Thinking beyond the possible: How YSPH is shaping public health policy

Health policy doesn’t usually grow in a Petri dish, but two initiatives at the Yale School of Public Health (YSPH) have developed innovative approaches for studying public health up close and translating the school’s research into community impact across Connecticut.

The Health Policy Practicum provides students hands-on training in developing and advocating for law that advances public health through placements with state legislators, executive agencies, and nonprofits.

The placement preceptors, often short-staffed, assign the students important research and policy work. “Our students get to see what happens with their work as Yale’s proximity to the Capitol enables them to attend committee hearings and meetings and contribute to the legislative process,” said Shelley Diehl Geballe, JD '76, MPH '95, professor in the practice (health policy). “I also insist that students testify in writing and orally on at least one bill of their choosing. While most students at first are a bit fearful, they’re all smiles afterwards. Testifying breaks a barrier—they’ve learned they can give voice to their knowledge.”

Down the hall from Geballe’s office is the State Collaborations to Advance LEarning, or SCALE, laboratory co-led by Dr. Jacob Wallace, PhD, associate professor of public health (health policy) and Department Chair and Professor of Public Health Dr. Chima Ndumele, PhD, MPH. SCALE is a research and policy institute whose goal is to improve the lives of low-income and other vulnerable individuals in Connecticut and beyond by forming hands-on partnerships with state policymakers to improve the social safety net.

The SCALE model is to embed YSPH researchers and data scientists within state agencies, such as Connecticut's Department of Social Services. The analysts are employed by YSPH but receive state credentials, work side-by-side with policymakers, and have a data access agreement. The initiative began several years ago and has been growing steadily—building out its team and infrastructure—with the aim of making a direct impact on communities.

“We want to be a trusted partner to states and not be viewed as just another academic lab that only puts out research,” said Wallace.

Geballe’s practicum started more than a decade ago, after she began teaching Public Health Law at YSPH in 2011. Based on past experience co-teaching a legislative advocacy clinic at Yale Law School, she developed the Health Policy Practicum as a complementary course in 2013.

“Through the Yale Law School clinic work, I was awakened to the power of students’ hands-on learning about the law and the power of being mentored by people who know how things are done,” Geballe said.

In addition to the students’ hands-on work, the practicum includes a weekly class on state lawmaking processes and current state issues, and classes to build skills needed for their work. While the practicum began with about 10 students, it has since tripled in size, and in the last several years it has had about 30 students from multiple YSPH departments. While students initially worked primarily with state legislators, they now also work in state and local government agencies, state constitutional offices, and various non-profit organizations with health-related legislative agendas, Geballe said. She’s developed a "matchmaking" process to ensure students are placed where their skills and interests align with their preceptor’s needs.

For Livia Cox, MPH ’25, that meant working with State Senator Saud Anwar, MD, MPH ‘98, the senate chair of the Connecticut General Assembly’s Public Health Committee. Anwar speaks to first-year health policy students each fall in Geballe’s class, and Cox found him inspiring. She was drawn to “his passion and commitment to opioid policy and homelessness, and his commitment to using policy as a lever, as a tool through which we can achieve health justice.” Cox worked on a strategy to fight opioid overdoses for the Public Health Committee, and says she was inspired by how Anwar, a working physician, has created "a career that spans both the clinic and the committee,” she said. “Through my work with him, I saw how integral policy is to the delivery of care.”

Anwar has been working with Geballe’s YSPH students since 2019. He called them "one of the highlights of every session because of their passion, commitment, and excellence in doing groundwork and helping in all aspects of health care policy work and partnership.”

While Geballe’s students work with legislators, SCALE works most closely with Connecticut’s executive branch through its partnership with the Department of Social Services. The origins of SCALE can be traced back several decades, well before Wallace and Ndumele became YSPH faculty.

One of Wallace’s first jobs was working for the New York Medicaid program, where he came to appreciate both the mission and the complexity of the Medicaid program. Ndumele, who started his career working with federally qualified health centers in the metro Boston area, was also deeply influenced by the challenges he observed in reliably getting evidence-based care to vulnerable populations. Separately, each realized the potential for state government to transform lives, but also the many constraints that policymakers face in realizing this vision.

“There is a constant stream of fires to put out when you work for a Medicaid agency,” Wallace said. “It makes it hard to invest in research and data science efforts that take time but are critical to getting the policymaking process right.”

Their experiences instilled in them the importance of moving “beyond traditional translation” and into direct collaboration with state governments. SCALE is Wallace and Ndumele’s effort to do that. Over the past several years, they have assembled a team of researchers, data scientists, policy experts, and communication professionals that allow SCALE to be an effective partner to state governments—offering rapid-cycle, data-driven insights—while also producing research for publication in peer-reviewed journals.

“The best part about our partnerships is the two-way learning,” Ndumele said. “Our embedded team offers insights from research that states may not otherwise be aware of, but our research agenda is, in turn, shaped by learning more about the details of safety net programs from states and what open questions they have.”

One of the data scientists is Michael Smith, who joined SCALE to help states rigorously evaluate their programs and policies. Smith said he was, “impressed by the lab’s ability to take on complex policy domains and vast data systems. By doing so, we’re helping state officials reduce uncertainty and be more ambitious in supporting beneficiaries.”

One of SCALE’s key areas of research is around reducing the administrative burdens that can cause eligible people to lose Medicaid coverage or SNAP benefits simply because they missed a form or couldn’t access help. “We know the Medicaid program saves lives,” Wallace said. “It should be a dignified process to navigate. It should be user-centered.”

Designing programs that help make SNAP and Medicaid part of “a smarter safety net,” accessible to more people, and more coordinated in their administration, has been a focal point of the work, said Ndumele. Supported through a mix of public and philanthropic funding, their work follows a "test and learn” model that more closely mirrors the rigor of clinical research. “It’s straightforward,” Wallace said. “If you're going to deploy a policy, you should test whether it works.”

However, the test and learn model applied to policy and the delivery of services isn't just about getting grants or publishing papers, Wallace said, but “to help states decide what actually works before they scale policies statewide.”

SCALE’s partnership with Connecticut has already begun to show promising results. By using the gold standard methods for research about the effects of treatments and policies, SCALE’s test and learn model has already started to provide the state with rigorous new evidence about which programs are most effective.

"With rapid-cycle testing, we don’t have to wait years to see change. We can test, learn, and refine—and that momentum allows us to aim higher than we thought possible,” Wallace said. “What we learn in one state can inform programs elsewhere, creating a model where states can learn from each other and accelerate progress together.”