2023

Lifting All Communities

Roshan Bastani and Naomi Zewde
Dr. Roshan Bastani and Dr. Naomi Zewde

Healthy People 2030, the U.S. Department of Health and Human Services’ data-driven objectives for improving the nation’s health, defines health equity as “the attainment of the highest level of health for all people.” Within the UCLA Fielding School of Public Health’s first five years, the civil rights movement and the passage of historic Medicare and Medicaid legislation suggested the country was making progress toward that lofty goal. But today, wide gaps persist across communities in health and healthcare, driven by factors such as discrimination, income, housing, and education. One’s ZIP code remains a better predictor of life expectancy than their genetic code. And although the Affordable Care Act brought advances, the U.S. remains an outlier among high-income countries in not providing universal healthcare.

Addressing gaps in equity and advancing health through partnerships with communities and policymakers has been a defining characteristic of work at UCLA Fielding since its inception. Dr. Roshan Bastani (image, left), FSPH professor of health policy and management and director of the FSPH-based UCLA Kaiser Permanente Center for Health Equity, has been a leader in that effort since joining the school’s faculty in 1987. Bastani, a social and health psychologist, has devoted her career to address- ing disparities in cancer and other health outcomes through rigorous research and pragmatic interventions, working in close partnership with communities. Dr. Naomi Zewde (image, right), who came to the school in 2022 as an assistant professor of health policy and management, is a public policy scholar who focuses on how public institutions can deliver health, medical care, and economic security across the income distribution — and strategies for compressing that distribution to enhance equity.

ALTHOUGH YOUR WORK IS VERY DIFFERENT, BOTH OF YOU APPLY YOUR EXPERTISE TO PURSUING HEALTH EQUITY. WHY IS THAT SO IMPORTANT TO YOU?

NAOMI ZEWDE: The U.S. does such a poor job of equitably financing healthcare. We definitely can do it; other countries have figured it out. It’s economically feasible, administratively feasible, but something prevents us from using democratic levers in our collective best interests. Why can’t the 99% get a better healthcare system? I care about that.

ROSHAN BASTANI: I grew up in India and saw a lot of inequities in the social factors that drive disparities in health and healthcare. With my training in social psychology, I felt I could contribute what I had learned about drivers of human behavior to help disadvantaged groups overcome some of the barriers conferred by broader social factors. No matter what the disease, it is the same marginalized populations that experience disparities, resulting from the interactions of biology with the social environment. That is something I have worked to change.

HOW HAS PUBLIC HEALTH’S APPROACH TO HEALTH EQUITY ISSUES EVOLVED IN THE TIME YOU’VE BEEN IN THE FIELD?

RB: Early in my career, the approach among many academics was that “I know how to do this; I’m going to come and save you.” That’s the wrong attitude. The people who know better are the ones who are experiencing the inequities and the people on the ground working with those groups. We have seen a gradual evolution over time toward collaboration and working with what we call community assets, which are present in all communities. We have also learned that it is important to tailor our approaches to the particular context and population characteristics of the groups we are trying to assist.

NZ: In terms of insurance, when I began my career there was a belief that the consumer-directed health plan should have high deductibles so that consumers would price shop and have skin in the game. Over time, deductibles have increased, but that price shopping hasn’t driven savings. People still go to their doctor, their doctor tells them what to do, and they end up financially burdened. Today’s cost-savings innovations are more on the supply side — prior authorizations, narrow networks, managed care. The problem is that these generate their own inequalities. If you have less English fluency, you’re less likely to overcome a prior authorization, for example. So it’s still an evolving landscape in terms of how we get people the care they need.

The other change I’ve noticed is that people talk about race much more now. I don’t know where that will lead, but it’s a reflection of trying to make progress on these big, important issues. It’s a signal, for people like myself, that we have opportunities to express what a better world could look like.

