Karen Grépin

Karen Grépin
Assistant Professor of Global Health Policy

S.M. in Health Policy and Management, Harvard School of Public Health; Ph.D. in Health Policy and International Health Economics, Harvard University

Dr. Karen A. Grépin is an Assistant Professor of Global Health Policy at New York University’s Robert F. Wagner’s Graduate School of Public Service.   She holds a Ph.D. in Health Policy and International Health Economics from Harvard University and an S.M. in Health Policy and Management from the Harvard School of Public Health.  Her research focuses on the economics of health service delivery in developing countries, with a focus on sub-Saharan Africa. In particular, her work focuses priority setting in health systems, factors affecting the demand and supply of maternal health services, and the effectiveness of development assistance for health. She is the author of a well read a global health blog (http://www.karengrepin.com), which focuses on issues related to global health and global health policy and is an active participant on Twitter (@KarenGrepin).

Semester Course
Fall 2014 HPAM-GP.1831.001 Introduction to Global Health Policy

Why are some people in some countries so much healthier than others? This course will explore the factors that explain the unequal distribution of health and disease in the world. The course will begin with an introduction to the language of global health: the burden of disease, epidemiology, cost-effectiveness, and health systems. It will then analyze the rationale for and modes of intervention to improve global health by exploring a number of high-profile topics, including the HIV/AIDS epidemic, access to pharmaceuticals, human resources for health, and maternal and child health. The course will incorporate knowledge and views from multiple academic disciplines (public health, economics, politics, management, sociology, etc) and does not require any background knowledge. It is open to students in all degree concentrations.


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Fall 2013 HPAM-GP.1831.001 Introduction to Global Health Policy

Why are some people in some countries so much healthier than others? This course will explore the factors that explain the unequal distribution of health and disease in the world. The course will begin with an introduction to the language of global health: the burden of disease, epidemiology, cost-effectiveness, and health systems. It will then analyze the rationale for and modes of intervention to improve global health by exploring a number of high-profile topics, including the HIV/AIDS epidemic, access to pharmaceuticals, human resources for health, and maternal and child health. The course will incorporate knowledge and views from multiple academic disciplines (public health, economics, politics, management, sociology, etc) and does not require any background knowledge. It is open to students in all degree concentrations.


Download Syllabus
Fall 2011 HPAM-GP.1831.001 Introduction to Global Health Policy

Why are some people in some countries so much healthier than others? This course will explore the factors that explain the unequal distribution of health and disease in the world. The course will begin with an introduction to the language of global health: the burden of disease, epidemiology, cost-effectiveness, and health systems. It will then analyze the rationale for and modes of intervention to improve global health by exploring a number of high-profile topics, including the HIV/AIDS epidemic, access to pharmaceuticals, human resources for health, and maternal and child health. The course will incorporate knowledge and views from multiple academic disciplines (public health, economics, politics, management, sociology, etc) and does not require any background knowledge. It is open to students in all degree concentrations.


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Spring 2011 HPAM-GP.4830.002 Health Economics: Principles

This course provides the core microeconomic theories and concepts needed to understand health and health care issues in both the developed and developing world. It describes how the markets for health and health services are different from other goods, with a particular emphasis on the role of government and market failure. In addition it discusses the theoretical and empirical aspects of key health economics issues, including the demand for health and health services, supply side concerns, health insurance, the provision of public goods, and related topics. The course encourages students to fundamentally and rigorously examine the role of the market for the provision of health and health services and how public policy can influence these markets.


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Spring 2011 HPAM-GP.4832.001 Health Economics: Topics in International Health Policy

Building on HPAM-GP.4830, this course examines current health policy debates in developing countries from an economics perspective. Topics may vary but are likely to include the determinants of mortality and the factors that have contributed to historical declines in mortality, the contribution of income and education to health, the role of health in promoting economic development, the need for financial risk protection against health shocks, the economics of HIV/AIDS prevention and transmission, the control of malaria, the determinants of fertility, and other related topics. There will be a strong focus on applying theoretical insights from HPAM-GP.4830 and interpreting the relevant empirical literature.


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Fall 2010 HPAM-GP.1831.001 Introduction to Global Health Policy

Why are some people in some countries so much healthier than others? This course will explore the factors that explain the unequal distribution of health and disease in the world. The course will begin with an introduction to the language of global health: the burden of disease, epidemiology, cost-effectiveness, and health systems. It will then analyze the rationale for and modes of intervention to improve global health by exploring a number of high-profile topics, including the HIV/AIDS epidemic, access to pharmaceuticals, human resources for health, and maternal and child health. The course will incorporate knowledge and views from multiple academic disciplines (public health, economics, politics, management, sociology, etc) and does not require any background knowledge. It is open to students in all degree concentrations.


