Diana R Silver
Diana R Silver
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Vice Dean of Faculty Affairs
Professor of Public Health Policy and Management
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Professional overview
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Dr. Diana Silver's research explores the impact of variation in the implementation, adoption and repeal of state and local public health policies on health outcomes, particularly alcohol consumption, motor vehicle crashes, tobacco use, and food safety. Some of her other work has examined variation in access to publicly funded services such as clinics, after-school programs, parks and playgrounds. Her work has been funded by the National Institutes of Health, the Robert Wood Johnson Foundation, the New York City Department of Health and Mental Hygiene, and several other funders.
Dr. Silver's work has been published in a variety of prominent journals, including the American Journal of Public Health, the American Journal of Health Promotion, Public Health, Tobacco Control, Journal of Safety Research, Social Science and Medicine, the American Journal of Evaluation, PLoS One, Journal of Community Health, Journal of Immigrant and Minority Health, International Journal of Equity in Health, Globalization and Health, Youth and Society, Public Administration Review and Policy Studies Journal. She is an associate editor for the American Journal of Health Promotion, and serves on the New York City Department of Health’s Health Advisory Committee. She began her career focused on the developing policies and programs that could address the epidemics of AIDS, substance abuse and violence in New York City, in such settings as schools, workplaces, jails, and homeless shelters.
Dr. Silver teaches undergraduate and master’s level courses at the School of Global Health, and trains doctoral students. In 2015, Dr. Silver received NYU’s Distinguished Teaching Award, the university’s highest honor for teaching excellence.
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Education
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BA, History, Bates College, Lewiston, MEMPH, Health Education, Hunter College, New York City, NYPhD, Public Administration, New York University, New York City, NY
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Honors and awards
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Distinguished Teaching Award, New York University (2015)Steinhardt Goddard Award (2011)Annual Award for Outstanding Evaluation, American Evaluation Association (2010)Public Affairs Resident Scholar, The Rockefeller Foundation (2007)
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Areas of research and study
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Access to HealthcareAlcohol, Tobacco and Driving PoliciesFood Safety PoliciesImplementation and Impact of Public Health RegulationsInjury PreventionNew York Department of Health and Mental HygienePublic Health LawPublic Health Policy
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Publications
Publications
The effects of state regulations and alcohol consumption on traffic fatalities 1980-2010
AbstractSilver, D. R., Bae, J., Jimenez, G., Paul, M., & Mancinko, J. (n.d.).Publication year
2013Journal title
Public HealthVolume
127Page(s)
1117-1125Abstract~The geometry of motor vehicle deaths in the United States
AbstractAbaid, N., Porfiri, M., Porfiri, M., Silver, D. R., & Mancinko, J. (n.d.).Publication year
2015Journal title
PLoS OneIssue
in pressAbstract~The Impact of Medicaid Accountable Care Organizations on Health Care Utilization, Quality Measures, Health Outcomes and Costs from 2012 to 2023 : A Scoping Review
AbstractHolm, J., Pagán, J. A., & Silver, D. R. (n.d.).Publication year
2024Journal title
Medical Care Research and ReviewAbstractMost of the evidence regarding the success of ACOs is from the Medicare program. This review evaluates the impacts of ACOs within the Medicaid population. We identified 32 relevant studies published between 2012 and 2023 which analyzed the association of Medicaid ACOs and health care utilization (n = 21), quality measures (n = 18), health outcomes (n = 10), and cost reduction (n = 3). The results of our review regarding the effectiveness of Medicaid ACOs are mixed. Significant improvements included increased primary care visits, reduced admissions, and reduced inpatient stays. Cost reductions were reported in a few studies, and savings were largely dependent on length of attribution and years elapsed after ACO implementation. Adopting the ACO model for the Medicaid population brings some different challenges from those with the Medicare population, which may limit its success, particularly given differences in state Medicaid programs.The pros and cons of comprehensive community Initiatives at the city level: The case of the urban health Initiative
AbstractSilver, D. R., & Weitzman, B. C. (n.d.).Publication year
2009Journal title
The Foundation ReviewVolume
1Issue
1Page(s)
85-95Abstract~'They hear "Africa" and they think that there can't be any good services' - perceived context in cross-national learning : A qualitative study of the barriers to Reverse Innovation
AbstractHarris, M., Weisberger, E., Silver, D. R., & Macinko, J. A. (n.d.).Publication year
2015Journal title
Globalization and HealthVolume
