Life expectancy in Japan, South Korea, and much of urban China has now outpaced that of the United States and other high-income countries. With this triumph of longevity, however, comes a rise in the burden of noncommunicable diseases (NCDs) like diabetes and hypertension, reducing healthy life years for individuals in these aging populations, as well as challenging the healthcare systems they rely on for appropriate care.
The challenges and disparities are even more pressing in low- and middle-income economies, such as rural China and India. Moreover, the COVID-19 pandemic has underscored the vulnerability to newly emerging pathogens of older adults suffering from NCDs, and the importance of building long-term, resilient health systems.
What strategies have been tried to prevent NCDs—the primary cause of morbidity and mortality — as well as to screen for early detection, raise the quality of care, improve medication adherence, reduce unnecessary hospitalizations and increase “value for money” in health spending?
Fourteen concise chapters cover multiple aspects of policy initiatives for healthy aging and economic research on chronic disease control in diverse health systems — from cities such as Singapore and Hong Kong to large economies such as Japan, India, and China.
The following is Part 1 of a two-article series. For Part 2, please go here.
Stanford e-Oita is an online course for high school students throughout Oita Prefecture in the southwestern island of Kyushu, Japan, that is sponsored by the Oita Prefectural Government. Launched in fall 2019, it is offered by the Stanford Program on International and Cross-Cultural Education (SPICE) in collaboration with the Oita Prefectural Board of Education. SPICE is grateful to Oita Prefectural Governor Katsusada Hirose whose vision made this course possible.
Social media posts, video-conference invites, and webinar notifications flood our inboxes ever since COVID-19 drove traditional classroom instruction online. Distance learning has gone mainstream.
While distance learning may never replace traditional classroom instruction, it’s certainly transforming how we teach, learn, and behave. Amid the coronavirus pandemic, 30 Stanford e-Oita students in Japan—on the other end of my virtual classroom—showed me what distance learning can offer: a greater appreciation of where we live, renewed cross-cultural perspectives, and a chance to enhance one’s communication skills in a foreign language without a textbook, classroom, or a trip overseas.
Students from 15 high schools throughout Oita Prefecture—from the capital city of Oita to the tiny island of Hotojima—logged onto their laptops, tablets, and smart phones on Saturday mornings for my bi-weekly distance learning class. It’s a course offered to highly motivated students with a certain proficiency in English. They could attend a class as if they were in Palo Alto without ever having to leave their tatami-mat living rooms.
Stanford e-Oita focuses on three areas: U.S.–Japan relations, United Nations Sustainable Development Goals (UNSDGs), and entrepreneurship. These are the collective objectives of SPICE, the Oita Prefectural Board of Education, and Oita’s Governor Hirose. For six months, I explored their intersections with my students.
I designed a course curriculum that engages students to think critically about global issues, empowers them to take pride in their hometowns, and encourages them to give back to their communities. We took what’s happening in the world and made it relevant to their daily lives in Oita. Students took this a step further by exploring issues that were personally meaningful.
Students worked individually and collaboratively through guided group discussions, submitted written assignments, developed research projects, watched documentary films, and prepared multi-media slideshows as part of their final presentations—all in English. I also created virtual experiential learning opportunities for students by introducing them to guest speakers via Zoom. In the pre-COVID-19 days, I took students along with me on fieldtrips to National Historic Sites in Seattle’s International District and visited social activists on Vashon Island, Washington.
Stanford e-Oita is taught in English, but it is not an English language course. I offer my students a chance to become confident in English, competent in critical thinking, and fluent in accessing the technologies of a digital classroom. We use online platforms like Zoom and Canvas and take advantage of discussion boards, breakout sessions, and other digital tools which are not often used in Japanese schools.
