Health's biggest breakthroughs are happening at the local level

From air pollution in Bangladesh and antimicrobial resistance in Kenya to digital mental health interventions for young adults, Stanford King Center scholars are working alongside local partners to address some of the world's most pressing health challenges. Their research shares a common premise: effective solutions require local evidence, local partnerships, and a deep understanding of context. 

In Bangladesh, traditional coal-burning brick kilns are responsible for 17 percent of the country’s annual carbon dioxide emissions and 11 percent of its fine particulate matter, which can be inhaled and cause serious health problems.

Stanford’s Dr. Stephen Luby, professor of medicine, has led ongoing research and interventions to reduce emissions from such kilns, supported by the Stanford King Center on Global Development. Now, with Luby’s guidance, PhD student Parastou Ghazi, MA ’25, plans to study the long-term mortality effects of brick kiln pollution.

“A lot of public health work is packaging known truths into the context you’re working in,” says Ghazi. “We know air pollution is bad, but when you look at countries where air pollution is most pervasive, we don’t have local data.” Ghazi will combine machine-learning, satellite-derived pollution estimates, weather data, and monitors to measure pollution on the ground.

Ghazi’s study, for which she hopes to have preliminary results by the end of the year, is just one of many health-related projects the King Center supports around the world as it seeks to identify effective policies and programs to ensure healthy lives and wellbeing for all. King Center faculty, postdoctoral and predoctoral scholars, graduate students, and undergraduates across a variety of disciplines are working on research ranging from the use of artificial intelligence in digital mental health platforms to combating antibiotic resistance in vulnerable populations.

“Improving health is both an end in itself and a driver of broader development outcomes,” says King Center Faculty Director Katherine Casey, who is also the RoAnn Costin Professor of Political Economy at the Stanford Graduate School of Business. “Progress on health, for example, can further improve educational attainment and labor productivity.”  

‘Low-Hanging Fruits’

Efforts to reduce pollution from brick kilns in Bangladesh are part of Luby’s strategy to target the “low-hanging fruits” of public health work, Ghazi says.

Ghazi came to Stanford as a master’s student in part for the chance to study with Luby, who became her advisor.

“The mission of the lab is very solutions oriented,” she says.  

Brooks, who was a King Center graduate student fellow for the 2019-2020 academic year, worked with Luby and others to study the short-term health effects of exposure to brick kiln pollution. Working with another King Center team, the former Data for Development initiative, she also used satellite imagery and machine learning to show that existing regulations banning kilns near schools and health facilities were not being enforced.

Brooks’ randomized control study determined that among nearly 300 kiln owners in the country, interventions led to a 23 percent reduction in energy used to fire the bricks and a 20 percent reduction in both carbon dioxide and particulate matter.

Ghazi’s work, in contrast, will be retrospective in nature. In the region of Matlab, Bangladesh, building on existing data from the longest-running demographic survey in the Global South and conducting her own original research, she will evaluate mortality trends in communities downwind of the district’s two dozen kilns between 2000 and 2022.

“If someone is born in a household downwind of a brick kiln and they live there their whole life, how much longer could they have lived if they didn’t?” Ghazi asks. “What’s unique in this work is we have a solution. Now, if we can demonstrate how the exposure is actually affecting population health, we can really build public health investment for the intervention.”

Luby is also involved in another of the longest-running health-related King Center initiatives, the Initiative on Combating Lead Exposure, which has had an enormous impact in Bangladesh and other countries. The results, published in 2023, were dramatic. In 2019, before the multi-pronged intervention, 47 percent of market turmeric samples contained lead; in 2021, none of the samples did. Evidence of adulteration at turmeric mills—previously at 30 percent of mills—also dropped to zero, and the blood lead levels of workers at turmeric mills decreased in some cases by as much as 49 percent.

Led by King Center Affiliated Researcher Jenna Forsyth, PhD ’19, a team of Stanford researchers and local partners first identified that turmeric adulterated with the pigment lead chromate was a major source of lead in Bangladesh (the pigment makes the turmeric a brighter yellow). Next, they planned and implemented an 18-month intervention that included a public awareness campaign about the illegality of the adulteration, informational meetings with turmeric producers and processors, and a raid on wholesale markets with on-the-spot prosecutions of people found to have violated the law.

The initiative has since expanded its focus to other sources of lead such as unregulated battery recycling, and to other countries, including India, Pakistan, and Georgia.

Using AI to Improve Digital Mental Health Interventions

While some King Center scholars focus on environmental and infectious disease challenges, others are exploring how technology can expand access to care. King Center Postdoctoral Fellow Ananya Bhattacharjee studies how AI can improve the delivery of mental health interventions. The former Microsoft Research intern—he worked on training the company’s AI Copilot in empathy and understanding—is interested in the human-computer interaction, or how technology can help people in their daily lives.

At the King Center, Bhattacharjee is conducting a study that tests how the personalized delivery of mental health interventions impacts users’ experience. Generally, an intervention—such as a meditation exercise or a nudge to take some action—is delivered through a digital health delivery platform that decides, based on the user’s input, what content to deliver.

Bhattacharjee is working with Professors Emma Brunskill and Diyi Yang  to test a system that could, based on its evaluation of various inputs, choose from a variety of content delivery methods, depending on whether a person would be more receptive to a video, text, audio message, or some other format.

“Our idea is to enable this effort where the experience is generated based on your needs, preferences, and context,” he says.

Bhattacharjee and his team are now studying how this new approach works for young adults in North America, where many people turn to digital tools before seeking formal care. Early findings show promise for stress reduction, and the team aims to expand these tools for use in low- and middle-income countries, where barriers to accessing mental health services are substantially higher.

