Introduction The IOM Challenge

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					            REPORT OF THE


    Advisory Committee for Health Policy
      in the School of Public Health and
             Community Medicine




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Introduction: The IOM Challenge

        In 2003, the Institute of Medicine (IOM) asked the nation, “Who will keep the public
healthy?” (IOM, 2003). The IOM noted the new and accelerating challenges to the public‟s
health, and charged schools of public health with evolving “in part because current problems
demand new knowledge and approaches, and in part because of scientific advances and the
increased understanding of the determinants of health, their linkages, and their interactions”
(IOM, p. 108). Noting the many disciplines represented by faculty in schools of public health,
the IOM asserted that these schools are “uniquely poised to embrace the transdisciplinary
approach to education and research that is necessary for an ecological focus” (IOM, p. 108).

       The IOM charged schools of public health with six major responsibilities:

        1). Educate the educators, practitioners, and researchers, and prepare public health
leaders and managers;
        2). Serve as a focal point for multi-school transdisciplinary research as well as traditional
public health research to improve the health of the public;
        3). Contribute to policy that advances the health of the public;
        4). Work collaboratively with other professional schools to assure quality public health
content in their programs;
        5). Assure access to life-long learning for the public health workforce; and
        6). Actively engage with various communities to improve the public‟s health.

        Throughout the report, the IOM underscored the
centrality of politics, policy development, and policy              SCHOOLS OF PUBLIC
analysis to improvements in the public‟s health.                    HEALTH PLAY A PRIMARY. .
                                                                    ROLE IN HEALTH POLICY
       In January, 2004, Dean Pat Wahl created a                    DEVELOPMENT AND
multidisciplinary committee to examine how the University           DISSEMINATION. IOM, p.4
of Washington‟s School of Public Health and Community
Medicine should respond to the IOM‟s call to action in the area of health policy. This report
summarizes the deliberations of that committee over the 7 months of its deliberation.

The Dean‟s Charge
       The Dean‟s overall charge, in keeping with the IOM‟s recommendations, recognized that
the SPHCM has a multi-faceted role to play in improving public health policy. The Dean asked
the Committee to:

       1). Develop a five-year strategic plan for building greater health policy content
throughout the SPHCM, coupled with a realistic implementation plan, recognizing that over 80%
of SPHCM‟s funding comes from grants and contracts. The strategic plan should address
SPHCM‟s involvement in all four legs of the health policy stool: research, teaching, translation
and dissemination, and policy analysis.     [IOM 1-6]




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THE COMMITTEE RECOMMENDS THAT
SCHOOLS OF PUBLIC HEALTH..PLAY A
LEADERSHIP ROLE IN PUBLIC POLICY
DISCUSSIONS AND THE FUTURE OF THE                  With regard to research activities, the Dean
U.S. HEALTH CARE SYSTEM, INCLUDING
                                                   asked the Committee to:
ITS RELATION TO POPULATION HEALTH.
IOM p. 5
                                                      1) Determine research and funding
                                                           opportunities in health policy-related
       issues relevant to the health of the public; [IOM 2, 3, 4, 5]
    2) Explore the advantages of focusing our activities around one or more specific themes;
       [IOM 2, 3, 4]
    3) Conduct an environmental scan to identify both “customers” and competitors for this
       work; and [IOM 2, 3, 4, 6]
    4) Investigate the relative advantages and disadvantages of alternative structures that might
       organize our initiatives; for example, a center, an institute, a resource center, or a
       permanent steering committee. [IOM 2, 3, 4]

     With regard to teaching, the Dean asked the Committee to:
     1) Determine education and training opportunities in health policy development and
     implementation for both degree-oriented students and others, including relevant professionals
     in the community. [IOM 1, 5]

    Two final components of the Dean‟s charge cut across the others:
    1) Identify key intersections of SPHCM with other units, both on campus and in affiliated
       institutions and agencies, that could be expanded to enhance health policy across the
       University; and [IOM 1-6]
    2) Determine the most appropriate role for the Health Policy Analysis Program within and
       across each of the four areas of activity, and HPAP‟s relationship to any new structure that
       might be created. [IOM 1-6]

       The Dean‟s letter outlining the purpose of the Committee and its specific charge appears
in Appendix A.

The Health Policy Advisory Committee: Membership and Methods

       The Committee included representatives from the Schools of Law, Pharmacy, Medicine,
Nursing, and the Evans School of Public Affairs as well as the SPHCM. A roster of Committee
members and staff appears in Appendix B.

        A key function of the Committee was to identify and engage a broad range of
stakeholders: research partners (on campus and from other academic institutions and research
organizations), market partners (trade associations, industry organizations), public partners
(government decision makers), and funders (public and private). The purpose of this
“stakeholdering” was to explore the (many) strengths of the SPHCM and its partners in relation
to the burgeoning needs of the national and regional health policy community and the interests
and priorities of those who would fund our work. The Committee‟s work was informed by
presentations from its diverse membership (including a tutorial on the policy process presented
by Aaron Katz – see Appendix E); presentations by Patricia Lichiello (Acting Director of HPAP)
and Steve Smith (Professor from the Evans School of Public Affairs); site visits to eight policy
centers around the country (see Appendix C); individual interviews with Committee members

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and other key informants (see Appendix D); a report on the health policy landscape and the
strategic opportunities it affords written by Rick Carlson, consultant to the Committee; as well as
significant exploration of web-based information. The Committee met six times from February
through July, 2004.

       The Committee defined health policy as the “discipline” that systematically studies how
science, values, and decision processes combine to generate public decisions that guide
population health and health care financing and delivery. The relationship between policy
research and analysis, and policy development that guided the Committee‟s thinking appears as
Appendix E.
                                                         SIMPLY PUT, USING THE CRUDE
         The outcome of the Committee‟s work was a
                                                         FORMULA THAT “SCIENCE +
set of recommendations and a 5-year strategic and        POLITICS=POLICY,” DWELLING ON
implementation plan associated with the                  THE SCIENCE WITHOUT APPROPRIATE
recommendations regarding research and translation       ATTENTION TO BOTH POLITICS AND
and dissemination.                                       POLICY WILL NOT BE SUFFICIENT
                                                         FOR SCHOOLS TO BE SIGNIFICANT
                                                         PLAYERS IN THE FUTURE OF PUBLIC
                                                         HEALTH AND HEALTH CARE. IOM p. 4

Findings
Assessment of the internal environment
        The University of Washington School of Public Health and Community Medicine is
uniquely positioned to contribute in the area of health policy. The SPHCM houses and partners
with some of the best scientists in the country: biomedical scientists including genetic medicine
specialists, geneticists, bioinformaticists, epidemiologists, biostatisticians, pathobiologists,
toxicologists, and others. SPHCM is also home to national leaders in the social sciences:
economics, law, sociology, behavioral science, program evaluation, bioethics, and others; as well
as the clinical sciences: medicine, nursing, pharmacy, and social work. The Health Policy
Analysis Program has carried the banner for applied policy research and policy analysis for 30
years, and the Department of Environmental and Occupational Health Services has a
longstanding working relationship with the Washington State Department of Labor and
Industries and the Department of Health. In the area of education and training, SPHCM‟s
Department of Health Services has a defined policy curriculum, complemented by health policy
coursework in other departments within the Health Sciences, a strong health law program in the
Gates Law School, and a top national school of public policy in the Evans School of Public
Affairs. The relatively new Ph.D. program in the Department of Health Services includes health
policy as a core competency. The Department of Health Services also houses the SPHCM‟s
growing commitment to undergraduate education in public health. The new Certificate in Health
Policy, based in Health Services but drawing upon campus-wide teaching resources, has just
become available to graduate students in SPHCM and other schools across the campus (es) (see
Appendix F). The Northwest Center for Public Health Practice and the MHA program both
sponsor non-degree training courses for mid-career health and public health professionals.

        The faculty on the Committee, as well as the other faculty who were interviewed as part
of the Committee‟s work, expressed strong support for heightened and better integrated activity
in health policy. There was interest among the faculty in having assistance in creating a policy
frame around existing research and having assistance with disseminating the results of existing

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research to decision makers. There was enthusiasm for connecting relevant research across
schools and departments, and for creating interdisciplinary teams to pursue new policy research.
The topics of interest varied expectedly among the faculty. However, the variation centered
around several major areas: biotechnology and innovation, environmental health, health
promotion, and nutrition.

Assessment of the external environment
         Site Visits: Appendix C contains summary notes for each of the site visits. The sample of
institutions visited was not necessarily fully representative, but consisted of programs known
through collegial relationships and/or reputation. A balance was sought, however, across two
important dimensions: subject matter, and degrees of integration with other university schools,
departments, programs, and faculty. The subject matter included aging, mental health, genomics,
bioethics, food and nutrition, law, technology assessment, public health and health services. The
degree of integration ranged from voluntary and not university affiliated (Colorado Health
Institute), to highly integrated (School of Public Health at UC, Berkeley). Further, of the
academic institutions visited, four were within public universities and four were within private
ones. Through the site visits, the Committee found that:

    1. Colleagues at the other universities were very forthcoming. All felt that UW was
       particularly credible in the research and health policy fields because of its stature as a
       major biomedical research institution. The reputation of the SPHCM‟s Health Policy
       Analysis Program was viewed as good in those areas in which it has conducted work.
    2. All felt that the timing for policy work, particularly with regard to health care reform,
       public health infrastructure, and challenges such as obesity and genomics, was very good
       to optimal.
    3. Most, if not all, felt very strongly that the “translation” function was critical, but rarely
       undertaken well.
    4. Most appeared to be concerned about funding, even those with endowments (e.g. Tufts),
       but none of the concerns seemed urgent.
    5. All had specific sources of core funding. For some, core funds were associated with
       specific multi-year research grants. For others, core funds came from endowments or
       private foundation grants. A few sites had substantial state resources to undertake state
       health policy work. The policy center at the University of Southern Maine was one such
       center. The policy center at USM operates as part of the Muskie School of Public
       Affairs, and conducts very specific projects for the state in exchange for a large ($1M)
       annual budget (partly generated by Medicaid matching funds to Maine).
    6. Most felt that a distinct challenge would be to identify and maintain a consistent focus
       because of the multiplicity of faculty interests and project possibilities.
    7. All urged significant integration with university activities, even as it was often remarked
       that the bureaucracy could be daunting. The exception was the Center for Public Policy
       and Genetics at Johns Hopkins. In this somewhat isolated case, this view arose from a
       substantial ($9.9M) award from the PEW Foundation to found the Center, giving it
       considerable latitude as to structure. Integration is not easy, particularly the integration
       of the staff who work predominately on specific state health policy projects and regular
       research faculty. Often interaction occurs around common data sets as opposed to
       common projects.
    8. All sought greater levels of collaboration with other schools, departments, programs and
       faculty. None felt that enough in this respect had been accomplished.


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    9. The site that was most actively engaged in state-specific health policy work noted the
       importance of building and maintaining close relationships between center staff and
       decision-makers. Because this center focuses on work for a particular state agency, the
       key players are relatively constant over time. Even with this advantage, maintaining
       sufficient trust and visibility is very time consuming (and time specific).