In order to ensure access and equity, students who did not have access to a computer or Wifi were able to return to their schools on Saturday mornings to take the class in the computer labs. Most students worked on tablets (some used smartphones) and grew accustomed to the online format within a few weeks. For the most part, e-Oita students were excited and open to technology enabled learning. One student noted, “For me, using Zoom in this new style of class is really refreshing. Students are scattered all over Oita and you’re in America but we’re all communicating through my tablet. It’s so cool!”
Getting Japanese students on board Stanford’s rigorous distance learning program, in a foreign language, was a challenge at first. In fact, the learning curve was steep for all of us. I taught my students the word “troubleshoot” early on and walked them through online setting changes to video presentation uploads.
Here are some lessons learned:
Distance learning provides learning opportunities for students in less accessible communities—in rural towns or islands—where traditional classrooms are unable to serve.
Distance learning allows students to re-invent themselves with a new audience, with people you have never met.
Distance learning can create an informality that breaks down the wall between teachers and students and makes their relationship less hierarchical. This is a new experience for students from Japan.
Distance learning allows instructors to invite speakers whose participation is not limited by geography, departmental budgets, disabilities, or availability of a considerable amount of time. All they need is a quiet corner, a laptop with Wifi, and a time commitment of 30 minutes to an hour.
Section Manager Hironori Sano and Teachers’ Consultant Keisuke Toyoda of the Global Education Acceleration Project Team (High School Education Division) of the Oita Prefectural Board of Education, reflected, “The most amazing thing is seeing how our students developed through the program. They have acquired five important skills: (1) the ability to cooperate with people around them; (2) the ability to state their ideas; (3) knowledge of Japan and Oita; (4) the confidence to communicate in English; and (5) the confidence to make a contribution in the world.”
Kasumi Yamashita
“Teach-from-Home” mandates have altered not only where and what we teach but how we learn: it has reset our mindset. As I reflect on the past six months as the instructor of SPICE’s e-Oita program, I recognize the lessons in patience, resilience, and empathy that my students have taught me. My students were neophytes to distance learning but were digital natives from halfway around the world.
In part two of this series, I will focus on Stanford e-Oita’s priorities (United Nations Sustainable Development Goals), guest speakers, final student presentations, and assessment.
APARC's China Program recently hosted Center Fellow Thomas Fingar for the webinar "Was America’s China Policy a Foolish Failure? The Logic and Achievements of Engagement." In this talk, Fingar examines the longtime U.S. strategy of engagement with China as well as the potential shift toward a strategy of decoupling. "Much recent commentary on U.S. relations with China claims that the policy of 'Engagement' was a foolish and failed attempt to transform the People’s Republic into an American style democracy that instead created an authoritarian rival," he says. "This narrative mocks the policies of eight U.S. administrations to justify calls for 'Decoupling' and 'Containment 2.0.'” Fingar argues that the policy of Engagement has been fruitful and that Decoupling is not only inadvisable but also unattainable. Watch:
Thomas Fingar is a Shorenstein APARC Fellow in the Freeman Spogli Institute for International Studies at Stanford University. From 2005 through 2008, he served as the first deputy director of national intelligence for analysis and, concurrently, as chairman of the National Intelligence Council. His forthcoming edited volume is Fateful Decisions: Choices That Will Shape China's Future, co-edited with Jean Oi (Stanford University Press, May 2020).
On June 25, 2020, Thomas Fingar gave a companion address to "Was America’s China Policy a Foolish Failure? The Logic and Achievements of Engagement" to the National Security Forum of Northern Nevada.
APARC Fellow Thomas Fingar on the U.S. Intelligence Report that Warned of a Coronavirus Pandemic
In our online conversation, Fingar discusses the 2008 National Intelligence Council report he oversaw and that urged action on coronavirus pandemic preparedness, explains the U.S. initial failed response to the COVID-19 outbreak, and considers the implications of the current crisis for U.S.-China relations.
While Wuhan, China was the first epicenter of the COVID-19 pandemic, every nation in Asia has been deeply affected by the spread of the virus. In a virtual seminar convened by the Freeman Spogli Institute, APARC experts discuss the social and economic impacts of COVID-19 and the various policy responses to the pandemic across Asian nations.
