马塞拉-阿尔桑 医师-经济学家

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Marcella Alsan
Physician-Economist | Class of 2021
Investigating the role that legacies of discrimination and resulting mistrust play in perpetuating racial disparities in health.


Portrait of Marcella Alsan

Title
Physician-Economist
Affiliation
John F. Kennedy School of Government, Harvard University
Location
Cambridge, Massachusetts
Age
44 at time of award
Area of Focus
Economics, Health Policy
Website
Harvard University: Marcella Alsan
Health Inequality Lab
National Bureau of Economic Research: Marcella Alsan
Social
Twitter
Published September 28, 2021
ABOUT MARCELLA'S WORK
Marcella Alsan is an economist and physician investigating the role that legacies of discrimination and resulting mistrust play in perpetuating racial disparities in healthcare usage and health outcomes. She has drawn on her training in the separate disciplines of economics and medicine to address a range of topics related to health inequities, but she has focused most consistently on devising methods for identifying and measuring variations in trust as determinants of health.

Her most influential work to date provides empirical evidence for the widely held hypothesis that mistrust of medical institutions contributes to poor health indicators experienced by Black men in the United States. This demographic group has among the lowest life expectancies of any racial and ethnic group in the nation. In the 2018 paper “Tuskegee and the Health of Black Men,” she and her co-author examine the long-term effects of the infamous Tuskegee syphilis study conducted by the U.S. Public Health Service from 1932 to 1972. The study secretly denied treatment for the disease to hundreds of Black men in rural Alabama. The authors based their analysis on historical data on different demographic groups’ use of medical services from the National Health Interview Survey, among other sources, before and after public disclosure of the exploitive experiments in 1972. A marked decrease in medical care use and an increase in rates of mistrust of medical professionals and in mortality were found among Black men in closer geographic proximity to the Tuskegee study. The authors’ estimates indicate that, after the Tuskegee revelation, life expectancy at age 45 for Black men fell by up to 1.5 years, a remarkably large effect. Spurred by these findings, Alsan and colleagues designed a randomized control trial to test whether being treated by a Black male doctor might improve trust and increase utilization of preventive healthcare services by Black men. They created a preventive care clinic in Oakland staffed by both Black and non-Black physicians and recruited over 1,300 Black male participants who were offered free screening services and randomly assigned a doctor for evaluation. As detailed in her subsequent paper, “Does Diversity Matter for Health? Experimental Evidence from Oakland” (2019), Alsan uncovered significant positive effects of interacting with a racially concordant physician: patients were much more likely to select every recommended preventive service—such as cholesterol tests, diabetes screenings, and flu vaccines—after meeting with a Black doctor.

Alsan is currently engaged in a number of projects to further explore how physician messaging affects patient health behaviors, including if non-Black physicians’ acknowledgment and discussion of the medical field’s past injustices improves take-up of health care services among Black patients. She is also working with a group of interdisciplinary collaborators to tailor communications about the COVID-19 vaccine for communities that have limited confidence in and connection to the health care system. Through these and other projects, Alsan is bringing powerful evidence to bear on the importance of diversity in the medical profession and on efforts to improve health outcomes for historically marginalized and mistreated populations.

BIOGRAPHY
Marcella Alsan holds a BA (1999) from Harvard University, an MPH (2005) from the Harvard School of Public Health, an MD (2005) from Loyola University, and a PhD in economics (2012) from Harvard University. Alsan served as an associate professor of medicine and, by courtesy, of economics and health research and policy at Stanford University prior to joining the faculty of the Harvard Kennedy School as a professor of public policy in 2019. Her work has been published in the American Economic Review, Quarterly Journal of Economics, Journal of Political Economy, The Lancet Infectious Diseases, and Annals of Internal Medicine, among other journals.



马塞拉-阿尔桑
医师-经济学家 | 2021级
调查歧视的遗留问题和由此产生的不信任在延续健康方面的种族差异中的作用。


马塞拉-阿尔桑的肖像

标题
医生-经济学家
工作单位
哈佛大学约翰-肯尼迪政府学院
工作地点
马萨诸塞州剑桥市
年龄
获奖时44岁
重点领域
经济学、卫生政策
网站
哈佛大学。马塞拉-阿尔桑
健康不平等实验室
美国国家经济研究局。马塞拉-阿尔桑
社会
推特
发表于2021年9月28日
关于马塞拉的工作
马塞拉-阿尔桑是一名经济学家和医生，她研究歧视的遗留问题和由此产生的不信任在延续医疗服务使用和健康结果方面的种族差异方面所起的作用。她利用自己在经济学和医学两个独立学科的训练，解决了一系列与健康不平等有关的问题，但她最关注的是设计方法来识别和测量作为健康决定因素的信任的变化。

迄今为止，她最有影响力的工作为广泛持有的假设提供了经验证据，即对医疗机构的不信任导致了美国黑人男性的健康指标不佳。这一人口群体是美国所有种族和族裔群体中预期寿命最低的。在2018年的论文《塔斯基吉和黑人男子的健康》中，她和她的合著者研究了美国公共卫生局从1932年到1972年进行的臭名昭著的塔斯基吉梅毒研究的长期影响。这项研究秘密地拒绝对阿拉巴马州农村的数百名黑人男子进行疾病治疗。作者的分析基于1972年公开披露剥削性实验之前和之后不同人口群体使用医疗服务的历史数据，这些数据来自全国健康访谈调查等。在距离塔斯基吉研究较近的黑人男子中，发现医疗服务的使用明显减少，对医疗专业人员的不信任率和死亡率都有所增加。作者的估计表明，在塔斯基吉事件发生后，黑人男子45岁时的预期寿命最多下降了1.5年，这是一个非常大的影响。在这些发现的刺激下，阿尔桑及其同事设计了一个随机对照试验，以测试由黑人男性医生治疗是否会提高黑人男性的信任度并增加他们对预防保健服务的利用。他们在奥克兰建立了一个由黑人和非黑人医生组成的预防保健诊所，并招募了1300多名黑人男性参与者，向他们提供免费筛查服务，并随机分配一名医生进行评估。正如她在随后的论文《多样性对健康有影响吗？来自奥克兰的实验证据》（2019年）中详细说明，Alsan发现了与种族一致的医生互动的重大积极影响：患者在与黑人医生见面后，更有可能选择每一项推荐的预防服务--如胆固醇测试、糖尿病筛查和流感疫苗。

Alsan目前正在参与一些项目，以进一步探索医生的信息传递如何影响患者的健康行为，包括非黑人医生承认和讨论医疗领域过去的不公正现象是否会提高黑人患者对保健服务的接受程度。她还与一组跨学科合作者合作，为那些对医疗保健系统信心不足、与医疗保健系统联系有限的社区量身定制关于COVID-19疫苗的沟通。通过这些项目和其他项目，阿尔桑正在为医学界多样性的重要性以及为改善历史上被边缘化和受虐待人群的健康状况带来有力的证据。

个人简历
马塞拉-阿尔桑拥有哈佛大学的学士学位（1999年）、哈佛大学公共卫生学院的公共卫生硕士学位（2005年）、洛约拉大学的医学博士学位（2005年）和哈佛大学的经济学博士学位（2012年）。在2019年加入哈佛大学肯尼迪学院担任公共政策教授之前，阿尔桑曾在斯坦福大学担任医学副教授，并礼聘经济学和健康研究与政策的副教授。她的作品发表在《美国经济评论》、《经济学季刊》、《政治经济学杂志》、《柳叶刀传染病》和《内科医学年鉴》等杂志上。