    Funding Sources: According to The Foundation Center‟s March, 2004 “Update on
Foundation Health Policy Grantmaking,” grant dollars targeting health policy activities more
than tripled from 1995 to 2002, to total nearly $360 million. The share of overall foundation
giving in this area rose from 1/11th in 1995 to 1/8th in 2002. The number of foundations funding
health policy activities climbed by more than half to 136, including some of the nation‟s largest.
In 2002, the top ten foundations in terms of their grants for health policy activities were: the
Robert Wood Johnson Foundation (310 grants totaling $225 M), California Endowment (45
grants totaling $31M), Pew Charitable Trusts (4 grants totaling $16 M), W. K. Kellogg
Foundation (8 grants totaling $13.5 M), John D. and Catherine T. MacArthur Foundation (11
grants totaling $11 M), the Commonwealth Fund (9 grant totaling $10 M), Rockefeller
Foundation (25 grants totaling $8 M), California Wellness Foundation (35 grants totaling $4 M),
Ford Foundation (20 grants totaling $4 M), and the David and Lucile Packard Foundation (12
grants totaling $3 M). Each of the foundations has specific policy interests and agendas; the two
California foundations restrict their giving to projects that affect the health of Californians.

    Appendix G presents information on the funding interests of major foundations as they relate
to health policy research. This information was drawn from the top ten foundations that fund
health policy research and analysis; “data dumps” from the UW Central Development Office on
health care foundations, health policy foundations, a list of local foundations, and a list of health
policy grants nationwide; and our review of key funding sources of ten similar policy centers
throughout the country. Appendix G contains information on approximately 40 funding sources,
not all of which would be considered viable. The fields of information for each record include
foundation and program name, program emphasis, grant ranges, and deadlines.

Competition: Resources were not sufficient to undertake a comprehensive competitive
assessment. However, the Committee found that:

       1. There is significant competition in the core field of health services research, with
       many institutions chasing a large, but far from bottomless, pot of money.
       2. There is specific competition in certain subject matter areas, such as food and
       nutrition, public health, and genomics. In the fields of food and nutrition (particularly
       obesity) and genomics, the competitors are few in number, and the funding horizons are
       expanding.
       3. It is clear that a significant share of federal research dollars will be allocated to topics
       related to genetic services and genomics.
       3. From a competitive posture, it also appears that most university-based programs are
       not effectively branded, positioned and focused to be substantial performers. At least one
       of the key reasons for this relative weakness is actually also a strength: the great width,
       depth, and intellectual capacity at a university. The University of Pennsylvania is one of
       a few universities that has focused its research strategically to great advantage.
       4. Given the above, there is a real opportunity to improve on the marketing performance,
       within clearly acceptable constraints.


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       5. Ultimately, of course, success against competitors has much more to do with the
       quality of the work, and the commitment of the participant faculty.

A Special Note on State Health Policy
        Since 1974, the SPHCM has had a strong presence in state health policy through the work
of the Health Policy Analysis Program (HPAP). While the nature of this work has evolved over
time as HPAP‟s funding (sources and amounts) and context have changed, its focus has always
been on issues relevant to near term health policy decisions in Washington State. In recent years,
HPAP‟s activities have included an annual legislative conference attended by 500-600 local and
regional policy makers and stakeholders; the Safe Table Forums that bring together smaller
groups to discuss specific policy issues, often around an HPAP-authored white paper; as well as
a wide variety of short term grant and contract-funded projects for state agencies, state-based
private groups and associations, and national foundations. The work of HPAP is recognized,
both locally and nationally, as important and of high quality. By being integrally involved in the
state health policy process and by providing information relevant to the immediate needs of state
policy makers, HPAP has created a very visible “state face” for the University and the SPHCM.

        The Committee strongly believes that the UW, particularly as a public university, has an
obligation to contribute to high quality health policy decision making in Washington. The
dilemma, however, is that neither the state nor the University are able to commit the core
                                            resources required to sustain the applied policy
  THE PACE OF POLICY
                                            analysis work over time [Note: the state has funded
  DEVELOPMENT IS POORLY
  MATCHED WITH THE PACE OF                  some core policy analysis activities at the Evergreen
  SCIENTIFIC RESEARCH. IOM p. 2             State College in Olympia, although the funds are not
                                            restricted to health policy and most of the work is in
                                            other areas]. To be done correctly, this work requires
large amounts of time interacting with a wide range of stakeholders, building trust, learning
about issues, and changing gears as the people and issues change. As the Committee looked
around the country at other state health policy programs operating within universities that do this
type of work (see Appendix H), it discovered that all have significant sources of core support –
from state government generally, from specific state agencies, from foundations, or in
conjunction with specific research project grants (in which case the policy activities are more
narrowly defined to relate to the research project). Policy programs without such core support
focus on more traditional research and do little of the applied work.

        The Committee reluctantly concluded that at this point in time, in this financial and
political context, the University‟s contribution to state health policy must be from a different
vantage point – at once both narrower and broader: narrower in the sense of fewer resources
committed to the time-intensive “on the ground” work, but broader in the sense that future UW
policy research focused on critical health policy topics, enhanced by a greater commitment of a
number of Schools and Departments within the University and complemented by the integration,
translation, and dissemination of that research, will yield findings applicable to state policy
makers. In taking this approach, the Committee understands that some opportunities are lost
(while others are gained). It further recommends that the Resource Center proposed in this
report maintain, as part of its mission, a continuing connection with the Washington State health
policy community in as many ways as are feasible (continuing the Washington Health
Legislative Conference and the Safe Table Forums are specific examples), including seeking


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new sources of revenue to support these efforts. This recommendation is in no way a negative
reflection of the value of HPAP‟s past efforts, but simply the best course of action given current
funding realities.


Recommendations
The Committee made recommendations in two primary areas: policy research and analysis
(including dissemination of research and analysis results), and teaching and training.

Research and Policy Analysis
                                                       High quality, relevant research is not only
    PUBLIC HEALTH RESEARCH                     what funds the bulk of SPHCM activities, it is
    ANSWERS THE QUESTIONS: WHAT                also what creates the most national and
    ARE THE CONSEQUENCES TO HUMAN              international visibility for the school. Therefore,
    HEALTH OF THE WAY WE LIVE, AND
                                               a purposeful research agenda must be at the core
    WHAT CAN BE DONE TO IMPROVE IT?
  IOM, p. 117                                  of the SPHCM‟s health policy initiative. There
                                               are two general approaches that can make a
                                               contribution in this area. First, we should
maximize the value of ongoing research, and second, we should pursue new research. With
regard to the former, we must find ways to connect the silos within which much faculty research
is conducted. A central value among SPHCM faculty is the importance of viewing the
determinants of health broadly from an ecological perspective. However, if we wish our
decision makers to take this view, we need to expand our own thinking in this direction by cross-
pollinating our work with the work of our colleagues. With regard to the latter, we believe we
need to complement the individual efforts of faculty grant-writing with a somewhat more
focused research agenda established through a strategic process that anticipates as well as
responds to areas of policy concern.

         The choice of focus is important both externally
and internally. It needs to be seen from the outside as      SCHOOLS OF PUBLIC HEALTH
sufficiently specific to be clear and cogent (and thus       SHOULD EMPHASIZE THE
marketable). At the same time, however, it needs to be       IMPORTANCE AND CENTRALITY
sufficiently broad to encompass much of the diversity        OF THE ECOLOGICAL
of faculty policy research interests as well as the          APPROACH. IOM, p. 111
changing policy landscape. We have, therefore,
recommended a focus that is based in perspectives
(e.g., health ecology) rather than topics (e.g. environmental health), with the understanding that
the topics fall within the perspectives.
We recommend:

               The SPHCM should create a Resource Center for Health Policy (Resource
                Center) to focus and facilitate policy research and practice. The Resource Center
                would be advised by representatives from SPHCM, Law, Public Affairs,
                Pharmacy, Medicine and Nursing.




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     The mandate of the Resource Center should be “Translating Science and
       Technology into Public Health Policy Research and Practice.” Around this
       mandate, the Resource Center should have the following functions:
          o Scanning the environment for emerging policy issues, funding
             opportunities, and research partnerships;
          o Connecting and integrating, as appropriate, ongoing health policy relevant
             research across the UW campus(es);
          o Assisting faculty who wish to create a health policy frame for faculty-
             initiated projects in any topic area;
          o Initiating research projects that fit within its scope, as defined by the
             Resource Center agenda (developed in conjunction with the Advisory
             body);
          o Developing private sector collaborations, both as sources of funding and
             as partners in projects funded by third parties;
          o Translating into accessible language and disseminating the results of UW
             research and analysis to public and private decision makers;
          o Maintaining and strengthening, through collaboration with other SPHCM
             activities (e.g., the Northwest Center for Public Health Practice, the
             Center for Public Health Nutrition), a long term relationship with state
             and regional policy makers;
          o Addressing specific state health policy issues upon request as resources
             permit; and
          o Supporting teaching programs relating to health policy.

     Resource Center-initiated work should be consistent with four theme areas:
          o The multiple determinants of health [the ecological health model – e.g.,
             the Center for Public Health Nutrition (Drewnowski, PI), the Health
             Promotion Research Center (LoGerfo, PI), and the substantial body of
             work conducted by Donald Patrick, Deb Bowen, and others]
          o The impact of major new technologies on health care (with special
             attention given to the biotechnologies) and their impact on health care
             delivery systems [the resource allocation and distribution aspects of
             biotechnology, including the impact on health and resource disparities] –
             e.g., the Center for Excellence in ELSI Research (Burke, PI); the Genetic
             Services Policy Project (Watts, PI); multiple projects directed by faculty
             within the Institute for Public Health Genetics
          o Optimizing the best of medicine in a health care delivery system in
             transition – e.g., the Genetic Services Policy Project (Watts, PI); pending
             Labcorp project relating to the cost effectiveness of diagnostic tests
             (Sullivan and Ramsey, PIs)
          o Achieving primary prevention of illnesses and injuries through the
             identification and control of hazards to public safety and health [the
             hazards component of the ecological health model] – e.g., the Air
             Pollution and Cardiovascular Disease Project (Joel Kauffman, PI)
     The Health Policy Analysis Program‟s 30-year legacy of state-focused policy
      analysis and dissemination should be continued in the work of the Resource
      Center, but the separate identity of HPAP, which is associated with a narrower
      range of activities and topics, should not be maintained.


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             The specific agenda for Resource Center-initiated research would be developed in
               conjunction with the advisory body (see below).

       The SPHCM faculty and their colleagues across the UW campus(es) produce world class
research funded by a variety of project-specific grants and contracts. The results of all of these
                                                   projects, at some level or another, could
    THE COMMITTEE RECOMMENDS THAT                  contribute to sound decision making by public
    SCHOOLS OF PUBLIC HEALTH                       and/or private decision makers, a fact that is
    ENHANCE DISSEMINATION OF                       not lost on some funders of policy research.
    SCIENTIFIC FINDINGS AND                        Recent federal RFAs (e.g., the Center for
    KNOWLEDGE TO BROAD AUDIENCES,                  Excellence in Health Promotion Economics
    INCLUDING ENCOURAGING THE                      (CDC) and the Genetic Services Policy Project
    TRANSLATION OF THESE FINDINGS                  (HRSA)) explicitly required significant
    INTO POLICY RECOMMENDATIONS
                                                   dissemination activities with explicit funding
    AND IMPLEMENTATION… IOM, p. 5
                                                   for them. Some observers see this as a trend
                                                   that will continue if not expand. The SPHCM
has an opportunity (and a responsibility) to disseminate the research findings of its faculty to
decision makers at a time and in a format in which it is useful and accessible.