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WHAT HAVE YOU FOUND TO BE THE BEST WAY YOU CAN MAKE A DIFFERENCE IN ADVANCING THE POLICIES THAT WOULD PROMOTE EQUITY?

NZ: A lot of it is around advocacy. I’ve come to understand that being an activist is a job, and that my role is to provide information that can help activists build power. At FSPH, the California Health Interview Survey [CHIS] is great because it provides representative data on different populations. When communities go to legislators with concerns, they have stories, but to be able to back those up with data is a powerful way to communicate. As academics, we produce data that supply activists with facts they can use as fuel. Rooted in research but understanding the needs of advocates, we can contribute to building better structures.

RB: You do need legislators who are open to listening. In California, we have that. That’s not true in many parts of the country, where there are entrenched beliefs that are difficult to change. Look at the issue of gun violence. How many deaths do we need to have meaningful gun legislation? We saw how divisive mask and vaccine mandates were. In many cases, we know the answers in public health, but it’s not so easy to achieve necessary policies. That doesn’t mean we don’t keep trying until we do achieve the change we are seeking. Tobacco product pricing and smoking restrictions are great examples of persistence.

DR. ZEWDE, YOU CAME TO UCLA FIELDING ONLY RECENTLY. WHAT WAS THE DRAW FOR YOU?

NZ: The first thing I learned about the school was that I was teaching out of Tom Rice’s [FSPH distinguished professor of health policy and management] textbook, “The Economics of Health Reconsidered,” and it was one of the only health-econ textbooks with anything critical to say about the market for health insurance. We have to teach students the theoretical justifications for the American healthcare system so they can understand why our policies were designed the way they were and how the system functions. But those policies are quite problematic, so the fact that this textbook takes a critical look was really useful. After that I came to learn about Jerry Kominski’s [professor emeritus of health policy and management] work, which was instrumental in reducing the burden of deductibles under the Affordable Care Act in California.

AND DR. BASTANI, WHAT WAS THE SCHOOL’S APPEAL FOR YOU WHEN YOU ARRIVED IN 1987?

RB: How applied the research was. I was trained in social psychology, which is much more theoretical. What I loved about FSPH was that everything was done in the real world. One of my first mentors here was Lester Breslow, the former dean of the school who had served as director of public health for California. I had never met anyone like him, who was not just about academics and publishing papers. He took me under his wing, and I couldn’t believe all of the opportunities I was exposed to for real-world impact.

WHAT DO YOU SEE AS THE SCHOOL’S STRENGTHS OVER THE YEARS IN THE FIELD OF HEALTH EQUITY?

RB: Our faculty focused on health equity well before it became such a central issue — before the term “health disparities” even existed. And what has distinguished the school’s work all along is not blaming individuals — not saying, “they’re not doing this, they’re not doing that, how can we make them change,” but instead focusing on the larger societal and system structures that produce health inequities. If we change the system, policies, and healthcare providers, we’re going to do more in the long run than if we focus on what the patient or individual “did wrong.”

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WHAT MAKES YOU HOPEFUL THAT PROGRESS CAN BE MADE IN HEALTH EQUITY?

NZ: I feel optimistic. Take climate change. The vast majority of people want meaningful improvement. There are solutions out there, and we live in a democracy. Maybe it’s to be expected that change doesn’t occur overnight. But all we can do is keep moving forward.

RB: There are many examples in public health’s recent past that should give us cause for optimism. Cervical cancer was a major killer in this country and it is almost nonexistent now, although it’s still a major health issue in other parts of the world. We did that. When I was starting, approximately 20% of eligible women were getting mammograms. Now it’s over 80%. But it didn’t happen overnight; it took decades. Same with tobacco — there was a lot of resistance, but over time, most states have adopted the policies that were successful in California. We just have to persist, and over time I believe that change will happen.

