Get to know Andrew Anderson, Ph.D., a member of HBHI’s core faculty and assistant professor in the Department of Health Policy & Management at the Johns Hopkins School of Public Health. His work aims to increase the visibility of healthcare needs among historically marginalized populations. Before Hopkins, Andrew was an assistant professor at Tulane University, a research scientist and Phyllis Torda health care quality fellow at the National Committee for Quality Assurance (NCQA), and a director of quality measurement at the National Quality Forum (NQF). He is also a former with the Robert Wood Johnson Foundation (RWJF) health policy research scholar, a RWJF Health Equity Scholar for Action, and a Health Affairs Health Equity Trainee.

 

 

Where did you grow up? Tell us a little bit about your childhood and early life.

I was born into a Jamaican immigrant family, and I lived in Jamaica for a short time after being born in Montgomery County, right outside of D.C. So, parts of my childhood were spent in this somewhat rural town in Jamaica called Port Antonio. It was a very quiet, wholesome childhood, going back and forth between Maryland and Jamaica because my parents wanted me to know my culture and stay connected to my family there. I spent a lot of time with my friends playing outside, climbing trees, picking fruits, and at the beach. I was also a Boy Scout for seven years, from middle school into high school, and I was my troop leader. I went to public schools in Maryland and then went to the University of Maryland. I was considering becoming a biologist, specifically an entomologist—somebody who studies insects. I did some observational research work on a farm during an undergraduate fellowship, which was interesting to me, but the long-term career prospects didn't seem quite what I wanted. From there, I took a kind of windy, but short, path towards public health.

How did you become interested in influencing health policy through research?

I was a clinical research coordinator apprentice at Hopkins in the School of Medicine, where I did some work with their cystic fibrosis clinic. Cystic fibrosis is unique in that it has a huge national registry, where clinicians keep track of a multitude of factors about the people who have this condition—all of their life experiences and their demographic characteristics—and they track closely their clinical outcomes and responses to pharmaceuticals and different treatments, and having this data has led to an incredible doubling of the life expectancy for people with cystic fibrosis. So that's how I started becoming interested in health services research, and then later, interested in the bigger policy questions about why the healthcare landscape looks the way it does. Why is insurance tied to employment? Why is quality so variable based on what doctor you go to or what hospital you go to, and why is it so different for certain groups?

What do you think, if anything, people generally misunderstand about the American healthcare system?

The first thing that comes to mind is that while many people believe the solution to dysfunction in health care is to have a single-payer health system—and it might be—people aren’t thinking deeply enough about the specific outcomes we want to achieve and how the proposed solutions will or won’t get us closer to that. In the U.S., we currently have almost every form of healthcare system that you can imagine having. If you want to look at something that's like say, Germany’s health system, we have Medicare Advantage. If we want to look at something like Canada’s health system, we have traditional Medicare. For something closer to the UK’s health system, we have the VA. We have these microsystems that can teach us about what any of those models could look like in the United States if we were to reform our current system. And I think the lesson from those systems is that the United States is really complicated. Our population is geographically dispersed in weird ways. It's hard to get the reach, the quality, and the range needed. There are a lot of tradeoffs. The good news is that there are lots of improvements that can be made to fix our current system, and we don't necessarily have to throw it out and try to start over with something else.

Are there any developments in health care that give you hope about where we’re headed?

I’m glad to see more recognition of the interconnectedness between public health and healthcare. We’re finding a compromise where clinicians can still maintain their autonomy while also recognizing that they're one point along a spectrum of trying to improve the public's health, which requires collaboration amongst clinicians but also non-medical entities. Something that I learned from my time in New Orleans, is that much of the critical public health gets done by collaborating with non-public health actors to address the issues that impact public health. For instance, New Orleans has one of highest crime rates among cities in America and it influences the health outcomes of the people who live there, and the health care costs as well. So, the local health department there is always thinking about working with law enforcement, working with schools, leveraging all the possible interventions to reduce violence.

How did you get involved with the Hopkins Business of Health Initiative?

I was really excited to get involved with the Business of Health Initiative because the private sector clearly has a central role in the healthcare system, which is largely privatized. I appreciate that HBHI gets people together to think about how we can make that a force for good, how to make profit seeking an engine for positive change. HBHI is also pulling together different units across the university to think about these questions since they're such huge issues. We need people from all the different disciplines working together.

If you could snap your fingers and fix it overnight, what's one thing you'd love to change about U.S. healthcare?

I think we've really been slow to move from volume to value. The fee-for-services model still dominates, and the progress is so slow, and it can almost feel like, is it even worth continuing down this path?  So if I could snap my fingers and do it, I would just move everything over immediately, and then we can evaluate whether or not it's the right solution. It’s where we're going so let's just get it done and then we can course-correct as needed.

Marginalized communities are often portrayed as being at a disadvantage, health-wise, but as a first-generation American, what are some of the strengths that you think immigrant communities have in health and wellbeing?

Well, there's a lot to be said about that. One thing that we don't pay a lot of attention to is the people who are doing well in these communities, across the board. We look at the average person, and we don't look at the upper tail of the distribution. In certain counties in America, the life expectancy for black Americans is higher than those of white Americans within the same county. What does that mean? We can study these examples of positive deviance and learn from those examples and from what those historically marginalized communities are doing well. What are the circumstances that they live in, and how can we replicate that for a larger group of people?

Last question: What do you like to do in your free time?

I love to read, especially novels, and I’m always kind of jumping around genres when it comes to books. Lately I’ve been obsessed with books set around World War Two. I read one and then I jumped on to the next, to the next, to the next… So reading is big for me. I also like listening to interviews and debates, I'll just have those going in the background while I'm cooking or doing things around the house. I like to exercise and basically do anything outdoors, especially taking long walks and running along the water where I live in Fells Point.