Senior Fellow Xueguang Zhou focuses on the phases of crisis response taken by the PRC in the early stages of the unfolding coronavirus outbreak. Center Fellow and Korea Program Deputy Director Yong Suk Lee discusses the policy responses of the South Korean government. Southeast Asia Program Director Don Emmerson offers a comparison of different governance strategies and actions implemented across Southeast Asian countries, while Karen Eggelston, APARC's deputy director and director of the Asia Health Policy Program, addresses the response of health systems in Japan and South Asia.
APARC Fellow Thomas Fingar on the U.S. Intelligence Report that Warned of a Coronavirus Pandemic
In our online conversation, Fingar discusses the 2008 National Intelligence Council report he oversaw and that urged action on coronavirus pandemic preparedness, explains the U.S. initial failed response to the COVID-19 outbreak, and considers the implications of the current crisis for U.S.-China relations.
WATARU FUKUDA Chief Representative of the Shizuoka Prefectural Government in Singapore Global Affiliates Program Fellow, 2014-16
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In Singapore, the government is strongly restricting our business activities and daily life. Foreign companies like the one I work for worry about receiving penalties from the government for violating COVID-19 prevention measures. In Japan, the government is asking people to self-isolate in their communities. It seems like there is a big difference between Japan and Singapore in how the authorities are handling COVID-19.
TSUYOSHI KOSHIKAWA Chief Advisor, Japan International Cooperation Agency Expert for the Ministry of Planning, Finance, and Industry in Myanmar Global Affiliates Program Fellow, 2014-15
I currently live in Naypyitaw, Myanmar, though I am originally from Japan. Naypyitaw is currently not under shelter-in-place, though the city of Yangon is. In Naypyitaw, restaurants are serving only take-out meals, and most amusement facilities like movie theaters, karaoke boxes, bars, and beauty salons have been closed. There are still a few big department stores open, as well as the public golf course and tennis courts.
At the time of this writing, the number of known COVID-19 cases in Myanmar is nearly 150, and I am worried about the potential risks because the healthcare and medical information systems here are not as organized as in countries like Japan, the UK, or the United States.
Anyone with a fever of 37.5 degrees C (99.5 F) or higher is being kept from entering Yangon. The Ministry of Health is taking all traveler’s temperatures at the airport, railways stations, and the exits of all highway interchanges throughout Yangon. Foreigners with a fever of 38 degrees C (100.4 F) have been told that they will not be permitted into private hospitals anywhere in Myanmar at present. Isolation wards in general hospitals will accommodate foreigners. The situation is frightening, but with frequent handwashing and hygiene, we are trying to take care of each other.
XIAOYUAN SHI Deputy General Manager in the Internal Audit Bureau at the Industrial and Commercial Bank of China Global Affiliates Program Fellow, 2012-13
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In China, we’ve been dealing with COVID-19 since last December. The government locked down Wuhan City starting in January and asked all people to avoid gatherings or unnecessary trips out. Wearing masks in public and frequently washing hands have also been required. We've strictly followed these directives. As manufacturing, entertainment, social activities, and travel have been suspended, society has slowed down and the economy has experienced significant losses.
Thankfully, our efforts have worked. The new confirmed cases are mostly coming in from foreign travel. Big cities like Beijing and Shanghai have low infection rates, and people feel much less stressed. Social life, work, and production are recovering, and the lockdown of Wuhan City has been lifted. Most schools will continue to use online classes for the time being and restaurants are still not fully open, but I think the most difficult time is behind us.
It’s impossible to spot all of the potential virus carriers, and therefore precautionary measures like avoiding going out unnecessarily, wearing masks in public, and handwashing are still recommended. I’ve not heard of COVID-19 cases or deaths among my acquaintances, thankfully, but the conditions here have proven that this virus is highly infectious and death is possible. I hope our practices here can provide some references for other places where it is spreading.
