Meet the Team: Jacob Bor, Human Capital Initiative

Jacob Bor is a founding and core faculty member of the Human Capital Initiative (HCI) at the Global Development Policy Center. The HCI brings an interdisciplinary team of researchers together across Boston University to contribute to the advancement of innovative research on the political economy of human development. 

He is an Assistant Professor in the Departments of Global Health and Epidemiology at Boston University School of Public Health. His research applies the analytical tools of economics and data science to the study of population health, with a focus on HIV treatment and prevention in southern Africa. Jacob’s current research interests include chronic disease management in low resource settings; economic spillover effects of HIV treatment; decision-making in HIV-endemic risk environments; population health impacts of social policy; and causal inference in public health research. He holds an Sc.D. from the Harvard School of Public Health.

Below, Jacob discusses his research interests in human capital, health policy decision-making, and the one policy change he would make overnight:

When did you join the GDP Center Human Capital Initiative and what drew you to study human capital in the first place? 

I was one of the founding members of the HCI with Mahesh Karra, Samuel Bazzi (now at UCSD), and Kehinde Ajayi (now at the World Bank). In the beginning, Mahesh, Sam, Kehinde and I put this idea together around work in health, population, migration, and education – and it’s been really wonderful over the last few years to see the program grow to include other areas of human capital and development, like labor, political economy, and gender.

I think one of the unifying frames of HCI is that people make decisions in their lives to invest in themselves, in their human capital. HCI researchers ask how people make those decisions. If you understand how they make those decisions you can make policy that helps them. Research coming out of HCI also emphasizes that people make human capital investment decisions in the context of political, economic, and cultural constraints. We care about human capital because it’s important for people to be able to achieve the things they value and but we also ask why some people have access to more human capital than others and how those patterns get reproduced, and those are questions of politics and economics that knit our various fields together.

What are your current research interests and how does your research align with the HCI?

I have two broad areas of interest. One is on HIV treatment and prevention in Sub-Saharan Africa. My other research interest is around health disparities in the US and the structural determinants of those disparities

One of the big questions in HIV policy has been the transition from treating people with HIV when they’re sick, to treating people with HIV to prevent the virus from spreading to other people. The rationale moves from being about one person’s health to being about their partner’s health, their child’s health and the health of the community. I have a number of projects around this idea of how you make this leap from individually-focused medical policy to population-oriented health policy.

In one project, we have looked at people’s access to information around the preventative benefits of HIV treatment. Scientists have known since 2011 that treatment virtually eliminates transmission. That information has been shared in the Global North, but it has not been widely disseminated globally. We’ve done surveys where we see people really don’t have this information. And we’ve reviewed the global literature on this topic and demonstrated large knowledge gaps.

We are currently working on an intervention to help HIV counselors provide information on HIV treatment-as-prevention to patients. This project was recently awarded an R34 Intervention Development and Pilot Grant from the National Institute of Mental Health. In collaboration with my South African collaborator, Dr. Dorina Onoya, at the Health Economics and Epidemiology Research Office (HE2RO), we will design the intervention and pilot it in a randomized evaluation. The study will also look at what messages motivate people the most – and whether people can be motived by altruistic considerations.

Another strand of research looks at the impact of recent HIV policy changes in South Africa, where they are trying to test and treat everyone who is HIV positive in the hopes of reducing transmission. We’ve developed a National HIV Cohort based on South Africa’s centralized laboratory database. In a recently funded R01, we are using this to evaluate the impacts of test-and-treat on HIV care outcomes and to identify points at which patients are at high risk of exiting care. 

The GDP Center is an interdisciplinary research center that encourages cooperation among researchers of different backgrounds and expertise. How is interdisciplinarity important to you in your work?

 Interdisciplinarity is absolutely essential. I’m not someone who has a hammer and goes around looking for nails, I am someone who finds questions who interest me and if there are people I need to work with or new skills to learn, then that’s what I prefer to do.

It’s been an interesting road. A few examples along those lines – I originally trained as a health economist with a background in applied econometrics. That’s still my bread and butter, but if you want to test a question around behavior, then being able to design a randomized controlled trial (RCT) is helpful. If you think you might design something that has the potential to be scaled up, then putting that together with stakeholders on the ground – HIV activists, support groups, qualitative researchers, communications experts – is critical to get a sense of the issues and how to talk about them.

I once conducted a systematic review of qualitative studies on the reasons people refuse HIV treatment, which is something I never imagined I would do. But this isn’t a question you can ask in a survey, because there are just so many possible reasons. To get to this question, we pooled all of the qualitative research done on treatment refusal, which allowed us to compile narratives from dozens of populations in different study settings to identify common themes. It’s not something I would have said, yes this is my natural element, but it was exactly the right way to go about answering this question.

Being a professor and researcher of international health, what is your take on the COVID-19 pandemic and global response so far?

As an American, I think it’s hard to speak beyond our country on this topic, because the response here has been so tragic. But my main takeaways are that first, in terms of the impact on poverty, health, and the economy, COVID-19 shows how interconnected the world is. Secondly, it is clear the American government failed at international health cooperation by withdrawing from the World Health Organization. Stepping back from international cooperation as they did in such a pivotal moment was the worst example to set. Third, we learned that libertarianism doesn’t work for public health. It was a mistake to tackle this issue at the individual level, by giving people freedom to make their own decisions. It should have been tackled at the government level with clear policy, instead of just exhorting people to behave “responsibly.” Public health is a public good and it is important to invest in national regulations that people are required to follow, in government-directed manufacturing capacity or supply chains, if that’s needed. Instead, we have given up on the idea that we should tackle this together.

 How has the outbreak of COVID-19 affected your work, as well as research interests?

Between January and March 2020, I had the good fortune of receiving several new grants for projects in South Africa. Whereas originally I would have travelled there to do the research, I have spent the past year setting up these projects, all the administrative and design things, virtually with fantastic collaborators in South Africa. It turns out I didn’t need to be there to get this research done so that’s been a great lesson from all of this and the importance of really strong collaborators.

I also became very interested in trying to understand what’s happening in the US around COVID-19, health equity impacts, and the public health response. With BUSPH co-authors, I have published papers looking at disparities in physical distancing by neighborhood income level, the impact of unemployment insurance on food insecurity, and state heterogeneity in impacts of lockdowns.

 If you could make one policy change overnight, what would it be?

To come up with a global agreement on tax revenues so that profits are taxed in a country where revenues are created rather than whatever tax shelter the headquarters are located, which could just be a PO Box. Governments and their ability to respond to public crises have been really undermined due to a lack of fiscal resources. We need government now more than ever in so many ways to develop and use human capital to overcome global challenges like COVID-19 and climate change.

What advice would you give to others interested in studying human development and public health?

Academic training is certainly one path, and I’ve really enjoyed my career, but I don’t want to necessarily encourage people to follow the same path. I would encourage people to get involved with community, advocacy, and service delivery organizations – on the ground work – anywhere. I think this gives really important context to academic study. I also think just reading trusted news sources and analyses of what’s going on in the world. I once saw Noam Chomsky give a lecture with so much detail, and at the end, he was asked, “but where did you read that?” and he said “it’s in the New York Times and the Washington Post, but at the bottom of the page or in between the lines.” Sometimes you have to read between the lines to get the big picture or the real story, so I would encourage people to do that.

What book, podcast, film, TV show, activity are you enjoying right now?

I am really enjoying spending time with my son at home. Because of the pandemic, we have had the opportunity to spend more time together – playing legos, reading Winnie-the-Pooh, going ice-skating – it turns out we really like each other!

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