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In today's global economy, access to resources around the world has never been easier. The high tech industry has always been in the forefront of globalization in lowering costs, acquiring talent as well as serving markets. For instance, Asian countries have long been known for their vast manufacturing bases for western high tech industry.

In recent years, thanks to Y2K, India has become the leader in software outsourcing. China, given its expanding economy as well as its open market direction, has rapidly become the emerging location for multi-national semiconductor companies to outsource their product development amidst China's own burgeoning integrated circuit (IC) industry. Mr. Lee has first-hand experience in building and managing an IC product development center in Shanghai, China. He will discuss the challenges of operating a R&D organization in an environment of different languages and cultures. He will also share his vision of the future of the IC industry in China.

Mr. Lee is Group Vice President and general manager of Timing Solutions Products at Integrated Device Technology, Inc.(IDT), a public semiconductor company of $650 million annual sales, focusing on valued-added solutions for communication, consumer and computing markets. He has been with IDT for the last 22 years and has served various management roles. In 2001, he architected the acquisition of Newave Semiconductor Corporation in China and established the Shanghai Product Development Center for IDT. Before joining IDT in 1984, Mr. Lee spent 5 years at Intel Corporation as a technologist for the early development of flash memory technology. Mr. Lee earned his B.S. degree in Electrical Engineering from National Taiwan University in 1975 and M.S. degree from Case Western Reserve University in 1979.

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Jimmy Lee Group Vice President & General Manager of Timing Solutions Products Speaker Integrated Device Technology, Inc.
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Dr. Liu first offered his view on the current state of the software industry's development and in particular software outsourcing to China. Software prices and margins continue to drop. Coupled with this reality is Liu's view that "only 10-15% of software development is truly innovative and therefore suitable to be developed in Silicon Valley". As software development platforms and communication technologies, especially the Internet, become ubiquitous and affordable, distributed software development is becoming the rule.

China's challenges and advantages in software outsourcing

Compared to India, the leader in software outsourcing, China has its own distinct challenges. Chinese software companies have almost no U.S. customers for a number of reasons: language barriers, different working styles, customers' concern for software piracy, and the lack of experienced programmers and technical managers in China. Yet, China also has its advantages. Not only does it have a rapidly expanding domestic software market, but it also has a large pool of fresh engineering talent. "The key, therefore," asserted Dr. Liu, "lies in someone creating the right environment to train and build a local team to be able to develop and deliver world-class software products."

Augmentum's software development goals

This is what Augmentum has set out to accomplish. "...[W]e want to build a world-class, distributed development team for software product development... like the ODM model in the PC world..." declared Dr. Liu. Based on this vision, Augmentum's strategy hinges on its insistence to develop software for top US customers, such as Motorola, Business Objects, and PalmSource--and to rely primarily on local Chinese engineers. Explained Liu: "We want to make sure that the center of most of the people of that team is going to be in China, even though the locomotive, the teachers, is in the U.S., because that's where the leadership is in the software product development world."

Drawing on decades of experience developing top software teams at IBM and other companies, Dr. Liu detailed his company's efforts to attract the brightest local engineers and train them to be even better. He explained, "Culture and team is the true differentiation of Augmentum.... The real...challenge is to build the right culture with the right core team." The company insists on having no expatriates in their China operations but promoting close interaction between experienced mentors in the U.S. and the young teams in China, sometimes using some creative approaches for recruitment and training. For example, Augmentum puts all of its new hires under "a stress test" after hiring and proactively maintains an "upfront churn of at least 30%" in the first three-month period." Their end goal: "a world-class software development team that can bridge the East and the West but still has a cost structure comparable to local companies."

Liu's focus for the future

Despite experienced leadership, ties to leading U.S. companies, and strong young software teams, Augmentum faces real challenges. Liu acknowledged skeptics who question the ability to build a world-class team through working on the "crumbs of companies" of "projects they don't want to work on themselves." Nevertheless, he is confident in the trajectory of Augmentum's future growth, as the company is expecting to double its employees every year for the coming few years. In addition, Dr. Liu's vision includes a landscape beyond Augmentum. "I have a very simple focus. I want to train a lot of world-class software developers in China to serve the world. Many of them will not be working for Augmentum. It is fine...I want to bring my experience to there to make it happen. And the best vehicle to do that at this moment and time, the wave [that] I want to jump on is outsourcing, because it is growing the fastest."

