Children's health
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Objectives: To determine whether China's New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care, and the individual policy attributes have affected the operation and use of village health clinics.

Design: We performed a difference-in-difference analysis using multivariate linear regressions, controlling for clinic and individual attributes as well as village and year effects.

Setting: 100 villages within 25 rural counties across five Chinese provinces in 2004 and 2007.

Participants: 160 village primary care clinics and 8339 individuals.

Main outcome measures: Clinic outcomes were log average weekly patient flow, log average monthly gross income, log total annual net income, and the proportion of monthly gross income from medicine sales. Individual outcomes were probability of seeking medical care, log annual "out of pocket" health expenditure, and two measures of exposure to financial risk (probability of incurring out of pocket health expenditure above the 90th percentile of spending among the uninsured and probability of financing medical care by borrowing or selling assets).

Results: For village clinics, we found that NCMS was associated with a 26% increase in weekly patient flow and a 29% increase in monthly gross income, but no change in annual net revenue or the proportion of monthly income from drug revenue. For individuals, participation in NCMS was associated with a 5% increase in village clinic use, but no change in overall medical care use. Also, out of pocket medical spending fell by 19% and the two measures of exposure to financial risk declined by 24-63%. These changes occurred across heterogeneous county programmes, even in those with minimal benefit packages.

Conclusions: NCMS provides some financial risk protection for individuals in rural China and has partly corrected distortions in Chinese rural healthcare (reducing the oversupply of specialty services and prescription drugs). However, the scheme may have also shifted uncompensated new responsibilities to village clinics. Given renewed interest among Chinese policy makers in strengthening primary care, the effect of NCMS deserves greater attention.

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BMJ
Authors
Grant Miller
Scott Rozelle
Kim Babiarz
Grant Miller
Scott Rozelle
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There used to be something called child health policy. It was focused on crafting a national agenda for child health and was explicit in distinguishing the special needs of children from those of the adult world. During earlier periods, child health policy was dedicated to translating the rapidly expanding science of child development and pediatrics into crucial programmatic priorities and implementation strategies.[1] and [2] The concern was as much for coherence as rigor and found concrete expression in the White House Conferences on Children and Youth that were held under the leadership of virtually every president from Theodore Roosevelt through Richard Nixon. There has been no such conference since 1971; recent bills to organize such a conference are currently languishing in Congress.

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Academic Pediatrics
Authors
Paul H. Wise
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Karen Eggleston
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Karen Eggleston, Director of the Asia Health Policy Program, seeks to hire two research assistants at the advanced undergraduate or graduate social science level to assist with several projects, including an international comparative study of government financing for health service provision and provider payment. The RA should have a solid background in microeconomics; some background in health economics and comparative health policy; and near-native fluency in English. Knowledge of another European or Asian language (especially Chinese, Japanese, or Korean) would be an advantage. Ideally the RA would be a student whose own studies are related to the topic of health care financing and payment incentives in developing and/or transitional economies, or more generally in public economics, the government sector, and social protection policies. The work would be for autumn quarter, with possibility of extension to winter quarter. Compensation is competitive and commensurate with RA experience. Please send CV and brief statement of interest and related qualifications to Karen Eggleston at karene@stanford.edu by September 24th.

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Background. Despite growing wealth and the growing commitment of China’s government to providing quality education, a significant share of children across rural China still have no access to regular sources of iron-rich foods, vitamins and other micronutrients. Such poor diets may not only result in high incidences of nutritional problems, including anemia, good nutrition has been shown to be an effective input into the creation of human capital.

Objective. To increase our understanding of the extent of anemia in poor Shaanxi Province’s primary schools, and identify structural correlates of anemia in this region. Methods. A cross-section survey was conducted. Data were collected from 4000 grade fourth grand students (ages 9 to 11) in 70 primary schools in poor rural areas of Shaanxi province. Structured questionnaires and standard test were used to gather data. Trained nurses carried out the hemoglobin tests (using Hemocue finger prick kits) and anthropomorphic measurements using high quality equipment.

Results. The paper shows that the overall anemia rate is 21.5% (39%) when using a blood hemoglobin cutoff of 115 g/L (120 g/L). We find that those students that are boarding at school and those students that eat lunch away from home are more likely to be anemic. Children with anemia are found to have lower height for age (HAZ) scores and have higher incidences of stunting.

