Academic Purpose of Health Care in Health Economics

My decision to pursue a PhD in Health Policy in the Health Economics track at Stanford University and enter academia stems from my academic and professional experiences in the fields of economics and policy, my personal experience as a woman from India growing up with a chronic illness, and my unwavering commitment to help those who are most affected by social stratification and weak policy mechanisms.

I was born with a rare form of chronic pancreatitis, a genetic illness endemic to India. Growing up with a chronic illness, I have constantly struggled to not let it affect my education or mobility. I am able to do this to a large extent because I belong to a relatively higher socioeconomic class, have a supportive family and community, and was able to get early access to preventive and post-operative health information. Having worked in international development for most of my adult life, I have come to realize that my initial endowments in terms of wealth, education, and geography within India have reduced the burden of my illness significantly. This is not the case for a vast majority of people in the developing world who are trapped in a cycle of poverty, which is both a significant cause and effect of poor health.

Delivery of health information is an impactful and direct way to improve health outcomes, yet there is mixed evidence on the most effective targeting and delivery mechanisms. Behavior change in developing countries is significantly influenced by the person providing the information, the tendency of people to align their choices with those of their peers, local beliefs, and traditional knowledge. Additionally, targeting this information to the most vulnerable populations presents its own challenges and often health policies can inadvertently exclude these marginalized groups. The focus of my research is to understand the constraints and determinants of health behaviors, and advance the use of effective targeting and information delivery to improve these behaviors.

My interest in the role of the community in targeting health policies arises from my work at Georgetown University where I contributed to academic research for the first time while working with Professor Andrew Zeitlin on the evaluation of the Second Northern Uganda Social Action Fund (NUSAF2). As a result of my extensive work on NUSAF2 and my familiarity with the dataset, I was given the opportunity to study the effectiveness of community based targeting under this large scale asset transfer scheme for my graduate thesis. I created a measure of welfare by adopting the methodology used for Uganda’s poverty index and tested factors related to errors of inclusion using a model that drew upon Alatas et al. (2010) . An interesting result of my analysis was that the community uses criteria that are very different from conventional measures of poverty (in terms of consumption and assets) while deciding who is poor and who isn’t. This sparked an interest in me to further understand how community members form their beliefs about their neighbors, and how it influences policy outcomes.

I had the opportunity to study social networks in the context of caste and affirmative action, and information diffusion and aggregation, while working with Drs. Arun Chandrasekhar and Emily Breza at J-PAL South Asia. I managed the implementation of a field experiment on networks across 240 villages in the context of the Indian demonetization policy of 2016 that varied the delivery of information about the policy and measured the quality of the information aggregated . During this time, I also ran pilots testing an extension of the DeGroot Model which studied social learning under varied initial signals . This work exposed me to the nuances of social networks analysis and I acquired a refined understanding of how social learning mechanisms work in developing countries. Conducting several qualitative interviews and observations analyses on these projects also illuminated the prevalence of caste-based segregation in Indian village communities and the attitudes and perceptions around it.

At the Stanford Center for Health Education (SCHE), my co-author and I are currently studying the effect of social learning on the adoption of positive health behaviors through a large scale quasi-experimental design with Noora Health - a not-for-profit based in India - which provides information on ante and post-natal care to new mothers through training sessions in rural hospitals. While there are significant benefits to learning through peers over learning individually , we are seeking to understand frictions in the aggregation of information through social learning . For instance, during interviews and focus group discussions during field visits to rural Karnataka (India),

I learned that family dynamics and the role of the mother-in-law in particular play a significant role in the take-up of practices by the new mother. To closely understand social learning mechanisms in these settings, we are testing the use of Whatsapp groups (a mobile-based messaging platform) to vary the seeding of health information within the family. We will also leverage community level networks data and hospital records to test which targeting units are most effective for the take up of healthy practices in the community - the mother, the family, or the community health worker. Additionally, we will explore heterogeneity in effects by examining differences by subgroups like caste and religion.

While I have developed a strong foundation in economic theory and empirical approaches during my undergraduate and master’s programs, I believe the Health Policy program at Stanford University is the ideal place for me to expand my training and application into the domain of health economics. I have consulted with Drs. Alsan and Miller to enhance our work at SCHE and their inputs have already helped frame the research I am currently pursuing. I would welcome the opportunity to work under their mentorship. In particular, Dr. Alsan’s work on understanding the historical and socioeconomic factors affecting the health and health-seeking attitudes of a population, and Dr. Miller’s work in understanding the role of behavioral factors like the motivation of health workers would provide me the insight and guidance necessary to bring my research to fruition.

I also wish to learn what policies and health systems have worked in the domestic case from Drs. Baker and Bundorf in healthcare financing and technology adoption and apply this to a development context. The opportunity to pursue my doctoral studies at Stanford particularly appeals to me as I would like to continue working on ongoing projects at SCHE as well as leverage the working relationships I have established with academics across the schools of Economics and Medicine. Additionally, based on my conversations with Dr. Baker and current graduate students, I am eager to be part of Stanford’s academic community and produce collaborative research with its outstanding faculty and peers.

I firmly believe that long term improvements in health outcomes are only possible through sound policy and effective targeting. I wish to contribute to the growing body of academic work in health policy by exploring new methodologies, closely studying the determinants of health behaviors, and applying it to real-world challenges in developing countries. 

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