Faculty Referenced in this Article

Roshan Bastani Headshot
Roshan Bastani
Health Policy and Management
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Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
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Dr. Lillian Gelberg
Lillian Gelberg
Health Policy and Management
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Faculty/staff profile placeholder image
Annette Maxwell
Health Policy and Management
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Vilsa Eliana Curto
Vilsa Eliana Curto
Health Policy and Management
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Dr. William McCarthy
William J. McCarthy
Health Policy and Management
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Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
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Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
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Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
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Dr. Jennifer Wortham
Jennifer Wortham
Health Policy and Management
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Faculty/staff profile placeholder image
Jose J. Escarce
Health Policy and Management
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Faculty/staff profile placeholder image
Lori Pelliccioni
Health Policy and Management
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Vickie Mays
Vickie Mays
Health Policy and Management
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Faculty/staff profile placeholder image
Thomas Priselac
Health Policy and Management
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Dr. Aria Fallah
Aria Fallah
Health Policy and Management
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Mangione, C
Carol Mangione
Health Policy and Management
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Faculty/staff profile placeholder image
Barbara Berman
Health Policy and Management
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Emily Abel
Emily Abel
Health Policy and Management
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Leah Vriesman
Leah Vriesman
Health Policy and Management
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Faculty/staff profile placeholder image
Steven Teutsch
Health Policy and Management
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Dr. Beth Glenn
Beth Glenn
Health Policy and Management
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Dr. Risha Gidwani
Risha Gidwani
Health Policy and Management
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Rosenstock
Linda Rosenstock
Environmental Health Sciences Health Policy and Management
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Faculty/staff profile placeholder image
Neal Halfon
Health Policy and Management
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Diana Hilberman
Diana Hilberman
Health Policy and Management
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Nadereh Pourat
Nadereh Pourat
Health Policy and Management
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Dr. John Lu
Z. John Lu
Health Policy and Management
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Image of Dr. Susan Ettner
Susan Ettner
Health Policy and Management
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Faculty/staff profile placeholder image
Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

Health Policy and Management
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Faculty/staff profile placeholder image
Alan Tomines
Health Policy and Management
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Warren Scott Comulada
Warren Scott Comulada
Health Policy and Management
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Faculty/staff profile placeholder image
Robert Brook
Health Policy and Management
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Gerald Kominski
Gerald Kominski
Health Policy and Management
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Paul Chung
Paul Chung
Health Policy and Management
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Dr. Kristen Choi
Kristen Choi
Health Policy and Management
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Ron D. Hays
Ron D. Hays

