Workshop Goals

On the first day, develop a set of research interventions (surveys, experiments, archival searches, participant observations, etc.) that will gain some leverage in measuring differential policies in Europe and their impact on integration, however specified; or in examining the various immigrant populations to measure their differential success in integration, however specified. Each of the participants (either singly or in collaboration) will write up one or two research proposals that lay out the outcomes of interest and the strategy for explaining variation on those outcomes.  Discuss problems and opportunities for each of the submitted proposals and fulfill this first goal.

The second goal of the workshop, and the subject for the second day, to think through three related issues. The first is how to frame the set of proposals in a way that they all fit into a well-defined framework, as if each proposal were a piece of a coherent puzzle. The second is to think through funding sources for this set of interventions that would allow us to conduct the research we proposed and to continue collaborating across these projects. The third is to explore whether there are scholars whose work we know who should be invited to join our group and become part of the grant proposing team.

Wednesday, May 7, 2014 Agenda

I.  Citizenship (discussant Thad) – [9-11AM]

  • Hainmueller/Hangartner – Return on getting citizenship; encouragement design in Switzerland
  • Gest/Hainmueller/Hiscox – Encouragement design on citizenship in US (Chicago)
  • Hainmueller/Laitin – Encouragement design on citizenship in France
  • Alter/Margalit – Immigration and political participation, where immigrants get immediate rights to citizenship (Israel)
  • Dancygier/Vernby – return on citizenship for labor market success (Sweden)

II. Local Context (Rafaela) [11:15-12:15]

  • Adida/Hangartner – RDD on Sudanese refugees in various US cities; experiment with IRC on Iraqi/Chaldian integration in El Cajon

III. Contracts of Integration (Yotam) [1:30-3PM]

  • Hainmueller/Hangartner – Integration Contracts and Naturalization
  • Hainmueller/Laitin – Integration Contracts in France

IV. Discrimination (Jens) [3:30-5PM]

  • Ortega/Polavieja – Immigrants and Job security in Spain and elsewhere in Europe
  • Margalit – Overcoming employer abuse of immigrant workers
  • Dancygier/Vernby – failure of immigrants to get nominated for political office

Thursday, May 8, 2014 Agenda

Discussion on what investments in collective goods might advance this research perspective productively. We might look at favorable granting institutions and how we might combine our memos into a macro proposal; or we might think about building a common research infrastructure (in the way J-PAL has done for experimental development studies). Working towards a jointly authored volume might be another way to aggregate our research projects. All of this discussion depends on the complementarities that emerge from our discussions on Wednesday. David will chair the Thursday discussion.

Reuben W. Hills Conference Room

Department of Political Science
Stanford University
Encina Hall, W423
Stanford, CA 94305-6044

(650) 725-9556 (650) 723-1808
0
James T. Watkins IV and Elise V. Watkins Professor of Political Science
laitin.jpg PhD

David Laitin is the James T. Watkins IV and Elise V. Watkins Professor of Political Science and a co-director of the Immigration Policy Lab at Stanford. He has conducted field research in Somalia, Nigeria, Spain, Estonia and France. His principal research interest is on how culture – specifically, language and religion – guides political behavior. He is the author of “Why Muslim Integration Fails in Christian-heritage Societies” and a series of articles on immigrant integration, civil war and terrorism. Laitin received his BA from Swarthmore College and his PhD from the University of California, Berkeley.

Affiliated faculty at the Center for International Security and Cooperation
Affiliated faculty at The Europe Center
David Laitin (Workshop Faculty Organizer) Stanford University Speaker

616 Serra Street
Encina Hall West, Room 100
Stanford, CA 94305-6044

0
Associate Professor of Political Science
Europe Center Affiliated Faculty
101105_JensHainmueller_1583.jpg

Jens Hainmueller's research has appeared in journals such as the American Political Science Review, American Journal of Political Science, Journal of the American Statistical Association, Review of Economics and Statistics, Political Analysis, International Organization, and the Journal of Statistical Software, and has received awards from the American Political Science Association, the Society of Political Methodology, the Midwest Political Science Association.

Hainmueller received his PhD from Harvard University and also studied at the London School of Economics, Brown University, and the University of Tübingen. Before joining Stanford, he served on the faculty of the Massachusetts Institute of Technology.

