Southeast Asia, home to over 640 million people across 10 countries, is one of the world’s most dynamic and fastest growing regions. APARC just concluded the year 2019 with a Center delegation visit to two Southeast Asian capital cities, Hanoi and Bangkok, where we spent an engaging week with stakeholders in the academic, policy, business, and Stanford alumni communities.

Led by APARC Director Gi-Wook Shin, the delegation included APARC Deputy Director and Asia Health Policy Program Director Karen Eggleston, Southeast Asia Program Director Donald Emmerson, and APARC Associate Director for Communications and External Relations Noa Ronkin. Visiting Scholar Andrew Kim joined the delegation in Bangkok.

With a focus on health policy, our first day in Hanoi included a visit to Thai Nguyen University, a meeting with government representatives at the Vietnam Ministry of Health, and a seminar on healthy aging and innovation jointly with Hanoi Medical University.

Image

Throughout the day, Eggleston presented some of her collaborative research that is part of two projects involving international research teams: one that assesses public-private roles and institutional innovation for healthy aging and another that examines the economics of caring for patients with chronic diseases across diverse health systems in Asia and other parts of the world. We appreciated learning from our counterparts about the health care system and health care delivery in Vietnam.

Shifting focus to international relations and regional security, day 2 in Hanoi opened with a roundtable, “The Rise of the Indo-Pacific and Vietnam-U.S. Relations,” held jointly with the East Sea Institute (ESI) of the Diplomatic Academy of Vietnam (DAV). Following a welcome by ESI Director General Nguyen Hung Son, the program continued with remarks by Shin, Emmerson, ESI Deputy Director General To Anh Tuan, and Assistant Director General Do Thanh Hai.

Image

The long-ranging conversation with DAV members included issues such as the future of the international order in Asia; the U.S. withdrawal from multilateralism; the concern about a lack of U.S. engagement in Southeast Asia, sparked by President Trump’s absence from the November 2019 summit of the Association of Southeast Asian Nations (ASEAN) at a time when China is bolstering its influence in the region and when ASEAN hopes to set a code of conduct with China regarding disputed waters in the South China Sea; the priorities for Vietnam as it assumes the role of ASEAN chair in 2020; and the challenges for the Vietnam-U.S. bilateral relationship amid the changing strategic environment in Southeast Asia.

In the afternoon we were joined by members of the American Chamber of Commerce in Hanoi at an AmCham-hosted Lunch ‘n’ Learn session on Vietnam's challenges and opportunities amid the U.S.-China rivalry. The event featured Emmerson in conversation with AmCham Hanoi Executive Director Adam Sitkoff.

Image

Moving to Bangkok, delegation members Shin, Eggleston, Emmerson, and Kim spoke on a panel for executives of the Charoen Pokphand Group (C.P. Group), one of Thailand’s largest private conglomerates, addressing some of the core issues that lie ahead for Southeast Asia in 2020 and beyond in the areas of geopolitics, innovation, and health.

Image

We also enjoyed a tour at True Digital Park, Thailand’s first startup and tech entrepreneur’s campus. Developed by the C.P. Group, True Digital Park aspires to be an open startup ecosystem that powers Thailand to become a global hub for digital innovation.

The following day, Shin and Emmerson participated in a public forum hosted by Chulalongkorn University’s Institute of Security and International Studies (ISIS Thailand), "Where Northeast Asia Meets Southeast Asia: The Great Powers, Global Disorder and Asia’s Future.” They were joined by ISIS Thailand Director Thitinan Pongsudhirak and Chulalongkorn University Faculty of Political Science Associate Dean for International Affairs and Graduate Studies Kasira Cheeppensook. The panel was moderated by Ms. Gwen Robinson, ISIS Thailand senior fellow and editor-at-large of the Nikkei Asian Review.

Image

As part of that discussion, Emmerson speculated that – driven by deepening Chinese economic and migrational involvement in Southeast Asia’s northern tier – Cambodia and Laos, less conceivably Myanmar, and still less conceivably Thailand could become incorporated de facto into an economically integrated “greater China” that could eventually reduce ASEAN to a more-or-less maritime membership in the region’s southern tier. Emmerson’s speculation was made in the context of his critique of ASEAN’s emphasis on its own “centrality” to the neglect of its lack of the proactivity that would serve as evidence of centrality and of a desire not to be rendered peripheral by the growing centrality-cum-proactivity of China. The event was covered by the Bangkok Post (although that report’s headline and quote of Emmerson are inaccurate, as neither the panel nor Emmerson predicted the “break-up of ASEAN.”)

