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New Center At Brown To Study Health Care Systems Across Countries

PROVIDENCE, R.I. [Brown University] — It's an often-cited fact that the United States spends more money on health care than other high-income countries yet still faces enormous challenges in cost, quality and access to care, says Dr. Ashish K. Jha, dean of the Brown University School of Public Health.

What's less understood, Jha notes, is how health care systems in other nations function to serve their people, and how different strategies for operating health systems can impact population health.

To uncover insights for the benefit of all countries into how health systems work and how they struggle, a new center at the School of Public Health will bring together researchers to analyze health systems across the globe. Jha introduced the premise behind the new Center for Health System Sustainability at a Tuesday, April 23, panel discussion about health policy challenges around the world.

"There's a ton to be learned across countries," he said. "This center really tries to get at, in my view, the heart of that question of, 'How can we all learn from each other, and how can we all do better?'"

The dean formally launched the center during the event among faculty and students from the School of Public Health, as well as researchers, scholars and international partners. Jha moderated a discussion that offered local and global perspectives, beginning with pressing health policy challenges facing Rhode Island and other U.S. States, and then expanding to the challenges in high-income countries in Europe and Asia, as well as the policies used to address them.

Countries around the world have similar objectives, said Irene Papanicolas, a professor of health services, policy and practice at the School of Public Health who will direct the new Center for Health System Sustainability: Improve people's health, deliver care that's responsive to personal needs, treat all people with respect and dignity — and accomplish this in an equitable and financially sustainable way. At the same time, she said, there are shared global challenges: aging populations, chronic disease and illness, prohibitively expensive new treatments, pandemics and climate change.

It's a missed opportunity that case studies from different countries haven't been used to compare strategies and understand how health policy decisions affect population health outcomes, said Papanicolas, who recently came to Brown from the London School of Economics.

"And now we're at this interesting juncture where international comparisons are a necessity," said Papanicolas, who has worked closely with governments and organizations to inform policymakers on issues related to health system performance assessment. "New systems need to be more cooperative, more global, in terms of the solutions that they find. Ultimately, we need to change what health systems look like and think beyond artificial national boundaries if we're going to improve health globally."

According to Papanicolas, the Center for Health System Sustainability will leverage patient data and global partnerships to produce comparative insights and actionable policy recommendations to help countries learn from one another. The goal is to optimize patient care and build resilient, sustainable health systems across the globe.

The center will house the International Collaborative on Costs, Outcomes and Needs in Care, a partnership of 15 collaborators from North America, Europe, Asia and the Pacific committed to advancing the development of methods and measures in comparative health systems research. Papanicolas and Jha are among the co-leaders of this collaborative.

The center will include faculty, staff and researchers from Brown as well as international research partners, including Jon Cylus from the European Observatory on Health Systems and Policies and Luca Lorenzoni from the Organisation for Economic Co-operation and Development. Cylus, who is based in Barcelona, and Lorenzoni, who is based in Paris, joined Papanicholas and Jha at the launch event.

5 Ways To Treat Lupus On Brown Skin

Caused by an autoimmune condition that attacks your organs and tissues, lupus is no joke. According to the Lupus Foundation of America, Black women, in particular, are roughly three times as likely to develop the disease compared to white women. 

Given that Black folks have a higher prevalence in general – with higher rates of organ damage and mortality – it's no wonder lupus should be taken seriously!

But did you know there are common sense, easy ways to handle this disease? That you don't have to dive down the deep end and take crazy risks for some extreme, unheard-of 'cure'?

Believe it. 

RELATED: Don't Ignore the Signs: Early Signs of Lupus all Sistas Should Know

While lupus is a challenging autoimmune disease that can affect anyone, it hits Black Americans particularly hard. In fact, among the Black community, the risk of developing lupus is two to three times higher than that of Caucasians, and when it comes to symptoms, it can be a whole different ball game.

For Black folks, lupus tends to show up in some unique ways that everyone should be extra vigilant about.

First off, let's talk about those lupus rashes. While most folks might get that classic "butterfly" rash on their face, it's more likely to pop up on the scalp and ears in Black patients. Lupus appears to have a special preference for certain spots on dark skin, making it trickier to spot sometimes.

Then there's the issue of hair loss. Losing your hair can be tough for anyone, but for Black folks, it's a whole different level. Obviously, Black hair is a large part of personal and cultural identity, so when lupus starts messing with that, it can take a toll on people emotionally.

Unfortunately, lupus can also cause dyspigmentation, which is basically changes in skin color, as well as scarring and

Students From Brown University And Tougaloo College Investigate Public Health Challenges In Rural Areas

In a hybrid class, students at Brown and Tougaloo learn about conducting public health research in rural communities. Photo by Kenneth Zirkel.

The rural public health class is organized around the study of a wood pellet facility in Gloster, Mississippi, and its effects on the health of the local community. Photo courtesy of Erica Walker.

The student researchers bring different perspectives, experiences and training to the collaboration. 

