Health Policy Commons^™

Global Health Financing Of Diagonal Interventions: Building Resilient And Sustainable Health Systems In Sub-Saharan Africa, Lucy Kim

Master in Public Policy Theses

Background: Global health financing has historically prioritized disease-specific “vertical” programs over broader “horizontal” strengthening of general health systems. Vertical programs in HIV have led to unprecedented reductions in mortality worldwide, but HIV remains a significant public health threat in sub-Saharan Africa, where vertical strategies have long been criticized for creating fragmented health systems. In response, global health strategies have shifted towards combining vertical investments with broader horizontal activities, commonly referred to as “diagonal” programming. While evidence suggests that diagonal programming has the potential to create more resilient and sustainable health systems, evaluating its value for money is challenging due to …

Beyond The Ban: Chhaupadi Abolition And The Governance Of Menstrual Autonomy In Western Nepal, Nikita Paudel

Master in Public Policy Theses

This thesis examines how two decades of efforts to abolish chhaupadi have shaped the everyday conditions under which women and girls experience menstruation in western Nepal. Chhaupadi, commonly understood as menstrual seclusion, has been addressed through Supreme Court directives, national policy, criminal law, municipal implementation instruments, hut demolition campaigns, public health programming, and rights-based advocacy. Yet the practice has persisted, adapted, and in some cases moved into less visible spaces. Rather than treating this as a simple gap between law and practice, this thesis asks how abolition efforts themselves have become part of the regulatory regime through which menstruation is …

Patterns Of Tobacco Marketing And User Engagement On Social Media In Indonesia: Challenges For Digital Public Health, Resti Yulianti Sutrisno, Nopryan Ekadinata, Sutantri Sutantri, Dinasti Pudang Binoriang, Enrico Aditjondro, Rachfiansyah Rachfiansyah, Yosef Rabindanata, Silvia Dini, Rebecca Perl, Riska Rachmawati, Bertha Tesma Wulandari, Dianita Sugiyo

Kesmas

Large-scale tobacco marketing on social media has resulted in widespread population-level exposure, particularly in Indonesia, which faces growing challenges in digital public health. This study aimed to assess the associations between platform type and marketing tactics and identify correlations of user engagement. An analytical cross-sectional study was conducted using secondary data from the Tobacco Enforcement and Reporting Movement (TERM), collected from January 2022 to August 2023. A total of 21,255 tobacco marketing posts from social media were analyzed. Platform–tactic associations were examined using Chi-square tests, and multivariable Poisson regression was used to identify factors associated with user engagement. The findings …

Diabetes And Hypertension Frequencies And Trends In The Health Districts Of Sololá, Alejandro Cerón, Sophie Perfetto, Ana Textor, Sidona Alemayehu, Emilia Alvear Escobar, Adele Beard, Sarah Berson, Rachel Bryant, Jennifer Calzontzi, Rylee Castro, Eva Cress Palencia, Jake Czarnecki, Jordyn Epstein, Nikki Harris, Patience Hinojos, Max Hippisley, Erin House, Jackson Hullett, Nathan Johnson, Amelie King, Saule Lankelyte, Juan Loya, Ashley Mackenzie, Ilana Mighdoll, Molly Morrill, Maria De Jesus Ramos Jimenez, Lilly Teklemedhin, Joseph Trujillo, Lauren Verachtert, Nathan Verachtert, Violet Vreeland, Alex Welch, Jada Wright

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students, Graduate Teaching Assistants, and instructor of “The Social Determination of Health” class taught in the fall of 2025 at the University of Denver. The report was prepared for Dr. Luis Pablo Méndez, of the Vice Ministry of Health Regulation, Surveillance and Control, of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: How can available data about service production can be used to inform the planning process for the implementation of the Global Hearts Initiative’s HEARTS technical package in the Distrito de Redes Integradas de …

A Prevalence Study Of Iron Deficiency Anemia Among Children In Elbasan, Albania: Directions For Health Care Policy, Artilda Lala

All Dissertations

Iron deficiency anemia (IDA) is one of the most prevalent disorders worldwide, especially in children from low-income and underdeveloped countries. In Albania, anemia is a major public health concern with many unstudied regions (prefectures and rural municipalities). Childhood IDA can impair cognitive development, immunity and overall well-being, so early diagnosis and prevention of anemia is critical. This study examined the prevalence of IDA in children aged 0-10 years in the district of Elbasan, Albania. The data were additionally analyzed for relationships with demographic (age, gender, education, parental education and child academic performance) and nutrition variables.