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China’s Incentives to Work Within the U.S.-led International Order Remain Compelling, Argues Thomas Fingar
In a video Q&A, Fingar discusses the challenges for the U.S.-China relationship and the principles that shape China’s foreign policy and international behavior.
Since March, a series of escalations have heightened tensions in the South China Sea. From the sinking of a Vietnamese fishing boat to an ongoing standoff with the Malaysian navy, China has been accused of taking advantage of the COVID-19 pandemic to further its control of the South China Sea. Beijing’s actions on the water are not all that different than what it was doing just a few months ago. But having them continue amid a global health crisis has sparked a new level of outrage. And the nationalistic response from Chinese authorities has only added fuel to the fire. These developments highlight the new normal in the South China Sea, which will continue long after COVID-19 fades.
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Gregory B. Poling is Senior Fellow for Southeast Asia and Director of the Asia Maritime Transparency Initiative at CSIS. His research interests include the South China Sea disputes, democratization in Southeast Asia, and Asian multilateralism. Mr. Poling’s writings have been featured in Foreign Affairs, the Wall Street Journal, Nikkei Asian Review, and Foreign Policy, among others. He has authored or coauthored multiple works including The Thickening Web of Asian Security Cooperation (RAND Corporation, 2019), Building a More Robust U.S.-Philippines Alliance (CSIS, August 2015), and A New Era in U.S.-Vietnam Relations (CSIS, June 2014). Mr. Poling received an M.A. in international affairs from American University and a B.A. in history and philosophy from St. Mary’s College of Maryland.
AN: My story is rather unusual. I am half-Vietnamese and half-Chinese. My hometown was nicknamed “the foggy sleepy town” as it was high up on a mountain, veiled with a thick layer of fog, and surrounded by forest and waterfalls. Back then, hardly anyone ever left to go overseas. When I was 15 years old, I was awarded the ASEAN scholarship by the Singapore Ministry of Education. My parents were concerned, but I was eager to explore the world beyond my small town and decided to move to Singapore. I completed my high school education and subsequently was awarded the Temasek Education Foundation’s Sunburst Scholarship to complete my bachelor’s degree at the National University of Singapore. I got my first job as a management consultant at Accenture Consulting. I was based in Singapore but had many opportunities to travel and work on projects all around the Asia-Pacific region. I spent eleven years in Singapore, which were my formative years, and thus I consider Singapore as my second home.
Subsequently, I embarked on a journey to explore and learn about other continents — I became a Canadian permanent resident and moved to Vancouver, British Columbia in 2018. I then worked and travelled full-time for about two and a half years, all over Latin America and Europe. During the same period of time, I was planning my next career move: switching from the private sector to the policy world. This was the reason why I applied to the MIP program.
I believe my international exposure contributes significantly to my future career in international policy as these first-hand experiences help me to understand the beautiful diversity of cultures; to develop an appreciation for the nuanced differences between cities, regions, countries and continents; to listen, observe, and empathize with the challenges faced by the people; and to reflect on how effective policy-making can have a positive, sustainable, and scalable impact on their daily lives.
What was your work experience like?
Upon graduation in 2015, I joined Accenture as a management consultant. I helped the company launch the Internet of Things (IoT) Centre of Excellence Innovation Lab in Singapore, the first of its kind in Asia Pacific. My job allowed me to be a generalist, a strategist, and to gain exposure to multidisciplinary fields. I travelled extensively and the learning curve was steep, which was perfect for a fresh graduate to accumulate meaningful working experience rapidly.
After three years, I started strategizing my long-term plan and spent more time reflecting on my passion for education. I have a vision that one day, the international community will have an integrated universal education system that is accessible to every child around the world. I believe that a career in international policy can enable me to make a scalable and sustainable impact, while capitalizing on the power of digital technology, to work towards making my vision a reality. That’s why I decided to apply for a master’s degree in international policy with a focus on digital technology.