11Issue
1AbstractBackground: Country-of-origin of a product can negatively influence its rating, particularly if the product is from a low-income country. It follows that how non-traditional sources of innovation, such as low-income countries, are perceived is likely to be an important part of a diffusion process, particularly given the strong social and cognitive boundaries associated with the healthcare professions. Methods: Between September and December 2014, we conducted eleven in-depth face-to-face or telephone interviews with key informants from innovation, health and social policy circles, experts in international comparative policy research and leaders in Reverse Innovation in the United States. Interviews were open-ended with guiding probes into the barriers and enablers to Reverse Innovation in the US context, specifically also to understand whether, in their experience translating or attempting to translate innovations from low-income contexts into the US, the source of the innovation matters in the adopter context. Interviews were recorded, transcribed and analyzed thematically using the process of constant comparison. Results: Our findings show that innovations from low-income countries tend to be discounted early on because of prior assumptions about the potential for these contexts to offer solutions to healthcare problems in the US. Judgments are made about the similarity of low-income contexts with the US, even though this is based oftentimes on flimsy perceptions only. Mixing levels of analysis, local and national, leads to country-level stereotyping and missed opportunities to learn from low-income countries. Conclusions: Our research highlights that prior expectations, invoked by the Low-income country cue, are interfering with a transparent and objective learning process. There may be merit in adopting some techniques from the cognitive psychology and marketing literatures to understand better the relative importance of source in healthcare research and innovation diffusion. Counter-stereotyping techniques and decision-making tools may be useful to help decision-makers evaluate the generalizability of research findings objectively and transparently. We suggest that those interested in Reverse Innovation should reflect carefully on the value of disclosing the source of the innovation that is being proposed, if doing so is likely to invoke negative stereotypes.Transportation to clinic : Findings from a pilot clinic-based survey of low-income suburbanites
AbstractSilver, D. R., Blustein, J., & Weitzman, B. C. (n.d.).Publication year
2012Journal title
Journal of Immigrant and Minority HealthVolume
14Issue
2Page(s)
350-355AbstractHealth care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City,we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a populationbased survey would yield information about substantial transportation barriers to health care.Understanding policy diffusion in the U.S. : An information-theoretical approach to unveil connectivity structures in slowly evolving complex systems
AbstractAnderson, R. P., Jimenez, G., Bae, J. Y., Silver, D. R., Macinko, J. A., Porfiri, M., & Porfiri, M. (n.d.).Publication year
2016Journal title
SIAM Journal on Applied Dynamical SystemsVolume
15Issue
3Page(s)
1384-1409AbstractDetecting and explaining the relationships among interacting components has long been a focal point of dynamical systems research. In this paper, we extend these types of data-driven analyses to the realm of public policy, whereby individual legislative entities interact to produce changes in their legal and political environments. We focus on the U.S. public health policy landscape, whose complexity determines our capacity as a society to effectively tackle pressing health issues. It has long been thought that some U.S. states innovate and enact new policies, while others mimic successful or competing states. However, the extent to which states learn from others, and the state characteristics that lead two states to influence one another, are not fully understood. Here, we propose a model-free, information-theoretical method to measure the existence and direction of influence of one state's policy or legal activity on others. Specifically, we tailor a popular notion of causality to handle the slow time scale of policy adoption dynamics and unravel relationships among states from their recent law enactment histories. The method is validated using surrogate data generated from a new stochastic model of policy activity. Through the analysis of real data in alcohol, driving safety, and impaired driving policy, we provide evidence for the role of geography, political ideology, risk factors, and demographic and economic indicators on a state's tendency to learn from others when shaping its approach to public health regulation. Our method offers a new model-free approach to uncover interactions and establish cause and effect in slowly evolving complex dynamical systems.Understanding the political context of "new" policy issues : The use of the advocacy coalition framework in the case of expanded after-school programs
AbstractBrecher, C., Brazill, C., Weitzman, B. C., & Silver, D. R. (n.d.).Publication year
2010Journal title
Journal of Public Administration Research and TheoryVolume
20Issue
2Page(s)
