In its fourth round of funding, the Center for Health Research is pleased to award 8 new small research grants.
Health care organizations poised to embrace change-or those that score high on "change readiness"-are generally more likely to convert a variety of strategic changes into specific practices and behaviors sooner and more completely, and as a result, are also more likely to perform better than those who are lower on change readiness. "Change readiness" in this context is found within the cultural norms and values of medical departments within medical centers. In this study, Jennifer Chatman (Business; chatman@haas.berkeley.edu) and her research team will focus specifically on cultural norms that support change initiatives in health care organizations because of the substantial change occurring in the industry and the lack of an established "ideal model" of health care organizations, with the goal of developing a set of tools and metrics that would help health care organizations to become agile and able to change quickly and effectively.
Each day close to 20,000 people are infected with the HIV virus worldwide; a large portion of whom are infected through unprotected sex with commercial sex workers in developing countries. While condoms are an effective defense against the transmission of HIV and other sexually transmitted infections, large numbers of sex workers are not using them with their clients. One policy response to stopping the transmission of HIV/AIDS in Latin America has been to regulate sex workers. Paul Gertler (Business/Public Health; gertler@haas.berkeley.edu) and his group will study these regulations and how they affect economic incentives to use condoms and economic returns to sex work in Ecuador, where it is legal and often regulated. The present study will test two hypotheses. First, that regulation increases sex worker incentives to use condoms, which if true, will result in decreased transmission of STIs/HIV/AIDS. Second, that if sex workers engage in less risky behavior (e.g. by enforcing condom use), then they are compensated less, decreasing their economic returns.
Empirical findings calling for a new model of distributive justice include the following assumptions: first, social disparities in early life "get into the body" by affecting the autonomic nervous system of certain children, who then tend to take low positions in social hierarchies; second, "low-hierarchy" children have identifiable health vulnerabilities over their lifetime; third, once a child develops autonomic sensitivity, he or she faces a u-shaped curve of future health risks, so that under supportive social conditions children who might have had worse health can have better-than-average mental and physical health outcomes; fourth, parental behaviors and broader social influences play a critical role in which children will develop poor long-term health. Jodi Halpern (Public Health; jhalpern@socrates.berkeley.edu) hopes to extend current philosophical theories of justice to address the needs of socially disadvantaged children who develop long-term biologic vulnerabilities and to contextualize recent empirical findings showing that parental factors play a critical role in the development of such vulnerabilities by examining how parental factors themselves are strongly related to pre-existing social disparities.
In 1999, the City of Berkeley Division of Public Health issued a health status report identifying disparities across a range of health indicators. For example, average lifespans for residents of South and West Berkeley ranged from 62 to 64 years; while those in North Berkeley, the Berkeley Hills, and the Claremont area lived approximately 20 years longer, with average lifespans ranging from 80 to 84 years. In response, the public health department in the City of Berkeley has been engaged in a process of community assessment and dialogue to address key health disparity issues. However, it has become clear that this process could be facilitated by a stronger grounding in the theoretical literature and in an analysis of existing survey data. Denise Herd (Public Health; tiara@berkeley.edu) plans to describe common pathways that might predict disparities in different types of health problems and to uncover common pathways for addressing such problems, such as whether key programmatic and or structural changes-improved recreational opportunities or civic services, for example-can help alleviate some health and social problems.
How do centralized, technically driven, federal bureaucracies account for and respond to local-level knowledge in implementing their programs? The answer, as a growing literature in the social sciences documents, is that most do not. Instead, this is a habitual arena for bureaucratic failure. The Centers for Disease Control and Prevention (CDC), on the other hand, has a long history of successful community-level program implementation. Unfortunately, there has been virtually no social science research on the CDC as an organization. Ann Keller's (Public Health; ackeller@socrates.berkeley.edu) project addresses this remarkable gap in the literature and will evaluate CDC strategies in order to assess their relevance for other organizations that struggle with effective implementation at the local level. Gathering her data through a series of in-depth interviews of CDC officials and community members currently participating in CDC programs, Dr. Keller's will study conduct her study with both a cross-case and a within-case comparison.
Warfare has a major impact on health and economic development, by destroying infrastructure-including hospitals, clinics, roads, and power lines-and by leaving deep physical and psychological scars on its survivors. Another widespread legacy of warfare is the presence of landmines / unexploded ordnance (UXO). In addition to the direct injuries sustained by those who inadvertently detonate them, landmines/UXO are likely to have other negative effects on health and well-being. Landmines/UXO make it dangerous for mobile vaccination teams to visit rural clinics, disrupt humanitarian relief efforts, and make it risky for farmers to plough and weed their fields, all of which adversely affect nutrition, overall health, and income. Yet despite some interesting case study evidence, and growing international attention, little systematic empirical research has examined this issue thoroughly. Using a recently declassified dataset containing detailed figures on ordnance used by the U.S. Navy and Air Force during the Vietnam War, Edward Miguel (Economics; emiguel@econ.berkeley.edu) hopes to provide credible quantitative evidence on the long-run effects of landmines/UXO on health and economic outcomes in Vietnam.
Some colorectal cancer patients survive longer than others; these differences in survival are associated with a variety of factors, including health behaviors, demographic and socioeconomic characteristics, and characteristics of the tumor itself (e.g., site, stage, and grade). Although there is a growing body of research indicating that characteristics of the built environment are associated with health behaviors (e.g., physical activity) and different health outcomes, it is unknown whether these characteristics are associated with differences in survival among people diagnosed with colorectal cancer. William Satariano (Public Health; bills@berkeley.edu) will assess the feasibility and utility of incorporating measures of the built environment to enhance population-based studies of colorectal cancer survival. His major goals are to investigate the availability and accessibility of community-level data to characterize the neighborhood environment (defined here, as the census block) of six Bay Area Counties (Alameda, Santa Clara, San Mateo, San Francisco, Marin, and Contra Costa counties) and whether selected measures of the built environment (including measures of social capital) explain differences in survival among colorectal cancer patients diagnosed in the San Francisco Bay Area between 1995-2000, after adjustment for traditional demographic and socioeconomic variables.
The American medical care system is under major strain. When the baby-boomer population enters the over-65-year-old age group between the years 2020 and 2030, the number of older people in the country will double, enormously increasing the burden on the nation's health care systems. While programs to prevent disease and to improve health-seeking health care have been moderately successful in middle-class populations, they have been far less successful among people in lower-class positions. One of the most potent factors in improving health-seeking medical care and other prevention behavior is the influence of others in one's social network. What it is about social connections that results in these outcomes? Dr. Syme and his colleagues plan to study this issue in Cuba, where many people have a set of rich social connections rarely observed in the United States and where health services are used very frequently and effectively. The "Cuban connection" will enable them to investigate, for the first time, the relative importance of social support and social settings for health outcomes. By examining these social network pathways that influence behavior, S. Leonard Syme (Public Health; slsyme@berkeley.edu) hopes to broaden current understanding of how the determinants of network structure influence health.
© 2005 UC Regents. All rights reserved.
