Global Health

Violent conflicts claim 3,000 lives per day through wars, bombings and attacks that dominate the news media. Meanwhile, behind the headlines, 20,000 people die each day from causes related to hunger and poverty. Physical security and food security are deeply connected. Over a billion people suffer from chronic food insecurity, a situation that feeds violent conflict and weakens national and international security. Food insecurity is especially problematic in agricultural regions where income growth is constrained by resource scarcity, disease, and environmental stress.

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Abstract
Improving the productivity of small farmers is essential for economic development in most poor countries.  Providing access to timely and relevant information could improve the opportunities available to farmers.  However, there are significant challenges related to literacy, infrastructure, access to technology and social, cultural, institutional and linguistic gaps between producers and consumers of knowledge.  The increased adoption of mobile phones is rapidly reducing the physical barriers of access.  Providing voice-based services via low-cost handsets could empower farmers to become producers as well as consumers of knowledge.  In this talk, I discuss several applications my students and I are developing to explore this potential.  Avaaj Otalo (Gujarati for "voice stoop") is the voice-based equivalent of an online discussion board. Farmers and agricultural experts call a toll-free line to ask questions, provide answers, and listen to each others questions, answers and experiences.  We conducted a six-month trial deployment of Avaaj Otalo with fifty farmers in Gujarat, India. Farmers found it useful to learn both from experts and other farmers, sharing advice on many topics - including the best time to sow fodder, recipes for organic pesticides, and homemade devices to scare away wild pigs at night. Digital ICS allows coffee cooperatives to monitor quality and organic certification requirements, and to be more responsive to farmers' needs.  Field inspectors use mobile phones to document growing conditions and record farmers questions and comments through a combination of text, audio and images.  In a six-month trial deployment, the system significantly reduced operational costs, saving the cooperative approximately $10,000 a year.  The cooperative also obtained richer feedback from its members, which can be used for targeting extension, improving decision-making and reaching out to consumers.  In both of these systems, voice provides not only an accessible interface to information, but a medium for aggregating and representing knowledge itself.  We found this approach more suitable for engaging communities more comfortable with oral forms of communication, for whom text and structured data represent significant barriers to expression.  Most importantly, we have found that rural communities have a deep desire to be "heard", and simply need the tools required to define and achieve "development" on their own terms.

Tapan Parikh's research focuses on the use of computing to support sustainable economic development across the World. I want to learn how to build appropriate, affordable information systems; systems that are accessible to end users, support learning and reinforce community efforts towards empowerment, economic development and sustainable use of natural resources. Some specific topics that I am interested in include human-computer interaction (HCI), mobile computing and information systems supporting microfinance, smallholder agriculture and global health

Summary of the Seminar
Tapan Parikh, of UC Berkeley School of Information, spoke about a number of projects that are using mobile phone based technology to give small businesses the information they need to improve productivity. He argued that voice technology has distinct advantages over text, because it overcomes challenges of illiteracy while responding to a strong need people feel to be heard. 

Information is key for economic development and empowerment. But information is worthless unless it is also useable (leads to decisions the business owner can actually take), trusted (comes from a source he respects) and relevant (speaks about the issues he is facing). For information to be really empowering, it must also be two way: there must be ways for individuals to create content themselves.

Tapan described three current projects he is involved in:

Hisaab: Microfinance groups in India often suffer from poor paper based record keeping, making it difficult for the group to track loans and repayments. The Hissab software was designed with an interface suitable for those who may be illiterate and/or new to computing. The use of voice commands and responses in the local language, Tamil, prevented the software from feeling remote and inaccessible and contributed to the success of this initiative. 

Avaaj Otalo: Agricultural extension workers provide advice to farmers on pests, new techniques etc to help improve yields. But often they have limited reach, visiting areas only rarely, or perhaps lacking the expertise to respond to all the problems they encounter. Avaaj Otalo is a system for farmers to access relevant and timely agricultural information over the phone. By dialing a phone number and navigating through simple audio prompts, farmers can record questions, respond to others, or access content published by agricultural experts and institutions. The service has been hugely popular, with farmers willing to spend time listening to large amounts of material to find what they want. The opportunity to be broadcast was a major attraction, reflecting the desire to be heard and to create media rather than be a passive consumer of it.

Digital ICS: Smallholders' compliance with organic, fair-trade and quality requirements is usually measured via paper based internal inspections. The data uncovered by these is vital but often lost. Digital ICS is a mobile phone based application that allows inspectors to fill out the survey digitally, enhance it with visual evidence (e.g. from camera phones) and upload it onto a web application. This is being piloted with coffee farmers in Mexico. A key finding from the work is that farmers want to know who ends up drinking their coffee, what they pay for it and what they think about it. Greater links between producers and consumers may therefore be another area for this project to investigate.  