Conclusions. If this part of Shaanxi province is representative of the rest of Shaanxi’s poor rural areas (or all national designed poor counties in China), this means that tens of thousands (or millions) of children in rural Shaanxi (all national designed poor counties in China) may be anemic. Although we were not able to pinpoint the exact determinates and causal effects of anemia, the main implication of this work is that anemia remains a serious health problem for educators and health officials in rural China.

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Ecology of Food and Nutrition
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Scott Rozelle
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Building on the foundation of 2009-10 workshop "Legalizing Human Rights in Africa," the 2010-11 interdisciplinary research workshop will extend the examination of human rights discourse and institutions in Africa to broader questions around second and third generation rights. The workshop will canvas human rights insights from a broad sweep of disciplinary expertise, such as history, science, engineering anthropology, sociology, philosophy, law and political science. The goal of the workshop is to broaden human rights scholarship beyond single disciplinary domains.

Because the field of second and third generation human rights is broad, we have narrowed the discussion topics to the most urgent ones that are well suited to interdisciplinary analysis by anticipated workshop participants. Initial sessions will lay the foundation for the generational framework of human rights in Africa and the recent progression beyond civil and political rights. The workshop will proceed to discuss a wide range of the most significant and timely second and third generation human rights challenges in Africa.

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Helen Stacy Moderator

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616 Serra Street
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Consulting Scholar, 2014-16; Visiting Associate Professor 2013-2014, 2010-2011
dan_pressebilde7.jpg PhD

Professor Dan Banik is a Consulting Scholar at CDDRL and is currently completing a study examining the impacts of development aid from Norway and China on poverty reduction in Malawi and Zambia. He is a professor of political science and research director at the University of Oslo’s Centre for Development and Environment (SUM). He is also holds a visiting professor at China Agricultural University in Beijing.

Prof. Banik has conducted research in India, China, Bangladesh, Malawi, Uganda, Ethiopia, Tanzania, South Africa and Mexico, and directs the interdisciplinary research program 'Poverty and Development in the 21st Century (PAD)' at the University of Oslo. He has previously served as the head of the Norwegian-Finnish Trust Fund in the World Bank for Environmentally and Socially Sustainable Development (TFESSD) and on the Board of the Norwegian Crown Prince and Crown Princess's Foundation. His books include ‘The Democratic Dividend: Political Transition, Poverty and Inclusive Development in Malawi (with Blessings Chinsinga, Routledge 2016), ‘The Legal Empowerment Agenda: Poverty, Labour and the Informal Economy in Africa’ (2011, Ashgate), ‘Poverty and Elusive Development’ (2010, Scandinavian University Press) and ‘Starvation and India’s Democracy’ (2009, Routledge).

Prof. Banik is married to Vibeke Kieding Banik, who is a historian at the University of Oslo.

 

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Dan Banik CDDRL Visiting Scholar 2010-2011 Speaker
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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
rsd15_081_0253a.jpg MD, MPH

Dr. Paul Wise is dedicated to bridging the fields of child health equity, public policy, and international security studies. He is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics, Division of Neonatology and Developmental Medicine, and Health Policy at Stanford University. He is also co-Director, Stanford Center for Prematurity Research and a Senior Fellow in the Center on Democracy, Development, and the Rule of Law, and the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Wise is a fellow of the American Academy of Arts and Sciences and has been working as the Juvenile Care Monitor for the U.S. Federal Court overseeing the treatment of migrant children in U.S. border detention facilities.

Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston. His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School and was the founding Director or the Center for Policy, Outcomes and Prevention, Stanford University School of Medicine. He has served in a variety of professional and consultative roles, including Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, Chair of the Strategic Planning Task Force of the Secretary’s Committee on Genetics, Health and Society, a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH, and the Health and Human Secretary’s Advisory Committee on Infant and Maternal Mortality.

Wise’s most recent U.S.-focused work has addressed disparities in birth outcomes, regionalized specialty care for children, and Medicaid. His international work has focused on women’s and child health in violent and politically complex environments, including Ukraine, Gaza, Central America, Venezuela, and children in detention on the U.S.-Mexico border.  

Core Faculty, Center on Democracy, Development and the Rule of Law
Affiliated faculty at the Center for International Security and Cooperation
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Paul Wise Richard E. Behrman Professor of Child Health and Society and CHP/PCOR Core Faculty Member; CDDRL, CISAC Affiliated Faculty Commentator
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OBJECTIVE Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.

METHODS Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.

RESULTS Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.

CONCLUSIONS Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.

