HW 2.14.17 Washington

HW 2.14.17 Washington

by Samuel Washington -

Assignment #5

•Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
*inspired by a recent article from CNBC about Bills Gates’ thoughts on the impact of nationalism on global health:
http://www.cnbc.com/2017/02/14/bill-gates-new-nationalism-could-put-global-health-in-danger.html

Although not a formal policy at this time, a new surge of support for nationalism (which some are saying is coming closer to isolationism) may have significant health implications on the global health community.

•Describe why an evaluation of that policy is informative (primarily about the policy, or primarily a test of hypothesized mediators?)

Evaluation of the policy, included its potential impact on international function for global health efforts and impact on the spirit of international cooperation and health initiatives, is imperative to understand how the changing political climate will impact global health. The Gates Foundation endowment of $40 billion provides critical funding and aid to systems that would otherwise cease to exist.

•Specify the outcomes and populations you think most affected or least affected by the policy.

The effect of this changing climate will likely be inversely proportionate to the amount of aid received, meaning those countries most dependent upon aid will be affected most.

A prior example of the effect of isolationism on health is the current state in Myanmar, which is only recently opening itself to the international arena. To date, those that can afford it seek medical attention (checkups, surgeries, consultations) in neighboring countries due to the lack of resources and up-to-date medical knowledge. A success story, it was reported that South Korea was previously received similar aid and is now a ‘donor country’ to the world, per the report.

With regards to the Gates Foundation, they note several specific populations such as Asian sex workers, the 122 million children in various third world countries and the 300 million in developing worlds who now have access to modern contraception.

•Propose a study design to evaluate the policy

–Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health


A possible study would be a retrospective review of the prospective data collected as part of the World Health Organization, looking at the past 5-10 before the implementation of the policy and the 5-10 years following the policy. Between these two time periods should be transition period which surrounding the initiation of the policy. The biggest challenge lies in the granularity of the data and how to accurately measure the effects. Measuring the amount of aid going to each region/country does not provide a direct measure of the impact on health. Quantifying clinics/hospitals closed after implementation would be difficult to measure accurately. Other health outcomes may also relay on a longer followup in order to see the effect; when observed or measured early the observed associations may underestimate the true effects.

Re: HW 2.14.17 Washington

by Maria Glymour -

Thanks for this example Sam, though I need more guidance to understand it fully.  How do you define "nationalism" and are you conceptualizing this as a country-level variable or an individual level variable?  If a country level variable, it is indeed a challenging exposure to evaluate.  Maybe it is worth breaking down into the components for which you can conceptualize an intervention to modify. For example, if you specifically hypothesize that communities with high in-migration rates from diverse places of origin experience health benefits from that in-migration, that is easier to evaluate.  If you hypothesize that people residing in places with enforcement of immigration rules that is particularly aggressive experience worth health, that is also potentially testable (though not easy...one of your classmates proposed this).  

There is some controversy in the causal inference literature about how broadly you can frame the question with a counterfactual perspective (see Krieger and Davey Smith's recent commentary responding to Vandenbroucke and Broadbent).  My view is that if you can tie the exposure to a specific policy, it is amenable to evaluation of the health effects.  Sometimes we don't have the data we need though!

Maria