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Steve Wallace |
As chairperson of the American Public Health Association's Gerontological Health Section, Steven P. Wallace has led an effort to raise the profile of aging issues. Most prominently, he has provided expertise and direction in the association's planning of Public Health Week (April 4-10), whose theme this year is healthy aging.
One would think that at a time when Americans are living longer than ever and the first baby boomers are approaching their 60s, healthy aging would find a ready audience. But that isn't always the case, notes Wallace, associate director for public service at the UCLA Center for Health Policy Research and a professor in the UCLA School of Public Health. "When you ask people what age they consider old, it always seems to be 5-10 years older than they are," he says. "There's a stigma attached to old age - and yet, we're all aging, regardless of how old we are."
Wallace's interest in the issue of aging and inequality as it pertains to minority elderly groups is rooted in his upbringing. The son of a political scientist father whose family lost 23 members in the Holocaust, Wallace grew up in a home in which dinner-table conversations frequently focused on societal problems. As an undergraduate at UC Santa Cruz, he initially majored in chemistry with plans to go to medical school. But he quickly discovered that his passions were less in clinical medicine than in how social factors influence the health of individuals and populations. By his senior year, Wallace had switched majors to sociology. Once he decided that medical school wasn't for him, Wallace enrolled in a Ph.D. program in medical sociology at UC San Francisco, where he would train under Carroll Estes, a national leader in gerontological research and social policy. Wallace's interest in pursuing that line of research was reinforced by weekly dinners throughout his undergraduate years at the home of his grandparents, who lived in Santa Cruz. "When I got to San Francisco, I would often think about my grandparents and the issues they were facing," Wallace says. "It helped to put what I was learning in the context of their lives."
Most of Wallace's work in graduate school and in the years that followed focused on issues of long-term care, including differences in nursing-home-care use by race and ethnicity. "Given that African Americans, Latinos and Asians were all using nursing homes less than whites, I was interested in the reason," he says. "Was it economic barriers, discrimination, or cultural factors such as more family support of the elderly in these populations?" Over the years, Wallace has concluded that all three play important roles.
While continuing to weigh the balance of these factors in long-term care, he has broadened the scope of his studies to examine other areas important to elders, including racial patterns in managed care. "Managed care continues to be the favorite cost-control idea at the federal level, and California has the highest managed care penetration among the Medicare population," Wallace says. "Because California is such a diverse state, if we can identify models of managed care that provide the best access and quality to older patients, it could provide important lessons to the nation."
Wallace, who has been on the UCLA School of Public Health faculty since 1990, was approached by colleague E. Richard Brown not long after the Center for Health Policy Research was established and asked to join the center's executive staff. "The center's focus on vulnerable groups and population-based approaches to improving health was very appealing," Wallace says. "In addition, a lot of what I was interested in doing involved being in the community, whether it was to evaluate programs or partner with local organizations and community groups for the purposes of both research and influencing policy." The center, he decided, was the perfect fit.
Along with his continuing research activities, Wallace has played a leading role in two of the center's key community service efforts. He was principal investigator for Health DATA, a training and technical assistance program designed to help community, service, and advocacy groups improve their capacity to use health research data to address important public health issues and advance public health policy. And he heads "New Tools for Improving Health Policy Making in California," which develops statistical methodology using data from the California Health Interview Survey (CHIS), U.S. Census and other surveys to estimate rates of uninsurance and chronic conditions at assembly, senate, and congressional district levels. "Having data about health insurance and chronic conditions at the legislative district level can be very helpful in moving policy agendas forward, and that type of small-area information had not been available in the past," explains Wallace. As with Health DATA, he adds, the project empowers communities to work for social change that reduces health inequalities.
Wallace has become increasingly engaged in public policy issues that affect minority elders. "Most policies and discussions of the elderly assume that it's a homogeneous group," he says. "To the contrary, the elderly population is following the younger age groups in becoming more and more diverse, and there are large differences involving culture and language that, if not considered, tend to result in doing a disservice to the most vulnerable groups." Efforts to promote healthy aging tend to take on a white, middle-class perspective, he contends. Meanwhile, it will become increasingly difficult to ignore the issue of long-term care as the number of elders with chronic illnesses and disabilities continues to grow significantly in the years ahead; Wallace intends to do his part to ensure that the impact of long-term care policy proposals on minority elderly groups is considered.
The knowledge that his work can make a difference, along with the ability to mentor students who will go on to conduct similarly important work, is what drives Wallace more than anything else. "I never want to just sit around and come up with interesting ideas that float off into the ether," he says. "My goal is to come up with concrete ideas that can help improve the lives of people who aren't benefiting as much as they should from being in the wealthiest country in the world."
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