Biography of Leonard Liu

Leonard Liu has spent 30 years in the systems industry, with a track record of developing innovative computing technologies into successful businesses. Most recently, he served as president of ASE Group, a leading provider of IC test and packaging services, having held roles as Chairman and CEO of Walker Interactive Systems, COO of Cadence Design Systems, and President of Acer Group. He was an early champion of outsourcing to India and China at Cadence and Walker. Dr. Liu began his career at IBM where he was responsible for the creation and implementation of SQL and the management of CICS, SNA and AIX, eventually overseeing the worldwide Database and Language lines-of-business. He received his undergraduate degree from Taiwan University and his Ph.D. from Princeton University.

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Focus on Innovation and Entrepreneurship in Greater China

SPRIE is a multidisciplinary research program at Stanford University that focuses on innovation and entrepreneurship in leading high technology regions in the United States and Asia. SPRIE has an active community of scholars at Stanford as well as research affiliates in the United States, Mainland China, Taiwan, Japan, Korea, Singapore, and India. During 2005-2006, SPRIE is expanding a new initiative on the rise of leading high technology regions in Greater China and their impact on the global knowledge economy. Specific research topics include globalization of R&D, executive leadership, university-industry linkages, venture capital industry development and leading high technology clusters in Greater China. In addition, industries of ongoing research at SPRIE include semiconductors, computers, telecommunications, and software.

SPRIE Graduate Research Fellows: Research Assistantships & Support for International Field Research

As part of its new initiative on innovation and entrepreneurship in Greater China, SPRIE will select outstanding Stanford students as SPRIE Graduate Research Scholars. SPRIE Graduate Research Scholars will work with SPRIE faculty and senior researchers at Stanford for two (or more) academic quarters in 2005-2006 to gather and analyze data, conduct interviews in Silicon Valley, contribute to publications, and advance progress on the overall project agenda. During summer 2006, they will conduct SPRIE field research through interviews or surveys with business and government leaders in Beijing, Shanghai, or Hsinchu. As part of SPRIE's international research team, they will have the opportunity to interact closely with project leaders and visiting scholars at Stanford as well as partners in Asia, such as the Ministry of Science and Technology, Tsinghua University, or Zhongguancun Science Park in Mainland China or the Industrial Technology Research Institute (ITRI) in Taiwan. They will also participate in SPRIE's public and invitation-only seminars and workshops with academic, business, and government leaders. The financial award will include RA support at 15-20 hours/week (or equivalent) plus summer stipend to cover travel, living expenses, and research.

How To Apply (limited to current Stanford graduate students)

Successful candidates will have demonstrated a track record of superior analytical ability, strong oral and written communication skills (including full fluency in English and Chinese), knowledge of high technology and entrepreneurship, high motivation, and willingness to be part of a dynamic international research team.

Applicants should submit:

  1. A brief statement (not to exceed two single-spaced pages), which describes the candidate's interests and skills,
  2. a curriculum vitae
  3. contact information for 2 references, preferably recent professors, advisors, or employers

Send applications to:

SPRIE
Encina Hall - East 301
Stanford University 94305-6055

or by email to George Krompacky. Questions? Please contact George Krompacky, Program Coordinator, by email or call 650.725.1885

Deadline for receipt of all materials: December 30, 2005

Applicants will be notified of decisions in January 2006

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The film "Silent Killer: The Unfinished Campaign Against Hunger," hosted by NPR's Scott Simon, offers a compelling examination of both the problem and solutions surrounding world hunger. The program aired on PBS station KQED/San Francisco on Wednesday, November 2nd at 11:00 p.m.

