Health Management and Policy

Health Management and Policy

What’s a Child’s Life Worth?

Recent research finds that when it comes to money allocated for health care, most Americans prefer to distribute resources to save life-years earlier in life rather than later. Daniel Eisenberg, assistant professor of health management and policy, has been working with faculty in the UM Department of Pediatrics to understand why—and what it means for our health care system.

In a nationally representative survey of over 2,000 participants, Eisenberg and his colleagues asked respondents to select an imaginary government program that would either save the lives of 100 ten-year-olds or a randomly selected number of 60-year-olds. Seventy percent of the respondents chose the program that would save 100 children—even when the alternative program would save up to 1,000 60-year-old adults. This was the case both for respondents who were parents of children under 18 and for nonparent respondents over the age of 50, and for all ethnic groups and socioeconomic backgrounds represented in the survey. The preference for children also held when the researchers asked people about programs to prevent nonfatal illnesses.

In other words, American adults, regardless of age, socioeconomics, race and other demographics, largely preferred to prevent both deaths and nonfatal illnesses among children as compared to older adults. The findings, says Eisenberg, imply the existence of “age weights.” That is, the survey respondents seemed to place greater emphasis, or weight, on quality-adjusted life-years for children versus adults.

One of the respondents on the survey commented, “Let us hope we must never make decisions such as these.” Yet while questions about the allocation of health care resources by age are uncomfortable to answer, Eisenberg notes, they are important for policymakers to consider as they try to contain health care spending—especially in a world where people are living longer lives. —by Valentina Stackl <

Driven to Distraction

Noting that 21 percent of all reported injury crashes in the U.S. in 2009 involved distracted driving, and that young drivers who text-message while driving are at six times the risk of a collision than drivers who don’t text, SPH Professor Peter Jacobson argues that policymakers must urgently address the dangers to public safety posed by new technologies.

Jacobson’s remarks appear in a commentary he co-authored with Lawrence O. Gostin of the Georgetown University Law Center in the April 14, 2010, issue of the Journal of the American Medical Association. Jacobson and Gostin discuss the dangers of texting, dialing, e-mailing, and talking on cell phones while driving—as well as other distracting activities, like eating and grooming—and outline the legal precedents for government intervention at both the state and federal levels. They also examine corporate responsibility.

“Reducing distracted driving requires concerted action at every level of government,” they write. “A combined program of legislative restrictions, educational campaigns, and manufacturer design changes offers the best prospect to improve highway safety.” <

On April 30, Michigan Governor Jennifer Granholm signed a state ban on texting while driving, effective July 1.

Kids and the War on Smoking

On a daily basis, nearly 4,000 U.S. children under the age of 18 try their first cigarette. At least a thousand of those go on to become regular smokers. “Many of these kids will become addicted before they are old enough to understand the risks and will ultimately die too young,” says Food and Drug Administration Commissioner Margaret A. Hamburg, calling this “a preventable public health disaster for our country.”

In an effort to lower the number of kids who take up smoking, the FDA—which last year received unprecedented powers to regulate the manufacturing, marketing, and sale of tobacco products— is instituting new requirements this June that will:

  • Prohibit the sale of cigarettes or smokeless tobacco to people younger than 18
  • Prohibit the sale of cigarette packages with fewer than 20 cigarettes
  • Prohibit distribution of free samples of cigarettes
  • Restrict distribution of free samples of smokeless tobacco
  • Prohibit tobacco brand-name sponsorship of any athletic, musical, or other social or cultural event
  • Keep tobacco manufacturers from giving children free hats, T-shirts, and other memorabilia bearing tobacco-product names on them

“If you can keep kids from starting to smoke, that’s key to ensuring that we defeat this epidemic,” says Cliff Douglas, SPH adjunct lecturer and director of the UM Tobacco Research Network. “Despite everything we know about tobacco, 46 million Americans—fully 20 percent of the population—still smoke, and that’s an extraordinarily high percentage. Our long-term prospects for success rest on our ability to denormalize tobacco use in society and drastically cut youth initiation.” <

In Combating Teen Smoking: Research and Policy Strategies, SPH faculty members Peter Jacobson , Paula Lantz, and Kenneth Warner tackle the question of why adolescents take up smoking and what we can do both to keep them from starting and to help them quit. Published in 2001 by UM Press, the book synthesizes much of the relevant research on the topic and recommends multiple ways to reduce teenage tobacco use, including antismoking media campaigns, clean indoor air laws, and increased cigarette prices. The book’s additional co-authors are Jeffrey Wasserman, Harold Pollack, and Alexis Ahlstrom.