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Spring 2010 HPAM-GP.2850.001 International Health Economics
This course provides an introduction to key concepts in health and development economics analyzed from the perspective of developing countries. The course will cover concepts such as market failure, public goods, the role of government, the determinants of health, and historical health improvements. The course will also explore the relationship between health, education, labor supply, and economic growth. In addition, we will explore factors affecting the demand and supply of health services in developing countries, including health insurance, prices, quality, behavioral economics, and information. The course will draw upon the health economics literature from both developed and developing countries but will focus on empirical examples from developing countries. The course will make use of intermediate econometric tools and thus is intended only for students with a previous course in microeconomics and statistics; however, no previous background in health or health economics is required.
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Spring 2010 UPADM-GP.0232.001 Global Health: Policies, Politics, and Institutions

Following an unprecedented mobilization of resources (financial and otherwise) for HIV, new infections are down across much of sub-Saharan Africa (SSA), prevention interventions are having some impact, and access to care and treatment services are up, which has reduced AIDS-associated mortality. Still, two-thirds of all people living with HIV are in SSA, as are half of all new infections and nearly three-quarters of AIDS-related deaths. Meanwhile, the lingering global economic malaise is squeezing donor and domestic budgets alike, and a global shift in focus from HIV to health systems and other health concerns may jeopardize hard-won gains. It’s an ambivalent picture that portends an uncertain future, and this course unpacks the political, economic, socio-cultural and epidemiologic nuances of HIV in the region. Global, national and community-level perspectives are explored through a mix of primary and secondary sources, as well as quantitative and qualitative literature. Following a review of HIV epidemiology and pathophysiology, the course examines the rollouts of HIV prevention, care and treatment services (particular attention is given to the South African epidemic and AIDS response); costs, financing and global HIV governance; the relationship between AIDS, sex and poverty; and concludes by considering the future of the AIDS epidemic and response in SSA.


Download Syllabus
Fall 2009 HPAM-GP.1831.001 Introduction to Global Health Policy

Why are some people in some countries so much healthier than others? This course will explore the factors that explain the unequal distribution of health and disease in the world. The course will begin with an introduction to the language of global health: the burden of disease, epidemiology, cost-effectiveness, and health systems. It will then analyze the rationale for and modes of intervention to improve global health by exploring a number of high-profile topics, including the HIV/AIDS epidemic, access to pharmaceuticals, human resources for health, and maternal and child health. The course will incorporate knowledge and views from multiple academic disciplines (public health, economics, politics, management, sociology, etc) and does not require any background knowledge. It is open to students in all degree concentrations.


Download Syllabus
  Projects
Health in Brazil, Russia, India, China (BRIC): TEE for Collaborative Learning
Description
Where the Money Goes: Mapping Aid for Better Impact
Description
Health, Environmental, and Development Policy in Ghana
Description
Date Publication/Paper
2014

Victoria Y Fan, Karen A Grépin, Gordon C Shen & Lucy Chen 2014. Tracking the flow of health aid from BRICS countries Bulletin of the World Health Organization 2014 Jun 1;92(6):457-8. doi: 10.2471/BLT.13.132472.
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Margaret E. Kruk, Miriam Rabkin, Karen Ann Grépin, Katherine Austin-Evelyn, Dana Greeson, Tsitsi Beatrice Masvawure, Emma Rose Sacks, Daniel Vail and Sandro Galea 2014. ‘Big Push’ To Reduce Maternal Mortality In Uganda And Zambia Enhanced Health Systems But Lacked A Sustainability Plan doi: 10.1377/hlthaff.2013.0637 Health Aff June 2014 vol. 33 no. 6 1058-1066
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Abstract

In the past decade, “big push” global health initiatives financed by international donors have aimed to rapidly reach ambitious health targets in low-income countries. The health system impacts of these efforts are infrequently assessed. Saving Mothers, Giving Life is a global public-private partnership that aims to reduce maternal mortality dramatically in one year in eight districts in Uganda and Zambia. We evaluated the first six to twelve months of the program’s implementation, its ownership by national ministries of health, and its effects on health systems. The project’s impact on maternal mortality is not reported here. We found that the Saving Mothers, Giving Life initiative delivered a large “dose” of intervention quickly by capitalizing on existing US international health assistance platforms, such as the President’s Emergency Plan for AIDS Relief. Early benefits to the broader health system included greater policy attention to maternal and child health, new health care infrastructure, and new models for collaborating with the private sector and communities. However, the rapid pace, external design, and lack of a long-term financing plan hindered integration into the health system and local ownership. Sustaining and scaling up early gains of similar big push initiatives requires longer-term commitments and a clear plan for transition to national control.