Our delegation visit in Bangkok concluded with a buffet dinner reception and panel discussion jointly with the Stanford Club of Thailand.

Image

Moderated by Mr. Suthichai Yoon, a veteran journalist and founder of digital media outlet Kafedam Group, the conversation focused on the changing geopolitics of Southeast Asia, innovation and health in the region, and the opportunities and challenges facing Thailand-U.S. relations. It was a pleasure to meet many new and old friends from the Stanford and IvyPlus alumni communities.

APARC would like to thank our partners and hosts in Hanoi and Bangkok for their hospitality, collaboration, and the stimulating discussions throughout our visit. We look forward to keeping in touch!

Author Michael Schuman writes an opinion piece informed by Scott Rozelle's publication Past Successes and Future Challenges in Rural China's Human Capital 

"Many investors and economists continue to believe China’s rise to global economic greatness is inevitable. Modern history, however, tells us that graduating from emerging- to a developed-economy status is hardly automatic. An overly intrusive state, dependence on debt, feeble gains in productivity and poor resource allocation are all reasons to fear China might struggle with the transition like so many nations before it...'China must significantly raise its level of human capital if it wishes to attain high-income status. In the end, China can only be as competitive as its people.'"

Read the full story here. 

A special section in the latest issue of the journal Asian Survey, coedited by APARC and the Korea Program Director Gi-Wook Shin, suggests a new framework in both social discourse and policy that reflects the varied complexities of Korea’s increasingly diverse migrants and that charts a course forward for a nation that is staring into a demographic abyss.

South Korea (hereafter Korea) is widely regarded as among the world’s most ethnically and linguistically homogeneous countries. In 1990, Korea counted only 49,000 foreigners amongst its population. But over the last two decades, the number of migrants in the country has grown dramatically, reaching 2.3 million (or 4.5% of the population) in 2018. Just as important is the growing diversity of migrants coming to Korea. In addition to unskilled workers and marriage migrants from developing countries, they increasingly include skilled migrant workers and marriage migrants from a range of developed Western countries.

These more recent migrant groups, however, do not fit into the dominant framework of Korean multiculturalism, and often remain invisible in Korean society, facing discrimination and largely left out of social discourse and government policy. For a nation that is aging faster than any other developed country and that struggles with weak global talent competitiveness, it is crucial to better understand the growing heterogeneity and complexity of migrants beyond their dichotomized depictions as Korean versus non-Korean in ethnicity and citizenship.

This is the focus of a special section in the July/August 2019 issue of the journal Asian Survey, titled Korea’s Migrants: From Homogeneity to Diversity. Coedited by APARC and the Korea Program Director Gi-Wook Shin and former Koret Fellow in Korean Studies Rennie J. Moon (now associate professor at Yonsei University’s Underwood International College), the special section collects articles that examine issues of class and highlight the contributions of migrants from both human and social capital perspectives, with an eye to a better appreciation of the values of diversity and transnationalism. “By doing so,” write Shin and Moon, “we aim to provide a better understanding of the varied experiences, realities, and complexities of Korea’s increasingly diverse migrant groups” and to “suggest a new framework in both social discourse and policy that reflects these complexities.” The articles in the special collections were originally presented and discussed at the Korea Program’s ninth annual Koret Workshop.

Diversity within Korea’s Migrant Groups

To capture the diversity and complexity of Korea’s migrants, Shin and Moon say, scholars need to examine within-group variation. The papers in the special section do so with respect to three migrant groups—marriage migrants, return migrants, and skilled labor—by focusing on nontraditional, relatively under-researched, highly skilled populations, mostly from developed countries, within those groups:

University of Sheffield scholar Sarah A. Son studies cross-border marriages between Korean men and Anglophone women, and shows that these Western women have very different experiences and social expectations compared with Asian female marriage migrants from developing countries. Western women bring greater perceived socioeconomic equality to the relationship by virtue of their economic position, education, and cultural background, and do not fit the common description of Asian female marriage migrants as representative of hypergamy (marrying a partner of higher social status). They also do not conform to the Korean state’s vision of social integration and resist its policy provisions to a greater degree than Asian marriage migrants. In fact, multiculturalism policy has failed to engage this Western migrant group.

