Q and A with Alex Hollingsworth

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IUJUR recently sat down with Alex Hollingsworth, a professor of Health Economics at the IU School of Public and Environmental Affairs, to discuss his experience in research, current research topics, and advice for undergraduates who want to get involved in research.

How did you get started in your current field? How did you get involved in research?

I'm a health economist. I graduated with my PhD in 2015. I've been doing research since then. When I was an undergraduate, I was originally a business major and wanted to go to business school. Then I became interested in poverty—I wanted to know why certain countries were poorer than other countries.

The more I got into that, the more I thought I was going to go into economic development. But I wasn't asking the right questions because I didn't have the right institutional detail to be effective in that space.

I realized the best questions that I have enough institutional background to address are related to health in the U.S. So as I was doing work in graduate school, my interest shifted from economic development and poverty to health and welfare within the United States.

My mom is a doctor, my dad worked in insurance. I knew that area better than I thought. One thing leads to another, and you end up meeting people working on other papers and it kind of snowballs into your research agenda. But all that is motivated by trying to figure out public policies or regulations that are welfare-improving. Specifically, I ended up doing research on substance abuse and energy policy.

I started off being more interested in energy policy, and how certain types of regulations, like reducing fossil fuel in our electricity mix, may decrease air pollution or change downwind mortality. Through that effort, I collected a lot of data on mortality and emergency department visits.

I started reading a lot about the recent opioid crisis and a colleague and I decided that the data I collected could be used to explore the crisis. We looked into it and found that when there is a large unemployment shock, adverse opioid events increase, meaning more deaths and more emergency department visits.

After working in that space and diving deep into one question, you're left with more unanswered questions than you have answers. Maybe you answer one or two things, but now you have twenty more questions. So it's just developed a whole other series of papers.

 

It sounds like when you started out in your undergraduate career, you didn't really have research as one of your main focuses. What does research mean to you now?

I was probably always the type of person that would do research, I just didn't necessarily know what I was doing. It's not like I would sit around and go to Google Scholar and find papers when I was in high school—I don't know if Google Scholar was around then.

But I didn't quite have the right framework to move into academic research until I was in college. I started seeing what my professors were doing, and gradually, my interest in research burgeoned. They weren't just people that taught classes. If anything, that was just a minor role in what they were doing. They had this sort of behind-the-scenes life that came out of what seeing they were working on.

 

What is health economics?

Others may disagree with this, but I view health economics as a questions-based field. You could have many questions and someone would say, "Oh, yeah, that's related to health," with different approaches.

Economics has a standard toolkit for doing things, but even within economics, some tools are more used in certain fields than others, and in health you could see a variety of papers that approach similar questions. It's the questions that are more unifying than the techniques. One project might be totally theory and one might be based more on machine learning—both could be health economics.

 

Is there anyone's research or work that inspires you?

There's lots of people, in particular my colleagues here at SPEA. Kosali Simon, Coady Wing, Victoria Perez, and Seth Freedman are all health economists who do wonderful work. When you see what they work on, it keeps you going. We get an email every time they publish something. It's kind of neat.

 

In summer 2017, you participated in a Bike Listening Tour, a bike ride that involved talking to strangers about their views of the Affordable Care Act. What was that experience like?

It was a great experience. The lead author, Paul Gordon is a physician at the University of Arizona. I met him there when I was working on my PhD. He was on a sabbatical and he was traveling across the country on a bike, which he planned before I got involved.

He, as a physician and a medical educator, realized that while people don't like the ACA, they don't seem to understand it. He wanted to elucidate the reasons why people didn't like it. The former dean of Arizona's medical college, Jim Dalen had previously done a survey where they telephoned people and essentially asked, "Why don't you like the ACA?"

They found out that most people didn't like the ACA because they didn't like the government intruding on their lives. But oddly, most people got the majority of their information from 2012 political advertisements on television, which is not ideal. Paul thought that during his bike ride across the country on his sabbatical, it would also be a nice opportunity to do some long-form interviews with people about this issue.