Jens Hainmueller Stanford University Speaker
Claire Adida UC San Diego Speaker
Dominik Hangartner London School of Economics and Political Science Speaker
Kare Vernby Uppsala University, Sweden Speaker
Yotam Margalit Columbia University Speaker
Francesc Ortega Queens College CUNY Speaker
Thad Dunning UC Berkeley Speaker
Rafaela Dancygier Princeton University Speaker
Simon Ejdemyr Stanford University Speaker
Simon Hix London School of Economics and Political Science Speaker
Workshops
Authors
Christian E. Ollano
News Type
News
Date
Paragraphs

This summer Stanford’s Center on Democracy, Development, and the Rule of Law (CDDRL) is welcoming new leadership to oversee the growth and development of the Program on Arab Reform and Democracy (ARD), one of the Center's principal research programs examining contemporary issues of political development in the Arab world.

Lisa Blaydes, assistant professor of political science at Stanford, will assume the role of faculty co-director, working together with CDDRL Director Larry Diamond to help shape the program's research agenda. Blaydes will be joined by Hesham Sallam, currently a CDDRL pre-doctoral fellow completing his Ph.D. in government at Georgetown University. He will serve as the program's new associate director, assuming operational management and developing the program's research initiatives and activities at Stanford and throughout the Arab world, in partnership with the faculty co-directors. Sallam is also joining CDDRL as a research associate. In that capacity he will produce research and publications on questions related to political and economic reform in the Arab World.

Sallam is replacing ARD's founding director Lina Khatib, who left CDDRL last year to assume directorship of the Carnegie Endowment for Peace's Middle East office in Beirut.

"We are very excited to have Hesham Sallam assuming this leadership role in the ARD program, and joining the research staff of CDDRL,” said Diamond. “Hesham is not only a superb scholar of Arab politics and political economy, but has also been deeply engaged in analytic and public policy debates about the future of the region. His deep knowledge and broad credibility in the field will be strong and immediate assets to the program, and will help us build on the strong foundation laid by our founding program leader, Lina Khatib."

“I am extremely delighted to join the CDDRL and FSI family,” said Sallam. “I look forward to working closely with the Stanford community, faculty, students, and staff, to expand interdisciplinary discussions of Arab politics and society on campus.”

“By enhancing its intellectual engagement with scholars and activists in Arab world, ARD will continue to nuance our understanding of conflicts over political, social and economic rights in the region by supporting critical scholarship and by developing innovative research agendas,” he said.

Sallam’s dissertation examines how Islamist movements have impacted the politics of economic reform in Egypt before and after the Arab uprisings in 2011. His previous research has received the support of the United States Institute of Peace and the Social Science Research Council. Sallam also serves as co-editor of the Jadaliyya, a leading online magazine, which invites critical debate and analysis of current events in the Arab world from academics, activists and journalists. 

Diamond expressed great enthusiasm over the addition of Lisa Blaydes to the program’s faculty leadership. “Over the past several years, Lisa has rapidly emerged as one of the most original and influential scholars of politics and social change in the Arab world,” he said. “She brings to the program intense intellectual curiosity, scholarly distinction and a keen interest in advancing social science studies of the Arab world."

Blaydes, a specialist in comparative politics and politics in the Middle East, recently published the book, Elections and Distributive Politics in Mubarak’s Egypt, which examines the complex relationships among regimes, rent-seeking elites and citizens fostered by authoritarian elections.

“The Arab world is at a critical juncture,” said Blaydes. “Although mass protests have transformed public political consciousness, the long-term impact of the protest movement on more concrete forms of power has yet to be determined. Policy-relevant scholarly research such as that conducted by the Program on Arab Reform and Democracy may help us to identify pathways to political reform.”

Blaydes and Sallam, together with Diamond, participated in the most recent ARD Program conference on political change in the Arab world. Held in collaboration with the Center for Research on Globalization and Democratic Governance at Koc University in Turkey, the conference brought together leaders in policy, academia and government to address issues of violence and government transitions in the region following continuous civil unrest and political uncertainty.

Founded in 2010 with annual support from the Moulay Hicham Foundation, CDDRL's Program on Arab Reform and Democracy aims to be a hub for intellectual capital about issues related to good governance, social change and political reform in the region, producing rigorous and policy-relevant academic research. Conferences and seminars in the U.S. and the Arab world provide innovative forums for academics and policy-makers to advance new ideas and approaches to the most pressing issues facing the region today.

