The Epidemiological Transition in Overweight and Obesity Prevalence

My early graduate work studied how obesity prevalence changes with country and individual wealth. It is well known that obesity prevalence is highest among wealthier population strata within poorer countries, but the burden of obesity shifts to poorer population strata as national wealth increases. No previous research examined how this shift occurs, but such information is vital to targeting nutritional interventions. This motivated me to estimate the relationship of asset-based personal wealth with overweight and obesity and examine how that relationship varies with country wealth. I found that the poorest population strata in upper-middle income countries experience a sharp rise in obesity with economic development, with no change in the obesity prevalence of the richest strata. This suggests that the poorest may be subject to different forces causing obesity than the richest strata. Currently, I'm investigating the role of food prices in rising obesity in the case of Mexico.
  1. Templin T , Hashiguchi TC, Thomson B, Dieleman J, Bendavid E. The overweight and obesity transition from the wealthy to the poor in low-and middle-income countries: a survey of household data from 103 countries. PLoS medicine. 2019 Nov;16(11).
  2. Bhattacharya J, Miller G, Seira E, Templin T . Free Trade, Food Prices, and Obesity in Mexico. (in progress)

Health Systems and Noncommunicable Diseases

As a research fellow at IHME and consultant for CFR, I led quantitative analyses examining health system financing and readiness for chronic diseases. These projects were motivated by wide-spread acknowledgement that low- and middle-income countries will likely face strained health systems due to myriad factors. Despite this consensus, it remains unclear which drivers are critical for investment, further limited by international community disagreement on how to account for resources spent on health. Through a series of papers, we analyzed allocation of development assistance based on health need, quantified health system readiness for chronic diseases, and investigated the role of political determinants for health. This work motivated the Council on Foreign Relations to convene the first independent task force, including the Office of Management and Budget, on considering noncommunicable diseases as a US foreign policy concern.
  1. Wigley S, Dieleman JL, Templin T , Kiernan S, Bollyky TJ. Democracy and implementation of non-communicable disease policies. The Lancet Global Health. 2020 Apr 1;8(4):e482-3.
  2. Bollyky TJ*, Templin T* (*co-first), Cohen M, Schoder D, Dieleman JL, Wigley S. The relationships between democratic experience, adult health, and cause-specific mortality in 170 countries between 1980 and 2016: an observational analysis. The Lancet. 2019 March 14.
  3. Haakenstad A, Templin T , Lim S, Dieleman JL. The financing gap framework: using need, potential spending and expected spending to allocate development assistance for health. Health Policy and Planning. 2018 Feb 5. 33 (Supplement 1): i47-i55. doi:10.1093/heapol/czx165.
  4. Bollyky TJ, Templin T , Cohen M, Dieleman JL. Lower-Income Countries That Face the Most Rapid Shift in Noncommunicable Disease Burden Are Also the Least Prepared. Health Affairs. 2017 Nov; 36(11):1866-1875. doi: 10.1377/hlthaff.2017.0708.
  5. Bollyky TJ, Templin T , Andridge C, Dieleman JL. Understanding the relationships between non-communicable diseases, unhealthy lifestyles, and country wealth. Health Affairs. 2015 Sep; 34(9):1464-1471. doi: 10.1377/hlthaff.2015.0343.
  6. Wigley S, Dieleman JL, Templin T , Kiernan S; Bollyky TJ. Effect of Autocratization on Universal Health Coverage: a synthetic control analysis. (Under Preparation)
  7. Bollyky TJ, Dieleman JL, Mumford JE, Templin T , Wigley S. Democracy and Universal Health Coverage. (Under Preparation)

Financing Global Health and Global Burden of Disease Publications

While at IHME, I worked in the Financial Resources for Health research group. We provided estimates of health spending by payer and health focus area for each country. This work continues to be published annually as the Financing Global Health report, and is presented at USAID, the Gates Foundation, World Bank, and World Health Organization to guide global health priority setting. I recently also wrote about accounting methodologies used for development assistance.
  1. Templin T , Bendavid E. What counts as development assistance for reproductive, maternal, newborn, and child health?. The Lancet Global Health. 2020 Mar 1;8(3):e312-3.
  2. Dieleman JL, . . . Templin T , . . . Murray CJL. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016-40. The Lancet. 2018 April 17. doi: 10.1016/S0140-6736(18)30697-4.
  3. Dieleman JL, . . . Templin T , . . . Murray CJL. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995–2015. The Lancet. 2018 April 17. doi: 10.1016/S0140-6736(18)30698-6.
  4. Dieleman JL, . . . Templin T , . . . Murray CJL. US Spending on personal health care and public health. JAMA. 2016 Dec 27. 316(24):2627-2646. doi:10.1001/jama.2016.168885.
  5. Kulikoff XR , Morris J, Nguyen G, Smith A, Templin T . Health metrics priorities: a perspective from young researchers. The Lancet. 2016 Nov 12. doi: 10.1016/S0140-6736(16)32134-1.
  6. Dieleman JL, Templin T , . . . Evans TG, Murray CJL, Kurowski C. A health financing convergence? Using past trends and relationships to forecast national spending on health by payer for 184 countries, 2015 – 2040. The Lancet. 2016 Apr 13. doi: 10.1016/S0140-6736(16)30167-2.
  7. Dieleman JL, Schneider M, Haakenstad A, Singh L, Sadat N, Birger M, Templin T , . . . Murray CJL. Development assistance for health: past trends, relationships, and the future of international financial flows for health. The Lancet. 2016 Apr 13. doi: 10.1016/S0140-6736(16)30168-4.
  8. Murray CJL,. . . Templin T , . . .Salomon JA, Lopez AD, Vos T. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. The Lancet. 2015 Aug 27. doi: 10.1016/S0140-6736(15)61340-X.
  9. Dieleman JL, Graves CM, Johnson E, Templin T , Birger M, et al. Sources and focus of health development assistance, 1990 – 2014. JAMA. 2015 Jun 16. 313(23):2359-2368. doi:10.1001/jama.2015.5825.
  10. Naghavi M, . . . Templin T , . . . Vos T, Lopez AD, Murray CJL. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014 Dec 17. doi: 10.1016/S0140-6736(14)61682-2.
  11. Dieleman JL, Templin T . Random-effects, fixed-effects and the within-between specification for clustered data in observational health studies: a simulation study. PloS One. 2014 Oct 24. doi: 10.1371/journal.pone.0110257.
  12. Kassebaum NJ, . . . Templin T , . . . Lopez AD, Naghavi M, Murray CJL, Lozano R. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2014 May 2. doi: 10.1016/S0140-6736(14)60696-6.
  13. Dieleman JL, Graves CM, Templin T , Johnson E, Baral R, Leach-Kemon K, Haakenstad AM, Murray CJL. Global health development assistance remained steady in 2013 but did not align with recipients’ disease burden. Health Affairs. 2014 Apr. doi: 10.1377/hlthaff.2013.1432.
Policy Reports
  1. Institute for Health Metrics and Evaluation. Financing Global Health 2015: Development assistance steady on the path to new Global Goals. Seattle, WA: IHME, 2016.
  2. Institute for Health Metrics and Evaluation. Financing Global Health 2014: Shifts in funding as the MDGs close. Seattle (WA): IHME, 2015.
  3. Institute for Health Metrics and Evaluation. Financing Global Health 2013: Transition in an age of austerity. Seattle (WA): IHME, 2014.