A cross-sectional study design was …

Refugee Stigma And Its Toll On Mental Health: Development And Validation Of The Refugee Stigma Scale (Rss), Hamed Abdollahpour Ranjbar, Khaled Elazab, Ibrahim Yigit, Fatema Almeamari, Ceren Acartürk, Gülşah Kurt, Janet Turan, Andrea Norcini Pala, Bulent Turan

Student Publications [Scholarly]

Background Unprecedented, forced displacement, especially from conflict and war areas, requires addressing resultant mental health issues. Aim Refugees experience mental and physical health problems due to post-displacement stressors, and the pervasive stigma associated with refugee status can exacerbate these difficulties, highlighting the need for a comprehensive assessment tool to understand various facets of refugee stigma. Method We developed the refugee stigma scale (RSS), consisting of 43 items informed by the literature, qualitative and quantitative data. The scale includes four theoretical dimensions of stigma: perceived community stigma, experienced stigma, anticipated stigma and internalised stigma. To examine convergent validity, validated self-report measures …

The Social Standing Versus The Mind Standing Of Older Adults In Egypt: Cross-Sectional Analysis Of The Relationship Between Social Capital And Cognitive Functions, Shaza H. Shinaishen Dr

Theses and Dissertations

Introduction: Egypt's population, much like that of other countries, is expected to age considerably over the course of the coming decades. Although biological and socioeconomic predictors of cognitive function have been studied widely, personal level social capital remains unexplored, especially in LMICs.

Purpose: This study primarily investigates the relationship between individual social capital and cognitive functioning among older adults aged 65 years and older in Egypt using the structural and cognitive components of social capital, including group membership, civic engagements, and caregiving roles.

Methods: A cross-sectional survey on 363 older individuals in different geographical and demographic segments of Egypt using …

Covid-19 & Healthcare (Re)Privatization? A Comparative Analysis Of High And Medium Per Capita Gdp Countries, Kristina Donders, Kaitlyn Matthews, Brittany Reyes, Frank. H. Rizzo

Working Papers Series

This paper examines whether the COVID-19 pandemic accelerated healthcare privatization in high- and medium-GDP countries. Drawing on political economy theories of path dependence and privatization, we analyze changes in public and private healthcare expenditures in eight countries: Canada, Chile, Denmark, Georgia, Luxembourg, Norway, the Philippines, and South Korea—comparing data from 2019 and 2022. Using World Bank indicators on healthcare financing, GDP, aging populations, and food insecurity, we find that although healthcare expenditures generally increased during the pandemic, this increase was primarily in public, not private, spending. Case studies of Georgia and South Korea reveal that local economic and demographic pressures, …

Lessons For Public Policy From The Covid-19 Pandemic, Olga Shvetsova

Political Science Faculty Scholarship

In the early 2020s, as the COVID-19 pandemic unfolded, governments, bureaucracies, and health practitioners around the globe faced unforeseen tasks and responsibilities. The novelty and intensity of the crisis spurred innovation and experimentation in public policy, health policy, and crisis management. However, the pandemic also revealed bottlenecks and adverse incentives within policy framework and healthcare systems. From this experience, critical lessons emerged: the paramount importance of swift and well-informed policy responses and the ability to optimize ongoing policy response as the crisis unfolds.