            We recommend:

             The Resource Center should engage in a core set of activities around
              dissemination of research to decision makers. There should be a designated
              director of these activities within the Resource Center and a support staff to
              assure their quality, relevance and coordination.
             Core dissemination activities should include continued involvement in the
              Washington Health Legislative Conference (perhaps in partnership with other
              organizations)
             The Resource Center should continue involvement in forums such as Safe Table,
              and in monitoring reports such as the Pulse Report.
             The core should also include maintenance (and enhancement) of an easily
              accessible web site through which individuals could access periodic issue briefs
              such as those prepared for the Safe Table forums, as well as faculty research
              reports and publications. Additional issue briefs and white papers related to
              ongoing or completed faculty research should be encouraged, funded by the
              specific project grant or contract.
               The Resource Center should sponsor an annual policy research conference open
                to both researchers and policy makers from around the region that would
                highlight specific research projects, their integration, and their relevance to
                public policy. A central intent of the conference would be to create a dialogue
                between researchers and policy makers.
             The Resource Center should consider other activities to further its mission,
              including developing and sponsoring conferences and seminar programs, and
              initiating a visiting scholars program.




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       There are a number of structural, financing, and
governance issues surrounding the Resource Center that
need to be addressed. While the details of these issues go   THE MOST STRIKING CHANGE IN
                                                             PUBLIC HEALTH RESEARCH IN
beyond the charge of this Committee, we discussed the
                                                             THE COMING DECADES IS THE
overarching values relevant to structure, financing, and     TRANSITION FROM RESEARCH
governance. In particular:                                   DOMINATED BY SINGLE
                                                             DISCIPLINES, OR A SMALL
             A key function of the Resource Center is       NUMBER, TO
              business development and resource              TRANSDISCIPLINARY RESEARCH
              generation, particularly with regard to the      IOM, p.117
              targeted research component. We
              recommend that there be significant,
              stable funding for these activities that is complemented (as opposed to replaced)
              by specific project funds. At a minimum, funds should be provided for support
              of the Resource Center director, leadership of the business development and
              dissemination functions, as well as adequate staff support and marketing
              activities (see below).
             We recommend that support for the development of the Resource Center be
              pursued with the Deans of complementary Schools (e.g., Law, Nursing,
              Pharmacy, Medicine, Evans), perhaps through a request to the Vice Provost for
              Research. This request would be formatted as a 5-year strategic plan for
              development of the Resource Center.
             Because of the multi-school involvement in the Resource Center, a clear
              governance structure is essential. While we provide some thoughts in this area in
              Section 3, we recommend that more detailed work on issues of appropriate
              governance be undertaken by another body. The Department of Health Services
              is willing to provide an administrative home to the Resource Center.
             The Resource Center‟s activities should be integrated significantly in the
              SPHCM‟s development activities.




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Teaching and Training
                                                              THE COMMITTEE BELIEVES
                                                              THAT IT IS THE
        The students who graduate from the SPHCM are          RESPONSIBILITY OF SCHOOLS
the future leaders in public health science and practice,     OF PUBLIC HEALTH TO
public health and health services research, and health        BETTER PREPARE THEIR
services administration. They must all achieve basic          GRADUATES TO UNDERSTAND,
competencies in health policy, including an understanding     STUDY, AND PARTICIPATE IN
of the policy process and how information and research        POLICY RELATED ACTIVITIES.
affect and are affected by policy. Those who wish to get      IOM, p.121
more in depth training and/or specialize in health policy
must have the opportunity to do so.

       We recommend:

            The SPHCM should offer a health policy concentration/major to students at both
              the masters and PhD levels. This concentration could be created through the
              Health Policy Research track of the MPH in Health Services for masters students
              and within the PhD program in the Department of Health Services and the
              Department of Environmental and Occupational Health Sciences for doctoral
              students. [Note: Policy is already an important component of two of the degree
              programs in the Institute for Public Health Genetics.] As the doctoral program in
              the Evans School of Public Affairs is implemented, joint opportunities for
              students between this program and PhD programs in SPHCM (particularly in
              Health Services and Environmental and Occupational Health Sciences) should be
              explored. These concentrations should be aggressively marketed to attract
              excellent students of health policy. Adequate support would be required to
              develop policy practica, supervise policy capstone and thesis projects, and add
              new courses that cannot be found elsewhere on campus.
            All required 511 courses in the SPHCM should include content on the policy
             perspective. All degree programs should evaluate the adequacy of policy
             training beyond the 511 requirement.
            The availability of the new Health Policy Certificate Program should be
              advertised broadly within the SPHCM and elsewhere on campus as appropriate,
              with additional funding as required to accommodate the larger volume of
              students.
            The list of electives accepted for credit toward the Health Policy Certificate
              Program should be continually monitored and updated to include relevant course
              work from across the UW Seattle campus as well as the UW Bothell and UW
              Tacoma campuses. We should encourage the engagement of students from a
              wide variety of disciplines and settings to enrich not only the experience of our
              students, but also to increase the connection of the faculty in these areas.
            The Health Policy Certificate Program should maintain a web site that serves as a
              central resource to students interested in health policy, including courses,
              interested faculty, informational resources, and job opportunities.




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             The director of the Health Policy Certificate Program should be responsible for
               coordinating the SPHCM's teaching activities, including the maintenance of the
               web site. Staff resources should be available to assist in this purpose.
             Core health policy content should be developed as a distance module for use in
              the expanding array of distance offerings in the SPHCM. This content should
              address as many of the basic competencies outlined in Appendix I as is feasible.
             Health policy content should be added as appropriate to the various professional
              training programs in the
              SPHCM, including, for              THE COMMITTEE RECOMMENDS THAT
              example, the programs offered      SCHOOLS OF PUBLIC HEALTH FULFILL
              by the Northwest Center for        THEIR RESPONSIBILITY FOR ASSURING
              Public Health Practice, and the    ACCESS TO LIFE LONG LEARNING
              Best Practices Workshops in        OPPORTUNITIES FOR SEVERAL
              the MHA program.                   DISPARATE GROUPS. IOM, p.125



Additional Thoughts on a Resource Center for Public Health Policy
Mission:
The mission of the Resource Center is twofold: first, to improve the quality of health policy
analysis and decision making at the national, regional, and state levels by increasing the quantity
of accessible policy relevant research and information and by increasing the amount of informed
dialogue about important health policy issues; and second, to heighten the profile of the
University of Washington‟s health policy research capabilities and increase the impact of UW
programs on the emerging health policy debate at all levels. This mission will be accomplished
by integrating, facilitating, initiating, and disseminating health policy research around a theme of
translating science and technology into health policy research and practice.

The Resource Center will be developed as a “utility” for use by faculty desiring to engage in
policy-related research and its dissemination. In order to do so, the Resource Center will provide
six core service functions:

1. Scanning and Monitoring: Assess opportunities for policy research, first by scanning the
mid-to-long-term policy horizon to strategically identify policy research questions upstream of
demonstrable need; and second, by systematically monitoring available sources of financing,
such as federal agencies, and providing potentially interested faculty with information about such
opportunities.

The Resource Center‟s Advisory body will review the scanning function on a quarterly basis to
add its input and to make modifications in the process as necessary. The monitoring function is
currently undertaken in a variety of informal ways by different Schools and Departments. Those
activities will, of course, continue. The Resource Center will add value to these efforts by
searching specifically for cross-School and Department opportunities, and by emphasizing non-
government (e.g., foundation) initiatives. The two added activities will be (a). more systematic
coordination of existing monitoring to identify cross-School and Department projects, and (b). a
greater emphasis on non-governmental initiatives and opportunities, such as developing profiles
of health care foundations.

13
2. Policy Research Issue delineation: For such faculty as may request it, assist in
identifying policy research opportunities and issues and enhancing proposals for research
funding with sharper delineation of policy issues and options (such as, for example, collaboration
with a group of faculty in the preparation of the Center for Health Promotion Economics
proposal recently submitted to CDC by the Department of Health Services).

3. Engaging the Private Sector: Enhance research initiatives and increase funding
opportunities through private sector collaboration. This task will be undertaken in two
fundamental ways by securing private sector engagement in advisory and collaborating roles to
increase the relevance of the work (as with the extensive private sector engagement in the recent
successful proposals on genetic services policy submitted to HRSA), and securing private sector
policy research clients (such as in the two projects currently being negotiated with MEDCO
Health Services, and LabCorp, and ongoing projects such as those of the Health Promotion
Research Center).

Because collaboration with private sector clients can raise issues of scientific ethics and
academic freedom, the Advisory body will oversee the development of policies to guide this
work (consistent with University policies), and will be responsible for monitoring project
development and outcomes in this area.

4. Initiating Policy Research Proposals: Initiate new research that fits within the Resource
Center‟s focus as determined in conjunction with the Advisory body. While much of the policy
research work to be undertaken will be secured through responses to RFP‟s and RFA‟s, the
Resource Center will also initiate proposals on topics of significant interest to one or more
faculty, and/or, on topics of crucial policy relevance as identified by the Resource Center‟s
scanning process (and vetted through the Advisory body). Appendix J lists some examples of
health policy research projects in which faculty interest has already been expressed.

5. Dissemination/Translation of Policy Research: Make research results accessible and
available to public and private sector decision makers. This function will increasingly serve as a
differentiator in many competitive policy research areas, especially given the current emphasis
being placed in RFA‟s on “translation” of research findings to affected stakeholder groups. The
Resource Center will develop a strong internal capability in all aspects of dissemination and
translation, including development of publications accessible to a lay audience; support and
ancillary materials in the development of proposals; facilitation of advisory group participation;
meeting planning skills; various electronic systems for interaction such as webcasting; and
conference and seminar development, facilitation and logistics. While an important focus of the
dissemination and translation function will be research conducted with UW faculty involvement,
there will be important policy issues for which UW research is not the only source of research
and information. In these instances, the Resource Center will serve as a translator (as necessary)
and a broker of relevant work conducted by others (as, for example, through a policy research
conference or issue forum). The SPHCM already has significant strengths in this area through
the work of the Health Policy Analysis Program, the Northwest Center for Public Health
Practice, the Center for Nutrition Policy, the Health Promotion Research Center, the Policy
Analysis and Program Evaluation Initiative of the Department of Environmental and
Occupational Health Sciences, and other projects. The Resource Center would coordinate and
collaborate with this ongoing work.


14
The Resource Center‟s dissemination and translation expertise will be a available to all
participating Schools and faculty, but could also be operated as a cost-plus utility.