Wallenberg Theater
Bldg 160

Tapan Parikh Assistant Professor Speaker University of California, Berkeley; affiliate in the Department of Computer Science at the University of Washington
Seminars
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Pharmaceutical policies are interlinked globally, yet deeply rooted in local culture. The newly published book Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, edited by Karen Eggleston, examines how pharmaceuticals and their regulation play an important and often contentious role in the health systems of the Asia-Pacific.

In this colloquium, contributors to Prescribing Cultures discuss how the book analyzes pharmaceutical policy in China, Korea, Japan, Thailand, Taiwan, Australia, and India, focusing on two cross-cutting themes: differences in “prescribing cultures” and physician dispensing; and the challenge of balancing access to drugs with incentives for innovation.

As Michael Reich of Harvard University says in his Forward to Prescribing Cultures,

“The pharmaceutical sector…promises great benefits and also poses enormous risks.… Conflicts abound over public policies, industry strategies, payment mechanisms, professional associations, and dispensing practices—to name just a few of the regional controversies covered in this excellent book.

The tension between emphasizing innovation versus access -- a topic of hot debate on today’s global health policy agenda -- is examined in several chapters…

This book makes a special contribution to our understanding of the pharmaceutical sector in China… Globalization is galloping forward, with Chinese producers pushing the pace at breakneck speed. More and more, our safety depends on China’s ability to get its regulatory act together…”

The colloquium features presentations by Naoko Tomita (Keio University), Anita Wagner (Harvard University), and Karen Eggleston (Stanford FSI Shorenstein Asia-Pacific Research Center). They will give specific examples of how pharmaceutical policy serves as a window into the economic tradeoffs, political compromises, and historical trajectories that shape health systems, as well as how cultural legacies shape and are shaped by the forces of globalization.

Oksenberg Conference Room

Anita Wagner Speaker Harvard University
Naoko Tomita Speaker Keio University

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
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Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director, Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
CV
Date Label
Karen Eggleston Speaker Stanford University
Seminars
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With what now seem like almost weekly product scandals, recalls, and supply chain exposes, the public increasingly wants to know more about the products they are putting in, on, and around their families. Until recently, consumers had no way to find out the full impacts of the products they consumed. However, with advances in information technologies, product assessment methodologies, and web and mobile platforms, there is now a real potential to radically increase transparency in consumer markets and global supply chains. Dara O'Rourke, Associate Professor at UC Berkeley, will discuss an experiment in providing information to the public about the environmental, social, and health impacts of products and companies: GoodGuide. GoodGuide's award-winning web and iPhone apps have been featured recently in the New York Times, Newsweek, Time, and even Oprah's Magazine! Dara will discuss GoodGuide's long-term vision, current strategies, and the information technologies they are applying to this challenge.

Dara O’Rourke is an Associate Professor at the University of California, Berkeley, and the co-founder of GoodGuide. Dara’s research focuses on systems for monitoring the environmental, labor, and health impacts of global production systems. His research has been featured in The New York Times, The International Herald Tribune, The Boston Globe, The Los Angeles Times, The Economist, Business Week, Newsweek, Time, and TechCrunch. Dara has served as a consultant to international organizations such as the World Bank, the United Nations Development Programme, the Organization for Economic Cooperation and Development, and a wide range of domestic and international non-governmental organizations. He has degrees in Mechanical Engineering, Political Science, and Energy and Resources, and he previously taught at MIT.

GoodGuide seeks to revolutionize how consumers see and interact with products and companies. GoodGuide provides a suite of tools that offer information about the environmental, social, and health performance of products and companies to consumers at the point of purchase (through web and mobile apps), and that empower people to screen and compare products based on their personal values and concerns. GoodGuide's tools seek to empower millions of consumers to buy products that better match their values, to avoid products that are detrimental to their health, the environment, or issues they care about, and to participate in a more transparent marketplace.

CISAC Conference Room

Dara O'Rourke Good Guide and Associate Professor of Environmental and Labor Policy Speaker UC Berkeley
Seminars
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Why do community-based education and social persuasion programs for promoting healthy lifestyle and preventing chronic disease sometimes fall short of our expectations? Why are population effects so difficult to engineer and why are they so ephemeral?

This research carried out at USC, the Claremont Graduate University, and collaborating institutions in China integrates across social, behavioral, and neurocognitive sciences to address those questions. We conclude tentatively that the answer to each of the questions may lie in individual and context variability relative to program response, and that in order to more fully address the question of prevention program response variability requires engagement and integration across several levels of science to consider the roles of social groupings, environmental selection and design, social influence processes, and brain biology.

What works in one social, cultural or organizational setting may not be so effective in another. What works for persons with certain genetic and experiential backgrounds may be totally ineffective for persons with different dispositional or personality characteristics. In a series of community/school based prevention trials carried out in markedly different southern California and central China settings, we have uncovered domains of consistent response, and other domains of substantial environment- and disposition-based response variability.