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Lynne C. Huffman
Paul H. Wise
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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
rsd15_081_0253a.jpg MD, MPH

Dr. Paul Wise is dedicated to bridging the fields of child health equity, public policy, and international security studies. He is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics, Division of Neonatology and Developmental Medicine, and Health Policy at Stanford University. He is also co-Director, Stanford Center for Prematurity Research and a Senior Fellow in the Center on Democracy, Development, and the Rule of Law, and the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Wise is a fellow of the American Academy of Arts and Sciences and has been working as the Juvenile Care Monitor for the U.S. Federal Court overseeing the treatment of migrant children in U.S. border detention facilities.

Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston. His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School and was the founding Director or the Center for Policy, Outcomes and Prevention, Stanford University School of Medicine. He has served in a variety of professional and consultative roles, including Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, Chair of the Strategic Planning Task Force of the Secretary’s Committee on Genetics, Health and Society, a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH, and the Health and Human Secretary’s Advisory Committee on Infant and Maternal Mortality.

Wise’s most recent U.S.-focused work has addressed disparities in birth outcomes, regionalized specialty care for children, and Medicaid. His international work has focused on women’s and child health in violent and politically complex environments, including Ukraine, Gaza, Central America, Venezuela, and children in detention on the U.S.-Mexico border.  

Core Faculty, Center on Democracy, Development and the Rule of Law
Affiliated faculty at the Center for International Security and Cooperation
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Paul H. Wise Richard E. Behrman Professor of Child Health and Society, Stanford University Speaker
Eduardo Miranda Professor of Civil and Env Engineering, Earthquake Engineering Specialist Speaker

CDDRL
Stanford University
Encina Hall, C147
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Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies
William L. Clayton Senior Fellow at the Hoover Institution
Professor, by courtesy, of Political Science and Sociology
diamond_encina_hall.png MA, PhD

Larry Diamond is the William L. Clayton Senior Fellow at the Hoover Institution, the Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies (FSI), and a Bass University Fellow in Undergraduate Education at Stanford University. He is also professor by courtesy of Political Science and Sociology at Stanford, where he lectures and teaches courses on democracy (including an online course on EdX). At the Hoover Institution, he co-leads the Project on Taiwan in the Indo-Pacific Region and participates in the Project on the U.S., China, and the World. At FSI, he is among the core faculty of the Center on Democracy, Development and the Rule of Law, which he directed for six and a half years. He leads FSI’s Israel Studies Program and is a member of the Program on Arab Reform and Development. He also co-leads the Global Digital Policy Incubator, based at FSI’s Cyber Policy Center. He served for 32 years as founding co-editor of the Journal of Democracy.

Diamond’s research focuses on global trends affecting freedom and democracy and on U.S. and international policies to defend and advance democracy. His book, Ill Winds: Saving Democracy from Russian Rage, Chinese Ambition, and American Complacency, analyzes the challenges confronting liberal democracy in the United States and around the world at this potential “hinge in history,” and offers an agenda for strengthening and defending democracy at home and abroad.  A paperback edition with a new preface was released by Penguin in April 2020. His other books include: In Search of Democracy (2016), The Spirit of Democracy (2008), Developing Democracy: Toward Consolidation (1999), Promoting Democracy in the 1990s (1995), and Class, Ethnicity, and Democracy in Nigeria (1989). He has edited or coedited more than fifty books, including China’s Influence and American Interests (2019, with Orville Schell), Silicon Triangle: The United States, China, Taiwan the Global Semiconductor Security (2023, with James O. Ellis Jr. and Orville Schell), and The Troubling State of India’s Democracy (2024, with Sumit Ganguly and Dinsha Mistree).

During 2002–03, Diamond served as a consultant to the US Agency for International Development (USAID) and was a contributing author of its report, Foreign Aid in the National Interest. He has advised and lectured to universities and think tanks around the world, and to the World Bank, the United Nations, the State Department, and other organizations dealing with governance and development. During the first three months of 2004, Diamond served as a senior adviser on governance to the Coalition Provisional Authority in Baghdad. His 2005 book, Squandered Victory: The American Occupation and the Bungled Effort to Bring Democracy to Iraq, was one of the first books to critically analyze America's postwar engagement in Iraq.

Among Diamond’s other edited books are Democracy in Decline?; Democratization and Authoritarianism in the Arab WorldWill China Democratize?; and Liberation Technology: Social Media and the Struggle for Democracy, all edited with Marc F. Plattner; and Politics and Culture in Contemporary Iran, with Abbas Milani. With Juan J. Linz and Seymour Martin Lipset, he edited the series, Democracy in Developing Countries, which helped to shape a new generation of comparative study of democratic development.