 6. Strategic Marketing and Positioning: Use proven marketing techniques to enhance the
visibility and success of the University‟s health policy research programs. In addition to the
scanning and monitoring functions outlined in (1) above, another successful approach is to
develop workshop and seminar programs to add visibility to the University‟s capabilities. Some
examples of this approach include the policy research conferences sponsored by HPAP in the
past, many of the institutes sponsored by the NWCPHP, the new Best Practices Leadership
programs developed by Denny Pointer, and a panel presentation being developed for the
Grantmakers in Health Annual Meeting in early 2005 that affords us the opportunity to present to
the leadership of most of the health care foundations in the U.S.

Financing and Governance:
Adequate resources and appropriate governance are essential to the success of the Resource
Center. While a full exploration of these important aspects of the Resource Center‟s operation
are beyond the scope of this report, we offer the following thoughts.

Given the multidisciplinary nature of the work, involvement of a number of Schools,
Departments, and Institutes across campus is important to the Resource Center‟s operation. The
SPHCM, given its desire to respond to the IOM‟s directives around health policy, is prepared to
take the lead role in creating the Resource Center, but will seek collaboration and co-sponsorship
across the campus.

Ideally, resources (either real or in-kind or both) would come from all partners in proportion to
the participation of their faculty and the benefits they derive from the Resource Center‟s
activities. Similarly, governance responsibility should be shared by the partners, again in
proportion to their participation. A number of questions in this area need to be answered:
              Who appoints the director of the Resource Center?
               If the governance is shared among the participating entities through a governing
                committee, who determines the committee‟s membership?
               In particular, is membership conditioned on resource contribution? Do in-kind
                resources “count” on equal terms with financial resources?
               Are there different levels of membership (e.g., voting and non-voting) that carry
                different conditions?
               Who appoints the specific members of the committee?
               What are the powers and responsibilities of the committee?
               Does the director of the Resource Center report to the committee, and to whom
                does the committee report?
               Given the importance of collaboration with non-University partners, is there a
                governance role for these entities, or should there be a separate advisory (as
                opposed to governing) body to include their perspectives?

With regard to resources, there are additional questions:


15
          What level of core support is adequate to maintain the central functions of the
           Resource Center?
          Where should these resources come from?
              o A flat tax on participating entities?
              o “Sales” of committee membership (offered, perhaps, at different levels of
                  “price” and participation)?
              o A proportion of the indirect costs of the projects that are run through the
                  Resource Center?
              o Inclusion of Resource Center personnel in the direct costs of grant
                  proposals?
              o External development activities?
              o Other?




Five-Year Strategic and Implementation Plan




16
Research and Analysis/
                                  05                     06                     07                    08                  09
RCHP
Strategic Plan Process;
Completion of Strategic   Launch of RCHP
Plan; UW approvals
                          Secure Core          Financial Breakeven                           National
                                                                       Secure “outpost”
Implementation            Support; three       reached; 5 proactive                          Recognition;
                                                                       Genomics capability
Milestones                proactive            proposals; three                              one of three “best”
                                                                       from RWJF
                          proposals            secured overall                               Policy Pro-grams
                                                                       SPHCM, Law, Public
Participating Schools/                         SPHCM, Law, Public                            Business School
                          SPHCM, Law                                   Affairs; Pharmacy,
Departments                                    Affairs; Pharmacy                             added
                                                                       Medicine, Nursing
Overall Gain in
participating School      2%                   3%                      5%                    7.5%                  10%
Revenues; net
RCHP Gross Revenues,
                          .75M                 1.50M                   3M                    4M                    5M
per Year (cumulative)
ROI, per Year             2:1                  4:1                     6:1                   8:1                   10:1

Dissemination/detail
                          Consolidation of     Launch of
Establish RCHP            Functions, e.g.,     Conferencing/
capability                Surveying/           Meeting planning
                          Prioritizing RFA‟s   functions
                          Meeting Planning     Consolidation of
In-House “Utility”        support; e.g.,       Literature Search and   Breakeven on          Net Revenues, 20%     30%
services                  WEBinar              Proposal Support        Dissemination Costs   surplus over costs    surplus
                          capability           functions
                          Executing on Safe
Meeting/conferencing                           First major RCHP        Three sponsored/      Five sponsored
                          Tables Programs,                                                                         ETC.
activity                                       Conference              Financed Meetings     Meetings
                          annual Leg. Conf.
Teaching/Training

17
In sum, the Committee believes the SPHCM, in keeping with the recommendations of the Institute of
Medicine, has a significant obligation and an important opportunity to focus and enhance its health
policy activities in research, teaching and training, and dissemination. The multidisciplinary
Resource Center for Health Policy proposed in this report provides a necessary focal point for this
work. As a next step in bringing the Resource Center to life, the Committee recommends the
formation of a small working group to address the financing and governance issues raised in this
report.




18
                                     Appendix A
                                Charge to the Committee


            SCHOOL OF PUBLIC HEALTH AND
               COMMUNITY MEDICINE
                               OFFICE OF THE DEAN
                                          BOX 357230
                                          206-543-1144
TO:           CINDY WATTS, CHAIR
              AARON KATZ
              MELISSA AUSTIN
              WYLIE BURKE
              ALISON CULLEN
              JEFF HARRIS
              PAT KUSZLER
              MIKE SILVERSTEIN
              WILL WELTON
              JACK THOMPSON
              SHARON MORRIS
              SEAN SULLIVAN
              ADAM DREWNOWSKI
              TOM KOEPSELL
              DEBBIE WARD
              RICK DEYO
              BOB CRITTENDEN
              BILL DOWLING, EX OFFICIO
              RICK CARLSON, CONSULTANT

FROM:         PATRICIA W. WAHL, PHD
              DEAN
              SCHOOL OF PUBLIC HEALTH AND COMMUNITY MEDICINE

DATE:         JANUARY 7, 2004

RE:           HEATH POLICY CHARGE LETTER

Thank you for your interest in serving on the Advisory Committee for Health Policy in the School of
Public Health and Community Medicine. The purpose of the Advisory Committee is to examine how
to organize the SPHCM‟s resources, in collaboration with other programs and schools across campus,
to strategically respond to the Institute of Medicine‟s call for involvement and leadership in health

19
policy. A key function of the Task Force will be to identify and engage a broad range of
stakeholders: research partners (on campus and from other academic institutions and research
organizations), market partners (trade associations, industry organizations), public partners
(government decision makers), and funders (public and private).             The purpose of this
“stakeholdering” is to explore the (many) strengths of the SPHCM and its partners in relation to the
burgeoning needs of the national and regional health policy community and the interests and priorities
of those who would fund our work.

We are on the threshold of profound enrichment of health care and population health through the
waves of discovery triggered, among other things, by rapid advances in medicine and the sequencing
of the human genome. The pace of public policy development to guide the implementation of these
technologies, however, is poorly matched with the pace of their discovery. It is clear that the ability
of scientific research to produce better health outcomes is compromised by the inadequacies, even
perversities, of our health care system‟s existing organization and financing. Beyond the challenges of
genomics, growing consumerism, demographic changes, and workforce trends lie others associated
with the vital need to calibrate the power of these new technologies with the social, ethical, economic
and policy issues that they create. Thoughtful and well informed policy processes that integrate our
knowledge base and our societal values to address these and other thorny health care issues have
never been more important.

Health policy is the “discipline” that systematically studies how science, values, and decision
processes combine to generate public decisions that guide health care financing and delivery. The
centrality of health policy was recognized by the Institute of Medicine in its 1988 report, The Future
of Public Health, and again in its 2003 report, Who will Keep the Public Healthy. In the latter report,
“contributing to policy that advances the health of the public” was listed as one of the six major
responsibilities of schools of public health. The report recommends that “(f)aculty should be
involved in policy development and implementation for relevant issues and play a leadership role in
public policy discussions about the future of the United States health care system.” (page 2) This is
clearly a fortuitous time for schools of public health to become involved in developing rational policy
processes, informing policy decisions, and training policy makers.

The University of Washington School of Public Health and Community Medicine is uniquely
positioned to contribute in this area. The SPHCM houses and partners with some of the best
scientists in the country: geneticists, bioinformaticists, epidemiologists, biostatisticians,
pathobiologists, toxicologists, and others. SPHCM is also home to national leaders in the social
sciences: economics, law, sociology, program evaluation, bioethics, and others; as well as the clinical
sciences: medicine, nursing, and social work. The Health Policy Analysis Program has carried the
banner for applied policy research and policy analysis for 25 years. In the area of education and
training, SPHCM‟s Department of Health Services has a strong policy curriculum, complemented by
health policy coursework in other departments within the Health Sciences, a strong health law
program in the Gates Law School, and a top national school of public policy in the Evans School of
Public Affairs. The relatively new Ph.D. program in the Department of Health Services includes
health policy as a core competency. The Department of Health Services also houses the SPHCM‟s
growing commitment to undergraduate education in public health. Within the next six months, a new
Certificate in Health Policy, based in Health Services but drawing upon campus-wide teaching
resources, will also be available to master‟s students in SPHCM and other schools across the campus.
SPHCM is poised to have a seat at the national health policy table that will debate the issues brought



20
to us by increasing technology, growing needs, and limited resources; but we must think strategically
about how to best to get there.

The exploration of SPHCM‟s best course of action is an iterative and interactive activity. It involves
parallel work within and outside the University. We have long been successful at the usual
mechanisms for obtaining support (responding to RFP‟s) from the usual sources (NIH, AHCQR,
RWJ). But in a climate of spending austerity among our old funding partners, we need to seek new
approaches and new partners to complement them. Given the nature of the issues we might seek to
explore, our new partners might include regional foundations with wider mandates, corporate support
(primarily from corporate foundations), mixes and matches of the above. We might also consider
prudent use of innovative financing models such as industry-based shared-research models, wherein
stakeholders might be persuaded to finance the work.

An important piece of the Advisory Committee‟s task is to consider the extent to which SPHCM‟s
efforts should be guided by specific themes. The need to seek non-traditional funding sources,
specifically from private sector organizations, suggests the importance of positioning: that is,
focusing our initiatives around a set of topics and activities that form a coherent whole that can be
articulated. Some obvious candidates for such a theme are genomics, environmental health,
occupational health, nutrition, chronic disease, and workforce issues.

SPHCM‟s success in mounting a nationally recognized health policy research program will depend
upon our ability to think strategically, to engage the right research and market partners, and to secure
sufficient financial support. The work of the Advisory Committee is central to beginning this
process. Specifically, the Committee is asked to:
    1. Conduct an environmental scan to identify both “customers” and competitors for this work.
    2. Develop a five-year strategic plan for building greater health policy content throughout the
        SPHCM, coupled with a realistic implementation plan, recognizing that over 80% of
        SPHCM‟s funding comes from grants and contracts. The strategic plan should address
        SPHCM‟s involvement in all four legs of the health policy stool: teaching, research, policy
        analysis, and translation and dissemination.
    3. Identify key intersections of SPHCM with other units, both on campus and in affiliated
        institutions and agencies, that could be expanded to enhance health policy across the
        University.
    4. Determine education and training opportunities in health policy development and
        implementation for both degree-oriented students and others, including relevant professionals
        in the community.
    5. Determine research and funding opportunities in health policy-related issues relevant to the
        health of the public.
    6. Explore the advantages of focusing our activities around one or more specific themes.
    7. Investigate the relative advantages and disadvantages of alternative structures that might
        organize our initiatives; for example, a center, an institute, a resource center, or a permanent
        steering committee.
    8. Determine the most appropriate role for the Health Policy Analysis Program within and across
        each of the four areas of activity (teaching, research, policy analysis, and translation and
        dissemination), and HPAP‟s relationship to any new structure that might be created.