Antibiotic Resistance: The Growing Threats And Potential Solutions, Olisaemeka Zikora Akunne, Blessing Nkechi Emmanuel, Umar Faruk Saidu, Ayobami Sunday Akinnawo, Nasiru Ademola Adeyemi, Livia Chinaza Egoh, Malami Aishatu Muhammad, Olusegun Ayo Ade-Adekunle, Deborah Ahuoyiza Peter, Anne Amina Freitas

Department of Biomedical and Translational Sciences Faculty Publications

Antibiotic resistance (AR) has become a critical global health crisis, threatening the efficacy of antibiotics and increasing healthcare costs, morbidity, and mortality. The One Health approach, which emphasizes the interconnectedness of human, animal, and environmental health, is increasingly recognized as an essential framework for addressing the complex drivers of AR. This review explores the mechanisms of resistance, such as genetic mutations, horizontal gene transfer, and biofilm formation, along with contributing factors such as the overuse of antibiotics in healthcare and agriculture. We assess both traditional and emerging strategies to combat AR, including antimicrobial stewardship, the development of new antibiotics, and …

Moral Panic Or Public Health Crisis? Lessons From Drugs And Gambling For “Addictive” Design, Matthew B. Lawrence, Haomin (Kevin) Yan

Faculty Articles

In her important book, Unwired: Gaining Control Over Addictive Technologies, Gaia Bernstein illustrates the value of a comparative approach, drawing lessons from fights around the regulation of tobacco and ultra-processed food for the regulation of social media. Building on Bernstein’s work, this symposium contribution aims to draw additional insight from experience with drug and gambling regulation for the regulation of social media, video games, AI, and other potentially-addictive technologies.

Specifically, after introducing Bernstein’s book and the foundation it lays, we draw six lessons from the study of psychoactive drugs and gambling. As we elaborate below: Lesson one is that …

Impact Of Volume-Based Procurement Policy On Coronary Stent Use In Tianjin: Interrupted Time Series Analysis, Zhao Yang, Liangyu Ni, Wei Zhao, Yuxi Li, Yongyi Wu, Qiyun Zhu, Linlin Da, Weijia Liu, Qi Zhang, Jianping Li, Bin Jiang

Health Behavior, Policy & Management Faculty Publications

Objectives

This study aimed to analyze the impact of China’s centralized volume-based procurement policy on the procurement and utilization of coronary stents in Tianjin from 2019 to 2021.

Methods

An interrupted time-series design was used to assess monthly procurement data of coronary stents and balloons in Tianjin from January 2019 to December 2021.

Results

The volume-based procurement policy significantly reduced coronary stents prices, with an average price reduction of 92.67% for ten selected stents, and the lowest price dropped to 469 CNY. Following policy implementation, annual procurement in Tianjin increased by 59.55%, and tertiary hospitals demonstrated a significant monthly level …

The Challenge Of Regulating Pharmaceutical Clinical Trials In The 21st Century With A Focus On Guatemala, Alejandro Cerón, Antonio Ricafort, Carter Saccocio, Maria Delmonte, Jordan Vasquez, Amarri Bishop, Julia Atwood, Addison Bucsko, Jordan Lewis, Alexandra Welch, Itzael Garcia, Ella Wald, Selena Johnson, Crystal Jin, Talya Riciputi, Lindsey Speer, Vanessa Udo-Obong, Soren Engberg, Tessa Lindstrom

Anthropology: Undergraduate Student Scholarship

This report was prepared by the students and instructor of the "Right to Health in Theory and Practice" class taught in the fall of 2024 at the University of Denver. The report was prepared for the Vice Ministry of Health Regulation, Surveillance and Control of the Ministry of Public Health and Social Assistance of Guatemala. The work used the following guiding question: What can a country like Guatemala do to regulate international pharmaceutical clinical trials in the context of research commercialization? In other words, the work was guided by three important elements. First, the regulatory aspect of clinical trials. Second, …

How White Supremacy Travels Through Time: Anti-Literacy Laws, Dei Bans, And The Issue Of Black Self-Determination In Public Health., Nicole V. Ford

Electronic Theses and Dissertations

This dissertation used a qualitative policy content analysis (PCA) of historical anti-literacy laws and modern DEI bans to answer two research questions: What is the connection between anti-literacy laws and DEI bans? How do anti-literacy laws and DEI bans create an environment that maintains white supremacy? A PCA exercise informed the analysis of historical anti-literacy laws in South Carolina (1834), Georgia (1829), North Carolina (1830), Louisiana (1830), Virginia (1831), and Alabama (1833) and modern DEI bans in Texas (2023), Alabama (2024), and Florida (2023) to find the connection between the laws. Findings from this dissertation illustrate how white supremacy operates …

