Professor, Health Behavior and Health Systems
Education & Experience:
My PhD is in Medical Sociology from Yale University and I received my Bachelor’s degree from the City University of New York with honors in economics and history. I am a member of Phi Beta Kappa.
I have been professor and chair of the Department of Social and Behavioral Sciences, UNT Health Science Center, 2005 – 2008 and professor 2008-2010, and since then professor in the Department of Behavioral and Community Health. I have also been professor of Health Policy and Management at the Johns Hopkins University from 1979 to the present (Professor Emeritus since 2005), and served as professor and chair of Epidemiology, Institute for Health Sciences, Berlin University of Technology (Germany), from 1997-2005. I am currently a Fellow in the Institute for Patient Safety. I have been Associate Professor of Epidemiology and Public Health in the Yale School of Medicine and Yale Department of Sociology, 1967-1973 and have held several visiting professorships including at Yale, Harvard, the Berlin University of Technology and the Medical University of Hannover, Germany.
Teaching Areas & Public Health Interests:
I have been teaching courses on Global Health and Health Disparities at the UNTHSC School of Public Health. I have also designed with colleagues at UNTHSC SPH the curriculum for a Certificate Program in Global Health for university students and outside professionals.
My early work on the impact of economic change on mental disorder has served as the basis for the epidemiological field of unemployment and psychological ill health. In recent decades, epidemiological research has increasingly demonstrated the importance of socioeconomic factors on mortality, for nearly all causes of death, and regardless of age and sex. Expanding these individual-level analyses, my research over 35 years, at the national level, has given evidence of the impact of economic change on mortality patterns over time. These national-level studies have shown that changes in population socioeconomic status are heavily responsible for national mortality trends and fluctuations. This work has contributed to the literature on socioeconomic indicators on health. It has been applied to states, regions and cities of the US, as well highly developed and developing countries. This has been the basis of my work in statistical modelling of life expectancy and mortality for samples of world societies, and in industrialized and developing countries. The key explanatory factors have been economic growth, health expenditures, education, employment, CO2 emissions and fertility.
My ecological models of US mortality have led to a patent in which the algorithm is now being applied to US hospitals with a focus on patient safety and reduction of in-patient mortality.
Professional Activities & Awards:
In 1997, I was given the career “Award for Excellence” for 25 years of scientific and policy research on the impact of the national economy on health by the American Public Health Association.
I have been consultant and given expert testimony to several US Congressional and Senate Committees and the US Department of Labor and the CDC, most recently I testified on energy and health implications for the US Senate Committee on Environment and Public Works. Internationally, I have been consultant to the World Health Organization European Region and to the WHO, Geneva Mental Health division, and WHO Office on Occupational and Environmental Health (Bonn, Germany). I testified and have been a consultant to the Parliaments of the United Kingdom, Sweden and to the Ministries of Health of Finland, Norway, Spain and Mexico.
Recently, I have co-organized (with Dr. Nico Rizzo) panels at the APHA annual meeting on the “Impact of the Great Recession on Heart Disease, Cancer and Stroke Mortality and Psychological Illness: Effects of Unemployment, Income and Health Expenditures” (2015) and on “Public Health Perspectives on Fuel Combustion, Climate Change and Health: Established Facts and New Discoveries” (2016).
I have been a principal contributor to the early research on the health impact of the economy since the 1970s. This area of work began with the book Mental Illness and the Economy, Harvard University Press, 1973, in which the basic relationship between national economic loss, unemployment and mental disorder was observed over 1841 to 1967 in the state of New York. I conducted two further studies for the United States Congress Joint Economic Committee in 1975 and 1984 that showed similar relations where increases in mortality, cardiovascular disease, suicide, homicide and cirrhosis were inversely related to the GDP and positively to the unemployment rate in the United States from the 1930s to the early 1980s. My article in the Lancet, 1979, demonstrated this relation for the first time in England and Wales, and thus for Europe. These studies were replicated with data from my studies for Sweden, Finland, Denmark, Germany, France, Italy, Spain, Belgium, Australia and New Zealand from the 1950s to the 1990s. These studies of the health implications of instability in the economic system have been the basis of simulations used in the formulation of national health and employment policy in the United States, European Union and the World Health Organization.
