme Court’s decision in Shelby County v. Holder. The court effectively removed the “preclearance” process that had required places with a history of racial discrimination to get Justice Department approval before changing their voting procedures. Dissenting justices and voting-rights advocates feared that this decision could lead to massive changes to election administration and ultimately to lower rates of voter participation in minority communities. In this paper, we evaluate the impact of this decision on election practices and on Black and Hispanic voter registration and turnout. We use a combination of administrative data on registration and voting, survey data on mobilization and local election administration, and state legislative records to examine different facets of the voting rights landscape after the Court's decision.
Bio: Prof. White research focuses on voting and voting rights, race, the criminal justice system, and bureaucratic behavior. Prof. White's work uses large datasets to measure individual-level experiences, and to shed light on people's everyday interactions with government.

Cecilia Menjívar, UC Los Angeles

Bio: Prof. Menjívar is a Professor and Dorothy L. Meier Social Equities Chair, her research focuses on the structural roots of inequalities and on how individuals’ social locations shape their responses to such conditions.