SEATTLE - There are a billion hungry people in the world. Fifteen thousand children-the equivalent of five times the victims of the World Trade Center bombings-die each day of hunger. Yet it doesn't have to be this way. We can end hunger-if we make a commitment to doing so. The new one-hour documentary Silent Killer: The Unfinished Campaign Against Hunger shows how it can be done. Shot on location in the United States, South Africa, Kenya, Rome, Mexico and Brazil, Silent Killer examines both the problem of hunger and solutions. The documentary and its companion Web site (www.SilentKillerFilm.org) will provide viewers with inspiration and information to become part of the effort to end hunger.

Produced by Hana Jindrova and John de Graaf (Affluenza, Escape from Affluenza), in association with KCTS/Seattle Public Television, Silent Killer will air on several California public television stations as follows:

KTEH/ San Jose: Sunday, October 16 at 5:00 p.m. (please confirm).

KOCE/ Huntington Beach: Sunday, October 23 at 4:00 p.m.

KQED/ San Francisco: Wednesday, November 2 at 11:00 p.m., repeating on

KQED Encore (Digital Channel 189), Thursday, November 3 at 10:00 p.m.

KVCR/ San Bernardino: Thanksgiving evening, Thursday, November 24 at 8 p.m.

KVIE/ Sacramento: Airdate and time to be announced.

KCSM/ San Mateo: Airdate and time to be announced.

(For all other stations, please check local listings).

Narrated by National Public Radio's Scott Simon, the film begins in South Africa's Kalahari Desert, where razor-thin Bushmen use the Hoodia cactus to fend off hunger. But now, a drug firm has patented the Hoodia's appetite-suppressant properties and is using it to make a diet product for obese Americans and Europeans. Hoodia is a metaphor for a world where some people die from too much food, but millions more die from too little.

We discover how serious the problem is in Kenya as we meet Jane Ininda, a scientist who is trying to make agriculture more productive in her country, while her own brother, Salesio, barely survives the drought, poor soils and pests that constantly threaten his crops. Through powerful stories, we come to understand the dimensions of the hunger crisis.

At the World Food Summit in Rome, we learn how activists have been working to end hunger since President John Kennedy declared war on it in 1963. But today, America's commitment to food security is less clear. In fact, world financial commitments to hunger research are now in decline.

But Silent Killer does not leave viewers feeling helpless. A visit to Brazil finds a nation energized by a new campaign called FOME ZERO-Zero Hunger. In the huge city of Belo Horizonte, we meet a remarkable leader and see how, under the programs she supervises, the right to food is guaranteed to all. In the countryside, we are introduced to the Landless Peasants' Movement, which is giving hope to millions of hungry Brazilians.

Can we end hunger, or will it always be with us? Why should we try? What will it take? What are we doing now? Can biotechnology play a role, and if so, how? Is hunger just a problem of distribution, or do we still need to produce more and better crops? These are the questions considered in this exquisitely photographed documentary.

EXPERTS featured in Silent Killer: The Unfinished Campaign Against Hunger and available for press interviews include:

David Beckmann - President, Bread for the World. Since 1991, Reverend David Beckmann has served as president of Bread for the World, a Christian group that lobbies the U.S. government for policy changes to end hunger in the United States and around the world.

Per Pinstrup-Andersen - World Food Prize Laureate 2001. A native of Denmark, Per Pinstrup-Andersen is the H.E. Babcock Professor of Food, Nutrition and Public Policy at Cornell University. He also serves as the chairman of the Science Council of the Consultative Group on International Agricultural Research.

Chris Barrett - Development Economist, Cornell University. Dr. Barrett is a professor of applied economics and management at Cornell University. His focus is on rural communities, primarily in Africa, concentrating on the dynamics of poverty, food security and hunger.

Walter Falcon - Development Economist, Stanford University. Dr. Falcon is the Farnsworth Professor of International Agricultural Policy at Stanford University (emeritus), co-director of the Center for Environmental Science and Policy, and former director of the Stanford Institute for International Studies.

PROGRAM TIE-INS: October 16 is the 25th observance of World Food Day-a worldwide event designed to create awareness, understanding and year-round action to alleviate hunger. (See www.worldfooddayusa.org.) In addition, October 24 is the 60th anniversary of the founding of the United Nations and its first agency, the Food and Agriculture Organization (FAO).