For more information on the Program on Arab Reform and Development, please visit: http://arabreform.stanford.edu/. 

Hero Image
encinaardimage
All News button
1
-

Mr. Chun Yungwoo, the national security adviser to the South Korean president from 2010 to 2013, will analyze Korea’s strategic situation in light of the current geopolitical dynamics and challenges to peace and security in Northeast Asia. He will assess the state of bilateral relations among key states in the region, including the risk of territorial disputes spiraling out of control due to domestic politics or miscalculation. As a former chief South Korean negotiator to the Six Party Talks on ending North Korea’s nuclear weapons program, Ambassador Chun will also present his ideas for making progress on North Korean denuclearization while discussing the existential crisis facing North Korea and the long-term future of the Korean Peninsula.

Chun Yungwoo is the chairman and founder of the Korean Peninsula Future Forum (KPFF). Previously, Ambassador Chun served as the National Security Advisor to President Lee Myung-Bak from 2010 to 2013. In his 33 years of service in the Ministry of Foreign Affairs, Ambassador Chun served as Second Vice Foreign Minister (2009-2010), Special Representative for Korean Peninsula Peace and Security Affairs and Head of the ROK Delegation to the Six-Party Talks (2006-2008), and Deputy Foreign Minister for Policy Planning and International Organizations (2005-2006). He was also the Korean Ambassador to the United Kingdom (2008-2009), Ambassador and Deputy Permanent Representative to the United Nations (2003-2005), and also held earlier diplomatic postings in France, Morocco, and Austria. Ambassador Chun received a BA from Pusan National University and Master of International Affairs from the School of International and Public Affairs at Columbia University.

 

Philippines Conference Room

Chun Yungwoo Chairman of The Korean Peninsula Future Forum Speaker
Seminars
-

*Open only to Stanford students.* 

Speaker Bio: 

Zahera Harb is one of the six 2013-2014 FSI-Humanities Center International Visitors and will be in residence at Stanford in May 2014. She is Senior Lecturer in International Journalism at City University London. She received her M.A. and Ph.D. in journalism studies from Cardiff University (United Kingdom). As an expert on Arab media, she has published widely on journalism ethics, conflict and war reporting, political communication and representation of Muslims and Islam in western media. Her recent publications include Narrating Conflict in the Middle East: Discourse, Image and Communications Practices in Lebanon and Palestine (2013) and Channels of Resistance: Liberation Propaganda, Hezbollah and the Media (2011). Dr. Harb also has 11 years of experience as a journalist in Lebanon working for Lebanese and international media organizations.

 

This event is co-sponsored by the Sohaib and Sara Abbasi Program in Islamic Studies, CDDRL Program on Arab Reform and Democracy, the Mediterranean Studies Forum, Stanford Humanities Center, Arab Studies Table, Stanford Language Center. 

Building 30, Room 102

Zahera Harb Senior Lecturer in International Journalism Speaker City University London
Seminars
Date
Paragraphs
CDDRL Director Larry Diamond addresses concerns of an intensifying democratic recession in a piece in The Atlantic. Despite recent turmoil in Ukraine and democratic breakdowns in Thailand and Turkey, among others, Diamond emphasizes the critical role economic development, globalization and the growth of civil society will play in the long-run inducement of democratic change worldwide.
Hero Image
democracy Logo
Protesters carry a large banner reading: ''Democracy'' as they participate in an anti-government protests organized by Bahrain's leading opposition Al Wefaq. Sept. 14, 2012.
Hamad I Mohammed / Reuters
All News button
1
News Type
News
Date
Paragraphs

President Barack Obama’s trip to four Asian nations – Japan, South Korea, Malaysia and the Philippines – set out to address an ambitious agenda, including trade negotiations, territorial disputes, and the threat of North Korea. Scholars at the Shorenstein Asia-Pacific Research Center in the Freeman Spogli Institute provided commentary to local and international media about the state tour.

Ambassador Michael Armacost, a distinguished fellow at Shorenstein APARC, evaluated the goals of the trip, saying it aimed to deliver a message of reassurance to East Asia that the U.S. rebalance is intact. Armacost highlighted the efforts to negotiate a 12-nation trade pact, the Trans-Pacific Partnership (TPP) as the centerpiece of the Obama trip to Asia. He was interviewed by Weekly Toyo Keizi, a Japanese political economy magazine. An English version of the Q&A is available on Dispatch Japan.