Download full-resolution headshot; photo credit: Rod Searcey.

Former Director of the Center on Democracy, Development and the Rule of Law
Faculty Chair, Jan Koum Israel Studies Program
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Larry Diamond Hoover Institution Senior Fellow, Expert in Democratic Development Speaker
Ralph Greco Director, General Surgery Residency Program, Stanford University Speaker
Carolyn Duffey Lecturer, Comparative Studies in Race and Ethnicity, Stanford University Speaker
Conferences
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In mid April, FSI convened a special conference on Technology, Governance, and Global Development, to examine how technical innovation solves, or fails to solve, the problems of chronic global underdevelopment.  Experts from business, medicine, philanthropy, academia, government and non-governmental organizations, along with young Stanford alumni, addressed technology's ability to help secure gains in health, economic development, agricultural innovation, food security, and human development.

With a wealth of expertise and on-the-ground experience, panelists tackled central issues and engaged in spirited debate, animated by moderator Philip Taubman.  "The Promise of Information and Communications Technology" examined whether technology can transform lives of individuals, even in poorly governed countries, finding encouraging evidence in technology-based medical and health services and novel approaches to economic development, including sharing vital information and banking via mobile phones. 

A panel of young Stanford alumni discussed their entrepreneurial efforts that led to the development of a low-cost, lifesaving incubator for low birth weight babies, the FACE AIDS program begun at Stanford that now has 20 chapters and has contributed some $2 million for treatment of people with AIDS in Africa, a new Global Health Corps to train health care workers, and other innovations to save lives in underserved areas.

Condoleezza Rice, former Secretary of State and National Security Advisor, gave the lunchtime keynote with a focus on why democracies are more effective and ultimately more efficient in delivering economic development. Democracies are better at protection of rule of law and property rights, she noted. Democracies are less corrupt, more in touch with their people, more stable, and better able to deliver the benefits of human capital development, health, and education to their population as a whole.

A third panel on "Governance, Innovation, and Service Delivery" addressed how innovative institutions and technologies could overcome poor governance and deliver needed services in underdeveloped regions. "Despite extraordinary growth in our technical capacity to prevent and treat child illness and death, we are seeing stagnation or a rise in mortality rates of children under five in some areas," said pediatrician Paul Wise. "This reflects gross failures in delivering highly efficacious health interventions." Some 9 million children still die each year, and 65 percent of child deaths in unstable areas are preventable, he noted. Wise has launched a new program to improve child health in areas of unstable governance through new integrated technical and political strategies.

A fourth session on "Creative Markets for Technical Innovation" honed in on the institutions, innovations, and incentives needed to stimulate development of products and services that address the needs of the poor. Panelists focused on pharmaceuticals, agricultural innovation, use of mobile technologies to share information on best practices, improved food security through innovative technology - such as solar-powered irrigation to expand growing seasons, crops, and incomes, and the development of human capital in China through rigorous evaluation, field trials, and nutritional intervention.

Among the experts addressing these vital issues were Google.org's Megan Smith, BP Solar's Reyad Fezzani, Center for Global Development President Nancy Birdsall, Gates Foundation Director of Agricultural Development Sam Dryden, Gilead Science's Clifford Samuel, dynamic Stanford alumni Nava Ashraf ‘97, Jared Cohen ‘04, Jane Chen ‘08, and Jonny Dorsey ‘07, and FSI's Coit D. Blacker, Joshua Cohen, Stephen D. Krasner, Paul H. Wise, Rosamond L. Naylor, and Scott Rozelle.

FSI Payne Lecturer Bill Gates, Co-chair of the Bill & Melinda Gates Foundation and Chairman, Microsoft, gave an address on "Giving Back: Finding the Best Way to Make a Difference."  He urged students to become involved in the central issues of global healthincluding the need to reduce child mortality through more vaccines and better delivery systemsand education, saying we need to find out "what works" and use the Internet to share lessons learned globally.

"We need to shift talent toward bigger needs," Gates said, urging students to provide the passion and ideas to drive us forward in health, education, and energy.  To make a difference, Gates advised, "Get your hands dirty, do the hard work in the actual environment, early in your career."  Telling students that he is looking for "great ideas," he challenged them to post answers on the Gates Foundation Facebook wall to three questions: What problems are you working on? What draws you in? How will you draw other people in to work on solutions to the world's great challenges.

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