I expect that the Advisory Committee‟s work will begin in January, and run through spring quarter.
Thank you for agreeing to be part of this important venture.


21
                                     Appendix B
                             Roster of Committee Members

     Melissa Austin, Ph.D.
                                                      Tom Koepsell, MD, MPH
     Professor, Epidemiology
                                                      Professor, Epidemiology
     Director, Institute for Public Health Genetics
                                                      School of Public Health
     School of Public Health
     Wylie Burke, PhD, MD                             Patricia Kuszler, MD, JD
     Professor and Chair, Medical History & Ethics    Professor; Associate Dean for Faculty
     Adjunct Professor, Medicine, Epidemiology        Research and Development
     School of Medicine School of Public Health       School of Law

     Rick Carlson, JD                                 Sharon Morris, BA
     Clinical Professor, Health Services              Senior Lecturer; Assistant Chair for
     School of Public Health                          Community Outreach Environmental Health
     Consultant to the Committee                      School of Public Health

     Bob Crittenden, MD                               Michael Silverstein, MD, MPH
     Associate Professor, School of Medicine          Assistant Director for Industrial Safety and
     Chief of Family Medicine Service                 Health Department of Labor and Industries
     Harborview Medical Center                        WISHA Services Division
     Rick Deyo, MD, MPH
                                                      Sean Sullivan, PhD
     Professor, Division of Gen. Internal Medicine
                                                      Professor, Pharmacy School of Pharmacy
     Co-Director, Robert Wood Johnson CSP
                                                      Health Services School of Public Health
     School of Medicine
     William L. Dowling, PhD, MA, MBA                 Jack Thompson, MSW
     Professor and Chair, Health Services             Senior Lecturer, Health Services
     School of Public Health                          Director, Northwest Center for Public
     Ex-officio member                                Health Practice    School of Public Health
     Adam Drewnowski, PhD, MA                         Debbie Ward, PhD
     Professor,Epidemiology                           Associate Professor
     Director, Nutritional Science Program            Psychosocial & Community Health
     School of Public Health                          School of Nursing
                                                      Cindy Watts, PhD
     Jeff Harris, MD, MPH, MBA
                                                      Professor, Health Services
     Senior Lecturer, Health Services
                                                      Director, Northwest Health Leadership
     Associate Director, Health Prevention Research
                                                      Institute    School of Public Health
     Center       School of Public Health
                                                      Chair of the Committee

                                                      Will Welton, DrPH, MHA
     Aaron Katz, CPH
                                                      Senior Lecturer; MHA Program Director,
     Senior Lecturer, Health Services
                                                      Health Services
     School of Public Health
                                                      School of Public Health



22
     Committee Staff
     Barbara Brooner                                 Kerri Petrin, MPH candidate
     Policy Analyst, Environmental Health            Research Assistant
     School of Public Health                         Institute forPublic Health Genetics
                                                     School of Public Health
                                 Michele Ritala
                                 Communications/Events Manager, Health
                                 Policy Analysis Program
                                 Health Services School of Public Health

     ----------------------
     A member of the Evans School of Public Affairs faculty originally on the committee was
     unable to serve for health reasons.




23
                                          Appendix C
                                       Site Visit Reports

Site Visit : Stanford and Berkeley
February 27, 28, 2004
        Synopsis: The occasion for the site visit to Stanford was a one day conference at the Law
School, sponsored by the Law and Biosciences program. The topic for this conference was policy
formation around Pre-implantation Genetic Diagnosis (PGD), but there is a wide array of projects
within the program.
        Beyond the Law and Biosciences program, there are many disparate policy related activities at
Stanford, but little, if any, effort to connect them. An example is the well known Center for Disease
Prevention Research, run for many years by Jack Farhquahr, M.D.
____________________________________________________________
Site Visit: Johns Hopkins Genetics and Public Policy Center.
March 17, 2004
        Synopsis: This Center, in design, is fundamentally different than the others reviewed,
primarily because its Director, Kathy Hudson, PhD, formerly with NHGRI/NIH, secured a $9.9M
grant from the Pew Foundation, leaving the site for the work to be undertaken through the grant to be
largely determined by Dr. Hudson. The Center also had a mandate from PEW to initially, and
perhaps, on a continuing basis, to focus on reproductive genetics. This work is now well underway,
with a primary focus on survey research.
        Structurally, the Center reports to the Phoebe R. Berman Bioethics Institute at Hopkins,
and is situated at the same location, which is the Washington DC campus of Johns Hopkins. Dr.
Hudson specifically elected a fairly independent model for the Center, which is governed by a semi-
independent Board of Advisors and located on Hopkins‟ D.C. campus. This degree of independence,
however, was largely determined by the leverage Dr. Hudson had, having first secured substantial
funding.
____________________________________________________________
Site Visit Report: University of Berkeley, School of Public Health
April 1, 2004
Synopsis: An interview with Jaime Robinson, PhD, at the School of Public Health yielded the
following points:
1. The policy focus at Berkeley is largely classical health services research (social science research);
2. The School of Public Health is the hub around which most policy work revolves, but the School is
also substantially financed by hard money, so the choice of research topics is fairly diverse;
3. Policy work drawing on the health sciences is either undertaken jointly with the Institute for Health
Care Policy at UCSF ( through Hal Luft ), or in collaboration with the School of Medicine at UCSF;
4. Research related to genomics is of growing interest, and the Berkeley campus is very active in
overall technology related research.
5. Finally, from a structural perspective, policy work is not centered anywhere, but undertaken on a
project basis as each project is developed.




24
____________________________________________________________
Site Visit Report: Duke University “Genome, Ethics, Law and Policy Program” (GELP).
March 18, 2004
         Synopsis: I met with Bob Cook-Deegan, Director of GELP, and with three faculty members
participating in the GELP program, James Boyle, Clark Havighurst, and Arti Rai, all from the Duke
Law School.
         GELP is a part of a larger Institute at Duke, The Institute for Genome Sciences and
Policy. The Program is multi –departmental, drawing from the Law School, the Medical School, the
Sanford Public Policy program, and the Fuqua School of Business.
         GELP was launched in 2003, and has not yet completed its program development activities.
There will be a relatively large emphasis on Law School involvement, in particular intellectual
property and patent issues. Structurally, GELP is highly integrated into the University. It has
developed a policy to eschew private sector financing.
____________________________________________________________
Site Visit: University of Colorado; Colorado Health Institute
March 13, 2004
         This site visit included two organizations: the University of Colorado, the Center for Bioethics
and Humanities, and the Colorado Health Institute.
         Synopsis: The University has relatively little health policy activity, as such. The Center does
address policy issues in the bioethics areas, but primarily through conferences and workshops, the
most prominent of which is its Summer Workshop Series on Bioethics, which usually focuses on
genetic issues. Last summer, it was testing, and this summer, 04, the subject is race and genetics.
         The more relevant organization from a policy perspective is the Colorado Health Institute
(CHI ) recently formed through the financing efforts of three regional Foundations, Rose, Caring for
Colorado, and The Colorado Trust.
         The idea behind CHI was that since all three Foundations are active in the health care
community, and were processing a number of proposals, that CHI could be both arbiter and program
developer for the health field, rendering the funding process both more efficient, as well as providing
the Foundations and the State a more “expert” organization to process proposals, as well as
undertaking independent work on State health policy issues.
____________________________________________________________
Site Visit : Tufts University, School of Nutrition, Science and Policy
April 14, 2004
         Synopsis: I had a thorough and highly informative discussion with Irvin Rosenberg, the
Executive Director of the Center, arranged through Adam Drewnowski.
         Tufts has established its program as probably the pre-eminent policy research program in
human nutrition. It is organized around two tracks: the science track, and a social policy track. The
School is a sterling example of the effectiveness of marketing, even if not called by that name. Few
in the larger health policy world do not know about, and highly regard, this program.
         The School seems very well positioned within the academic community, enjoying as it does a
large number of full and part-time faculty relationships. The School has many and diverse sources of
funding, including a substantial level of private sector work, and has more recently added a
substantial endowment.
         Very relevant to the Committee‟s work, the School views its role as to the science of human
nutrition as primarily interpretive and translational to a policy world little versed in the field.




25
____________________________________________________
Site Visit: University of Pennsylvania, Center for Bioethics.
April 15, 2004
        Synopsis: This Center, directed by Art Caplan, PhD, is often in the news, partly because Dr.
Caplan has positioned himself with the media, and partly, because U. PA was in the spotlight recently
because of the well-reported Gelsinger case. Dr. Caplan was out of town, but I did meet with Jon
Merz, JD, a colleague of Art‟s, and a lawyer at the Center with substantial savvy and experience with
intellectual property/patent issues, in general, but focused substantially on the genomics area.
        The Center undertakes a wide range of research and policy projects, and clearly has
established itself as a credible program. Jon was not particularly versed on the structural issues
relating to the University.
        One aspect of the interview that holds some lessons was the recent flap between the Center
(and eventually the University administration) and DeCode Genetics, the Iceland based company.
Apparently because of some interpretation questions about the findings rendered by the Center in a
project financed by Decode, the company challenged some of the findings, and refused to pay
remaining balances owing the University for work performed. The dispute was ultimately resolved,
but not without costs and antagonism.
____________________________________________________________
Site Visit: Rutgers University, Center for Aging, and Health Services.
April 23, 2004
        Synopsis: I met with three researchers at this Center. David Mechanic, PhD, is the Center‟s
director, but he was out of town.
        The meetings were organized by Joel Cantor, Director of the Center for State Health Care
Policy, well known to Aaron Katz, and the HPAP staff, and was also attended by Louise Russell,
PhD, and Carol Boyer, PhD, associate Director of the parent Center.
        The Center (not the state-focused group, referred to by Joel, as essentially a “wholly-owned”
subsidiary of the parent Center), appears to be very well funded, mostly, I would surmise, due to Dr.
Mechanics guidance. The Center for State Health Care Policy, itself, enjoys substantial funding,
much from national sources, though its research work is largely focused on New Jersey, since it is a
public university. The Center takes on only a small amount of private sector work because it has been
so successful in securing funding from established public and foundation sources.
        The Center, notwithstanding its more general sounding name, focuses substantially on the
mental health needs of an aging population, and, I believe therefore, that partly its success is due to
strategic positioning, intentional or otherwise.




