Impact Report: Health Policy

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Policy paths and perspectives during the pandemic

In February 2020, Manoj Mohanan walked with Duke alumnus and health changemaker Paul Farmer across the campus from the Sanford Building to Page Auditorium. The venue was packed for the momentous conversation between two global health experts. Just a few weeks later, a world health issue, COVID-19, locked the world down.

Mohanan leaped into the ensuing health crisis. He had already led and collaborated on large-scale research projects studying health policy questions in countries including India, Kenya and Rwanda. His work has identified crucial gaps in the implementation of health care delivery in India, and his work continues today with global organizations to understand how to implement change. As the pandemic unfolded, he explored the consequences of its impact on mental health outcomes and the resilience of future households, receiving a pilot grant to track its long-term effects. The pilot led to a $3.3M grant from the NIH. For this research in global health and on COVID-19 seroprevalence studies in India, he was recognized as one of the 100 Most Influential Academics in Government.

In March 2020, Sanford alumni Ryan Smith MPP’14 and Mariel Beasley MPP’13 recognized the need for more research on best practices, current data and evidence-based solutions for the struggling residents of Durham city and county as they faced the rapid spread of COVID-19.

Smith reached out to Sanford Dean Judith Kelley, who responded. As their summer internships disappeared, there was an opportunity for Sanford students to step in and help with a real-time crisis.

Working with the Durham Recovery & Renewal Task Force, 20 volunteers worked as research assistants – 12 MPP students and recent graduates, one undergraduate public policy major, four students from North Carolina Central University and one from UNC Chapel Hill.

Helping to consult and advise the mayor and county on local policy decisions that affected the lives of residents, these research assistants acted as a “rapid response think tank,” providing memos of best practices and emerging data on responses to COVID-19 to the task force and roundtable members. Helping to consult and advise the mayor and the county commissioner on local policy decisions that affected the lives of residents, these research assistants acted as a “rapid response think tank,” providing memos of best practices and emerging data on responses to COVID-19 to the task force and roundtable members.

Mary Grace Stoneking MPP’21 interned with the Durham City Manager’s office that summer and reflected: “This has taken every skill Sanford teaches in our classes and applied them in a real situation. I didn’t expect to see how a memo from an MPP student can change things in real-time.”

At the state level, Stephanie McGarrah MPP ’00 was appointed to lead the North Carolina Pandemic Recovery Office just three weeks after the North Carolina General Assembly passed a bill establishing the office.

“People love to use the analogy that you're trying to build a plane while you're flying it. And that's sort of what it felt like,” McGarrah said.

McGarrah found herself falling back on the skills she learned while at Sanford. By late 2022, the North Carolina Pandemic Recovery Office had coordinated federal funds received by state agencies and local governments and proper reporting and accounting of all funds, including the $3.6 billion from the Cares Act.

Sanford’s health policy research extended into other health issues even as the pandemic raged: mental health care, health insurance, caregiving for veterans, and more.

Kate Whetten and partners helped provide mental health care to orphans in multiple countries. Researchers trained laypeople as counselors to deliver treatment in both urban and rural communities in Kenya and Tanzania. They evaluated the progress of children and their guardians through sessions of trauma-focused cognitive behavioral therapy. The research demonstrated that lower-cost, scalable mental health solutions are possible for a part of the world where mental health resources are scarce.

Kate Bundorf published a study examining how web-based tools can help people choose insurance plans. The study focused on Medicare Part D, publicly subsidized prescription drug insurance for older adults. The researchers found that providing algorithmic expert recommendation helped people choose among plans. People who used the tool were more likely to switch plans, saved money and generally were more satisfied with the choice process.

By 2028, one in five North Carolinians will be 65 and older. To address the needs of this increasing population, the North Carolina Institute of Medicine (NCIOM) unveiled a set of 12 actionable recommendations aimed at enhancing social connections, falls prevention, food and nutrition security and mobility for the aging population in North Carolina. These recommendations, part of the report "A Place to Thrive: Creating Opportunities to Age Well in North Carolina," were formulated by the Task Force on Healthy Aging, which includes Sanford’s Nathan Boucher. Boucher was appointed to and served on the NC Institute of Medicine Health Aging Task Force during 2022-2023.