Many foreign policy issues shadowed the outset of President Obama’s Asia trip, the crisis in Ukraine and Syria, among others. Daniel Sneider, associate director of research at Shorenstein APARC, said in Slate that Asian nations notice where the United States focuses its time. Obama’s commitment to the region may have come across as distracted given the breadth of his current foreign policy agenda.

Sneider also spoke with LinkAsia on Obama’s stop in Tokyo. President Obama met with Japanese Prime Minister Shinzo Abe; the two leaders addressed issues surrounding territorial disputes and attempted to reach an agreement on outside market access issues in the TPP negotiations.

Donald Emmerson, director of Shorenstein APARC’s Southeast Asia Forum, offered an assessment of America’s ‘pivot to Asia’ and on the significance of the Malaysia and Philippines visits. He said the trip most notably reinforced America’s efforts to upgrade security commitments and promote freer trade negotiation in that region. The Q&A was carried by the Stanford News Service.

Emmerson spoke with McClatchyDC on two occasions about the Philippines leg of the tour. He commented on Obama’s statement reaffirming the United States’ security commitment to Japan, which recognized Japan’s administrative control over the Senkaku Islands. Emmerson suggested the greater context of claims in the South China Sea must be considered, including Manila’s. He also said maintenance of the security alliance is a positive step, but trade is a an essential part of the the pivot's sustainablility.

Hero Image
Obama Asia Trip Japan Logo
All News button
1
-

Abstract:

Moulay Hicham’s newly published memoir, Journal d’un prince banni, retells his personal life within the context of devastating political critique against the Moroccan political system, its authoritarian monarchy, and the “deep state” within that resists democratic change, the Makhzen.  Written during Moulay Hicham's time as a fellow at the Center for Democracy, Development, and Rule of Law at Stanford University, the volume is neither a settlement of accounts nor a gossipy narrative of frivolous stories.  It instead uniquely ensconces vivid personal recollections within the context of authoritarian politics.  The prince witnessed the rise of the system under King Hassan II, the long-lasting ruler who eliminated all opposition, centralized power, and linked a loyal community of courtiers, elites, and cronies to his will—the Makhzen.  The memoir reveals how Moulay Hicham’s aspirations towards autonomy and independence were constantly blocked by this system, often by either the King himself or his coercive apparatus, comprising the intelligence services and military.  At the same time, the nearly half-century reign of King Hassan exposes critical insight into the development of Moroccan politics and identity, from his acumen regarding the Western Sahara problem to his ability to make the kingdom a focal point of Arab politics after the demise of Nasserism. 

Those personal observations on governance continue with the royal ascent of Hassan’s son, Mohamed VI, who assumed the throne in 1999 and is Moulay Hicham’s cousin.  Replacing Hassan’s powerfully intent personality was this more humane yet political disengaged new king.  His inability to curb the Makhzen and enact meaningful democratic reforms shows the system’s very success.  Whereas the pressures of conforming to the system crushed many of those personalities who grew up in the court, Moulay Hicham managed to elude this destructive side through his self-imposed exile to the United States and his intellectual decision to criticize an authoritarian machine to which he was meant to belong.  As the memoir concludes, such resistance to change implicates the monarchy’s future.  Decades of political exclusion, false promises, and rising inequality have alienated much of the Moroccan public.  As the Arab Spring showed, such discontentment portends to future social and political conflict that could well discredit the monarchy, resulting in its overthrow after 350 years of continuous reign.

Journal d’un prince banni has become a literary and political phenomenon in Morocco and the Moroccan diaspora worldwide.  Its release ignited tumultuous debates within the press, social media, and civil society.  Dubbed an “exceptional document” by Le Nouvel Observateur, the memoir has become one of the best-selling non-fiction works in France.  Though print versions are currently unavailable in Morocco, electronic versions have been downloaded and disseminated on an exponential scale.  Arabic, English, and other language-editions are scheduled for release in the near future.

 

Speaker Bio:

Hicham Ben Abdallah received his B.A. in Politics in 1985 from Princeton University, and his M.A. in Political Science from Stanford in 1997. His interest is in the politics of the transition from authoritarianism to democracy.

