Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Findings: The major results are that although the factors driving the decisions on health insurance participation are basically the same for rural and urban citizens, the participation levels are quite different. The major difference is that urban SHI has higher coverage and urban citizens have higher income, resulting in a much larger urban medical expenditure.

 

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China Agricultural Economic Review
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Scott Rozelle
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In this paper we have two objectives - one empirical; one methodological. Although China's leaders are beginning to pay attention to health care in rural China, there are still concerns about access to health services. To examine this issue, we use measure of travel distances to health services to examine the nature of coverage in Shaanxi Province, our case study. The mean distance by road to the nearest health center is more than 6 km. When we use thresholds for access of 5 and 10 km we find that more than 40 (15) percent of the population lives outside of these 5 (10) kilometer service areas for health centers. The nature of the access differs by geographical region and demographic composition of the household.. The methodological contribution of our paper originates from a key feature of our analysis in which we use Geographic Information System (GIS) network analysis methods to measure traveling distance along the road network. We compare these measures to straight-line distance measures. Road distances (produced by network analysis) produce measures (using means) that are nearly twice as great as straight-line distances. Moreover, the errors in the measures (that is, the difference between road distances and straight-line distances) are not random. Therefore, traditional econometric methodsof ameliorating the effects of measurements errors, such as instrument variables regression, will not produce consistent results when used with straight-line distances.

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GeoJournal
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Scott Rozelle
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Background: Empty-nest elderly refers to those elderly with no children or whose children have already left home. Few studies have focused on healthcare service use among empty-nest seniors, and no studies have identified the prevalence and profiles of non-use of healthcare services among empty-nest elderly. The purpose of this study is to compare the prevalence of non-use of healthcare services between empty-nest and non-empty-nest elderly and identify risk factors for the non-use of healthcare services among empty-nest seniors.

Methods: Four thousand four hundred sixty nine seniors (60 years and above) were draw from a cross-sectional study conducted in three urban districts and three rural counties of Shandong Province in China. Non-visiting within the past 2 weeks and non-hospitalization in previous year are used to measure non-use of healthcare services. Chi-square test is used to compare the prevalence of non-use between empty-nesters and non-empty-nesters. Multivariate logistic regression analysis is employed to identify the risk factors of non-use among empty-nest seniors.

Results: Of 4469 respondents, 2667(59.7 %) are empty-nesters. Overall, 35.5 % of the participants had non-visiting and 34.5 % had non-hospitalization. Non-visiting rate among empty-nest elderly (37.7 %) is significantly higher than that among non-empty-nest ones (32.7 %) (P = 0.008). Non-hospitalization rate among empty-nesters (36.1 %) is slightly higher than that among non-empty-nesters (31.6 %) (P = 0.166). Financial difficulty is the leading cause for both non-visiting and non-hospitalization of the participants, and it exerts a larger negative effect on access to healthcare for empty-nest elderly than non-empty-nest ones. Both non-visiting and non-hospitalization among empty-nest seniors are independently associated with low-income households, health insurance status and non-communicable chronic diseases. The nonvisiting rate is also found to be higher among the empty-nesters with lower education and those from rural areas.

Conclusions: Our findings indicate that empty-nest seniors have higher non-use rate of healthcare services than non-empty-nest ones. Financial difficulty is the leading cause of non-use of health services. Healthcare policies should be developed or modified to make them more pro-poor and also pro-empty-nested.

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BMC Health Services Research
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Alexis Medina
Scott Rozelle
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This is an excerpt of the the article, which was first published in Stanford News. You can read the whole article here.

A Stanford-led study in China has revealed for the first time high levels of a potentially fatal tapeworm infection among school-age children. The researchers suggest solutions that could reduce infections in this sensitive age range and possibly improve education outcomes and reduce poverty.

The study, published in PLOS Neglected Tropical Diseases, focuses on Taenia solium, a tapeworm that infects millions of impoverished people worldwide and can cause a disorder of the central nervous system called neurocysticercosis. The World Health Organization estimates that the infection is one of the leading causes of epilepsy in the developing world and results in 29 percent of epilepsy cases in endemic areas. It is thought to affect about 7 million people in China alone.

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Science Magazine writes about REAP's work on early childhood development in rural China. Read the full article here.

Glasses askew and gray hair tousled, Scott Rozelle jumps into a corral filled with rubber balls and starts mixing it up with several toddlers. The kids pelt the 62-year-old economist with balls, and squealing, jump onto his lap. As the battle rages, Rozelle chatters in Mandarin with mothers and grandmothers watching the action. 

Elsewhere in this early childhood education center in central China, youngsters are riding rocking horses, clambering on a jungle gym, thumbing through picture books, or taking part in group reading. Once a week, caregivers get one-on-one coaching on how to read to toddlers and play educational games. The center is part of an ambitious experiment Rozelle is leading that aims to find solutions to what he sees as a crisis of gargantuan proportions in China: the intellectual stunting of roughly one-third of the population. "This is the biggest problem China is facing that nobody's ever heard about," says Rozelle, a professor at Stanford University in Palo Alto, California.

Surveys by Rozelle's team have found that more than half of eighth graders in poor rural areas in China have IQs below 90, leaving them struggling to keep up with te fast-paced official curriculum. A third or more of rural kids, he says, don't complete junior high. Factoring in the 15% or so of urban kids who fall at the low end of IQ scores, Rozelle makes a stunning forecast: About 400 million future working-age Chinese, he says, "are in danger of becoming cognitively handicapped."

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Bloomberg quotes REAP's research on China's healthcare system. Read the original article here

The outlines of China’s demographic challenge are well-known: By 2050 almost 27 percent of the population will be 65 or older, up from around 10 percent in 2015. Less recognized is that the crisis will hit hardest in rural villages.