CREDITS: Silent Killer was produced by Hana Jindrova and John de Graaf in association with KCTS/Seattle Public Television and is narrated by NPR's Scott Simon. Writer: John de Graaf. Photographers/Editors: Diana Wilmar and David Fox. Composer: Michael Bade. Executive Producer: Enrique Cerna, KCTS. Funding was provided by The Rockefeller Foundation.

DISTRIBUTOR: Silent Killer is presented nationally by KCTS/Seattle Public Television and is distributed by the National Educational Telecommunications Association (NETA).

WEB SITE: See www.SilentKillerFilm.org for more information about the film, including a full transcript, in-depth interviews with film characters and experts on hunger, a guide for teachers, a list of hunger facts and myths, a detailed "Take Action" section and additional resources. Color images from the film are posted on the site for press use, along with an online press kit.

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The Stanford Project on Regions of Innovation and Entrepreneurship (SPRIE) is a multidisciplinary research program of the Shorenstein Asia-Pacific Research Center at Stanford University that focuses on innovation and entrepreneurship in leading high technology regions in the United States and Asia. SPRIE has an active community of scholars at Stanford as well as research affiliates in the United States, China, Taiwan, Japan, Korea, Singapore, and India.

Fellowship Program

As part of its initiative on Greater China, SPRIE will select two outstanding post-docs or young scholars as SPRIE Fellows at Stanford for the academic year 2006-2007 for research and writing on Greater China and its role in the global knowledge economy. The primary focus of the program is the intersection of innovation and entrepreneurship and underlying contemporary political, economic, technological and/or business factors in Greater China (including Taiwan, Mainland China, Singapore). Topics of particular interest include, but are not limited to, globalization of R&D, executive leadership, university-industry linkages, venture capital industry development and leading high technology clusters in Greater China. In addition, industries of ongoing research at SPRIE include semiconductors, computers, telecommunications, and software.

SPRIE Fellows at Stanford will be expected to be in residence for at least three academic quarters, beginning the fall quarter of 2006. Fellows take part in Center activities, including research forums, seminars and workshops throughout the academic year, and are required to present their research findings in SPRIE seminars. They will also participate as members of SPRIE's team in its public and invitation-only seminars and workshops with academic, business and government leaders. Fellows will also participate in the publication programs of SPRIE and Shorenstein Asia-Pacific Research Center. The Fellowship carries a stipend of $40,000.

How to Apply

Applicants should submit:

1) A statement of purpose not to exceed five single-spaced pages which describes the research and writing to be undertaken during the fellowship period, as well as the projected products(s) that will be published;

2) a curriculum vitae (with research ability in Chinese preferred); and

3) 2 letters of recommendation from faculty advisors or other scholars. All applicants must have Ph.D. degrees conferred by August 30, 2006.

Address all applications to:

Stanford Project on Regions of Innovation and Entrepreneurship,

Shorenstein Asia-Pacific Research Center,

Encina Hall - East 301,

Stanford University

Stanford, CA 94305-6055

Questions? Please contact George Krompacky, Program Coordinator

Deadline for receipt of all materials: January 13, 2006

Applicants will be notified of decisions in March 2006

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China's software industry is at an inflexion point. For the past decade, China has been in the shadow of India's spectacular success in the IT outsourcing industry. While changes are underway, many challenges remain. However, it is possible to build software development teams in China, collaborating with teams in the United States, to be as good as software development teams anywhere in the world.

Dr. Liu will discuss his experience as Chairman and CEO of Augmentum, a value-added software development services company that has grown in two years to more than 450 people worldwide, 90% of them at Augmentum's development facility in Shanghai. Sixty percent of Augmentum's work is high-value added such as total products and solutions, from architecture to system integration test. All their customers are in North America -- many of them leaders in their respective industries.

Leonard Liu has spent 30 years in the systems industry, with a track record of developing innovative computing technologies into successful businesses. Most recently, he served as president of ASE Group, a leading provider of IC test and packaging services, having held roles as Chairman and CEO of Walker Interactive Systems, COO of Cadence Design Systems, and President of Acer Group. He was an early champion of outsourcing to India and China at Cadence and Walker. Dr. Liu began his career at IBM where he was responsible for the creation and implementation of SQL and the management of CICS, SNA and AIX, eventually overseeing the worldwide Database and Language lines-of-business. He received his undergraduate degree from Taiwan University and his Ph.D. from Princeton University.

