While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Frank Chaloupka, PhD, has built his career as an economist on a commitment to rigorous research as the foundation of sound policy. Author of hundreds of publications in leading peer-reviewed journals, he has taken on some of the nation's most intractable health problems—smoking, drinking, drug use and obesity.
While Chaloupka is modest about his accomplishments, others tend to use superlatives in describing his landmark contributions. "In my judgment, Frank Chaloupka has been the most creative and socially productive economist working on tobacco-control issues over the past two decades," says Kenneth E. Warner, PhD, Avedis Donabedian Distinguished University Professor of Public Health at the University of Michigan School of Public Health.
Danny E. McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids, says Chaloupka's work "contributed immensely to 47 states and the District of Columbia having passed more than 108 separate local, state and federal tobacco excise tax increases since 2000."
John A. Tauras, PhD, an economist and associate professor at the University of Illinois at Chicago whom Chaloupka has mentored, states flatly, "It is my firm belief that through his efforts, Frank Chaloupka is responsible for hundreds of thousands of lives saved worldwide."
From the lions in the field he has impressed, to the emerging scholars he has mentored, a common thread is apparent in their comments: Here is someone who has made a difference.
An economist by accident. Frank Chaloupka took his first economics course as a pre-med student because he had a social science requirement to fill and the class was conveniently scheduled. That chance decision was a game-changer. "The course was taught by a former state representative who showed me how theory could influence policy. I found those ideas more interesting than biochemistry," he says.
Chaloupka switched his major and looked for a mentor to help him use economic thinking to influence real-world decisions. Still interested in health, he was drawn to the work of Michael Grossman, PhD, at the City University of New York, considered by many the "father of health economics."
Grossman saw a leader in the making, "His 1988 PhD dissertation contained the first empirical application of the rational addiction theory developed by Nobel Laureate Gary Becker and Kevin Murphy. The research style in that paper, and in all of Frank's subsequent work, are models of applied economics in which carefully thought-out economic approaches to behavior by households and firms are used to inform important substantive and empirical problems, often of great public policy concern."
The two men have collaborated on numerous studies in the years since then.
After receiving his doctorate from City University of New York Graduate School, Chaloupka accepted a faculty position at the University of Illinois at Chicago, where he is now distinguished professor at the School of Public Health and the College of Business Administration. In addition to a longstanding funding relationship with the Robert Wood Johnson Foundation (RWJF), he has been funded by the National Cancer Institute, the Centers for Disease Control and Prevention (CDC), the Rockefeller Foundation and many others to conduct seminal tobacco-related research.
Making the connection with RWJF. RWJF's decision in the early 1990s to focus a significant portion of its grantmaking on reducing substance abuse came just as Chaloupka was starting his career. The timing worked well for them both.
Chaloupka was a researcher with two of RWJF's national programs, Tobacco Policy Research and Evaluation (see Program Results Report) and Substance Abuse Policy Research (also see Program Results Report) when he caught the attention of RWJF's Senior Scientist C. Tracy Orleans, PhD, and Research & Evaluation Vice President James R. Knickman, PhD (now the president of the New York State Health Foundation).
In 1996, when RWJF decided to launch Bridging the Gap: Research Informing Practice and Policy, Orleans reached out to Chaloupka and Lloyd Johnston to help design and co-direct the program. "As a team they brought unparalleled qualifications to lead this program," says Orleans. "Lloyd drew from his outstanding long-term leadership of the National Institute on Drug Abuse (NIDA)-funded Monitoring the Future survey of youth alcohol, drug and tobacco use, and Frank brought superb organizational skills and an outstanding ability to conceptualize and analyze multi-level policy interventions. Both had a strong commitment to mentoring the next generation of substance use policy researchers."
Bridging the Gap initially focused on determining the effect of laws and policies on youth substance use. "When we started Bridging the Gap, we had data showing how drug use among kids was changing," says Orleans. "But no one was monitoring the drivers of those changes and especially the policies that might have prompted them."
To fill that gap, Chaloupka, Johnston and their colleagues collected and analyzed data at the student, school, community and state levels, and concluded that:
Matthew Myers, president of the Campaign for Tobacco Free Kids, knows that community activists and public officials need the solid evidence behind those kinds of findings to counter attacks from tobacco companies. "One of the things I liked best about Frank and the entire Bridging the Gap team is that they were absolutely committed to first-rate, unbiased research," says Myers. "We used their data to be sure that the policies we advocated in communities were evidence-based."
Reducing smoking in other countries. As his work on tobacco control gained traction and credibility, Chaloupka reached out to economists in other countries. With support from the Rockefeller Foundation, for example, he taught junior economists from Southeast Asia how to analyze economic issues in a way that would affect policy. The power of that approach was evident when one of his trainees produced an analysis that led officials in Vietnam to raise tobacco taxes.
