University at Albany

"I always thought I was going to go to medical school and become a doctor, but after volunteering at a syringe exchange program, I realized that my passion was in public health where we can implement systemic changes to create an environment that promotes a culture of health." — Erika Martin, PhD

The medical profession's loss would prove to be public health policy's gain. Rockefeller Assistant Professor Erika Martin's decision to change her career path led her to the University of Michigan School of Public Health to pursue her master's in epidemiology and to Yale University where she earned a doctorate in health policy and administration. "I found that I was most interested in public health policies that can guide the development of a healthy culture. It's especially rewarding to be working with the people who are making health policy."

Policymakers seem to feel the same about Erika Martin. Her expertise is widely recognized, much sought after and highly valued in public health circles. Articles she's written or contributed to have appeared in an array of leading publications including the New England Journal of Medicine, Journal of the American Medical Association, and Health Affairs. Her research activities have brought in over $1 million in external funding to Rockefeller College. Martin, who is also a senior fellow and director of health policy research at the Nelson A. Rockefeller Institute of Government, has served by invitation on a National Academy of Science Institute of Medicine committee that produced two reports requested by the White House Office of National AIDS Policy regarding how to most efficiently use data to assess and monitor the impact of the Affordable Care Act and the national HIV/AIDS strategy. "Erika Martin is an insightful and productive scholar and a skilled analyst. But what sets her apart from other gifted, rigorous researchers is her devotion to helping governments find ways to use data and analysis to solve stubborn health problems. She's done that in her work on open data initiatives as well as models of public services patients — to the benefit of governmental practices as well as academic research," says Rockefeller Institute Director Thomas Gais.

Last year, Martin received a two-year career development award from the prestigious Robert Wood Johnson Foundation for which she's undertaking research on finding ways to make open health data more useful for public health practitioners and researchers. The Open Data Project, as she calls it, examines health-related data freely available to the public and provided in accessible and varied formats on government agency websites. "I'm trying to understand how we can make information on open data platforms more usable and fit for public health research. Currently, these data are often aimed at other user communities such as application developers. The Robert Wood Johnson Foundation is interested in practice-based research that's relevant and helpful to practitioners," Martin notes. The initiative involves a close partnership with the New York State Department of Health (DOH). DOH Deputy Commissioner for the Office of Public Health Guthrie Birkhead, New York State Deputy Secretary for Health Courtney Burke and Center for Technology in Government Director Theresa Pardo, who is also Open NY Adviser to Governor Andrew M. Cuomo, serve as Martin's research and practice mentors. In addition, Professor Martin has enlisted several doctoral students to assist with the literature review, complicated data sampling, data coding, analysis, and qualitative interviews.

At Rockefeller, Martin is part of a team of policy experts who are making an impact. "I think we're at a point where we have a critical mass of people who think about health policy issues through different lenses, in different ways, using different methodological approaches," says Professor Martin. The quest to create a healthier environment is well underway at Rockefeller.

"There are very few researchers in public health who look at how policy affects health, and certainly not a lot who look at how politics affect health. That's even more rare." — Ashley M. Fox, PhD

Politics matter. And Ashley Fox is demonstrating that through her research. A public health researcher with training in political science, Professor Fox's initial inquisitiveness about the connection between public policy and health outcomes was sparked during a visit to South Africa as an undergraduate in the summer of 2000.

"The International AIDS conference was going on in Durban at the time," explains Fox. "South Africa's then-President Mbeki shocked the world at the conference when he questioned the link between HIV and AIDS and suggested poverty was the underlying driver of HIV. I became very interested in why a government would respond in such a seemingly irrational way to a health threat — ignoring the established science. Attempts to sway this position within the public health community at the time that focused on reinforcing the science seemed to miss the political motivations behind this response."

Interestingly, Fox's dissertation while a PhD candidate at Columbia University later revealed that it's not the poorest countries that have the highest HIV infection rates; it's the more developed countries within Africa. And within those countries it's not the poorest people who are most affected. Rather, wealthier people are more likely to be infected with HIV. "My research sort of turned on its head some of the ideas at the time about HIV as the ultimate social disease and poverty as an underlying driver of HIV," says Fox. "It showed that the relationships were actually much more complex."

"Complex" is how Professor Fox characterizes many of the challenges facing policymakers today. "It's hard to actually identify the policies that matter, especially for health outcomes. Sometimes, policy matters in a circuitous way," she observes. She points to New York City's proposed "soda ban" that would have limited the size of sugar-sweetened beverages allowed to be sold in the city. Despite the fact that the ban was blocked in the courts and never enacted, the city saw a decrease in the consumption of sugary beverages and an improvement in the obesity rate among New York City children. Although there was no actual policy change, the widespread debate over the proposed policy may have been the catalyst for these positive health outcomes.

"Ashley's research represents the best of what we have to offer at Rockefeller with respect to policy analysis: methodologically sophisticated approaches to data analysis coupled with a nuanced understanding of the political and social contexts that so deeply affect how policies are made and implemented," says Rockefeller College Interim Dean Karl Rethemeyer.

Currently, Professor Fox is at work on a new project, funded by a Robert Wood Johnson Public Health Law Grant, that examines how differences in social policies across U.S. states affect income inequality within a state and infant and child health outcomes across states. "We know there's a lot of variation in health outcomes across U.S. states. Southern states tend to have worse health outcomes compared to northern states," notes Fox. "There's a red state-blue state divide but we really don't know to what extent this is because of differences in demographics versus policy differences. And, of course, if the variations are due to policy differences, ultimately politics drive policy."

Before coming to Rockefeller in fall 2014, Fox served as an assistant professor and lecturer at Mount Sinai School of Medicine in New York City. Prior to that she held postdoctoral fellowships in the Division of Health Policy and Administration at Yale University and in the Department of Global Health and Population at Harvard University. At Rockefeller she feels she's found "just the right fit," a place where she can delve deeply into public policy research, but also publish in the field of public health. She's acquired new colleagues like fellow HIV researcher Erika Martin with whom she's already teamed on an extensive project to evaluate New York State's Medicaid waiver. Undoubtedly, more collaborations await, as do many opportunities to continue to make a positive impact on public health.

This article originally appeared in the Spring 2015 Rockefeller College News Magazine.