Devon Newman, a junior in Brown's five-year undergraduate/master of public health program, is an intern at the Brown-Lifespan Center for Digital Health and has worked as a teaching assistant for multiple public health classes. Newman's group is looking at volatile organic compounds, which are air pollutants that can affect human health. For a recent assignment, the group started with longitudinal data provided by Walker and made statistical associations with meteorological conditions — for example, they looked at whether the day of the week has an impact on the amount of VOCs in the atmosphere. 

Newman is overseeing the statistical analyses for his group, and he's been able to advance his knowledge of the statistical programming language R. He said he typically does more than the assignment requires, such as organizing data and performing additional analyses, because he knows that the information is important to the success of the project. 

"I like to think we're giving Dr. Walker ideas about exploring different associations — maybe she'll look at our work and think, 'Oh, that's something I hadn't considered.'" Newman said. "It's live data, as opposed to a data set that a professor made for us to practice with."

One of the group goals is to unearth insights from the data, he said, to share practices with the community on what they can do to protect themselves from the effects of wood pellet plants, and to inform policy and advocacy efforts focused on regulating the industry.

"Knowing that our work will be put to use makes it a little more stressful than a typical class, because we are aware this has an impact on individuals, on livelihoods," he said. "But it's also really interesting and fulfilling."

Ta'Lynda Boyd, a Tougaloo senior majoring in biology, is another member of the VOC-measuring group. Boyd said she has enjoyed going on field visits to collect data and has liked seeing how the roles of individuals contribute to the success of the group. Rural Public Health is the first public health course she has taken, and she said she appreciated the willingness of her fellow group members to share strategies for working with data and presenting their analyses. Boyd felt it was valuable for her to see how students at another university, in a different geographical area with a different academic culture, approached the same assignment. 

"We got to do the research and bring the data back to [our Brown classmates] and then they asked us questions, like, 'How did you address that situation?' 'What did you all do to go get the data'?" Boyd said. "Then they'd do some analysis and we'd ask them, 'Well, how did you work that out with the data?' And then we'd all use that information to come to conclusions together. It just made a whole 360-degree circle that functioned correctly." 

Tougaloo senior La'Kedric Fultz is part of a group that collected noise measurements in downtown Jackson, as part of a separate project from the Gloster study. Fultz is majoring in biology, and while he has public health research experience from participation in the Jackson Heart Study Scholars Program, he'd never before worked with research-grade sound level meters.

"It was great to get hands-on experience in that way," Fultz said.

Fultz said that he appreciated that Walker made an effort to bring the Tougaloo students into the class at Brown even though they were Zooming in from Jackson, a time zone behind Providence.

Erica Walker, an assistant professor of epidemiology at Brown, visited Mississippi to show Tougaloo College students how to measure sound levels and assess community noise pollution. Photo courtesy of Erica Walker.

"I think that Dr. Walker did a very good job of making sure that our voices were heard, and that we felt like a part of the class," Fultz said. "She would often ask us directly to share our opinions with the class… We weren't in the same room with the Brown students, but honestly there wasn't much of a disconnect."

Defining rural public health

Walker, who grew up in a rural community outside of Jackson, wants to impart upon the students that rural communities have more in common than their small population sizes: They're often under-resourced, lacking in infrastructure and vulnerable to climate change, she said, as well as overlooked by health researchers and data scientists.

Walker cited several examples of the challenges of practicing and studying public health in rural areas: What are the public health implications of a town with no zoning, which has allowed the proliferation of industrial activity? What's the best approach to designing policies that carefully weigh economic development and environmental harm? How can researchers measure and evaluate the respiratory health of community members who live and work near poultry farms? 

"And how do you do this research in the face of limited interest, skepticism and distrust, in cooperation with communities that may have competing priorities?" Walker said "How do you deal with limited internet connectivity? Lack of interest from funders? Lack of physical and data infrastructure?"

Those considerations caught the interest of Pascale Carvalho, a junior at Brown concentrating in music and public health who was eager to put what she's learned about public health theory into practice in Walker's course.

"We tend to talk about things like redlining and urban-suburban geographical differences," Carvalho said. "But there's a completely different health issue and data collection issue that comes with living in a rural area. I didn't really have much background on how health and health services differ by geographic location. In the first two or three sessions of this class, I was able to gain perspective of the intersection that occurs between where you live, and what are your negative health outcomes."

One way to explain rural public health research to students, Walker said, was to frame it through the lens of an environmental health project — and that's how she decided to organize the class around the study of the Gloster wood pellet plant and its effects on the health of the local community. 

"I want to inspire students to undertake this type of science and study public health in rural areas like Gloster, which have often been affected by environmental injustices, and also be equipped to handle the challenges they may face," Walker said. "For students who come from rural communities, I wanted them to see how they can directly and tangibly apply what they have learned in this class to address issues in their own community."

At the end of the semester, the students will present their findings to the rest of the class as well as to Gloster community members. This summer, two of the students, including Fultz, will present their data analysis at the Mississippi Health Disparities Conference.

"The students in this class are at the forefront of efforts to examine and address this headline-making public health issue," Walker said. "I think it's really cool that the Tougaloo and Brown students are getting that experience, and getting involved."

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