Passive Smoking And Its Correlation With Stunting In Children: A Systematic Review, Anita Rahmiwati, Karlinda Karlinda, Hamzah Hasyim, Febriyansyah Febriyansyah

Kesmas

Passive smoking is a significant risk factor for stunting in children, highlighting the urgent need for effective public health measures. This study aimed to investigate the association between passive smoking and stunting in children aged 0 months-7 years. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted across multiple online databases, including PubMed, ProQuest, Science Direct, Willey Online Library, Sage Journal, Cambridge University Press, and Oxford Academic. The quality of included articles reporting observational studies was assessed using the Critical Appraisal Skill Programme (CASP) checklist, presenting data through narrative synthesis. Findings …

Nicotine Addiction: A Hidden Health Crisis, Macy J. Mcgrath, Andrea Walker, Anahita Mohammadkhah

[Archive] Belmont University Research Symposium (BURS)

In the United States, nicotine addiction is an ongoing health crisis (U.S Food and Drug Administration, 2023). Pivotal to this crisis is the prevalence and ease of access to devices that deliver nicotine. Covering a broad spectrum, devices range from traditional forms of tobacco such as cigarettes, pipes, etc. to new nicotine devices such as e-cigarettes and vapes. Yet, even with the health crisis looming, more and more individuals are becoming addicted to nicotine (Ayers et al., 2011; Lyu et al., 2022; Pokhrel et al., 2021). In particular, research indicates that the 18-24 age demographic is significantly more likely to …

The Impact Of Censorship On Covid-19 Policy Formation In The United States, Victor Wallis

Faculty Works

No abstract provided.

Beyond Borders: Exploring The Lived Experiences Of International Migrant Women In Nigeria, A Deep Dive Into Healthcare Realities And Utilization, Juliet Nwafor, Rowland Edet, Ezebunwa Nwokoch

Department of Sociology: Faculty Publications

This study explored access to and utilization of healthcare facilities among migrant women in an urban slum community in Nigeria, focusing on factors influencing healthcare-seeking behaviors and the implications for public health interventions. A qualitative case study-oriented research design was employed, involving in-depth interviews with 21 migrant women of reproductive age and 4 key informant interviews with healthcare workers in the Ayobo community of Lagos State, Nigeria. Data collection occurred from June to September 2018, and thematic analysis was used to interpret the findings. Three main themes emerged: living conditions, pattern of healthcare utilization, and factors influencing accessibility and utilization …

Commonalities And Differences In Governments’ Covid-19 Public Health Responses Around The World, Olga Shvetsova, Andrei Zhirnov

Political Science Faculty Scholarship

As the world enters the era of increased frequency of global health crises and natural disasters, with climate change looming as an ever-present threat, how we govern ourselves matters for the ways in which we will live through these difficult times. The authors in this volume provide observations backed by mixed methods of analysis on the many ways in which government organization and political realities affect crisis response and crisis management. In this chapter, we further strengthen the validity of their findings with large N global sample analyses where the timing and stringency of the adoption of public health policies …

The Social Determinants Of Health And Genocide: Towards A Public Health Integrated Framework Of Genocide And Mass Violence, Sian Persad, Cheng Xu

Genocide Studies and Prevention: An International Journal

This paper makes a normative argument about transformations of public health as a necessary condition required in any transitional justice process. We seek to bridge the gap between the fields of genocide and public health to understand the recursive relationship between genocide and the social determinants of health. We show that structures and institutions established during genocide create enduring impacts on the public health outcomes of victim and survivor groups even after the ousting of the original perpetrators. Our comparative analysis of the Rwandan Genocide and the colonial genocide of Indigenous communities in Canada surveys the available public health literature …

How Have Researchers Defined Institutions, Politics, Organizations And Governance In Research Related To Epidemic And Pandemic Response? A Scoping Review To Map Current Concepts, Austin Wu, Shivangi Khanna, Shelly Keidar, Peter Berman, Laura Jane Brubacher