2013

Grépin, K. A., & Klugman, J. 2013. Maternal health: a missed opportunity for development The Lancet, 381(9879), 1691–1693. doi:10.1016/S0140-6736(13)60981-2.
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Grépin, Karen and Kim Yi Dionne 2013. Democratization and Universal Health Coverage: A comparison of the experiences of Ghana, Kenya, and Senegal Global Health Governance, 6(2): 1-27.
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Abstract

This article identifies conditions under which newly established democracies adopt Universal Health Coverage. Drawing on the literature examining democracy and health, we argue that more democratic regimes – where citizens have positive opinions on democracy and where competitive, free and fair elections put pressure on incumbents – will choose health policies targeting a broader proportion of the population. We compare Ghana to Kenya and Senegal, two other countries which have also undergone democratization, but where there have been important differences in the extent to which these democratic changes have been perceived by regular citizens and have translated into electoral competition. We find that Ghana has adopted the most ambitious health reform strategy by designing and implementing the National Health Insurance Scheme (NHIS). We also find that Ghana experienced greater improvements in skilled attendance at birth, childhood immunizations, and improvements in the proportion of children with diarrhea treated by oral rehydration therapy than the other countries since this policy was adopted. These changes also appear to be associated with important changes in health outcomes: both infant and under-five mortality rates declined rapidly since the introduction of the NHIS in Ghana. These improvements in health and health service delivery have also been observed by citizens with a greater proportion of Ghanaians reporting satisfaction with government handling of health service delivery relative to either Kenya or Senegal. We argue that the democratization process can promote the adoption of particular health policies and that this is an important mechanism through which democracy can improve health.

2012

Grépin, Karen 2012. HIV Donor Funding Has Both Boosted And Curbed The Delivery Of Different Non-HIV Health Services In Sub-Saharan Africa Health Affairs July 2012 31:1406-1414
Abstract

Donor funding for HIV programs has increased rapidly over the past decade, raising questions about whether other health services in recipient-country health systems are being crowded out or strengthened. This article—an investigation of the impacts of increased HIV donor funding on non-HIV health services in sub-Saharan Africa during 2003–10—provides evidence of both effects. HIV aid in some countries has crowded out the delivery of childhood immunizations, especially in countries with the lowest density of health care providers. At the same time, HIV aid may have positively affected some maternal health services, such as prenatal blood testing. These mixed results suggest that donors should be more attentive to domestic resource constraints, such as limited numbers of health workers; should integrate more fully with existing health systems; and should address these constraints up front to limit possible negative effects on the delivery of other health services.

Grépin, Karen 2012. Efficiency Considerations of Donor Fatigue, Universal Access to ARTs and Health Systems Sex Transm Infect 2012;88:75-78
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Abstract

Objectives: To investigate trends in official development assistance for health, HIV and non-HIV activities over time and to discuss the efficiency implications of these trends in the context of achieving universal access to treatment and health systems.

Methods: Official development assistance for health, HIV programmes and non-HIV programmes were tracked using data from 2000 to 2009. A review of the literature on efficiency, treatment and health systems was conducted. Findings The rate of growth of donor funding to HIV programmes has slowed in recent years at levels below those required to sustain programmes and to move towards universal access to treatment. These trends are likely due to increased pressure on foreign aid budgets and donor fatigue for HIV programmes.

Conclusions: There is great need to consider how the limited resources available can be used most efficiently to increase the number of lives saved and to ensure that these resources also benefit health systems. Improving efficiency is much more than just improving the productive efficiency and also about ensuring that resources are going to where they will be the most beneficial and making investments that are the most efficient over time. These choices may be essential to achieving the goal of universal access to treatment as well as the sustainability of these programmes. 