Within the United States, I have done the major work on the impact of the economy on physical and mental health for the United States Congress Joint Economic Committee. I have also pioneered the field of simultaneous spatial and temporal analysis of the impact of income and employment on health.
I have performed analyses on the impact of economic development, and specifically unemployment, in major studies of U.S. states funded by the Ford Foundation, the U.S. Department of Labor, and the National Institute on Ageing. I also have been responsible for analyses of the impact on mortality, of alcohol and tobacco consumption, socio-economic status and employment patterns, in studies funded by the National Institute of Mental Health, National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. I have also published major studies of the impact of economic and social factors on health and mortality for the European Commission, most recently a study on duration of unemployment and self-perceived health in Europe. This study is available at: http://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=7908&visible=1
Over the last decade I have devoted most of my research efforts to factors that account for international differences in illness and mortality patterns. With the focus on industrialized countries, I have developed the first models of the impact of the Great Recession on suicide in 33 countries, including the U.S. and Europe. This study, “Profound Unhappiness in the International Recession: The Case of Suicide in Industrialized Countries,” is published in a Wiley volume edited in 2012 by the mathematical economics Nobel Prize winner Lawrence Klein. This has been followed by the first models of the impact of the 2008 recession on heart disease, stroke and cancer in the industrialized world, funded by the European Union (EU) available at: http://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=7909&furtherPubs=yes
I also directed the largest multi-country epidemiological study funded by the EU, on the effects of the Recession on company downsizing and subsequent mental and physical health. This study took place in four countries, the UK, France, Hungary and Sweden; the results were that not only those who became unemployed, but also the survivors, suffered considerable depression, alcohol problems and other health damage. The study, “Organizational Downsizing and Depressive Symptoms in the European Recession: The Experience of Workers in France, Hungary, Sweden and the United Kingdom” is published in PLOS ONE 9 (5), 2014), 1-14. The results of a follow-up study on the risk of psychological ill health and organizational downsizing have been accepted for publication by BMC Public Health.
I have published on the impact of world military expenditures on global cardiovascular mortality (Journal of Public Health Policy, 2016 February; 37 (1):20-35). This research demonstrates the opportunity costs of shifting government spending to military purposes as compared to health, education and welfare.
Recently, I have developed analyses of the effects of national health expenditures on reducing heart disease, cancer and stroke mortality in the United States and Europe, taking account of the health-damaging effects of the Great Recession. I proposed and analyzed new findings on the impact of the international recession and austerity measures on mental health, especially suicide, in my contribution to the forthcoming Oxford Textbook of Public Mental Health. This article highlights the reciprocal relationship between social class and mental health and examines the detrimental effects of recessions and economic inequality on psychological health, addictions and unintentional accidents.
I also am in process of completing a book contract with Oxford University Press on the impact of the world economy on global health. This covers my work over the past ten years on the contributions of sustainable economic growth, health expenditures, education, climate change and fertility to improving world life expectancy. Central to the issue of sustainable economic growth is the issue of innovation along with the evolution of knowledge. I had the opportunity to explore the significance of small networks for the evolution of knowledge and species longevity in a recent article accepted by Chaos, Solitons & Fractals.
Currently, I am involved in studies of patient safety, based on my patented algorithm for U.S. mortality. The socioeconomic elements of the algorithm, indicating patient and outpatient provider economic sources, stem from a model of U.S. population and hospital mortality in the past decade.
Most recently, I have been invited to write an editorial for the American Journal of Public Health on “Years of Life Lost, Age Discrimination, and the Myth of Productivity.” This AJPH editorial article is forthcoming in the October 2017 issue of the American Journal of Public Health
This page was last modified on August 28, 2017