Part of SPRIE's Greater China and the Globalization of R&D seminar series

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Leonard Liu Chairman and CEO, Augmentum, former executive at Cadence, Acer Group & IBM Speaker
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Despite a late start, Pakistan's information technology entrepreneurs and the government are hoping to make it big in the global marketplace for outsourcing of IT-enabled services. How have other countries succeeded and where does Pakistan stand?

Naween A. Mangi spoke from New York to Ron Hira, professor of public policy at the Rochester Institute of Technology, and Rafiq Dossani, senior research scholar at the Walter H. Shorenstein Asia-Pacific Research Center at Stanford University.

Software exports, call centres and medical transcription firms have become all the rage over the last three years. Young entrepreneurs are returning after years spent working at major tech firms in the US to start up their own ventures and the government is forecasting that IT will be the next big thing in Pakistan's economy.

So far, the numbers tell a less-than-compelling story. In 2004, although the software and IT enabled services business was worth $300 million, (including hardware the figure is $600 million), exports and outsourcing made up for just $33 million of that. By comparison, India logged $12.8 billion in software and services exports in 2004.

Still, the Pakistan Software Export Board, a federal body set up to promote outsourcing, forecasts that the business will grow by at least 45 per cent annually for the next five years. A lot of that growth will come from call centres and business process outsourcing which last year made up one-fourth of total exports. In the next ten years, the PSEB aims to be at the top of the class of tier two global IT companies.

But as experts and practitioners agree, Pakistan will need more than ambitious aims to meet that goal. Prof Ron Hira, whose new book Outsourcing America assesses the impact on the US job market, says the outsourcing industry is set for rapid growth in the next few years and if done right, developing countries like Pakistan could benefit from the boom.

Hira is an expert who has testified before the US Congress on the implications of outsourcing. "Pakistan isn't on the map yet," he says. "India dominates what most people think about [when it comes to outsourcing]."

Rafiq Dossani, an expert on outsourcing and a senior research scholar at Stanford University says there are several reasons for that. First, is the poor quality of infrastructure.

"When the Internet tanked recently, that created a really bad perception that the country has not thought through even the most rudimentary aspects," Dossani says. "Deregulation in this area is too limited." He says that while voice services have benefited from the deregulation, data services are still uncompetitive.

He says there are too many stumbling blocks since bandwidth is more expensive than in other countries. "The costs are outrageous at four or five times what they should be," he says.

Dossani identifies the thin segment of English speakers as a second hurdle in the way of a flourishing outsourcing industry in Pakistan. "Of the 30 per cent of the population that lives in urban Pakistan, one tenth speak English that's good enough to work at a call centre," he says. "And of those five million or so, only about one million are available to come into this field as the rest are working elsewhere."

Then, he says poor marketing also holds the industry back. "You just don't see the trade body [in Pakistan] working like India's Nasscom to project a positive image," he says. "The Pakistani diaspora has done well and there is a great need to better use that network."

He forecasts that the outsourcing business in Pakistan can be at least $1 billion in size but says this is only possible if alliances are formed with countries like India and China.

"The Philippines has done well by understanding that it cannot reach critical mass on its own and therefore forming alliances and pitching themselves as a second location to offset country risk," he says. Dossani also says Pakistan has the advantage of a highly skilled group of entrepreneurs which "is the reason why the tiny industry does exist."

Hira adds that since Pakistan entered into the industry late, playing catch up is an inevitable need. However, the sector can take advantage of the circumstances in other countries. "India has done a lot of things right," he says. "They have been successful at not just attracting foreign investment but also building their own companies and leveraging the large Indian diaspora," Hira says.

"India is also so talked about that people are comfortable doing business there. But since wages are rising, Pakistan can use that as an entry point." He says that while countries like India have accumulated critical mass and scale, others are distinguishing themselves in different ways.