2011

Grépin, Karen A, Leach-Kemon, Katherine , Schneider, Matthew, Sridhar, Devi. 2011. How to do (or not to do) ... Tracking data on development assistance for health Health Policy Plan. (2011)doi: 10.1093/heapol/czr076First published online: December 8, 2011
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Abstract

Development assistance for health (DAH) has increased substantially in recent years and is seen as important to the improvement of health and health systems in developing countries. As a result, there has been increasing interest in tracking and understanding these resource flows from the global health community. A number of datasets, each with its own strengths and weaknesses, are available to track DAH. In this article we review the available datasets on DAH and summarize the strengths and weaknesses of each of these datasets to help researchers make the best choice of which to use to inform their analysis. Finally, we also provide recommendations about how each of these datasets could be improved.

 

Kishore, S.P. et al. 2011. Youth Manifesto on Non-Communicable Diseases Global Heart, 6(4): 201-210

Grépin, Karen. 2011. Leveraging HIV Programs to Deliver an Integrated Package of Health Services: Some Words of Caution JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 August 2011 - Volume 57 - Issue - pp S77-S79 doi: 10.1097/QAI.0b013e31821f6afa
Abstract

Over the past decade, HIV programs have been successfully scaled up in many developing countries, leading some to wonder how the investments made into HIV infrastructure could be leveraged to deliver additional health services. Although the concept is appealing from many perspectives, integrating additional health services into existing vertical HIV infrastructure may not mitigate some of the challenges these programs have introduced in implementing countries. In addition, this approach to integration may countervail parallel efforts of the global health community to strengthen health systems and improve aid effectiveness. It might also undermine the HIV programs themselves. International donors and health system planners should carefully consider whether the benefits outweigh the potential costs of these well-intentioned integration efforts.

2010

Law, Michael and Karen Grépin. 2010. Is newer always better? Re-evaluating the benefits of newer pharmaceuticals Journal of Health Economics 29 (2010) 743–750
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Abstract

Whether newer pharmaceuticals justify their higher costs by reducing other health expenditures has generated significant debate. We replicate a frequently cited paper by Lichtenberg on drug “offsets” and find the results disappear using a more appropriate model or updated dataset. Further, we test the suitability of similar methods using newer hypertension drugs. We find our observational results run counter to well-established clinical evidence on comparative efficacy and conclude that our model, as well as other studies that do not adequately control for unobserved characteristics that jointly determine drug choice and health expenditures, are likely subject to significant bias.

2009

Grépin, K.A. & William D Savedoff. 2009. 10 Best Resources on Health Workers in Developing Countries
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Abstract

Key Messages

 

  • Until recently researchers and policymakers paid little attention to the role of health workers in developing countries but a new generation of studies are providing a fuller understanding of these issues using more sophisticated data and research tools.
  • Recent research highlights the value of viewing health workers as active agents in dynamic labour markets who are faced with many competing incentives and constraints.
  • Newer studies have provided greater insights into human resource requirements in health, the motivations and behaviours of health workers, and health worker migration. We are encouraged by the progress but believe there is a need for even more, and higher quality, research on this topic.

Savedoff, W. & Grépin, K.A. 2009. Chapter 3: Assessing Health Sector Corruption in Ethiopia
Abstract

In Assessing Corruption in Ethiopia, forthcoming from the World Bank (ed. Janelle Plummer)

2008

Grépin, K.A. & Reich, MR. 2008. Conceptualizing Integration: A framework for analysis applied to neglected tropical disease control programs PLoS Neglected Tropical Diseases, 2(4): e174

2007

Hodgkin, C, Abiose, A, Philippon, B, Reich, M, Remme, HJ, Thylefors, B, Traoré, M, Grépin, K. 2007. The Future of Onchocerciasis Control in Africa PLoS Neglected Tropical Diseases, 1(1): e74.

Hodgkin, C., Abiose, A., Philippon, B., Reich, M., Remme, H.J., Thylefors, B., Traora, M. & Grepin, K. 2007. The Future of Onchocerciasis Control in Africa PLoS Neglected Tropical Diseases, 1(1): e74

2006

Berndt, E.R., Cockburn, I.M. & Grépin, K.A. 2006. The Impact of Incremental Innovation in Biopharmaceuticals: Drug Utilization in Original and Supplemental Indications Pharmacoeonomics, 24 (supp 2): 69-86  

2003

Stabinski L., Pelley(Grepin), K., Jacob, S.T., Long, J.M. & Leaning, J. 2003. Reframing HIV/AIDS British Medical Journal, 327(7423): 1101-3