China’s cities attract a disproportionate share of government health spending, along with the best doctors, so rural residents must put up with care that is expensive but shoddy. The average cost of a hospital visit is 50 percent of the annual income of a city dweller; for rural residents it’s 1.3 times annual income. Meanwhile, a 2014 survey by Stanford’s Rural Education Action Program found that patients at village health clinics received an accurate diagnosis only about one-quarter of the time. Overprescription of drugs is rampant. 

About 60 percent of China’s senior citizens live in rural areas, where poverty is widespread and health care is poor.

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Purpose

The purpose of this paper is to evaluate the effect of adult children migration on the health status of elderlyparents. Increased labor migration in developing countries that lack adequate social security systems and institutionalized care for the elderly is a phenomenon that is important to understand. When their adultchildren go away to work, it is not clear what effect there will be on “left-behind” elderly parents.

Design/methodology/approach

This study employs nearly nationally representative data from five provinces, 25 counties, 101 villages and 2,000 households, collected from two waves of data in 2007 and 2011. This sample comprises a subset of households which include both elderly individuals (above 60 years old) and their grown (working-aged)children in order to estimate the impact of adult child migration on the health of elderly parents in ruralChina.

Findings

This study finds that adult child migration has a significant positive impact on the health of elderly family members.

Practical implications

These findings are consistent with the explanation that migration raises family resources, which in turn may contribute to better health outcomes for elderly household members.

Originality/value

This is the first paper to attempt to identify the relationship between household migration and the health of elderly parents within the Chinese context.

 

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China Economic Agricultural Review
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Purpose

The purpose of this paper is to measure the turnover (or stability in employment) of village clinicians in rural China over the past decade. The authors also want to provide quantitative evidence on the individual characteristics of the clinicians who provide health care to villagers in rural China and whether we should expect these individuals to be interested in continuing to supply quality health care in China’s villages in the coming years.

Design/methodology/approach

This paper uses data from a survey of rural China’s village clinicians conducted in five provinces, 25 counties, and 101 villages in 2005 and 2012. This paper also uses qualitative data from interviews with 31 village clinicians. Using a mixed methods approach, this study describes the turnover of village clinicians and the main factors that impact the career decisions of clinicians.

Findings
Turnover of China’s village doctors, while not trivial (about 25 percent of village doctors exited their field between 2005 and 2012), is still not overly high. Only five out of 101 villages did not have village clinicians in 2012. Of those that lost village doctors between 2005 and 2012, nearly all of them still had a village doctor in 2012 (either taken over by another local clinician or the position was taken by a newcomer). The authors find that three main sets of factors are correlated with the career decisions of village clinicians: village clinicians’ opportunity cost, the profitability of running a village clinic, and commitment to the field of medicine. In general, clinicians who left the village faced a much higher opportunity cost, had been running a clinic that was not profitable, and had fewer ties to the field of medicine. Newcomers over the same period had higher levels of education, went to higher profit clinics between 2005 and 2012, and had a stronger commitment to the field.
Originality/value

This study makes use of a data set with a large and nationally representative sample to provide a new perspective to better understand clinician turnover at village clinics, the career decisions of clinicians, and the implied trends for the quality and access to rural health care services in the future.

 

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China Agricultural Economic Review
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Alexis Medina
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REAP's social enterprise, Smart Focus Vision, along with several other global vision care startups, wins the 2016 Clearly Vision Prize. Read the original news release here.

The winners of the Clearly Vision Prize will share cash prizes totaling $250,000 to help them accelerate their progress and move us another step down the road towards a world where everyone can see.

Smart Focus

Smart Focus is uniting the powers of industry, government, hospitals and schools to provide high quality, low cost eye exams in China. They bring eye care directly into schools to make sure that students get the treatment they need. The country has a real problem with low awareness of the need for vision care. By focusing on serving youngsters in rural areas that might otherwise get left behind, Smart Focus is improving the vision of the next generation.

Visit Smart Focus

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REAP's Smart Focus Vision social enterprise wins the 2016 Clearly Vision Prize.
Smart Focus' CEO Mike Young (second from right), pictured with the other winners of the 2016 Clearly Vision Prize.
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Liat Clark from Wired writes about REAP's vision care social enterprise, Smart Focus Vision, winning the Clearly Vision Prize for startups that bring low-cost vision care to rural communities around the world. Read the original article here.

Smart Focus Vision

Stanford, CA

The US-based startup has partnered with eyewear company Luxottica OneSight to help scale eye care to ten million people in China that do not have access to affordable services. According to research conducted by Stanford University, only one out of six rural children in China has a set of glasses and most rural students have never had an eye exam. The for-profit ran a pilot operation in conjunction with the Chinese Academy of Sciences before launching in the provinces of Shaanxi and Gansu, where it distributes low-cost glasses, trains doctors and teachers, and constructs clinics. Teachers can test vision directly in classrooms and use mobile phones to automate patient referrals and prescriptions. Smart Focus argues the nonprofit route would never have been a sustainable or scalable way of helping the number of children that need eye care.

As well as a share of the prize money, the winners will have access to mentoring and be invited to a series of one-day events - Clearly Labs - around the globe where they can meet optometrists and other entrepreneurs. The campaign has a number of high-profile advisers onboard, including cofounder of Warby Parker, Neil Blumenthal and founder of Shanghai Tang, David Tang, who commented: "Access to good sight should not be a luxury. Yet, 2.5 billion people are still forced to go without clear vision. Radical new thinking is necessary to rectify this.”

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A Chinese girl with glasses provided by Smart Focus, a social enterprise spun out from Stanford and REAP that restores vision to children in rural China.
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