335-355AbstractThis article uses the Advocacy Coalition Framework to identify the stakeholders and their coalitions in the arena of after-school policy, which drew much new attention beginning in the early 1990s in many American cities. Using evidence from case studies in five cities, we show how the framework can be extended beyond stakeholder analysis to include identification of core and secondary value conflicts and of opportunities for policy analysis to help strengthen coalitions and pressures for change. Coalitions in each of the cities differ over core values relating to the purposes of after-school programs (academics versus "fun"), but policy analysts can promote common goals by developing options to deal with the secondary conflicts over the relative importance of facilities versus program content, the modes of collaboration between public schools and community based organizations, and the incentives for public school teachers to engage in staffing after-school programs.Up, up, up : A review of Triumph of the City: How our Greatest Invention Makes Us Richer, Smarter, Greener, Healthier, and Happier by Edward Glaser
AbstractSilver, D. R. (n.d.). In New York Times Book Review.Publication year
2011Abstract~Uses of Social Determinants of Health Data to Address Cardiovascular Disease and Health Equity : A Scoping Review
AbstractMcNeill, E., Lindenfeld, Z., Mostafa, L., Zein, D., Silver, D. R., Pagán, J., Weeks, W. B., Aerts, A., Rosiers, S. D., Boch, J., & Chang, J. E. (n.d.).Publication year
2023Journal title
Journal of the American Heart AssociationVolume
12Issue
21AbstractBACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. METHODS AND RESULTS: After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geo-coded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. CONCLUSIONS: Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.Uses of Social Determinants of Health Data to Address Cardiovascular disease and health equity: A scoping review
AbstractMcNeill, E., Lindenfeld, Z., Stein, D., Silver, D. R., Pagan, J., Weeks, W., Des Rosiers, S., Boch, J., & Chang, J. (n.d.).Publication year
2023Journal title
Journal of the American Health AssociationVolume
12AbstractAbstract Background Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Prior research suggests that social determinants of health have a compounding effect on health and are associated with cardiovascular disease. This scoping review explores what and how social determinants of health data are being used to address cardiovascular disease and improve health equity. Methods and Results After removing duplicate citations, the initial search yielded 4110 articles for screening, and 50 studies were identified for data extraction. Most studies relied on similar data sources for social determinants of health, including geocoded electronic health record data, national survey responses, and census data, and largely focused on health care access and quality, and the neighborhood and built environment. Most focused on developing interventions to improve health care access and quality or characterizing neighborhood risk and individual risk. Conclusions Given that few interventions addressed economic stability, education access and quality, or community context and social risk, the potential for harnessing social determinants of health data to reduce the burden of cardiovascular disease remains unrealized.Utilization patterns and perceptions of playground users in New York City
AbstractSilver, D. R., Giorgio, M., & Mijanovich, T. (n.d.).Publication year
2014Journal title
Journal of Community HealthVolume
39Issue
2Page(s)
363-371AbstractPlaygrounds are assumed to be an important resource for physical activity. This study investigates seasonal utilization, user preferences, and perceptions of safety and upkeep of public playgrounds in New York City. A cross-sectional survey was conducted from May 2010 to January 2011 across 10 playgrounds in low/middle income neighborhoods in each of the five boroughs in New York City. A total of 1,396 adults accompanying children were surveyed. Outcomes included playground as main place of outdoor play, and perceptions of playground upkeep and safety. Covariates included socio-demographics and other characteristics of playground users. Multivariable logistic regression with playground/season fixed effects were used. Utilization varied substantially across the four seasons. Blacks had higher odds of reporting the playground as the main place of outdoor play (AOR 1.78, 95 % CI 1.13-2.80, pVariance of US Hospital Characteristics by Safety-Net Definition
AbstractMcneill, E., Cronin, C., Puro, N., Franz, B., Silver, D. R., & Chang, J. E. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
9Page(s)
E2332392Abstract~Variation in U.S. traffic safety policy environments and motor vehicle fatalities 1980-2010
AbstractSilver, D. R., Silver, D., Macinko, J., Bae, J. Y., Jimenez, G., & Paul, M. (n.d.).Publication year
2013Journal title
Public HealthVolume
127Issue
12Page(s)