26
                                           Appendix D


                   List of Faculty and Key Informant Interviews

Sandra Archibald, Ph.D.
                                                      W.H.Knight, Jr., JD
Professor and Dean
                                                      Professor and Dean, School of Law
Evans School of Public Affairs
Melissa Austin, Ph.D.
                                                      Tom Koepsell, MD, MPH
Professor, Epidemiology
                                                      Professor, Epidemiology
Director, Institute for Public Health Genetics
Wylie Burke, PhD, MD                                  Patricia Kuszler, MD, JD
Professor and Chair, Medical History & Ethics         Professor; Associate Dean for Faculty Research
Adjunct Professor, Medicine, Epidemiology             and Development
School of Medicine                                    School of Law
Andrew Coburn, Ph.D.
                                                      Bill Lafferty, MD
Professor and Director, Institute for Health Policy
                                                      Associate Professor, Health Services
Muskie School of Public Service
                                                      Director,Health Policy Research Track
University of Southern Maine Portland, Maine
Bob Crittenden, MD
                                                      Patricia Lichiello, MA
Associate Professor, School of Medicine
                                                      Acting Director, Health Policy Analysis Program
Chief of Family Medicine Service
                                                      Health Services
Harborview Medical Center
Alison Cullen, ScD                                    Paul Miller, JD, Commissioner
Associate Professor, Evans School of Public           Equal Employment Opportunities Commission
Affairs                                               (joined the faculty of the School of Law, Fall 04)
Rick Deyo, MD, MPH                                    Sharon Morris, BA
Professor                                             Senior Lecturer; Assistant Chair for Community
School of Medicine                                    Outreach
Co-Director, Robert Wood Johnson CSP                  Environmental Health
Nives Dolshak, Ph.D.                                  Mike Silverstein, MD, MPH
Assistant Professor, Policy Studies                   Assistant Director, Industrial Safety and Health
UW Bothell                                            Dept. of Labor and Industries
William L. Dowling, PhD, MA, MBA                      Don Sloma, MPH
Professor and Chair, Health Services                  Washington Health Foundation
Adam Drewnowski, PhD, MA                              Sean Sullivan, PhD
Professor,Epidemiology                                Professor, School of Pharmacy
Director, Nutritional Science Program                 Professor, Health Services




27
JoLynn Edwards, Ph.D.                       Jack Thompson, MSW
Professor and Director                      Senior Lecturer, Health Services
Policy Studies                              Director, Northwest Center for Public Health
UW Bothell                                  Practice
Jeff Harris, MD, MPH, MBA
                                            Greg Vigdor, JD, MHA
Senior Lecturer, Health Services
                                            President
Associate Director
                                            Washington Health Foundation
Health Prevention Research Center
Tom Hazlet, Pharm D., Dr.Ph.                Debbie Ward, PhD
Assistant Professor, School of Pharmacy     Associate Professor, School of Nursing
                                            Will Welton, Dr. PH, MHA
David Kalman, Ph.D.
                                            Senior Lecturer, Health Services
Professor and Chair, Environmental Health
                                            Director, MHA Program
Aaron Katz, CPH
Senior Lecturer, Health Services




28
               Appendix E
      Health Policy Analysis Tutorial




     Health Policy Analysis Tutorial

                     Prepared for the
      Health Policy Advisory Committee
                     February 2004




           What is Policy Research?


     The development of new information
     designed to address a public policy
     issue.
                     For example:
     “Community Tracking Study,” Center for Studying
     Health System Change, funded by RWJF.
     "Risk Adjustment for Managed Care Capitation,"
     Cindy Watts and Margaret Stanley (Health Care
     Authority), funded by RWJF.




29
                What is Policy Analysis?
       A synthesis of economic, social, scientific, and
       political research findings that is designed to
       offer a series of options for resolving problems,
       including a discussion of pros and cons of these
       options.
     For example:

       “State Planning Grant Project on Access to Insurance,” HPAP,
       funded by HRSA.
       "Insurance Financing of Integrated Medicine," Willliam
       Lafferty et al, funded by National Institutes of Health.




            The Policy Analysis Framework

     • Identify and define the public policy issue
     • Understand the economic market context
     • Identify the stakeholders, their values and
       interests
     • Determine potential options for public policy
       action
     • Analyze strengths and weaknesses of options




          What is Policy Development?

       Policy development is a process that uses data,
       other information, and community values to
       address community problems or build
       community capacity; weighs the costs and
       benefits of policy options; chooses a desired
       option; and recommends programs and services
       to carry out that policy.




30
               Key Characteristics
           of Policy Analysis Projects
      • Sponsorship
        – Who sponsors the project – decision-making
          entity, other stakeholder, external funder?
      • Timing
        – Is the product targeted to inform a specific,
          date-certain decision?
      • Funding
        – Who funds the project – decision-making
          entity, other stakeholder, external funder?


                   Project Examples
                 by Key Characteristics

                     Sponsor       Timing        Funding

       Certificate            Specific
                     Legislature                 Legislature
       of Need                decision, not
                              date-certain
       Premera    Stakeholder Specific           External
       Conversion groups      decision,          funder +
                              date-certain       stakeholders
       State         Governor’s    No specific   HRSA
       Planning      Office        decision,
                                   funder
       Grant
                                   deadline



     How Research and Analysis Influences
                   Policy

     • Shapes thinking about issue (long term)
     • Identifies factors that influence issue (short
       term to long term)
     • Elucidates options for resolving issue
       (short term to medium term)
     • Can provide specific models (short term)


31
            Leverage Points in the Policy
               Development Process


                      Monitoring & Evaluation




     Implementation                             Policy Development
                      Where can University
                         have impact?




                       Policy Dissemination




             Methods of Policy Research
             and Analysis Dissemination

        •   Peer reviewed journals
        •   “Popular” journals
        •   Media relations/op-eds, press releases
        •   Briefs, white papers, fact sheets, reports
        •   Conferences, briefing sessions
        •   Testimony




32
          Policymakers’ Preferences
                for Information
     • From a credible, trusted source (university?)
     • Relevant to and timely for decisions policy makers
       are facing
     • Prepared in short, concise, user-friendly documents
     • Includes inferences and discusses pros and cons,
       rather than just presents data
     • Focuses on what is known and the implication of
       what is known, not what needs further study
     • Flows from relationships with policy makers, with
       researcher sometimes an informal resource
     • Disseminated via seminars, briefings, personal
       meetings (Safe Table Forums)
     • Available on the Web




33
                            Appendix F
                 Health Policy Certificate Program

     Health Policy

     The Graduate Certificate Program in Health Policy (CHP) is available for
     students already enrolled in University of Washington graduate degree
     programs. Priority is given to students enrolled in programs within the School of
     Public Health. Applications are accepted throughout the year and reviewed
     quarterly. Students will qualify for the certificate upon completion of three
     required courses, elective courses, and a capstone project.

     The three required courses are:

           HSERV 552,      Health Policy Development (3 credits)
           HSERV 587,      Health Policy Economics (3 credits)
           HSERV 551,      Health Law (2 credits)
            or
            HSMGMT 590 M,        Health Administration Law (4 credits)

     Required courses must be taken for a grade.

     Students choose electives from a list of approved courses, for a total of 15 credits
     (8-10 from required courses and 5-7 elective credits).

     In addition, during the quarter in which the student finishes the CHP course
     work, s/he will write a comprehensive case study of a health policy issue of the
     student‟s choice. The case study must include a definition of the issue, a
     description of the context of the issue (including relevant political and historical
     factors, laws, regulations, and major court cases), the economic markets affected
     by the issue, the stakeholders involved in the issue and their priorities/interests,
     2-3 options for addressing the issue (including the relevant decision-maker to
     implement the option) and the advantages and disadvantages of each option, and
     a final recommendation as to the appropriate course of action. The case study is
     expected to be 5-10 pages in length, not including the bibliography.

     The student will select 2 faculty members to review and comment on the
     capstone project, one of which must come from the student‟s home department
     or school, and one of which must come from the Department of Health Services.
     Students who wish to receive credits for an extensive case study can do so
     through the independent study mechanism.

     Completion of the Health Policy certificate program will be acknowledged on
     the student's official UW transcript. The student must be a matriculated UW


34
     graduate student during the quarter the graduate certificate is awarded.
     Certificates cannot be awarded retroactively.




     Application Instructions

     Students may apply to this program at any time during their graduate school
     tenure.
     (Note: All required courses counting toward the certificate must be taken for
     grades. This should be considered if the student decides to take required
     courses prior to entering the program).

     To complete the application, send the following items to:

     Professor Carolyn Watts,
     Department of Health Services,
     University of Washington,
     Box 357660,
     Seattle, WA 98195.

     1.   The completed Graduate Certificate program application form:
     Application Form

     2.   Current UW graduate school transcripts. Available at:
     www.washington.edu/students/reg/transcripts.html

     For additional information contact Prof. Watts at watts@u.washington.edu




     Approved Electives
             HSERV 553,   Politics of Health Care
             HSERV 554,   Health Legislation Seminar
             HSERV 522,   Program Evaluation
             HSERV 572,   Community Development for Health
             HSERV 580,   Society, Chronic Illness, and Disability
             HSERV 514,   U.S. Health and Health Care III: Health Policy Research
             HSERV 534,   Comparative Health Systems
             HSERV 531,   Problems in International Health


35
          PHG 512/LAW 562,      Legal, Ethical, and Social Issues in PH Genetics
          PHG 522,   Ethical Frameworks for PH Genetics
          PHG 523,   Genetics and the Law
          ENVH 471,    Environmental Health Regulation
          ENVH 584,    Occupational Health and Safety: Policy and Politics
          MHE 523,   Biomedical Ethics
          MHE 535/LAW H503,        Medical Ethics and Jurisprudence
          NURS 568,    Health Politics and Policy
          NURS 527,    Managing Effective Access and Utilization Within Care
           Systems
          NURS 584,    Critical and Interdisciplinary Approach to Health Policy
          PHARM 532,    Methods of Pharmaceutical Policy Analysis
          ECON 550,    Public Finance
          ECON 450,    Public Finance
          POL S 578,   Health Politics and Policy
          POL S 575,   Public Policy Processes
          PB AF 501,   Legislative Relations
          PB AF 506,   Ethics and Public Policy
          PB AF 513,   Public Policy Analysis
          PB AF 522,   Budgeting
          LAW A597,    Fundamentals of Health Law
          LAW H510,    Topics in Law and Medicine
          LAW H530,    Disability Law
          LAW A534,    Beginning and End of Life: Rights and Choices
          LAW B505,    Medical Malpractice
          LAW E518,    Ethical Issues in Public Health
          LAW H580,    Advanced Health Law