Eastern European wages are slightly higher than Pakistan and companies in that region have specialized in near-shoring by targeting the European market. Russia, meantime, is aiming at the U.S. market in both services and manufacturing while the Philippines and Malaysia are targeting services.

"The question really is how you separate yourself from the pack," Hira says. "You can compete on price to a certain extent but you have to offer something more to distinguish yourself."

He says U.S. companies are now moving from pilot stage outsourcing to full deployment which indicates both the success of the pilot projects and the rapid growth that is likely to come in the outsourcing market for the next few years. "There will continue to be a backlash from U.S. workers, but by and large there has not been any real policy movement to restrict outsourcing so there is still a large opportunity," he says.

Hira admits that the extent to which a growing outsourcing industry ties into the broader economy in terms of job creation remains unclear but he says, other advantages emerge. "In India, for example, it remains unclear that they've been able to link the benefits [from outsourcing] back in, but the big benefit is that they have created world class management which can then move into other sectors."

Therefore, Hira recommends that Pakistan take a long-term vision not for the next three or five years but for the next two decades. "Right now you can try to pick up the low hanging fruit and absorb the excess demand but don't just think about attracting the individual company to come [to Pakistan]," he says. "Think about how this will fit into the larger set of skills for your country so that you can differentiate yourself much later down the road."

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China has a large and growing elderly population, but to be old in China-particularly in the countryside-is to be vulnerable. In the country's rural areas there are few clinics and hospitals, and health insurance is virtually nonexistent. Compared with elderly Chinese living in urban areas, those in rural areas have a shorter life expectancy and a poorer quality of life.

Further, little academic research has focused on the health needs and health status of China's elderly. It is with the goal of addressing this deficit that Pengqian Fang, a trainee with CHP/PCOR's China-U.S. Health and Aging Research Fellowship, recently returned to China from Stanford. Fang is seeking to document the health disparities between China's rural and urban elderly population, and to use his findings to propose healthcare assistance programs for the elderly in rural areas of China.

Fang spent a year at Stanford studying health-services research concepts and methods and developing his research project.

In the project, which Fang refined with guidance from CHP/PCOR faculty, Fang will conduct a detailed survey of the health status, health needs, and healthcare utilization of elderly people in rural and urban areas of China, through in-home interviews in three Chinese provinces with different geographic and socioeconomic characteristics: Guizhou (in southwest China), Hubei (in central China), and Guangdong (in the southeast).

He will conduct the project in collaboration with the health departments of the

three provinces, and with support from Tongji Medical College in Wuhan, where he

is director and associate professor of healthcare management.

Fang's study will be among the first of its kind in China. Such research is needed, Fang explained, because China's elderly population (of whom 70 percent reside in rural areas) is growing steadily, and in the coming years its members will require medical services at increasing rates. According to the country's 2000 census, China has 132 million people over age 65, making up more than 10 percent of the population; the over-80 population, which numbers 10 million people, is increasing by 5.4 percent a year; and about 20 percent of all elderly people in the world live in China.

The elderly in China's rural areas face particular challenges in getting high-quality, affordable healthcare services, Fang explained. There are few clinics and hospitals in rural areas, and there is no government-sponsored health coverage for the elderly (like the United States' Medicare program) anywhere in China. All of these factors put China's rural elderly in a vulnerable position, especially those with disabilities or serious illnesses.

"This research will show the disparities that exist, and it will encourage a dialogue about policies to help rural elderly people in China," Fang said.

Fang plans to conduct his survey in the first half of 2005, analyze the data in the summer and fall, and return to Stanford in November 2005 to present the results. In each of the three provinces studied, the research team will recruit 500 households and will conduct interviews with all individuals age 65 and over who reside there, for an estimated final sample of 2,500 people.

The respondents will be asked for a variety of information, including their income and education, insurance status, health status, daily activities, social activity, mental health, utilization of healthcare services, and accessibility and affordability of medical care. The researchers will also interview community healthcare workers-including physicians, nurses, and administrative staff-to seek information on the health needs of the elderly and the barriers they and their healthcare providers face.