@UCLA since 1997

Health Policy and Management
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Faculty/staff profile placeholder image
Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
Read Faculty Profile
Dr. Paul Fu, Jr.
Paul Fu, Jr.
Health Policy and Management
Read Faculty Profile
Freund, Deborah
Deborah Anne Freund
Health Policy and Management
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silhoette
Ty Robbins
Health Policy and Management
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Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
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Jack Needleman
Jack Needleman
Health Policy and Management
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Laura Erskine
Laura Erskine
Health Policy and Management
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Dr. Dylan Roby
Dylan Roby
Health Policy and Management
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Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
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Corrina Moucheraud
Corrina Moucheraud
Health Policy and Management
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Dr. Samuel Sessions
Samuel Sessions
Health Policy and Management
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Burt Cowgill
Burt Cowgill
Health Policy and Management
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Davidson - headshop
Pamela Davidson
Health Policy and Management
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Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
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Galper, Michael
Michael Galper
Health Policy and Management
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Dr. Alice Kuo
Alice Kuo
Health Policy and Management
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Patricia Ganz
Patricia Ganz
Health Policy and Management
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Dr. Yvonne Flores
Yvonne Flores
Health Policy and Management
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Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
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Dr. Frederick Zimmerman
Frederick Zimmerman
Health Policy and Management
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Faculty/staff profile placeholder image
Emmeline Chuang
Health Policy and Management
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Faculty/staff profile placeholder image
Mark Litwin
Health Policy and Management
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Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
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Avram Kaplan
Avram Kaplan
Health Policy and Management
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Dr. Felicia Hodge
Felicia Hodge
Health Policy and Management
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Dr. Thomas Rice
Thomas Rice
Health Policy and Management
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Jeanne Miranda
Jeanne Miranda
Health Policy and Management
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Faculty/staff profile placeholder image
David Hayes-Bautista
Health Policy and Management
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Moira Inkelas
Moira Inkelas
Health Policy and Management
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Clifford Ko
Clifford Ko
Health Policy and Management
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Faculty/staff profile placeholder image
Brennan Spiegel
Health Policy and Management
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Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
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Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
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Olivia Jung
Olivia Jung
Health Policy and Management
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James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
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Dr. Xi Zhu
Xi Zhu
Health Policy and Management
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Dr. Elizabeth (Becky) Yano
Elizabeth (Becky) Yano
Health Policy and Management
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Dr. Jonathan Fielding
Jonathan Fielding
Health Policy and Management
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Dr. Anthony Schiff
Anthony Hunter Schiff
Health Policy and Management
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Gordon headshot
Thomas D. Gordon
Health Policy and Management
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Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
Health Policy and Management
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Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
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Faculty/staff profile placeholder image
Arlene Fink
Health Policy and Management
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Comanor, Bill
William Comanor
Health Policy and Management
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Robert Kaplan
Robert Kaplan
Health Policy and Management
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Michael Ong
Michael Ong
Health Policy and Management
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Balgrosky headshot
Jean Balgrosky
Health Policy and Management
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Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
Read Faculty Profile
Dr. Thomas Rice
Thomas Rice
Health Policy and Management
Read Faculty Profile
Gerald Kominski
Gerald Kominski
Health Policy and Management
Read Faculty Profile
Dr. Aria Fallah
Aria Fallah
Health Policy and Management
Read Faculty Profile
Image of Dr. Susan Ettner
Susan Ettner
Health Policy and Management
Read Faculty Profile
Dr. Xi Zhu
Xi Zhu
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Thomas Priselac
Health Policy and Management
Read Faculty Profile
Dr. Alice Kuo
Alice Kuo
Health Policy and Management
Read Faculty Profile
Dr. Felicia Hodge
Felicia Hodge
Health Policy and Management
Read Faculty Profile
Rosenstock
Linda Rosenstock
Environmental Health Sciences Health Policy and Management
Read Faculty Profile
silhoette
Ty Robbins
Health Policy and Management
Read Faculty Profile
Avram Kaplan
Avram Kaplan
Health Policy and Management
Read Faculty Profile
Vilsa Eliana Curto
Vilsa Eliana Curto
Health Policy and Management
Read Faculty Profile
Dr. John Lu
Z. John Lu
Health Policy and Management
Read Faculty Profile
Dr. Samuel Sessions
Samuel Sessions
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Barbara Berman
Health Policy and Management
Read Faculty Profile
Dr. Anthony Schiff
Anthony Hunter Schiff
Health Policy and Management
Read Faculty Profile
Emily Abel
Emily Abel
Health Policy and Management
Read Faculty Profile
Gordon headshot
Thomas D. Gordon
Health Policy and Management
Read Faculty Profile
Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Lori Pelliccioni
Health Policy and Management
Read Faculty Profile
Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
Read Faculty Profile
Freund, Deborah
Deborah Anne Freund
Health Policy and Management
Read Faculty Profile
Dr. Yvonne Flores
Yvonne Flores
Health Policy and Management
Read Faculty Profile
Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
Read Faculty Profile
Olivia Jung
Olivia Jung
Health Policy and Management
Read Faculty Profile
Dr. Kristen Choi
Kristen Choi
Health Policy and Management
Read Faculty Profile
Balgrosky headshot
Jean Balgrosky
Health Policy and Management
Read Faculty Profile
Dr. Paul Fu, Jr.
Paul Fu, Jr.
Health Policy and Management
Read Faculty Profile
Dr. Jonathan Fielding
Jonathan Fielding
Health Policy and Management
Read Faculty Profile
Davidson - headshop
Pamela Davidson
Health Policy and Management
Read Faculty Profile
Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
Read Faculty Profile
Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
Read Faculty Profile
Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Neal Halfon
Health Policy and Management
Read Faculty Profile
Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
Read Faculty Profile
Nadereh Pourat
Nadereh Pourat
Health Policy and Management
Read Faculty Profile
Dr. Jennifer Wortham
Jennifer Wortham
Health Policy and Management
Read Faculty Profile
Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
Read Faculty Profile
Jeanne Miranda
Jeanne Miranda
Health Policy and Management
Read Faculty Profile
Dr. Dylan Roby
Dylan Roby
Health Policy and Management
Read Faculty Profile
Leah Vriesman
Leah Vriesman
Health Policy and Management
Read Faculty Profile
Dr. William McCarthy
William J. McCarthy
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
David Hayes-Bautista
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Alan Tomines
Health Policy and Management
Read Faculty Profile
Comanor, Bill
William Comanor
Health Policy and Management
Read Faculty Profile
James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
Read Faculty Profile
Ron D. Hays
Ron D. Hays