A social influences based smoking prevention program framed in collectivist values and objectives worked to prevent smoking in one cultural setting but not another. And an individualist framed social influences program worked in the setting where the collectivist program did not. But the characteristics of the particular settings, which defined program success or failure, were different from what conventional (e.g., cultural psychology) wisdom would have led us to expect. Furthermore, both within and across cultural settings, the same individual dispositional characteristics moderated or determined program effectiveness, again in ways not predicted by the common cultural and behavioral science wisdom.

In recent studies carried out both in China and the U.S. we have found affective decision deficits, with known neural underpinnings, to account for rapid progression to regular smoking and binge drinking. These deficits are akin to the dispositional characteristics found earlier to moderate prevention program effects. Subsequent brain imaging studies confirm the hypothesized regions of neural involvement. Together these findings hold promise for more effective – situation and phenotype specific – approaches to engendering and sustaining more optimal individual and population health behavior.

Philippines Conference Room

Carl Anderson Johnson Dean & Professor of Community & Global Health Speaker Claremont Graduate School
Lectures
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This seminar will feature two presentations: an attempt to evaluate the impact of health policy under a decade of progressive governments in Korea; and an investigation into the health and economic well-being of the elderly in Korea. The presenters will be Dr. Byongho Tchoe, a 2008-09 visiting scholar at Stanford University, and Dr. Young Kyung Do, the inaugural postdoctoral fellow in the Asia Health Policy Program at Stanford.

Korea achieved universal health care coverage in 1989 only twelve years after the introduction of social health insurance under an authoritarian government. In 1992 a civil government won the presidential election. Consistent with a conservative ideology oriented toward market principles and globalization, that government emphasized competitive principles in health care policy. However, at the end of 1997 in the face of economic crisis, the progressive party won the Korean presidential election; their health emphasized strengthening equity, redistribution, and regulation of providers’ rent seeking behavior. Under successive progressive governments from 1998 to 2007, ambitious health policy reforms integrated insurers, separated prescribing from dispensing, reformed provider payment, expanded benefits coverage, increased medical-aid enrollees, and increased the role of government providers in the health care market. But in the election of 2007, they were defeated by a conservative party, which insists that competition among insurers and providers will enhance efficiency and quality in health care, and stresses consumer choice and responsibility.

Dr. Tchoe's talk will attempt to evaluate impact of health care policy under a decade of progressive governments in Korea. Although equity in both access to care and financial responsibility appear to be enhanced, there is controversy about whether the policies were cost-effective or improved health, and what will happen as the new government repeals regulations in the health care market. The return of economic crisis also brings renewed urgency to debates of economic and social policy.

Byongho Tchoe is a 2008-09 visiting scholar at Stanford University. After working at the Korea Development Institute from 1983 to 1995, he took up his current post with the Korea Institute for Health and Social Affairs. He has been influential in formulating health and social policy in Korea, having served as an advisor to the minister of health and social welfare and participated in many task forces and committees. In 2007, he was awarded a National Medal in honor of 30 years achievement related to Korea’s National Health Insurance. He has published many articles and books and served as president of the Korean Association of Health Economics and Policy and as vice president of the Korea Association of Social Security. He holds a master’s degree in public policy from Seoul National University and a Ph.D. in economics from the University of Georgia.

Young Kyung Do is the inaugural Postdoctoral Fellow in Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center. He completed his Ph.D. in health policy and administration at the University of North Carolina at Chapel Hill School of Public Health in August 2008. He has also earned M.D. and Master of Public Health degrees from Seoul National University (in 1997 and 2003, respectively). He earned board certification in preventive medicine from the Korean Medical Association in 2004. He received the First Prize Award in the Graduate Student Paper Competition in the Korea Labor and Income Panel Study Conference in 2007. He also is the recipient of the Harry T. Phillips Award for Outstanding Teaching by a Doctoral Student from the UNC Department of Health Policy and Administration in 2007. In May 2008, he was selected as a New Investigator in Global Health by the Global Health Council.

Daniel and Nancy Okimoto Conference Room

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-6530
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Visiting Scholar, 2008-09
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Byongho Tchoe is a 2008-09 visiting scholar at Stanford University. He began his research career at the KDI (Korea Development Institute) which is a topnotch government think tank in Korea and served from 1983 to 1995. After earning his PhD in economics, he continued his research career at KIHASA (Korea Institute for Health and Social Affairs) from 1995 up to now. 

He has always been an influential resource in formulating health and social policy in Korea, and served as an advisor to the minister of health and social welfare in 2000. He participated as a member of many task forces and committees for health and social policy making. He was awarded a National Medal for contributing 30 years achievement of National Health Insurance in 2007. 

He was also active in academic society. He published many articles and books. He served as a president of Korean Association of Health Economics and Policy and a vice president of Korea Association of Social Security. He holds a master's degree in public policy from Seoul National University and a PhD in economics from the University of Georgia. 

Byong Ho Tchoe Visiting Scholar, 2008-09 Speaker Shorenstein APARC
Young Kyung Do Postdoctoral Fellow, 2008-09 Speaker Shorenstein APARC
Seminars
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