My wife and I joined Paul for the portion of the ride across Ohio. While I was on that section, we talked about the paper, talking about how he was doing the interviews and I participated in a few. Every time they collected data, we would talk about the interviews.

I was involved with every stage thereafter, including the write-up. It was a pretty interesting project. Hearing what people think is really interesting, ignoring whatever opinion you have on the ACA. When you are pushed to explain any political issue past the initial talking points, you realize immediately how little you might understand about it. People have strong opinions, but they may not fully understand an issue.

 

When writing up the paper about the Bike Listening Tour, how did you transform interviews into quantifiable, digestible data?

They call that grounded theory. It's basically this idea that you don't start off with a traditional theory to prove or disprove. You let the data (that is, people’s lived experiences and thoughts) do the talking, you try to let the interviews speak for themselves. As you talk with people, you figure out the topics they're discussing. It is informative.

You could see, even in the few interviews that I participated in, the same themes emerging. People hated high deductibles, they hated higher premiums, they had some aversion to Obama, and some dislike to the idea that they were paying for other people who weren't taking care of themselves.

These are all valid concerns in certain lights, but it was without the full understanding of how the policy worked. But that wasn't our point. Our point was not to go out and teach people about the ACA, it was just to document what they don't like. Our survey was not representative of the entire U.S., but I think it was representative of the places that we went.

 

What projects are you currently working on or plan to work on in the future?

I'm currently working on a few papers related to substance abuse issues. We're looking at the legalization of marijuana and how that affects alcohol sales. We're finding heterogeneous and differential effects there: increases in cases of light beer sold but decreases in hard liquor and pints and things like that sold. When you regulate one good, marijuana, it might have effects on some other psychoactive substances as well, like alcohol.

I'm also working on some pollution regulation projects, looking at the effect of requirements to have a certain percentage of your electricity grid be from renewable sources and how that impacts coal production in other states. We have some preliminary work linking that to human health outcomes. Those are the two main strands I'm working on—a couple things related to the ACA as well, but that's not my primary area of research.

 

There have been a lot of changes to American healthcare in the past year. How does that affect your work?

As a policy researcher, often you benefit from interesting policies that are created. Today the rule is this, tomorrow the rule is that, but only in some places, and now you've set up something like a control group here and there. Regardless of my personal opinions, as a researcher, it's exciting to be able to see what might happen as incentives change. For example, when the individual mandate is changed—how do people to respond to that? I'm hopeful that that will help us design more effective policies in the future.

 

How do you think that academic research has a dialogue with policy?

There definitely is a dialogue. Many faculty here do work on Medicaid and the impact of the Affordable Care Act and Medicaid expansions on many different things, such as insurance take up, but also potential impacts on health and spending. Policy makers look to those results to justify decisions regarding insurance expansions or the use and funding of certain programs. Policy makers take this work seriously.

 

What research experience has been the most rewarding or the most challenging for you?

I really like working with other researchers. Working on projects with my co-authors here at SPEA and at other places has been the most rewarding because I get to bounce ideas off of them and the work is better for it. Any project where it's been collaborative has been rewarding, regardless of the topic.

Probably the most challenging has been working on the opioid and other mortality-related projects. I'll be working on my computer and I’ll have a realization every now and then that each one of these numbers is a human that died. I heard another researcher at Johns Hopkins once say that he can feel the body count.

I have moments where I feel the same and it's a little depressing. Sometimes you are too zoomed out, running regressions and plots points and then you’ll realize that these points represent humans that have died. It can be sobering.

But ultimately, the work is about learning and finding policies or situations that have contributed to the cause and things that might help. That's the goal, but it's a long slog. Even if I find something today, and I become convinced that this it important, it's the body of work that makes an impact. It's a complex, multidimensional issue.

 

Do you have any advice for undergraduates who want to get involved in research?

Just contact faculty, keep pushing. Find something you're really interested in doing. If you're not at all interested in it, you'll quickly burn out. Don't wait for the opportunities to come to you. Go find them—they are there. And almost every one of your professors has another life that you might not see where they do research, so go figure out what you want to do and become a part of it.