He has lectured in numerous universities and think tanks in North America and Europe. His work for the advancement of peace and conflict resolution has brought him to Kosovo as a special Assistant to Bernard Kouchner, and to Nigeria and Palestine as an election observer with the Carter Center. He has published in journals such Le Monde,  Le Monde Diplomatique,Pouvoirs, Le Debat, The Journal of Democracy, The New York Times, El Pais, and El Quds.

In 2010 he has founded the Moulay Hicham Foundation which conducts social science research on the MENA region. He is also an entrepreneur with interests in agriculture, real estate, and renewable energies. His company, Al Tayyar Energy, has a number of clean energy projects in Asia and Europe. 

 

Oksenberg Conference Room

CDDRL
Stanford University
Encina Hall
616 Serra Street
Stanford, CA 94305-6055

0
Consulting Professor
Ben_Abdallah.jpg MA

Hicham Ben Abdallah received his B.A. in Politics in 1985 from Princeton University, and his M.A. in Political Science from Stanford in 1997. His interest is in the politics of the transition from authoritarianism to democracy.

He has lectured in numerous universities and think tanks in North America and Europe. His work for the advancement of peace and conflict resolution has brought him to Kosovo as a special Assistant to Bernard Kouchner, and to Nigeria and Palestine as an election observer with the Carter Center. He has published in journals such Le Monde,  Le Monde Diplomatique,Pouvoirs, Le Debat, The Journal of Democracy, The New York Times, El Pais, and El Quds.

In 2010 he has founded the Moulay Hicham Foundation which conducts social science research on the MENA region. He is also an entrepreneur with interests in agriculture, real estate, and renewable energies. His company, Al Tayyar Energy, has a number of clean energy projects in Asia and Europe. 

Hicham Ben Abdallah Consulting Professor Speaker Stanford University
Conferences
Authors
News Type
News
Date
Paragraphs
Donald K. Emmerson, director of Shorenstein APARC's Southeast Asia Program and FSI senior fellow emeritus, offers insight on U.S. President Barack Obama's Asian tour. He says the trip most notably reinforces America's 'rebalance' efforts to upgrade security commitments and promote freer trade negotiation in that region.

When President Barack Obama this week began a high-profile visit to Asia, it called into question how effective the "Asian pivot" in America's foreign policy has been. A few years ago, Obama announced that a rebalancing of U.S. interests toward Asia would be a central tenet of his legacy. Now he is visiting Japan, South Korea, Malaysia and the Philippines to reassert the message that America is truly focused on Asia – despite finding itself repeatedly pulled away by crises in Ukraine and the Middle East, and political battles in Washington, D.C.

Stanford political scientist Donald K. Emmerson, an expert on Asia, China-Southeast Asia relations, sovereignty disputes and the American "rebalance" toward Asia, sat down with the Stanford News Service to discuss Obama's trip. Emmerson is a senior fellow emeritus at the Walter H. Shorenstein Asia-Pacific Research Center in the Freeman Spogli Institute for International Studies.

President Obama started his Asian pivot a few years ago. Have problems in Ukraine, Syria, Iran and at home detracted from this new approach?

The pivot as practiced continues unabated. The pivot as perceived has suffered from its displacement on various attention spans by superseding events and concerns, both foreign and domestic. President Obama's current trip to Asia is itself a reflection of these distractions. Originally planned for October, it was postponed by extreme political discord in Washington. But the chief elements of the pivot remain in place and in progress. They are most notably the upgrading of American security commitments and the effort to negotiate freer trade.

Why does this rebalancing in U.S. foreign policy make sense – or not?

The pivot certainly serves U.S. interests. Americans cannot afford to deny themselves, or be denied by others, the opportunities for trade and investment that Asia's most dynamic economies will continue to generate. The U.S. also needs to work with China and its neighbors to help ensure that China's rise serves the wider security interests of Americans, Chinese, Asians and the world, however dissonant the day-to-day advocacy of those interests may be. Ironically, by obliterating Obama's proposed reset of U.S.-Russia relations, Vladimir Putin has become an unintentional friend of the rebalance toward Asia. His aggression in Crimea and eastern Ukraine has made all the more urgent the need for Washington to pursue mutually beneficial relations with Beijing and the rest of Asia that could moderate China's willingness and ability to force its ownfaits accomplis in the East and South China Seas.