Faculty, Staff and Student Publications

In recent years, the literature on public health interventions and health outcomes in the context of epidemic and pandemic response has grown immensely. However, relatively few of these studies have situated their findings within the institutional, political, organizational and governmental (IPOG) context in which interventions and outcomes exist. This conceptual mapping scoping study synthesized the published literature on the impact of IPOG factors on epidemic and pandemic response and critically examined definitions and uses of the terms IPOG in this literature. This research involved a comprehensive search of four databases across the social, health and biomedical sciences as well as …

The Shortfalls Of Vulnerability Indexes For Public Health Decision-Making In The Face Of Emergent Crises: The Case Of Covid-19 Vaccine Uptake In Virginia, Lydia Cleveland Sa, Erika Frydenlund

VMASC Publications

Equitable and effective vaccine uptake is a key issue in addressing COVID-19. To achieve this, we must comprehensively characterize the context-specific socio-behavioral and structural determinants of vaccine uptake. However, to quickly focus public health interventions, state agencies and planners often rely on already existing indexes of "vulnerability." Many such "vulnerability indexes" exist and become benchmarks for targeting interventions in wide ranging scenarios, but they vary considerably in the factors and themes that they cover. Some are even uncritical of the use of the word "vulnerable," which should take on different meanings in different contexts. The objective of this study is …

Understanding And Assessing Demographic (In)Equity Resulting From Extreme Heat Exposure Due To Lack Of Tree Canopies In Norfolk, Va Using Agent-Based Modeling, Virginia Zamponi, Kevin O'Brien, Erik Jensen, Brandon Feldhaus, Russell Moore, Christopher J. Lynch, Ross Gore

VMASC Publications

Prolonged exposure to extreme heat can result in illness and death. In urban areas of dense concentrations of pavement, buildings, and other surfaces that absorb and retain heat, extreme heat conditions can arise regularly and create harmful environmental exposures for residents daily during certain parts of the year. Tree canopies provide shade and help to cool the environment, making mature trees with large canopies a simple and effective way to reduce urban heat. We develop a demographically representative 1 (agent): 1 (person) agent-based model to understand the extent to which different demographics of residents in Norfolk, VA are equitably shaded …

Impact Of A Multifaceted Intervention On Physicians' Knowledge, Attitudes And Practices In Relation To Pharmaceutical Incentivisation: Protocol For A Randomised Control Trial, Muhammad Naveed Noor, Mishal Khan, Afifah Rahman-Shepherd, Amna Rehana Siddiqui, Sabeen Sharif Khan, Iqbal Azam, Sadia Shakoor, Rumina Hasan

Department of Pathology and Laboratory Medicine

Introduction: In settings where the private sector constitutes a larger part of the health system, profit-gathering can take primacy over patients' well-being. In their interactions with pharmaceutical companies, private general practitioners (GPs) can experience the conflict of interest (COI), a situation whereby the impartiality of GPs' professional decision making may be influenced by secondary interests such as financial gains from prescribing specific pharmaceutical brands.
Methods and analysis: This study is a randomised controlled trial to assess the impact of a multifaceted intervention on GPs' medical practice. The study sample consists of 419 registered GPs who own/work in private clinics and …

Understanding Costa Rica's Response To The Covid-19 Pandemic: Competing Explanations, Lise Charles

The Journal of International Relations, Peace Studies, and Development

As the COVID-19 pandemic continues to have major impacts on the world, careful study of successful health systems is essential. Costa Rica has been identified as a country that has responded well to the pandemic with the proportion of death rates compared to infection rates being the lowest in comparison to other countries in Central America. This paper examines Costa Rica’s relatively successful response to the COVID-19 pandemic as a case study in good public healthcare management. This study also highlights the importance of theory for addressing urgent, practical development challenges to explore what theoretical frameworks can best explain the …

Addressing Human Trafficking As A Public Health Issue, Frances Recknor, Erica Di Ruggiero, Elsabeth Jensen

Center for Medical Ethics and Health Policy Staff Publications

Human trafficking is increasingly recognized as a significant global public health issue. Human trafficking (HT) exists in all nations, including Canada, and is estimated to impact 25 million people globally. HT is a crime that is not always visible. It is associated with a myriad of deleterious health outcomes arising from adverse living and working conditions, and the physical, sexual, and/or psychological violence often accompanying it. Human trafficking also disproportionately affects people living under vulnerable circumstances, particularly those with intersecting vulnerabilities. Public health can advance health equity for trafficked persons and add value to existing anti-trafficking (AT) efforts. Among its …

