George Kaplan, PhD

portrait of george kaplan

Home Institution: University of Michigan

Field: Social Epidemiology

Current Positions: University of Michigan

My Driving Question

What programs and policies will make the greatest positive impact on the health of communities and reduce inequalities?

Scholar Project 

Complex Systems, Population Health and Health Disparities 

Dr. Kaplan studies why some communities are healthy and others are not. Building bridges between two fields—public health and complex systems science—he’s exploring how computer simulations may be used to uncover insight about the factors that shape population health. That insight, in turn, can help inform social policies and programs.

Dr. Kaplan’s decades-long work has been to develop an expanded view of factors that contribute to population health and health disparities – not only physiological, medical, and behavioral factors, but also socioeconomic, educational, cognitive, emotional/psychosocial, neighborhood-based, work-related, legal, etc.

Over time, he realized something crucial was missing, namely how the “whole” is generated from the “parts.” Focus on the atomistic has led ironically to massive accumulation of facts, with no idea how they fit together. Dr. Kaplan experienced a major “ah ha” moment in discovering the world of complex systems simulation as used in the fields of engineering, physical sciences, and computer sciences.

With support from TIIH and the National Institutes of Health, Dr. Kaplan is exploring the potential for computer simulations to provide meaningful, useful integration of a wide range of factors that contribute to population health. His exploration so far has led to the development of a unique, JAVA-based computer model that attempts to generate an artificial world that operates based on what we know about the dynamic relationships among the multiple determinants of health.

Dr. Kaplan finds that a strength of this model is that it allows us to represent a multi-level, dynamic etiologic theory, while also providing the opportunity via computer simulation to pose a series of counter-factuals–“what-if” queries that are of great interest from a policy point of view. This is of particular importance when we want to capture the “big picture” where many forces are shaping health, with lots of interactions between them, and where it would never be feasible to conduct comprehensive trials or experiments that represent the confluence of these forces.

In some recent work, the model was used to simulate the determinants of racial disparities in obesity, and the role of three neighborhood policies (increasing availability of good food stores, increasing physical activity infrastructure and walkability, and increasing school quality) on the reduction of black/white disparities in Body Mass Index (BMI). The simulation model, which is grounded in the best evidence, allowed him to simulate 125 different combinations of these policies and to observe their differential impact on disparities in obesity across generations. Each of these policies had some impact on BMI and BMI disparities, but it was the combination of them that was most effective. With some combinations of these policies it was possible to demonstrate 90 percent reductions in BMI disparities between black and whites.

While much more work needs to be done in the development and validation of this simulation model, this example shows how the use of such an empirically-informed computer simulation model, which embraces complexity rather than eschewing it, allows us to deal with the complex pathways that link neighborhood policies to health related factors and disparities in those factors, and illustrates the use of a new set of tools in understanding integrative health.

Biography 

Professor George A. Kaplan, PhD, is a social epidemiologist whose work on the role of behavioral, social, psychological, and socioeconomic factors in health and health inequalities has been cited more than 63,000 times. A major theme in his work is the complex linkage between “upstream” and “downstream” factors in maintaining health, delaying disease, and improving function, with an emphasis on the social determinants of health.

Studies by Dr. Kaplan and colleagues have detailed the cumulative cost of socioeconomic disadvantage on health and functional outcomes in the elderly, the role of socioeconomic status and economic equity on the overall health of populations, the impact of neighborhood and community factors on health, the impact of life-course trajectories on a variety of health outcomes in adulthood, and the role of economic and social policies on health.

Dr. Kaplan is the Thomas Francis Collegiate Emeritus Professor of Public Health in the School of Public Health, a research professor at the Institute for Social Research, and director of the Center for Social Epidemiology and Population Health, all at the University of Michigan. He is a faculty member in the Center for the Study of Complex Systems at the University of Michigan. He was an Associate in the Population Health Program of the Canadian Institute for Advanced Research until its end. Dr. Kaplan was also the founding Director of the Robert Wood Johnson Foundation Health and Society Scholars Program at the University of Michigan.

Among his honors are membership in the Institute of Medicine, the National Academy of Social Insurance, the Academy of Behavioral Medicine Research, and election to the Presidency of the Society for Epidemiologic Research. Dr. Kaplan is the first public health scientist to be invited to address the Nobel Forum at the Karolinska Institute in Sweden.

In addition to being an internationally respected social epidemiologist, Dr. Kaplan is an accomplished fine art photographer. See his images.

Education and Training
  • Postdoctorate, epidemiology, University of California, Berkeley
  • Postdoctorate, health psychology, University of California, San Francisco
  • PhD, psychology, Cornell University
  • BA, psychology, Johns Hopkins University
Selected Honors
  • Society for Epidemiologic Research Distinguished Service Award (2022)
  • Chair, Network on Inequality, Complexity and Health 
  • ISS Highly Cited Researcher
  • Institute of Medicine (elected 2001)
  • First public health researcher to deliver a Nobel Forum Lecture (2000)
  • President, Society for Epidemiologic
    Research (2003-4)
  • National Academy of Social Insurance
    (elected 2003)
  • Academy of Behavioral Medicine Research (elected 1998)
  • MERIT Award, National Institute on Aging (1996-2006)
  • University of Michigan Society of Fellows (1999-2003)
  • Invited Plenary Speaker, Global Forum for Health Research (2003)
  • Fellow in Residence, Rockefeller Foundation Bellagio Center (2005)
  • John P. McGovern Award, University of Texas, School of Public Health at Houston (2006)
  • Invited Plenary Speaker, 11th World Congress on Public Health (2006)
  • Patricia Barchas Award-American Psychosomatic Society (2009)
  • The Abraham Lilienfeld Award, American Public Health Association (2012)
  • ISI Highly Cited Researcher
Selected Publications

Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”