Digital mental health tools “are a way to provide scalable mental health,” Bhattacharjee says. “People can seek support any time on their own, with less barriers than seeking formal therapy.”

Gut Check

King Center Faculty Affiliate Ami S. Bhatt, a professor of medicine and genetics, has spent years studying how the microbiome affects cardiometabolic diseases like cancer among people in Africa, including in rural and urban communities in Burkina Faso, Ghana, Kenya, and South Africa. Her work helps correct an imbalance in gut health studies, which have focused mostly on the developed world.

With the support of the King Center, some of Bhatt’s current work focuses on antibiotic or antimicrobial resistance (AMR) in informal settlements in Kenya. AMR is a major problem around the world, especially in low- and middle-income countries where the rate of infectious disease is higher. Bhatt and her team hypothesize that the conditions in informal settlements—including lack of access to clean water and poor sanitation—may increase the spread of AMR.

“If we find that the lack of proper latrines and toilet facilities is actually contributing to the spread of these multi-drug resistant organisms and antibiotic-resistant genes, that suggests that infrastructural improvements could be a way to curb the spread of these genes and dangerous organisms,” she says.

To better understand how antibiotic resistance spreads through vulnerable communities, Bhatt and her local partners, including the AWI-Gen Collaborative Centre, are collecting biological and environmental samples from informal settlements. They are using advanced DNA sequencing methods to identify which organisms are carrying antibiotic-resistant genes. Next, they will sample wastewater at each location. The idea is to learn more about how to identify, eliminate, and screen for AMR in communities.

The work has relevance around the world. Bhatt pointed out that AMR is a challenge for all countries, noting the spread of MRSA in the United States from hospitals to local populations.

“We live in a connected world,” she says. “People and their microbiomes are traveling on planes all the time. As a consequence, issues that are arising in specific geographic areas far away from where we live, will eventually come knocking at our door.”

Antimicrobial resistance is the focus of another King Center scholar as well. Postdoctoral Fellow Carlos Paramo’s work has studied the impact of incentivizing the use of diagnostic tests before malaria treatment to prevent people who do not actually have malaria from receiving treatment, which can lead to the spread of AMR. The research is based on an experiment that uses data from 140 pharmacies in Kenya, a high-malaria-prevalence country where nonetheless about 75 percent of people who purchase antimalarial drugs are negative for malaria.

“Malaria medications have become a very important tool for reducing mortality, but they are a tool for which effectiveness goes down if the parasites become resistant,” he says. “Obviously, we want to use them when it’s necessary and avoid using them when it’s not.”

Paramo and his team work closely with Maisha Meds, a provider of digital software for pharmacies that uses its data and customer relationships to test patient and provider incentives to improve health policies. They found that providing incentives for treatment based on the use of a diagnostic test reduced unnecessary treatment costs more than simply providing free tests. Compared to a control group, patients in the treatment groups were up to 23 percent more likely to have a diagnosis prior to purchasing malaria drugs, and, overall, use of malaria drugs dropped by 12 percent because patients who tested negative didn’t buy the drugs. 

“It ends up being a win-win,” he says. “Health care systems save money because they don’t have to spend on every patient a provider sees; and patients end up saving money because they don’t have to spend money on treatment.”

Paramo, who will join Boston University as an assistant professor of economics this summer, also worked with Maisha Meds for his dissertation and job market paper. His earlier research showed that healthcare providers play a critical role in the adoption of new health technologies. Studying contraceptive delivery in Kenya, he found that provider recommendations often matter as much as price incentives in shaping patient decisions. Together, his findings suggest that successful health interventions must account for both patient and provider behavior.

“This doesn’t mean that reducing prices to the patient doesn’t work,” he says. “It just means, if there is an effect on adoption from reducing prices, it’s sometimes being driven by the provider’s response rather than the patients.”

Taken together, Paramo said his research can help point policymakers in the right direction when choosing how to provide incentives to tackle a public health problem.

“When you’re trying to increase adoption of a simple health technology—like bed nets—that doesn’t require much information… price reductions can be very effective and very cost effective,” he says. “But, when you have more complex medical decisions, the decision is no longer a one-person decision, it’s a joint choice between a patient and a provider. Getting it right on who to target is quite important.”

Seeking Solutions Where They Are Most Needed

At the King Center, other health-related research includes an initiative to track HIV transmission through wastewater in South Africa; an effort to identify culturally relevant suicide prevention strategies in Lesotho, which has the highest suicide rate in the world; a study of whether non-cash incentives can increase blood donation in Sierra Leone; and an experiment seeking to improve the effectiveness of community health workers in India.

The projects span subject areas—economics, epidemiology, and computer science, among others—and address distinct challenges, but they share a common goal: working with local communities to identify sustainable solutions.

Whether addressing disease transmission, delivery of health services, or environmental health risks, King Center scholars share a commitment to generating evidence where it is most needed and translating research into practical solutions. By partnering with local communities and institutions, they are helping build healthier futures while advancing knowledge that can inform policy around the world. 

That’s Ghazi’s aim in Bangladesh. The data she is seeking—on the long-term mortality effects of brick kiln pollution—doesn’t exist. But she knows how to build on what does exist to collect the data herself.

“For local solutions, you need local evidence,” she says. “We shouldn’t choose where we work just based on whether there is data. If we are savvy enough, if we are collaborating with people within a country at their own institutions, we should be able to figure out ways to do research where the problems are the most pervasive.”