Older Adult Healthcare Utilization Patterns And Receptiveness Towards Healthier Sg Initiative, Micah Tan, Grace Cheong, Wensi Lim, Paulin T. Straughan

ROSA Research Briefs

The Healthier SG (HSG) initiative was launched by Health Minister Ong Ye Kung in March 2022. HSG marks a distinct departure from existing healthcare models as under this new initiative, greater emphasis is placed on preventive healthcare rather than reactive treatments. This shift in approach is envisioned to have a significant influence on the healthcare system in Singapore – for instance, by focusing on “health care” rather than on “sick care” it is hoped by some that this new model will discourage the ‘over-service’ of patients by doctors in Singapore (Lim, 2022). An integral component of the HSG initiative is …

Advocacy Spotlight: Are You An Advocate?, Vincent Benivegna Dds

The Journal of the Michigan Dental Association

Advocacy is crucial for dentists in Michigan, as they face a unique opportunity to impact Medicaid dental benefits positively. Governor Gretchen Whitmer's budget proposal for 2023 includes a substantial $240 million investment to revamp dental Medicaid benefits, a historic move for the state. The Michigan Dental Association (MDA) has actively engaged with government offices and legislators to ensure this opportunity is not missed. However, despite the MDA's efforts to mobilize members through action alerts, response rates have disappointed. The article emphasizes the importance of consistent advocacy, as it has the power to influence dental practices and the well-being of patients …

Bringing People Back Into Public Health Data: Community Feedback On A Set Of Visualization Tools - Summary Report, Alejandro Cerón, Mia Glover, Quisi Rodriguez-Oregel, Dani Thompson, Tom Adams, Naomi Asakura, Kaela Belknap, Anna Block, Nicole Boehler, Hannah Boeve, Sarah Bomers, Sasha Borovok, Grace Bryan, Kate Buffington, Majesty Cain, Beth Carideo, Haley Chesno, Grace Connell, Jake Corbett, Camille Cruz, Chloe Dawkins, Anna Denniston, Lydia Dickens, Sophie Duplock, Samuel Dwinell, Avery Ess, Sam Ferman, Ellis Geis, Ethan Graupmann, Xander Hedrick, Angel Hernandez-Miramontes, Grant Huyghe, Sara Ibrahiem, Anna Jamieson, Ian Kang, Allie Kris, Erin Lawrence, Maddie Leake, Ryan Leary, Taylor Loh, Charlotte Monroe, Alexander Nguyen-Lopez, Henry O’Daffer, Cat Parish, Jaylee Recountre, Grace Rizzo, Noah Roseth, Grace Rothstein, Katie Sage, Marie Saltzmann, Stephen Shlain, Riley Shores, Mackenna Simson, Mark Teneza, Jack Weinmeister, Justin Weinzweig, Alison Wenman, Patch Whelan, Lea Zimmerman

Anthropology: Undergraduate Student Scholarship

This course-based study is a product of the University of Denver’s Spring 2022 The Social Determination of Health (ANTH 2424) class. The study aimed to understand how well a set of public health visualization tools tells the data stories about people in Colorado, and about important public health problems. For this, a team of almost sixty undergraduate students taking the class, coordinated by three graduate teaching assistants, and directed by the course instructor interviewed a total of fifty-six people from Colorado, qualitatively analyzed those interviews, and wrote reports that draw conclusions and recommendations.

The Effect Of Rhetoric On Progressive Health Care Reform Policies’ Public Perception, Megan Geher

Honors Theses

Health care is one of the most contentious issues in United States politics today, and there are a variety of reform plans on the table. In order for these reform plans to be politically feasible, it is fundamental that the rhetorical framing strategies utilized are done so with caution. In this paper, I seek to understand to what extent rhetorical framing plays a role in how Americans perceive progressive health care reform plans. While there are many factors that go into public support of policies, rhetoric is one factor that cannot be ignored, as it has shown to have significant …