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