Investigator Awards In Health Policy Research Investigator Awards in Health Policy Research
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Investigators And Their Projects » Awards by Year:
Section Info
This section contains information about all of the projects and researchers that have been funded through the Investigator Awards program since the first grants were made in 1993. The indexes in this section can be used to identify investigators by name, area of expertise, or year of award. Throughout the site, you will find that each investigator’s name links to details including contact and project information.
»List Projects awarded in
Projects Awarded in 1997:
Investigator names link to complete details.
Peter S. Arno, Ph.D.The Impact of Growing Income and Wealth Inequality on Health in the United States
Award Year: 1997

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Dr. Arno assesses the impact of growing income and wealth inequality on health in the U.S. He explores the mechanisms through which economic disparities affect health and identifies implications for public policy. Two approaches are used to model the relationship between income and health: an aggregate national time series model and a pooled, cross-sectional time series model using states as the level of analysis. Research questions include: 1) Does the relationship between income inequality and health affect certain diseases or age, sex, and ethnic/racial groups more than others? 2) Do these relationships hold for changes in the wealth distribution of the population? 3) What mechanisms explain the relationship between income and wealth inequality and health? 4) What are the public policy implications of an independent relationship between income and wealth inequality and health outcomes? Results should heighten public awareness of the health implications of economic disparity and encourage the inclusion of these neglected health effects in the policymaking process.
Norman Daniels, Ph.D.Limit-Setting in Managed Care and Other Health Delivery Systems: Legitimacy, Fair Process, and the Goals of Health Care Reform
Award Year: 1997

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This project integrates theoretical work on justice and health care with practical research on decision-making and limit-setting in managed care organizations (MCOs). Dr. Daniels explores the issue of legitimacy and its role in decisions by private insurers and governments that affect patient welfare. Among the areas his study addresses are: 1) how conditions needed to establish legitimate limit-setting can be applied to create detailed and specific regulatory requirements; 2) how MCOs can use concepts of legitimacy to improve decisions about coverage of new technologies, treatment guidelines, and disease management; 3) incorporating these processes into regulatory requirements; 4) including specific features of fair process in benchmarks of fairness; and 5) using them to address issues of access, benefits, efficiency, and process in nations' health reform efforts and in developing countries. Dr. Daniels explores the conditions under which limit-setting decisions can achieve legitimacy and develops a matrix for evaluating fairness of health care reforms that can be used by the World Health Organization.
Steven G. Epstein, Ph.D.Social Equity, Group Identity, and the Medical Management of Difference
Award Year: 1997

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Federal policy changes, which include greater numbers of women and racial minorities in government-funded clinical trials, were designed to improve the health of these groups. Dr. Epstein explores the origins and consequences of incorporating gender and race variables into the design and evaluation of NIH-funded clinical trials and in trials of new drugs submitted for FDA approval. The intent is to: 1) identify the pressures that brought about these new "inclusionary" policies, which supplanted the prior focus of medical research almost exclusively on white men; 2) assess the impact of these policies on diversifying medical research; and 3) analyze the costs, benefits, ethical, and practical implications of biomedical diversity and equity for doctors, patients, medical researchers, drug developers, and society. Results discuss the consequences of redesigning clinical trials and whether these shifts are actually helping to achieve a more just and equitable public investment in medical research.
Arline T. Geronimus, Sc.D.Weathering Among African Americans in Persistent Poverty: Implications for Health Policy
Award Year: 1997

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Rates of early health deterioration and excess mortality among African Americans in poverty can be staggering and are primarily attributable to chronic disease. Dr. Geronimus coined the term weathering to suggest that cumulative experience with social inequality and stressful environments contributes to this rapid health decline. She further hypothesizes that relatively early fertility timing in poor, African American communities may be directly related to pervasive health uncertainty and accelerated lifecourse timetables. This project explores the connection between racial inequalities in health and high rates of teen childbearing in poor, African American communities and opens debate on policy implications. The study challenges the prevailing policy perspective that changing health or fertility behavior especially among teenagers alone will result in social improvements. Dr. Geronimus seeks to use the analytic framework of weathering to bridge disciplinary divides and inform the policy debate about how best to construe and address problems of poverty.
Steven Gortmaker, Ph.D.
James M. Perrin, M.D.		Changes in Health Status for Children With Chronic Health Conditions: Perspective on the Dynamics of Changing Scientific Knowledge, Services and Policy
Award Year: 1997

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The number of children in the U.S. suffering chronic health conditions more than tripled in the past three decades. However, public policies and programs have lagged behind the growth of new knowledge, limiting access to needed services. Focusing on SSI, Medicaid, Maternal and Child Health, and special education, Drs. Perrin and Gortmaker examine the prevalence and program participation of children with chronic health conditions, paying close attention to children living in poverty. Their model uses a society and health approach that recognizes the importance of both socioeconomic environments in the lives of children and scientific advances. The investigators apply a case-based approach to selected chronic conditions in each of five states, studying how health and welfare policies and programs connect with scientific knowledge. Recommendations will be developed to help align policies more closely with knowledge about effective interventions in children with chronic conditions.
Colleen M. Grogan, Ph.D.From Targeting to Universalism? The Limits and Possibilities of Institutional Change in the Medicaid Program
Award Year: 1997

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Significant social policy debate focuses on why the U.S. never achieved guaranteed health insurance for all citizens and whether universal or targeted programs are the answer. The typical American approach is to enact targeted programs and then focus on incremental expansions. Thus the crucial policy question is whether targeted programs can transform themselves into programs with universal characteristics. Dr. Grogan's project centers on the Medicaid program and its evolution from a public assistance program for the indigent to a payer of long-term care services for the middle class. Her objectives are threefold: 1) document Medicaid's partial universalization, analyzing how and why this expansion occurred; 2) evaluate its impact on the treatment of originally-targeted groups and on policymakers' support for the program; and 3) examine whether Medicaid's policy legacy limits the prospects for further expansions to new population groups or for improved services to existing Medicaid groups.
David Hemenway, Ph.D.Firearms and Public Health
Award Year: 1997

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Firearms are the second leading cause of injury-related death in the U.S. While attention to the problem has increased, the amount of research on the topic lags behind. This project provides new information about gun carrying, storage, brandishing, injuries, the use of guns in self-defense, and the connection between guns and suicide. It also synthesizes new public health literature relevant to firearms policy and analyzes private firearm surveys from college students and adults. Adopting a general public health framework, Dr. Hemenway develops beneficial and feasible firearm policy recommendations, seeking to alter the current social norm which accepts high levels of lethal violence as a part of American life. Findings will provide public health-oriented policy options for gun safety, firearm product oversight, collecting gun injury information, and the roles of the medical community and general public in firearm safety.
Rosemary A. Stevens, Ph.D., M.P.H.Specialization in American Medicine
Award Year: 1997

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Dr. Stevens examines specialization in American medicine during the past 25 years in order to shed light on recent trends and choices for the future. She looks at the structure of the medical profession and its response to significant change by examining the evolving roles of the 24 specialty-certifying boards. The project focuses on several contexts of specialty practice and how they have changed. These include: the science base and conceptions of disease; the emergence of new specialist fields; the treatment of chronic illness and disabilities that cut across traditional specialty domains; rapid changes in the job market for physicians and reductions in payment for services under managed care; and the changing roles of generalists and specialists and the resulting tensions between them. Dr. Stevens hypothesizes that the boards are quietly changing their role in American medicine. Her work provides insights about the ways in which the medical profession is and might be structured.