Where Practice Meets Policy, Kids Benefit

Watch pediatrician Gary Freed examine a newborn infant’s body, and you see decades of experience at work. Gently, he cups his fingers around the baby’s skull, feeling for soft spots. He checks the location of the ears—too low, and it may indicate a serious congenital problem. He places a finger inside the baby’s mouth, looking for signs of cleft palate, then listens to her heart and palpates the abdomen, checking for a healthy liver and spleen. He works the hip joints, counts the child’s fingers and toes, checks her hand and foot reflexes. As he works, Freed talks to the small circle of medical students and interns who’ve accompanied him on newborn service this morning. “See this redness?” he asks as he points to a pink streak on the newborn’s chest. “It’s perfectly normal—just skin getting used to the world.” The examination takes fewer than 10 minutes, and when he’s done, Freed turns to the infant’s parents and smiles. “Congratulations on your beautiful daughter.”

Twice a year Freed spends a week examining newborns as an attending physician at UM C.S. Mott Children’s Hospital. He also sees patients once a week at a pediatric clinic in nearby Canton. Both activities are part of his job as the Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery at the UM Medical School, but Freed says they’re also an important component of his work as a professor of health management and policy at UM SPH. Freed directs the UM Child Health Evaluation and Research (CHEAR) Unit, a multidisciplinary research center involving faculty from nine different UM schools, which is dedicated to improving children’s lives by evaluating the impact that government policies have on kids’ health.

“Every day, people are making decisions in this country about how to implement health care delivery, and most of those are made without data” Freed says. “We believe the more we can inject data into the decision-making process, the better those decisions will be.”

Since its inception in 1999, CHEAR has addressed a number of high-profile issues, including access to care for low-income children, childhood immunizations, subspecialty care for kids with chronic illnesses, obesity, and pediatric dental care. CHEAR takes no sides on these issues—but the group’s work has an impact. The state of Michigan relies on CHEAR to help determine the most efficient use of Medicaid funds for kids, and the U.S. Centers for Disease Control and Prevention has collaborated with CHEAR for the past 11 years to analyze and implement childhood immunization programs—most recently for H1N1 influenza.

Freed loves working with kids—whether it’s as a pediatrician making the rounds of the newborn service or as a researcher seeking to improve the health policies that directly affect children’s care. One job fuels the other, he says. “I’m not just an ivory-tower researcher. Some of my best research ideas come from patient interactions.” <

Study Shows Parents Both Hesitant and Confident about Childhood Vaccines

Parents hear a lot of information about the benefits of vaccines, but they also hear about dangers that can come with shots. How are parents making sense of all this conflicting information? In a national study from the Child Health Evaluation and Research (CHEAR) Unit at UM, researchers report that 90 percent of parents believe that getting vaccines helps protect children from disease. The study, which was published online in March in the journal Pediatrics, also shows that 54 percent are concerned about serious side effects from vaccines, and 25 percent believe that some vaccines cause autism.

“Our study shows the vast majority of parents in the U.S., nine in 10, are confident about the protection that vaccines give children,” says lead author Gary Freed, professor of pediatrics and communicable diseases in the CHEAR Unit at the UM Medical School. “But about one of every two parents in our study also expressed concerns about negative side effects they believe can occur with vaccines.”

Parents’ concern that some vaccines may cause autism is particularly disturbing. “All reputable evidence on this issue fails to show a link between vaccines and autism,” Freed says. “But it appears that current public health education efforts on this issue have not yet satisfied many parents’ concerns.”

Parents’ reasons for refusing vaccines differ by vaccine, the study reveals. Freed says this is a “very important discovery. It shows us that parents are weighing the pros and cons for each vaccine for their children. Sometimes, health care providers think that parents who are against one vaccine will be against all of them. But that does not seem to be the case.”
From UM Health System