What does it mean to be a skilled migrant returnee in Korea? Singapore Management University Research Fellow and former APARC Visiting Scholar Jane Yeonjae Lee provides an answer to this question by looking at the varying experiences and coping strategies of Korean returnees from New Zealand. She finds that, thanks to their educational and economic status, they fare better than traditional ethnic Korean return migrants, who experience hardships due to their status as unskilled labor. However, the process of skill transfer is not easy, and most of the skilled returnees are not fully accepted as Korean, experiencing some degree of alienation and disconnection based on their “overseas Korean” identities. In addition to greater social acceptance of skilled returnees, Lee argues, Korea needs a better policy mechanism for sustaining return migration.

Lastly, Shin, Moon, and former Koret Fellow in Korean Studies Joon Nak Choi (now an adjunct assistant professor at Hong Kong University of Science and Technology’s School of Business Management) focus on elite groups of skilled labor migrants, particularly foreign students studying in Korea and foreign professionals the country imports as skilled labor. The three authors aruge that Korea has largely failed to leverage the potential of these migrant groups, and that it must pay close attention paticularly to their human and social capital potential.

Migrants’ human capital stems from their specialized skills acquired through education, training, and work experience, which can benefit especially Korea’s small- and medium-sized firms. Their social capital is the value they can provide through their social ties that spread information and innovations and that form “transnational bridges” between Korea and their home countries. Social capital is especially advantageous for Korea’s large firms that compete in global markets.

The authors stress the need for Korea to develop a new policy framework, known as study-work framework, for cultivating social capital for skilled foreigners while in Korea. If Korea is to meet the challenges associated with its aging, depopulation, shrinking workforce, and weak position in the global war for mobile skilled talent, then it must “better appreciate the value of the cultural diversity [migrants] bring to its society and economy, as well as their human and social capital contributions.”

View the complete special section >>

Learn more about Shin’s and Moon’s related joint research project Migration, Cultural Diversity, and Tolerance >>

An estimated 210,000 girls may have “gone missing” due to China’s “Later, Longer, Fewer” campaign, a birth planning policy predating the One Child Policy, according to a new study led by Stanford Health Policy researchers published by the Center for Global Development.

The study looked at hundreds of thousands of births occurring before and during the “Later, Longer, Fewer” policy to measure its effect on marriage, fertility, and sex selection behavior. The policy, which began in the 1970s and preceded China's One-Child Policy, promoted later marriage, longer gaps between successive children, and having fewer children to cut the country's population. The study emphasizes that because this policy existed before ultrasound technology was widely available — and therefore before selective abortion was an option — these missing girls must have been due to postnatal neglect of infant girls, or in the extreme, infanticide.

The authors of the new study are Grant Miller, director of the Stanford Center on Global Poverty and Development, a core faculty member at Stanford Health Policy and senior fellow at the Freeman Spogli Institute for International Studies; Kimberly Babiarz, a research scholar at Stanford Health Policy; Paul Ma and Shige Song.

The researchers found that China’s “Longer, Later, Fewer” population control policy reduced total fertility rates by 0.9 births per woman and was directly responsible for an estimated 210,000 missing girls countrywide. The phenomenon of “missing girls” widely recognized in later years under the One Child Policy is largely thought due to sex-selective abortion after ultrasound technology spread across China.

“Prior research has shown that sex ratios rose dramatically under China's One-Child Policy, leading to stark imbalances in the numbers of men and women. But we’re finding that girls went missing earlier than previously thought, which can in part be directly attributed to birth planning policy that predates the One-Child Policy,” said Grant Miller, a senior fellow at the Stanford Institute for Economic Policy Research and a non-resident fellow at the Center for Global Development.

The top findings of the study include:

• The birth planning policy reduced fertility by 0.9 births per woman, explaining 28 percent of the overall decline during this period.

• The Later, Longer, Fewer policy is responsible for a roughly twofold increase in the use of “fertility stopping rules,” the practice of continuing to have children until the desired number of sons is achieved.