     LAW H570,   Biotechnology and the Law




36
                                          Appendix G
                                   Potential Funding Sources
         Entity            Match                                                         Fund Range     Due Dates
                                   for policy analysis, research, evaluation, and
RWJ Changes in Health              demonstration projects that provide public and
                                                                                         <$100,000 -
Care Financing and         Yes.    private decision leaders with usable and timely                      Open
                                                                                         $500,000
Organization                       information on health care policy and financing
                                   issues
AHRQ Grant Program
                                                                                                        Rolling
for Large Conference        Yes                                                          <$50,000
                                                                                                        until 7/06
Support
AHRQ Small Grant
Program for Conference      Yes                                                          <$50,000       Rolling
Support
                                                                                                        March 24th;
                                   …encourage preliminary, exploratory, or
AHRQ Small Research                                                                                     July 24th;
                            Yes    innovative research in new or previously              < $100,000
Grant Program                                                                                           November
                                   unexamined areas.
                                                                                                        24th
                                                                                                        Rolling and
California Healthcare                                                                    50,000 –
                            Yes    record of funding projects in other states                           specific
Foundation                                                                               750,000
                                                                                                        RFPs
                                   The goal over the next five years is to promote
                                   health among vulnerable individuals and
                                   communities through programming that:
Kellogg Foundation          Yes    empowers individuals, mobilizes communities,          Wide variety   Rolling
                                   engages institutions, improves health care quality
                                   and access, and informs public and marketplace
                                   policy.
Pew Advancing Policy               current policy priorities include „Genetics &                        Inquiry to
                            Yes
Issues                             Public Policy‟                                                       Invitation
                                   We support independent research on health
TheCommonwealth
                            Yes    and social issues and make grants to improve          Varies         Rolling
Fund
                                   health care practice and policy.
                                   … the Trust supports a wide variety of
Murdock Foundation          Yes                                                          Varies         Rollins
                                   projects and programs in the region
                                   Arts & Culture, Youth Engagement, Community
Paul G. Allen Charitable
                            No     Development & Social Change, and the Scientific
Foundation
                                   & Technological Innovation Programs
Macarthur Foundation        N      Policy research interest don‟t match

                                   Quality of care; Disparities in health; End-of-life
Atena Foundation             ?
                                   care; Connecticut; Diversity; Community Grants

Bill & Melinda Gates
                             ?     Global health issues and community projects
Foundation
                                   Asset building and community focus;
Ford Foundation              ?     Knowledge; creativity and freedom; Peace and
                                   social justice
John A. Hartford                   training of doctors, and other health professionals
                             ?
Foundation                         innovations in delivery of service

 37
                                    Appendix H
                               Academic Policy Centers

Name                    Center for Health Policy and Research
University Connection   University of Massachusetts Medical Center
Director                Jay Himmelstein, MD, MPH
Website                 www.umassmed.edu/healthpolicy
                        To promote and conduct applied health policy evaluation, research and education
                        aimed at improving the health and well-being of the people of the
Mission
                        Commonwealth of Massachusetts, with a focus on persons with disabilities and
                        those eligible for services from public agencies."
Type                    Academic
                        ●provide resources for health policy research activities on the UMass campus
                        ●promote collaborative evaluation and policy development efforts between
Major Activity          UMass and state agencies ●support innovations and quality initiatives in the
                        UMass Memorial Health Care Clinical System ●enhance and develop
                        educational programs at the undergraduate and graduate levels
                        ● long-term care policy ●research design and methods ●state health policy
Emphasis
                        analysis ●work and health policy
Funding                 not listed
                        ●Joint UMass/Harvard Ph.D. and postdoctoral program in occupational health
                        services research ●Joint UMass/Amherst Ph.D. program in Health Policy and
Teaching
                        Management ●Post-doctoral research trainingGenetics and Public Policy Center
                        - Johns Hopkins University

Name                    Genetics and Public Policy Center - Johns Hopkins University
                        The Center is part of the Phoebe R. Berman Bioethics Institute at Johns Hopkins
University Connection
                        University.
Director                Kathy Hudson, PhD
Website                 www.dnapolicy.org
                        The goal of the Center is to create the environment and tools needed by key
                        decision-makers in both the private and public sectors to carefully consider and
Mission
                        respond to the challenges and opportunities that arise from scientific advances in
                        genetics.
Type                    Academic
                        ●conducts research projects ●publishes a quarterly newsletterReproductive
Major Activity
                        Genetics
Emphasis                Reproductive Genetics
Funding                 The Pew Charitable Trusts
Teaching                None

Name                    Center for Genome Ethics, Law and Policy
                        The Center is a core component of Duke University's Institute for Genome
University Connection
                        Sciences and Policy
Director                Robert Cook-Deegan, MD
Website                 www.law.duke.edu/gelp
Mission                 Seeks to foster ethically responsible and socially beneficial uses of genome

38
                        science through research, teaching, and public discussion
Type                    Academic
Major Activity          Genomics
Emphasis                Not Listed
                        ●The Duke Endowment ●Duke University Medical Center ●Duke University
Funding                 Institute for Genome Sciences and Policy ●Fitzpatrick Foundation ●grants to
                        individual center faculty
Teaching                Postdoctoral

Name                    Center for Bioethics

University Connection   University of Pennsylvania

Director                Arthur Caplan, PhD
Website                 www.bioethics.upenn.edu
                        The Center employs [the language of bioethics] to promote scholarly and public
Mission                 understanding of the ethical, legal, social, and public policy implications of
                        advances in the life sciences and medicine.
Type                    Academic
                        ●conducts empirical, interdiscplinary research ●maintains bioethics resources
Major Activity
                        on the internet ●publishes a biannual newsetter ●holds a lecture series
Emphasis                'Bioethics
                        The UPenn School of Medicine provides the budget for operating support.
                        Additional support comes from Government agencies (including the Department
                        of Health and Human Services/HRSA, NASA, NIH, and the Office of Naval
Funding
                        Research); Tuition and foundations (including the Alpha-One Foundation, the
                        Walter & Elise Haas Foundation, the Hospice Foundation of America, The
                        Greenwall Foundation, and PETsMART charities)
                        Master of Bioethics, co-sponsors an undergratuate concentration, is involved in
                        medical school education, both teaches and advises students, maintains a
Teaching
                        growing array of continuing and executive education courses, and provides
                        clinical consultation.

Name                    Center for State Health Policy
University Connection   Rutgers University
Director                Joel Cantor, Sc.D.
Website                 www.cshp.rutgers.edu
                        The Center employs [the language of bioethics] to promote scholarly and public
Mission                 understanding of the ethical, legal, social, and public policy implications of
                        advances in the life sciences and medicine.
Type                    Academic
                        ●conducts empirical, interdiscplinary research ●maintains bioethics resources
Major Activity
                        on the internet ●publishes a biannual newsetter ●holds a lecture series
                        ●long-term care ●access to care ●racial and ethnic health disparities ●health
Emphasis                care performance measurement ●pharmaceutical ●state health data and
                        information
Funding                 Main Funding Sources Robert Wood Johnson Foundation
Teaching                None

Name                    Friedman School of Nutrition Science and Policy


39
University Connection   Tufts University
Director                Irwin Rosenberg, MD
Website                 www.nutrition.tufts.edu
                        To improve the nutritional well-being of people worldwide through: the creation
Mission                 of new knowledge, the application and dissemination of evidence-based
                        information and the education and training of future leaders in the field
Type                    Academic
Major Activity          ●Teaching ●Research
Emphasis                Nutrition
Funding                 Faculty seek their own funding for their specific projects
Teaching                Masters and doctoral degrees

Name                    Center for Health Policy Research
University Connection   University of California, Los Angeles
Director                E. Richard Brown, PhD
Website                 www.healthpolicy.ucla.edu
                        'The Center strives to understand and advance public health policies that can
                        improve access to health care as well as promote good health among diverse
Mission                 populations in California and the nation. Throughout its research and other
                        activities, the Center aims to address disparities and gaps in health studies and
                        access to health care among a variety of population groups.
Type                    Academic
                        ●research ●public service - the California Health Interview Survey (CHIS), the
                        Health DATA program, dissemination of Center publications and research
Major Activity
                        reports, policy briefings, forums, and seminars, speakers and expert advisors,
                        media outreach ●education
                        ●access to health care and insurance coverage ●health promotion and disease
Emphasis                prevention ●management of chronic conditions ●public programs and the
                        finance systems of health care
                        Department of Managed Healthcare (DMHC) First 5 California (California
                        Children and Families Commission) Henry J. Kaiser Family Foundation Indian
                        Health Service (IHS) Medi-Cal Policy Institute National Cancer Institute (NCI)
Funding
                        National Immigration Law Center (NILC) Robert Wood Johnson Foundation UC
                        Funding: California Program on Access to Care (CPAC) Institute for Labor and
                        Employment (ILE) Institute of American Cultures (IAC)
Teaching                None

Name                    Public Health and Health Policy Institute
University Connection   University of Wisconsin
Director                Patrick Remington
Website                 www.pophealth.wisc.edu/wphi
                        To become a primary resource for stimulating, creating, and communicating
Mission
                        useful public health and health policy research and analysis
Type                    Academic
                        ●development of an internet database for health information ●outreach activity
Major Activity          including: Bi-Annual Conferences, production of Health Policy Forums, annual
                        Wisconsin County Health Rankings
                        ●socioeconomic conditions and demography ●health status ●health services
Emphasis
                        use ●health care resources
Funding                 Robert Wood Johnson Foundation ●State of Wisconsin Department of Public

40
                        Health ●National Institute of Health ●Centers for Disease Control and
                        Prevention
Teaching                None

Name                    Center for Health Services Research
University Connection   University of Tennessee
Director                David M. Mirvis, MD
Website                 www.utmem.edu/center
                        To coordinate, promote and support health services and health policy research
                        and education among the faculty and students of the University of Tennessee,
Mission
                        Memphis, and to apply the talents of the faculty as a resource to policy makers
                        and planners for enhancing the health of the citizens of Tennessee.
Type                    Academic
                        ●provides consultation to members of the state legislature and state departments,
                        as well as health-related organizations in Tennessee ●co-sponsoring of monthly
Major Activity          conferences on health-related topics ●publishing Health Care Notes, a quarterly
                        newsletter ●publishing research briefs ●coordinates a Tennessee
                        Interdisciplinary Health Policy Fellowship
Emphasis                Health services
Funding                 Not listed
                        The Center coordinates a Tennessee Interdisciplinary Health Policy Fellowship
                        for senior law, medical and pharmacy students that rotates fellows through
Teaching
                        various agencies of state government that are active in health policy and
                        regulation.Kansas Health Institute

Name                    Oregon Health Policy Institute
University Connection   Oregon Health Science University
Director                Not listed
Website                 www.ohsu.edu/about/leadership.shtml
                        To develop, implement and evaluate health policy issues that affect Oregon and
Mission
                        its residents
Type                    Academic
                        ●health services research ●health policy analysis ●interrelationships between
                        health policy and other policy issues ●database development ●methods
Major Activity
                        development ●thesis and dissertation research, professional development and
                        education ●advice to public agencies and officials
                        The OHPI includes a collaborative core and four centers: ●Center for Health and
                        Disability Policy ●Center for Substance Abuse Research and Policy ●Center
Emphasis
                        for Policy and Research in Emergency Medicine ●Center for Environmental
                        Health Policy
Funding                 Not Listed
Teaching                None

Name                    California Policy Research Center
University Connection   University of California, Berkeley
Director                Andrés Jiménez


41
Website                 www.ucop.edu/cprc
                        The Center seeks to improve the health of individuals, families, and populations
Mission                 by understanding the problems, issues and alternatives in the design and delivery
                        of health care services.
Type                    Academic
                        CPRC informs California decision-makers by sponsoring research and
                        evaluations of major state programs and policies, drawing from the expertise of
                        the entire UC system. The Center also oversees legislatively mandated projects
                        and task forces involving the participation of key stakeholders in such policy
Major Activity          areas as education, energy, fiscal policy, land use, natural resources, public
                        health, social services, and transportation. Research findings and policy
                        recommendations are made available through publications and special briefings,
                        as well as activities co-sponsored with University-based programs and state
                        government entities.
Emphasis
Funding                 Not listed
Teaching                None