1117-1125AbstractObjective: To examine the impact of variation in state laws governing traffic safety on motor vehicle fatalities. Study design: Repeated cross sectional time series design. Methods: Fixed effects regression models estimate the relationship between state motor vehicle fatality rates and the strength of the state law environment for 50 states, 1980-2010. The strength of the state policy environment is measured by calculating the proportion of a set of 27 evidence-based laws in place each year. The effect of alcohol consumption on motor vehicle fatalities is estimated using a subset of alcohol laws as instrumental variables. Results: Once other risk factors are controlled in statistical models, states with stronger regulation of safer driving and driver/passenger protections had significantly lower motor vehicle fatality rates for all ages. Alcohol consumption was strongly associated with higher MVC death rates, as were state unemployment rates. Conclusions: Encouraging laggard states to adopt the full range of available laws could significantly reduce preventable traffic-related deaths in the U.S. - especially those among younger individuals. Estimating the relationship between different policy environments and health outcomes can quantify the result of policy gaps.What a Difference a Grade Makes : Evidence from New York City's Restaurant Grading Policy
AbstractRothbart, M. W., Schwartz, A. E., Calabrese, T. D., Papper, Z., Mijanovich, T., Meltzer, R., & Silver, D. R. (n.d.).Publication year
2019Journal title
Public Administration ReviewVolume
79Issue
5Page(s)
651-665AbstractCan governments use grades to induce businesses to improve their compliance with regulations? Does public disclosure of compliance with food safety regulations matter for restaurants? Ultimately, this depends on whether grades matter for the bottom line. Based on 28 months of data on more than 15,000 restaurants in New York City, this article explores the impact of public restaurant grades on economic activity and public resources using rigorous panel data methods, including fixed-effects models with controls for underlying food safety compliance. Results show that A grades reduce the probability of restaurant closure and increase revenues while increasing sales taxes remitted and decreasing fines relative to B grades. Conversely, C grades increase the probability of restaurant closure and decrease revenues while decreasing sales taxes remitted relative to B grades. These findings suggest that policy makers can incorporate public information into regulations to more strongly incentivize compliance.What Are the Financial Implications of Public Quality Disclosure? Evidence from New York City’s Restaurant Food Safety Grading Policy
AbstractMeltzer, R., Rothbart, M. W., Schwartz, A. E., Calabrese, T. D., Silver, D. R., Mijanovich, T., & Weinstein, M. (n.d.).Publication year
2019Journal title
Public Finance ReviewVolume
47Issue
1Page(s)
170-201AbstractGrading schemes are an increasingly common method of quality disclosure for public services. Restaurant grading makes information about food safety practices more readily available and may reduce the prevalence of foodborne illnesses. However, it may also have meaningful financial repercussions. Using fine-grained administrative data that tracks food safety compliance and sales activity for the universe of graded restaurants in New York City and its bordering counties, we assess the aggregate financial effects from restaurant grading. Results indicate that the grading policy, after an initial period of adjustment, improves restaurants’ food safety compliance and reduces fines. While the average effect on revenues for graded restaurants across the municipality is null, the graded restaurants located geographically closer to an ungraded regime experience slower growth in revenues. There is also evidence of revenue convergence across graded and ungraded restaurants in the long term.What does government spend on children? : Evidence from five cities
AbstractBrecher, C., Searcy, C., Silver, D. R., & Weitzman, B. C. (n.d.).Publication year
2004Abstract~What substance use services are advertised by local governments? An analysis of data from county websites in New York state
AbstractLindenfeld, Z., Mauri, A. I., & Silver, D. R. (n.d.).Publication year
2025Journal title
Public HealthVolume
239Page(s)
133-135AbstractObjective: To assess the substance use disorder (SUD) prevention and response activities that county governments in New York advertise. Study design: Cross-sectional study. Methods: We coded websites of county public health, mental health, emergency, and social service departments to identify whether any government agency provided information about ten evidence-based SUD services. We calculated the number and percentage of counties advertising each service, overall and by county size (medium/large and small). Results: The most common services advertised on county websites were Resource Lists (91.4 %), Naloxone Training, Education, or Distribution (74.1 %), and Addiction/Overdose Education (62.1 %), and the least common were Syringe Exchange (31.0 %) and Anti-Stigma Training or Resources (13.8 %). When counties were assessed by population size, each service was advertised by a higher percentage of medium/large counties than small counties. Conclusions: Despite public health researchers recommending that government responses to the overdose crisis include the SUD services examined here, many counties do not provide information to their constituents about several important services. Thus, even if these services are available, they may be unknown to residents.