@UCLA since 1997

Health Policy and Management
Read Faculty Profile
Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
Health Policy and Management
Read Faculty Profile
Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
Read Faculty Profile
Patricia Ganz
Patricia Ganz
Health Policy and Management
Read Faculty Profile
Dr. Lillian Gelberg
Lillian Gelberg
Health Policy and Management
Read Faculty Profile
Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
Read Faculty Profile
Corrina Moucheraud
Corrina Moucheraud
Health Policy and Management
Read Faculty Profile
Laura Erskine
Laura Erskine
Health Policy and Management
Read Faculty Profile
Diana Hilberman
Diana Hilberman
Health Policy and Management
Read Faculty Profile
Jack Needleman
Jack Needleman
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Arlene Fink
Health Policy and Management
Read Faculty Profile
Burt Cowgill
Burt Cowgill
Health Policy and Management
Read Faculty Profile
Dr. Elizabeth (Becky) Yano
Elizabeth (Becky) Yano
Health Policy and Management
Read Faculty Profile
Dr. Risha Gidwani
Risha Gidwani
Health Policy and Management
Read Faculty Profile
Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
Read Faculty Profile
Vickie Mays
Vickie Mays
Health Policy and Management
Read Faculty Profile
Dr. Beth Glenn
Beth Glenn
Health Policy and Management
Read Faculty Profile
Clifford Ko
Clifford Ko
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Jose J. Escarce
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Steven Teutsch
Health Policy and Management
Read Faculty Profile
Paul Chung
Paul Chung
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Brennan Spiegel
Health Policy and Management
Read Faculty Profile
Dr. Frederick Zimmerman
Frederick Zimmerman
Health Policy and Management
Read Faculty Profile
Galper, Michael
Michael Galper
Health Policy and Management
Read Faculty Profile
Roshan Bastani Headshot
Roshan Bastani
Health Policy and Management
Read Faculty Profile
Michael Ong
Michael Ong
Health Policy and Management
Read Faculty Profile
Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Emmeline Chuang
Health Policy and Management
Read Faculty Profile
Robert Kaplan
Robert Kaplan
Health Policy and Management
Read Faculty Profile
Moira Inkelas
Moira Inkelas
Health Policy and Management
Read Faculty Profile
Mangione, C
Carol Mangione
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Robert Brook
Health Policy and Management
Read Faculty Profile
Warren Scott Comulada
Warren Scott Comulada
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Mark Litwin
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Annette Maxwell
Health Policy and Management
Read Faculty Profile
Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
Read Faculty Profile

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