Do Chinese leaders view Obama's Asian pivot as a de facto containment approach to a rising China?

China's leaders do question U.S. intentions. But one ought not ignore the dozens and dozens of venues and ways in which the two countries' governments continue to cooperate on multiple fronts. In domestic terms it is politically convenient for Chinese hardliners to disparage American motives. As with the pivot itself, however, perception and practice are not the same thing.

Are Asian countries more rattled than ever by China's behavior in places like the South and East China Seas?

Concerned, yes; rattled, no. There are six or seven different claimants to contested land features and/or sea space in the South China Sea, not to mention the territorial tensions that also bedevil interstate relations in Northeast Asia. East Asian leaders are not lined up in a united front against Beijing. They are themselves divided. The more assertive China becomes, the more pushback it can expect. But most of the states in Southeast Asia do not want to ally with the U.S. against China, or with China against the U.S.

The U.S. and the Philippines are poised to sign a treaty that will expand America's military presence in the island country. What's the significance of the treaty?

Articles 4 and 5 of the treaty commit Washington and Manila to "act to meet the common dangers" implied by "an armed attack in the Pacific Area" on the "metropolitan territory" of either party, or on the "island territories under its jurisdiction," or on "its armed forces, public vessels or aircraft in the Pacific," and to do so "in accordance with its constitutional processes." But these provisions are hardly self-implementing; they require interpretation. Even if China were to forcibly evict the Philippine marines who now occupy Second Thomas Shoal in the South China Sea, the treaty would not automatically trigger an American military response. Applied to that scenario, the treaty would not instantly entrap the U.S. in a war with China. But the treaty would require some action or statement on the part of Washington. In Manila, Obama will try to reassure his Philippine host in this regard without enraging its Chinese neighbor.

Obama will be the first U.S. president in five decades to visit Malaysia. What does that visit mean for that country?

Of the four countries that Obama is visiting, it is in Malaysia that the pivot's third face after security and economy – namely democracy – will be most visible. Obama will be careful not to appear to enter into the domestic political turbulence Malaysia is experiencing, but his visits with civil society actors and university students in Kuala Lumpur will send the nonpartisan message that America remains committed to democratic values for itself and for Asians as well.

Clifton Parker is a writer for the Stanford News Service.

Hero Image
Obama Asia April2013 Japan logo
All News button
1
News Type
News
Date
Paragraphs
In a recent report, CDDRL Postdoctoral Fellow Amr Adly, with the support of the Center for International Private Enterprise, provides insight on post-revolution entrepreneurship in Egypt and Tunisia. He suggests that in order to advance their economies, governments must carry out comprehensive reforms that provide greater accessibility to formal institutional structures for the broadest base of private sector enterprises, namely, small business owners, rural enterprises, and female entrepreneurs.
Hero Image
Amr Pic 1
Cairo Nile city towers from Al Zamalek area just a few minutes after sunset.
Flickr/Marwa Morgan
All News button
1
Authors
News Type
News
Date
Paragraphs

Foreign aid for health care is directly linked to an increase in life expectancy and a decrease in child mortality in developing countries, according to a new study by Stanford researchers.

The researchers examined both public and private health-aid programs between 1974 and 2010 in 140 countries and found that, contrary to common perceptions about the waste and ineffectiveness of aid, these health-aid grants led to significant health improvements with lasting effects over time.

Countries receiving more health aid witnessed a more rapid rise in life expectancy and saw measurably larger declines in mortality among children under the age of 5 than countries that received less health aid, said Eran Bendavid, MD, an assistant professor in Stanford Medical School's Division of General Medical Disciplines and lead author of the study. If these trends continue, he said, an increase in health aid of just 4 percent, or $1 billion, could have major implications for child mortality.

“If health aid continues to be as effective as it has been, we estimate there will be 364,800 fewer deaths in children under 5,” he said. “We are talking about $1 billion, which is a relatively small commitment for developed countries.”

The study was published online April 21 in JAMA Internal Medicine. The study’s co-author, Jay Bhattacharya, MD, PhD, is an associate professor of medicine.

 

Bendavid and Bhattacharya are core faculty members at Stanford’s Center for Health Policy and Center for Primary Care and Outcomes Research at the university's Freeman Spogli Institute for International Studies.

Does it work?