• The Later, Longer, Fewer policy is also responsible for an increase in postnatal neglect, from none to 0.3 percent of all female births in China during this period.

• Sex selection behavior was concentrated among couples with the highest demand for sons (couples that have more children but no sons), with sex ratios reaching 117 males per 100 female births among these couples.

“Population control strategies can have unforeseen consequences and human costs,” Miller said. “At the same time, as China debates the future of birth planning policies, it’s also important to note that family planning policy does not appear to be the largest driver of fertility.”

Opioids overdoses now kill more Americans than car accidents or guns, with more than 350,000 Americans having succumbed to the painkillers since 2000.

“The opioid misuse and overdose crisis touches everyone in the United States,” Health and Human Services Secretary Alex Azar said in this recent report. “The effects of the opioid crisis are cumulative and costly for our society — an estimated $504 billion a year in 2015 — placing burdens on families, workplaces, the health care system, states, and communities.”

Now, new research led by Stanford shows that not only have opioid-related deaths jumped fourfold in the last 20 years, but that those most affected by the epidemic, and where they live, has also shifted dramatically. In fact, the District of Columbia has had the fastest rate of increase in mortality from opioids, more than tripling every year since 2013.

“Although opioid-related mortality has been stereotyped as a rural, low-income phenomenon concentrated among Appalachian or midwestern states, it has spread rapidly, particularly among the eastern states,” writes Mathew V. Kiang, ScD, a research fellow at the Center for Population Health Sciences at the Stanford University School of Medicine, in an original investigation published in JAMA Network Open.

The study found the highest rates of opioid-related deaths and more rapid increases in mortality were observed in eight states: Connecticut, Illinois, Indiana, Massachusetts, Maryland, Maine, New Hampshire and Ohio. Two states, Florida and Pennsylvania, had opioid-related mortality rates that were doubling every two years — and tripling in Washington, D.C.

Kiang and his co-authors, including Stanford Health Policy’s Sanjay Basu, MD, PhD,an assistant professor of medicine at Stanford Medicine, used data from the National Center for Health Statistics and corresponding population estimates from the U.S. Census. The other authors are Jarvis Chen, ScD, at the Harvard T.H. Chan School of Public Health, and Monica Alexander, PhD, in the Department of Sociology at the University of Toronto.

“It seems there has been a vast increase in synthetic opioid deaths in the eastern states and especially in the District of Columbia because illicit drugs are often tainted with fentanyl or other synthetic opioids,” Kiang said in an interview.  “People aren’t aware their drugs are laced and more potent than they expected — putting them at higher risk of overdose.”

Image

Synthetic opioid deaths now outnumber heroin deaths in these eastern states, which suggests fentanyl has spread to other illegal drugs and is no longer limited to heroin.

“The identification and characterization of opioid `hot spots’ — in terms of both high mortality rates and increasing trends in mortality — may allow for better-targeted policies that address the current state of the epidemic and the needs of the population,” the authors write.

The research suggests the opioid epidemic has evolved as three intertwined, but distinct waves, based on the types of opioids associated with mortality:

1. The first wave of opioid-related deaths was associated with prescription painkillers from the 1990s until about 2010.
2. From 2010 until the present, the second wave was associated with a large increase in heroin-related deaths.
3. And in the third and current wave, which began around 2013, the rapid increase is associated with illicitly manufactured synthetic opioids, such as tramadol and fentanyl.

“The evolution has also seen a wider range of populations being affected, with the spread of the epidemic from rural to urban areas and considerable increases in opioid-related mortality observed in the black population,” they write.

The Centers for Disease Control and Prevention reports that African-Americans experienced the largest increase in opioid overdose deaths among any racial group from 2016 to 2017, with a 26 percent surge.

“The identification and characterization of opioid ‘hot spots’ — in terms of both high mortality rates and increasing trends in mortality — may allow for better-targeted policies that address the current state of the epidemic and the needs of the population,” the researchers write.

States are trying to combat the epidemic by enacting policies, such as restricting the supply of prescription drugs and expanding treatment and access to the overdose-reversing drug naloxone.

“Treating opioid use as a disorder should be our top priority to curb the problem,” said Kiang. “Similarly, we have the ability that counteract the effects of an overdose — these life-saving drugs should be easily accessible and widely available.”