The China-U.S. Health and Aging Research Fellowship, administered jointly by

CHP/PCOR and the China Health Economics Institute (Beijing), aims to improve

healthcare quality and efficiency in China through an exchange program in which

selected Chinese health services researchers come to Stanford to study for six months to a year, and then return to China to conduct an original research project. The fellowship is funded by the National Institutes of Health's Fogarty International Center.

"I have learned very much from Stanford and this program," Fang said. "The classes I attended have given me very useful ideas." He noted that since health services research is still a young field in China-about ten years old-"we learn a lot from the United States, like how to ask the research question, how to get a grant, how to design a study."

One aspect of Stanford that particularly impressed Fang was its emphasis on interdisciplinary collaboration.

"This is a very good feature-the close relationship between different fields," he said. "In my country we are more focused on one narrow field."

Fang said he is interested in establishing research collaborations between Stanford and Tongji Medical College-an idea that he and CHP/PCOR's leadership will be exploring in the coming months.

There is much to admire about the U.S. healthcare system's emphasis on innovation and technology, Fang said. Still, he said, "I don't hope for China to follow the U.S. health system," with its heavy reliance on free-market principles. For one thing, "medicine here is very costly." He cited a personal example of how he fractured his arm in a minor bicycle accident, and how his emergency room visit for the injury, along with a follow-up physician appointment, cost more than $1,000. "I was surprised it cost so much," he said.

A review of the fellowship program conducted by officials at the China Health Economics Institute last fall concluded that it has been successful and valuable. Leaders at the institute said the trainees' Stanford experience has enhanced their intellectual abilities, their knowledge of research methodology, their leadership capacity, and their ability to collaborate internationally.

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For over five years the war in Chechnya has occupied a central and neuralgic place in Vladimir Putin's political agenda. In unleashing a renewed military campaign in September 1999-abrogating the cease-fire agreement that had terminated the earlier 1994-1996 war launched by then president Boris Yeltsin-President Putin sought to win American and Western acquiescence in, if not support for, Russia's military campaign by framing the conflict as a war on international terrorism.

For over five years the war in Chechnya has occupied a central and neuralgic place in Vladimir Putin's political agenda. In unleashing a renewed military campaign in September 1999-abrogating the cease-fire agreement that had terminated the earlier 1994-1996 war launched by then president Boris Yeltsin-President Putin sought to win American and Western acquiescence in, if not support for, Russia's military campaign by framing the conflict as a war on international terrorism.

However, far from extinguishing the conflict, or confining it within the territory of Chechnya, these policies have contributed to the spread of violence and instability far beyond the borders of the Chechen republic. Instead of pursuing strategies that would address the larger socioeconomic crisis of the predominantly Muslim regions of the Northern Caucasus, marginalize extremists, and win broad support from the population of the region, the brutality of Russian military forces and their local allies in the war in Chechnya and the repressive actions of the security services in neighboring republics have fanned the flames of hostility to Moscow and created conditions for the spread of radical Islamist ideologies and the recruitment of new adherents across the Northern Caucasus.

President Putin has treated the problems facing Russia as a product of state "weakness" and has called for strengthening Russia's unity and state power in response. Ostensibly in order to better combat terrorism, he has introduced a series of measures aimed at strengthening Russia's political unity and executive power at the expense of political pluralism, freedom of information, and civil society development. But by weakening or undermining Russia's fragile and weakly developed system of institutional checks and balances on central power, and reducing the transparency and accountability of official behavior, these policies may well be exacerbating rather than mitigating the challenges facing Russia today.

What began as a secular conflict over the political status of Chechnya has progressively been transformed into a wider struggle involving more radical fighters from other Muslim republics with an avowedly Islamist agenda that now threatens to destabilize the broader region of the Northern Caucasus. The past few years have also seen a rising tide of terrorist actions directed against local authorities and security services in other republics of the Northern Caucasus as well as against the Russian government and population more broadly, including terrorist acts aimed at targets in the city of Moscow itself.

From the dramatic seizure of some 800 hostages in a Moscow theater in October

2002, in which 129 hostages died from the effects of a lethal gas used by Russian security services in a bungled rescue operation, to the September 2004 horrific siege of an elementary school in Beslan, Southern Ossetia, in which over 300 civilians died-over half of them children-these episodes have not only challenged the official assertions that the war could be confined to Chechnya alone but have dramatized the inability of the Russian government to adequately protect the security of its population.