With his colleague at the University of Toronto, Prabhat Jha, MD, DPhil, Chaloupka also persuaded the World Bank to sponsor the research and writing of Curbing the Epidemic: Governments and the Economics of Tobacco Control, which Warner calls "the bible of international tobacco-control policy development. The final product is a remarkable example of how dedicated professionals can combine their powerful intellects, auspicious organizational skills and unlimited sweat equity to create a work of immediate and enduring importance."
Adding childhood obesity to his portfolio. As RWJF shifted its focus away from substance abuse and towards preventing childhood obesity, it recast Bridging the Gap, while retaining its infrastructure and stellar leadership of Chaloupka and Johnston. Since 2005, these two program directors have been doing for nutrition and physical education what they did for substance use: seeking out the connections between individual behavior and broader influences, such as school, community, and state and federal policies.
Chaloupka, who also remains engaged in tobacco-control research, calls obesity a "natural evolution of my work, with the theme being societal changes and health behaviors." He now gathers data about influences on childhood obesity such as community recreation programs, the availability of walking and biking paths, food advertising on television, food prices, state wellness policies and the location of food—and physical activity-related businesses.
Chaloupka's mentor Grossman has followed Chaloupka's work through this shift. He says "Frank's wide-ranging research on the economics of substance use and more recently on the determinants of obesity contain some of the most striking empirical findings that I have encountered in my forty-year professional career as an economist."
In some ways, Chaloupka says, obesity is a more complicated challenge than tobacco, because any tobacco use is harmful while the same cannot, of course, be said of eating food. But both involve behaviors with adverse consequences that are preventable and Chaloupka points to other parallels as well. "One thing that struck me as true across both issues is the role of prices in affecting decisions. During the time obesity has emerged as a significant health problem, we have seen dramatic decreases in prices of sugar-sweetened beverages, and increases in prices of fresh foods and vegetables."
He also observes that the potential power of big food companies to block new policies might mirror the capacity of big tobacco companies to derail efforts to restrict tobacco use. But this time, he added, "we are a bit ahead because we know how those things work."
Influencing young researchers. Chaloupka takes seriously his role in opening doors for a new generation of scientists interested in tobacco-control and obesity-prevention policy. "I like to create opportunities for people. With all the work we are doing and all the data we collect, it is important to give people freedom and let them grow."
Tauras, now a colleague at the University of Illinois at Chicago, and Sandra Slater, PhD, Bridging the Gap's first deputy director, are two of the researchers he has helped to train. "What makes him extraordinary" comments Tauras, "is his ability and deep desire to share his knowledge of tobacco control with others in an effort to save lives. Frank has had a profound lifelong influence on graduate students he has mentored, including me."
An honor richly deserved: The John D. Slade, MD, Memorial Advocacy Award. John Slade, MD, was a widely respected physician, researcher, professor and health activist who worked tirelessly to reduce the number of lives lost through tobacco addiction. He was the recipient of RWJF's first ever tobacco-control grant in April 1992: Treating Tobacco Addiction in Alcohol and Drug Treatment Programs Through a Statewide Model, otherwise known as STAT (see Program Results Report). RWJF's "Sacred Bundle" of stories about the Foundation's work in a number of fields, notes that this grant was "spurred by the vision of tobacco-control pioneer John Slade." The report goes on to state, "The lessons we learned... stand out in hindsight as the familiar and reliable standards of success that we've relied upon for many years across the spectrum of our programs.... We'd broken tobacco's defense code."
After Slade's untimely death in 2002, the Society for Research on Nicotine and Tobacco established the John Slade Award for individuals "who have made outstanding contributions to public health and tobacco control, commemorating his vision that science can make a difference in public policy."
Chaloupka is the winner of the American Public Health Association's John Slade Award for 2011, an honor he clearly has earned. According to RWJF's Orleans, the nomination letters emphasized his broad and pioneering contributions to tobacco control, and his exceptional dedication to communicating his research with great skill, humility and collegiality.
RWJF perspective. The Foundation has always believed that the best research informs the best policies. Its Substance Abuse Policy Research Program, Scholars in Health Policy Research Program, Health & Society Scholars, Active Living Research and Healthy Eating Research and others all encourage studies that not only add to knowledge about determinants of health, but use that knowledge to improve policies and ultimately improve lives.
RWJF has committed more than $57 million to Bridging the Gap. Under Chaloupka's and Johnston's leadership, the program became "one of RWJF's most productive and influential policy research initiatives, far exceeding the aims we envisioned for it," according to Orleans. "Frank and Lloyd and their colleagues have succeeded in generating and communicating a body of evidence that has profoundly shaped the national and international tobacco-control landscape."
Making a difference indeed!
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