Bendavid noted that there is much debate around foreign aid. Critics question whether it’s used effectively and reaches its intended recipients. They often argue that it discourages local development and displaces domestic resources that might otherwise be devoted to health. So the researchers devised a statistical tool to address the basic unanswered question: Do investments in health really lead to health improvements?

Bendavid said there are many reasons to suspect the answer would be no, though the findings proved just the contrary, with health-related aid leading to direct, beneficial outcomes.

“I think for many people, that will be surprising,” he said. “But for me, it fits with other evidence of the incredible success of public health promotion in developing countries.” In a previous study, for instance, he found that hundreds of thousands of lives were saved through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, in which the U.S. government invested billions of dollars in antiretroviral treatment and other AIDS-related prevention and treatment initiatives.

In the latest study, the two investigators used data from the Creditor Reporting System of the Organization for Economic Cooperation and Development, the world’s most extensive source of information on foreign aid. While aid programs for health grew during the 36-year study period, the largest period of growth occurred between 2000 and 2010, they found.

Stepped-up investments

It was during this decade that many governments and private groups stepped up their investments in health, including PEPFAR; the World Bank; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Gates Foundation; and the GAVI Alliance, among others, he said.

As a result, while health aid in 1990 accounted for 4 percent of total foreign aid, it now amounts to 15 percent of all aid, he said. And it’s become an important part of health budgets in recipient countries, accounting for 25-30 percent of all health-care spending in low-income countries, Bendavid said.

The researchers found that these funds were used effectively, largely because of the targeting of aid to disease priorities where improved technologies — such as new vaccines, insecticide-treated bed nets for malarial prevention and antiretroviral drugs for HIV — could make a real difference.

They observed the greatest health impacts between 2000 and 2010, when donor investments were at their peak. During the decade, under-5 child mortality declined from a mean of 109.2 to 72.4 deaths per 1,000, or 36.8 fewer deaths among those children in the countries that received the most health aid, the researchers found (a 34 percent reduction). In the countries receiving the least, under-5 mortality fell from 31.6 to 23.2 deaths per 1,000, or 8.4 fewer deaths per 1,000 live births (a 26 percent reduction), the researchers reported.

Life expectancy increases

During that period, life-expectancy figures also grew faster in countries with a greater infusion of health aid, Bendavid said. Life expectancy rose from 57.5 to 62.3 — an increase of 4.8 years — among the countries receiving the most aid. Among the countries receiving the least health aid, life expectancy increased by 2.7 years, from 69.8 to 72.5 years.

Bendavid said previous experience has shown that, on average, life expectancy has increased by nearly one year every four years in developed countries. But health-aid programs literally cut in half the time it took to reach this goal in developing countries. “In that same four-year span, they increased life expectancy by two years, rather than one year,” he said.

He said the results are not surprising if one considers some of the new health technologies made available to developing nations as a result of foreign aid. Childhood vaccines, including those for diphtheria, tetanus, polio and measles, have all but wiped out what used to be among the top killers of young children in the developing world. Health aid directed to providing insecticide-treated malarial bed nets also has been credited in recent studies with reducing malarial deaths among young children, he noted.

Among both adults and children, aid that has expanded the availability of antiretroviral drugs in the developing world has had a major impact on reducing deaths and improving overall life expectancies, he said. For instance, in a study published in 2012, Bendavid and colleagues found that PEPFAR’s health aid resulted in more than 740,000 lives saved between 2004 and 2008 in nine countries.

The researchers also found that the benefits of aid have a lasting effect: The telltale signs of aid’s relationship to reducing under-5 mortality were detectable for three years following the distribution of aid. The correlation between health aid and longer life expectancy overall was detectable for five years after the aid was distributed.

With aid commitments flattening amid the economic downturn, Bendavid said donors will have to be that much smarter in how they invest future dollars, focusing on the most cost-effective interventions and technologies.

“To date, there has been little consideration of how to use development aid in the most cost-effective manner,” he said. “That will have to change now that the funding level has reached a plateau.”

The study was funded by the George Rosenkranz Fellowship for Health Policy Research in Developing Countries and by the National Institutes of Health (grant K01AI084582).

Information about Stanford’s Department of Medicine, which also supported the work, is available at http://medicine.stanford.edu.

Ruthann Richter is the director of media relations at the Stanford School of Medicine.

All News button
1
Subscribe to Middle East and North Africa