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.

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.

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.”

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.

Asked to summarize his biography and career, Donald K. Emmerson notes the legacy of an itinerant childhood: his curiosity about the world and his relish of difference, variety and surprise. A well-respected Southeast Asia scholar at Stanford since 1999, he admits to a contrarian streak and corresponding regard for Socratic discourse. His publications in 2014 include essays on epistemology, one forthcoming in Pacific Affairs, the other in Producing Indonesia: The State of the Field of Indonesian Studies.

Emmerson is a senior fellow emeritus at the Freeman Spogli Institute for International Studies (FSI), an affiliated faculty member of the Center on Democracy, Development and the Rule of Law, an affiliated scholar in the Abbasi Program in Islamic Studies, and director of the Southeast Asia Program at the Shorenstein Asia-Pacific Research Center. Recently he spoke with Shorenstein APARC about his life and career within and beyond academe.

Your father was a U.S. Foreign Service Officer. Did that background affect your professional life?

Indeed it did. Thanks to my dad’s career, I grew up all over the world. We changed countries every two years. I was born in Japan, spent most of my childhood in Peru, the USSR, Pakistan, India and Lebanon, lived for various lengths of time in France, Nigeria, Southern Rhodesia (now Zimbabwe) and the Netherlands, and traveled extensively in other countries. Constantly changing places fostered an appetite for novelty and surprise. Rotating through different cultures, languages, and schools bred empathy and curiosity. The vulnerability and ignorance of a newly arrived stranger gave rise to the pleasure of asking questions and, later, questioning the answers. Now I encourage my students to enjoy and learn from their own encounters with what is unfamiliar, in homework and fieldwork alike. 

Were you always focused on Southeast Asia? 

No. I had visited Southeast Asia earlier, but a fortuitous failure in grad school play a key role in my decision to concentrate on Southeast Asia. At Yale I planned a dissertation on African nationalism. I applied for fieldwork support to every funding source I could think of, but all of the envelopes I received in reply were thin. Fortunately, I had already developed an interest in Indonesia, and was offered last-minute funding from Yale to begin learning Indonesian. Two years of fieldwork in Jakarta yielded a dissertation that became my first book, Indonesia’s Elite: Political Culture and Cultural Politics. I sometimes think I should reimburse the African Studies Council for covering my tuition at Yale – doubtless among the worst investments they ever made. 

Indonesia stimulated my curiosity in several directions. Living in an archipelago led me to maritime studies and to writing on the rivalries in the South China Sea. Fieldwork among Madurese fishermen inspired Rethinking Artisanal Fisheries Development: Western Concepts, Asian Experiences. Experiences with Islam in Indonesia and Malaysia channeled my earlier impressions of Muslim societies into scholarship and motivated a debate with an anthropologist in the book Islamism: Contested Perspectives on Political Islam. 

What led you to Stanford?

In the early 1980s, I took two years of leave from the University of Wisconsin-Madison to become a visiting scholar at Stanford, and later I returned to The Farm for shorter periods. At Stanford I enjoyed gaining fresh perspectives from colleagues in the wider contexts of East Asia and the Asia-Pacific region. In 1999, I accepted an appointment as a senior fellow in FSI to start and run a program on Southeast Asia at Stanford with initial support from the Luce Foundation.

As a fellow, most of your time is focused on research, but you also proctor a fellowship program and have led student trips overseas. How have you found the experience advising younger scholars?

In 2006, I took a talented and motivated group of Stanford undergrads to Singapore for a Bing Overseas Seminar. I turned them loose to conduct original field research in the city-state, including focusing on sensitive topics such as Singapore’s use of laws and courts to punish political opposition. Despite the critical nature of some of their findings, a selection was published in a student journal at the National University of Singapore (NUS). NUS then sent a contingent of its own students to Stanford for a research seminar that I was pleased to host. I encouraged the NUS students to break out of the Stanford “bubble” and include in their projects not only the accomplishments of Silicon Valley but its problems as well, including those evident in East Palo Alto.

That exchange also helped lay the groundwork for an endowment whereby NUS and Stanford annually and jointly select a deserving applicant to receive the Lee Kong China NUS-Stanford Distinguished Fellowship on Contemporary Southeast Asia. The 2014 recipient is Lee Jones, a scholar from the University of London who will write on regional efforts to combat non-traditional security threats such as air pollution, money laundering and pandemic disease.

Where does the American “pivot to Asia” now stand, and how does it inform your work? 

Events in Iran, Iraq, Afghanistan, Syria and now in Crimea as well, have pulled American attention away from Southeast Asia. Yet the reasons for priority interest in the region have not gone away. East Asia remains the planet’s most consequential zone of economic growth. No other region is more directly exposed to the potentially clashing interests and actions of the world’s major states – China, Japan, India and the United States. The eleven countries of Southeast Asia – 630 million people – could become a concourse for peaceful trans-Pacific cooperation, or the locus of a new Sino-American cold war. It is in that hopeful yet risky context that I am presently researching China’s relations with Southeast Asia, especially regarding the South China Sea, and taking part in exchanges between Stanford scholars and our counterparts in Southeast Asia and China. 

Tell us something we don’t know about you.

Okay. Here are three instructive failures I experienced in 1999, the year I joined the Stanford faculty. I was evacuated from East Timor, along with other international observers, to escape massive violence by pro-Indonesian vigilantes bent on punishing the population for voting for independence. The press pass around my neck failed to protect me from the tear gas used to disperse demonstrators at that year’s meeting of the World Trade Organization – the “Battle of Seattle.” And in North Carolina in semifinal competition at the 1999 National Poetry Slam, performing as Mel Koronelos, I went down to well-deserved defeat at the hands of a terrific black rapper named DC Renegade, whose skit included the imaginary machine-gunning of Mel himself, who enjoyed toppling backward to complete the scene. 

The Faculty Spotlight Q&A series highlights a different faculty member at Shorenstein APARC each month giving a personal look at his or her teaching approaches and outlook on related topics and upcoming activities.