The inept and chaotic handling of many of these terrorist attacks has brought into stark relief the poor performance of the security services, the incompetence of local officials, serious intelligence failures, and above all widespread official corruption. In the Beslan episode, to take just one example, the siege was carried out by some thirty-two terrorists, of several different nationalities, who were apparently able to bribe their way across a series of checkpoints to enter the republic and to utilize weapons and explosives stored on the site beforehand. The local authorities and the federal security services proved incapable of coordinating their actions to control the situation, and the Moscow-appointed president of the republic proved completely inept. Indeed, the most courageous and effective actor was Ruslan Aushev, the former president of Ingushetia, a figure removed from power by Moscow for resisting pressure for more coercive policies.

The Putin government has used these events to justify a series of measures which

are ostensibly intended to more effectively combat terrorism but which appear to

have little relation to the real terrorist threat. First, it has refused to seek a political solution to the conflict in Chechnya and has deliberately sought to undermine possible negotiations or international mediation and to delegitimize potential negotiating partners by demonizing a broad array of Chechen political figures within the country and abroad as "terrorists."

Conflating Chechen resistance with international terrorism, President Putin has explicitly refused to distinguish between more moderate figures and extremists and has exaggerated their ties to international terrorist organizations like Al Qaeda.

Domestically, the Russian government has used security concerns to justify ever greater restrictions on freedom of information, on civil rights, and on the role of nongovernmental organizations, particularly those engaged in the defense of human rights. The military and the organs of law enforcement have been given an ever freer hand, rarely if ever held accountable for their abusive behavior and atrocities against civilians.

Refugee camps in the neighboring republic of Ingushetia were closed and the international non-governmental organizations providing medical care and humanitarian assistance to refugees there were compelled to depart. The mass media have largely lost their independence and editors and journalists have been dismissed or attacked for expressing critical views.

A whole series of measures aimed at further centralization of political power and the strengthening of the executive branch have eroded the already fragile elements of federalism and separation of powers in the Russian political system. The autonomy and political influence of regions and republics has been sharply reduced. Parliament, now dominated by a single pro-presidential party, no longer acts as an independent check on executive power, and liberal political parties and their leaders have been marginalized. Most recently, the popular election of regional governors was abolished in favor of their appointment by Moscow, and a discussion is now under way of bringing even local government under tighter central control by eliminating the election of mayors as well.

Moreover, a high proportion of President Putin's appointees to key positions in

the regions are drawn from the military and security services, selected for their presumed loyalty to the president but often lacking political skills or understanding of local conditions. But the substitution of appointed for elected officials does not necessarily guarantee either loyalty or competence.

In the absence of a competitive party system in which political parties help create a web of ties between the central government and local populations, Putin's centralizing measures could well widen the chasm between state and society.

This growing emphasis on centralization, unity, repression, and secrecy is arguably exacerbating rather than mitigating the problems and making state power even more dysfunctional. In Chechnya and in the broader Caucasus region the brutality as well as the corruption of Russian military and security forces and their local allies-and their extensive reliance on torture, mass roundups, indiscriminate executions, disappearances of civilians, and simple extortion-has embittered many toward Moscow and made it increasingly difficult to win "hearts and minds" and build popular support. Indeed, the lack of transparency, and the difficulty of holding Russian officials accountable for abusive behavior, has led unprecedented numbers of Russian citizens frustrated by the unresponsiveness of their own government to seek redress at the European Court of Human Rights in Strasbourg.

Lacking a positive agenda for ameliorating socioeconomic conditions in the Northern Caucasus, the expanding operations of security forces across the Northern Caucasus, the closure of mosques, and the wave of often indiscriminate arrests have served to drive Islam underground and facilitated the spread of extremist ideologies. Without a coherent and sustained program of economic development that would create employment, housing, and education and offer alternative opportunities to an impoverished and alienated population, particularly young males, and absent a serious effort to eliminate corruption, these trends are likely to worsen.

Russia under Putin is facing a somber future.

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