Name                    Cecil G. Sheps Center
University Connection   University of North Carolina at Chapel Hill
Director                Timothy S. Carey, MD MPH
Website                 www.shepscenter.unc.edu/index.html
                        'The Schneider Institute for Health Policy‟s mission is to study emerging issues
Mission                 related to social policy and to develop society‟s policy alternatives for federal
                        and state governments.
Type                    Academic
                        An interdisciplinary program of research, consultation, technical assistance and
                        training that focuses on timely and policy-relevant questions concerning the
Major Activity          accessibility, adequacy, organization, cost and effectiveness of health care
                        services and the dissemination of this information to policy makers and the
                        general public.
Emphasis
Funding                 State and Federal
Teaching                None

                        Center for Health Policy (CHP)
Name
                        Center for Primary Care and Outcomes Research (PCIR)
University Connection   Stanford University
                        Director, CHP/PCOR: Alan M. Garber
Director
                        Executive Director, CHP/PCOR: Kathryn M. McDonald
Website                 http://chppcor.stanford.edu
                        CHP and PCOR are dedicated to education and rigorous investigation to
Mission
                        guide health policy and clinical practices.
Type                    Academic
                        Innovative research on critical issues of health care and health policy--
Major Activity
                        dedicated to providing reliable information for health policy and health

42
                        care delivery to public and private sector decision-makers.
Emphasis
Funding                 Donations together with national and international foundations
Teaching                Yes

Name                    Health Policy Institute of Ohio
University Connection   None
Director                William Hayes
Website                 www.healthpolicyohio.org
                        The Health Policy Institute of Ohio is an independent, nonpartisan,
                        statewide center that informs Ohio health policy by forecasting health
Mission
                        trends, analyzing key health issues, and communicating current research
                        to policymakers, state agencies and other decision-makers.
Type                    Independent
Major Activity          Research, Analysis and Communication
Emphasis
                        The Anthem Foundation of Ohio (based in Cincinnati) The Cleveland
                        Foundation    The George Gund Foundation (based in Cleveland) The
                        Health Foundation of Greater Cincinnati    The Mt. Sinai Health Care
Funding
                        Foundation (based in Cleveland) Saint Luke‟s Foundation of
                        Cleveland    Sisters of Charity Foundation of Canton with the Sisters of
                        Charity Foundation of Cleveland
Teaching                None

Name                    Texas Institute for Health Policy Research
University Connection   None
Director                Camille D. Miller (President/CEO)
Website
                        To provide leadership to improve the health of Texans through education,
Mission
                        research and health policy development.
Type                    Independent
Major Activity          Disaster response; education; information; presentations; workforce
                        A statewide non-partisan organization serving as a catalyst for the improvement
Emphasis                in the health of all Texans through education in health policy options and
                        grassroots community-based health solutions.
Funding                 State funded
Teaching                None

Name                    Institute for Health Policy - University of Southern Maine
                        Part of the Edmund S. Muskie School of Public Service at the University of
University Connection
                        Southern Maine.
Director                Andrew S. Coburn, PhD
Website                 muskie.usm.maine.edu/research/research_institutes_ihp.jsp
Mission                 Through a diverse range of research projects, public service activities, and

43
                        partnerships, the Institute for Health Policy seeks to increase access to health
                        care, enhance the quality of care, and eliminate disparities in the availability and
                        delivery of services.
Type                    Academic
Major Activity
                        ●children's health and welfare ●health care access & finance ●mental health
Emphasis                ●rural health ●chronic illness, disability & aging ●health care quality
                        management & improvement ●public health
                        Funding for the Institute come from the Muskie School of Public Service.
Funding                 Funding within each of the areas of emphasis is accomplished by grants awarded
                        to individual faculty.
Teaching                Yes

Name                    Center for Rural Health - University of North Dakota
                        Part of the School of Medicine & Health Sciences at the University of North
University Connection
                        Dakota.
Director                Mary Wakefield, PhD, RN
Website                 www.medicine.nodak.edu/crh
                        To serve the people of the state, region and nation. As a resource, we identify
                        and research rural health issues, analyze health policy, strengthen local
Mission
                        capabilities, develop community-based alternatives, and advocate for rural
                        concerns.
Type                    Academic
                        Four core areas: ●education and information dissemination ●program
Major Activity          development and community assistance ●research - health policy, health
                        systems, and health personnel ●policy analysis
                        The Center is the federally designated State Office of Rural Health for the state.
                        It connects the School of Medicine and Health Sciences and the university to
Emphasis
                        rural communities and their health institutions to facilitate developing and
                        maintaining rural health delivery systems.
Funding                 State funded
Teaching                None

Name                    Center for Health Services and Policy Research
University Connection   University of South Carolina
Director                John Woods, PhD
Website                 www.sph.sc.edu/CHSPRmain.asp
                        To coordinate and conduct research designed to improve the effectiveness,
                        efficiency, appropriateness and accessability of health care services and to
Mission
                        inform public policy in a manner that has a positive impact on the health-related
                        quality of life of South Carolinians
Type                    Academic
                        A focal point for coordinating and strengthening research that is relevant
Major Activity
                        to health services delivery and health policy
                        We strive to be a science-based, research organization, serving as a link
Emphasis
                        between academia and the community we serve

44
                        the four founding organizations: The Palmetto Health Alliance (Palmetto
                        Richland Memorial Hospital and Palmetto Baptist Medical Center), and
Funding
                        the University of South Carolina Institute of Public Affairs, School of
                        Medicine, and School of Public Health
Teaching                Not listed

Name                    Schneider Institute for Health Policy

University Connection   The Heller School for Social Policy and Management Brandeis University

Director                Not listed
Website                 www.sihp.brandeis.edu
                        The Schneider Institute for Health Policy‟s mission is to study emerging issues
Mission                 related to social policy and to develop society‟s policy alternatives for federal
                        and state governments.
Type                    Academic
Major Activity          Research
                        The focus of the Schneider Institute for Health Policy is on the needs of our most
Emphasis
                        vulnerable populations
                        Private, RWJ, Kaiser, Kellogg, Blue Cross Blue Shield, NIH, NIDA, NIAAA,
Funding
                        NIMH, NCI,NICHD AHRQ
Teaching                Graduate Level


Name                    Kansas Health Institute
University Connection   None
Director                Robert F. St. Peter, MD (President and CEO)
Website                 www.khi.org
                        To conduct research and policy analysis on issues that affect the health of
Mission                 Kansans and to communicate that information so that informed decisions can be
                        made which optimize our health.
Type                    Independent

                        ●policy analysis ●evaluation and monitoring ●data development and analysis
Major Activity
                        ●research capacity development ●communication of important findings
                        Research agenda is determined by certain priorities: ●relevance of projects to
                        Kansas and Kansans ●inclusion of population-based approaches and a broad
                        definition of health ●potential for collaboration with other research partners in
Emphasis
                        the state ●generation of non-partisan, high-quality and timely information
                        Activities fall into three categories: ●policy analysis and communication
                        ●evaluation and monitoring ●data development and analysis
Funding                 Almost exclusively funded through the Kansas Health Foundation (KHF)
Teaching                None




45
                                            Appendix I
                                       MPH Policy Competencies
                                 PROPOSED MPH1 POLICY COMPETENCIES
                                               4/26/04

USING „MENTAL MODELS,‟ STAKEHOLDER ANALYSIS, AND PUBLIC HEALTH SKILLS TO
SUPPORT POLICY DEVELOPMENT AND EVALUATION PROCESSES

1) Develop and explain one or more systemic model(s) of the policy process, incorporating and integrating
   relevant concepts, theory, and empirical evidence. 2
2) Identify relevant stakeholders, explaining their interests, significance, and roles within policy
   development and evaluation processes.
3) Explain the roles discipline-oriented public health professionals 3 play in:
   a) Informing the policy development process,
   b) Managing policy processes, and
   c) Analyzing and evaluating public policy effects and outcomes.

ANALYZING POLICY PROBLEMS AND DEVELOPING AND EVALUATING SOLUTION
OPTIONS

1) Collect, summarize, and interpret information relevant to a policy issue.
2) Identify, clarify, and articulate policy problems/issues, policy goals and relevant policy (solution)
   options.
3) Analyze policy issues and options effectively within the context of the relevant conceptual framework.
4) Identify and evaluate the expected outcomes and feasibility of policy options.
5) Select and apply current techniques in political and economic decision analysis and decision
   management, leading to policy decisions.
6) Identify, interpret, and implement public health laws, regulations, and policies related to specific
   policies and programs.

INFORMING, INFLUENCING, AND MANAGING POLICY PROCESSES

1) Define policy issues and goals using evidence from relevant literature, while applying evidence within
   relevant social and community context, and within the context of stakeholder interests
2) Provide effective analytic and evaluative support for policy development and policy management
   processes.
3) Provide effective advocacy support for policy development processes.
4) Provide effective communication support for policy development processes.
5) Manage policy groups and teams effectively, to achieve policy objectives.



DEVELOPING, MANAGING AND EVALUATING POLICY PROGRAMS



1
  Also apply to MHA curriculum
2
  Models should articulate social welfare goals and philosophies, and should include and integrate stakeholders and their
interests and relationships, process steps, political and economic decision and feasibility criteria, and decision and
evaluative processes
3
  i.e., statisticians, epidemiologists, environmental scientists and environmental health professionals, economists, program
specialists, clinicians, managers, etc.

46
1) Develop policy implementation plans (including goals, outcome and process objectives, and
   implementation steps) for translating approved policy options into effective programmatic structures.
2) Monitor and evaluate programs for efficacy, cost-effectiveness, and quality.




47
                                       Appendix J
                        Potential Health Policy Research Projects


Projects under Development
          (* indicates proposal submitted)

     1. Center for Health Promotion Economics (Doug Conrad and Sean Sullivan, co-PIs)*
     2. Cost Effectiveness Assessment of Pharmocogenomics (Karen Edwards, Wylie Burke, Ken
        Thummel, Sean Sullivan, Rick Carlson, in collaboration with MedCo).*
     3. Center for Health Law and Policy (Pat Kuszler, Kate Batuello, Cindy Watts, Rick Carlson and
        others)
     4. The Intersection of Genomics and the ADA (Paul Miller, Pat Kuszler, and others)
     5. The Political Economy of the Pharmaceutical Industry: Case Studies (Tom Hazlet, Lou
        Rossiter, Cindy Watts)
     6. Intellectual Property Issues in Genetics (Pat Kuszler, Rick Carlson)
     7. Consumer Directed Health Care: Early Evidence and Implications (Cindy Watts, Rick
        Carlson)
     8. Genetics for the Judiciary (Pat Kuszler, Kate Battuello, Paul Miller, and Rick Carlson)


Project Areas in which Faculty Interest has been Indicated

     1.   Occupational health psychology – in conjunction with Portland State University Center
     2.   Effectiveness of OSHA inspections
     3.   Case studies of the policy formation process
     4.   Public health impact of class action lawsuits
     5.   Public policy around obesity
     6.   Public policy implications of gene data banks




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