"I have a vision that one day, the international community will have an integrated universal education system that is accessible to every child around the world. I believe that a career in international policy can enable me to make a scalable and sustainable impact."
Anna Nguyen
1st year MIP student
Why did you apply to the MIP program, and why did you choose it over other programs?
During my time working as a management consultant, I had the chance to deep dive into the most innovative developments and learn about their potential applications in improving educational opportunities for children around the globe. I realize that digital technology has tremendous potential for transcending education, becoming the driving force behind a future where education is universal and accessible to all children worldwide. However, there is still much more to be done, and we need to take actions at a faster speed on a larger scale, especially with an active involvement of international organizations on the legislative level. Many ongoing efforts did not receive sufficient support, either legally or financially. This is particularly true with the most innovative technologies – where laws, regulations, and public sectors are still lagging behind. Given the immense potential that these technologies have in solving the existing issues, this area must be a top priority on our action list.
In order to turn this ambition into a reality, my first step is to establish my credentials in the policy space. The MIP program not only has strong international policy core courses that equip us with essential skills for policymakers, but also has a great specialization in cyber policy and technology policy. Furthermore, we have the chance to take cross-faculty courses in law, business, and computer science, among others. In addition, I appreciate the fact that Stanford University is situated at the heart of Silicon Valley with a booming technological ecosystem, which works perfectly because I want to keep digital technology close to my heart. Last but not least, I was awarded a full two-year fellowship from Stanford University’s Asia Pacific Scholars Fund, which empowers me to fully focus on my academic pursuit.
If you could describe your experience in the MIP program in one or two words, what words would you use?
It’s been a transformative experience. My knowledge repertoire, my world view, and my perspective are being expanded and transformed every single day in meaningful ways. I had an ambitious vision for a better world, but I did not know exactly how to get there yet. The experience at Stanford has helped me get clearer ideas and shape my strategies to achieve that vision.
The second word I would use is connectivity. The most amazing feature of being at Stanford is the chance to meet, connect, and exchange ideas with outstanding talents. We, MIP students, are so fortunate to be part of the Freeman Spogli Institute. The Institute houses world-class researchers, policymakers, thinkers and doers with impressive portfolio and experience working in international organizations, or for various government administrations, countries and continents. As the class size is relatively small, we have direct access to these professors and their knowledge repertoire. My classmates, from MIP and other faculties, never fail to impress me with their talents, hard work, resilience, and kindness. The diversity of the class is mind-blowing, our cohort has 25 students representing 12 different countries. As an international student myself, I love this diversity because we have many refreshing perspectives in every conversation.
And I’ve had the chance to participate in a long list of exciting activities since arriving on campus: I was the chair of the Cybersecurity Committee during the Stanford Model United Nations Conference last November. I participated in a learning immersion trip to Israel with Stanford Law School last December. I met and conversed with Ambassador Susan Rice and Michèle Flournoy. I took a course taught by Colin Kahl, the former National Security Advisor to former Vice President Joe Biden. I am now in a working group led by Marietje Schaake – former Member of the European Parliament. In the next year, I am looking forward to learning, innovating, connecting, and participating in many other initiatives and creating many more beautiful memories at Stanford.
The application for admission into the Ford Dorsey Master's in International Policy will open in late September. We hope to see you at an upcoming online event.
Maffy is a student in the Ford Dorsey Master’s in International Policy (MIP) program specializing in governance and development. She is originally from Mexico and graduated from Centro de Investigación y Docencia Económicas with a degree in economics. Before coming to Stanford, Maffy worked on financial inclusion policies and financial regulation at the Central Bank of Mexico.
Anna Nguyen is a student in the Ford Dorsey Master’s in International Policy (MIP) program specializing in cyber policy and security. Before coming to Stanford, Anna worked as a management consultant in Singapore and around the Asia-Pacific region. She earned her bachelor’s degree in business administration from the National University of Singapore.
In 2008, the U.S. National Intelligence Council (NIC) published the fourth installment in its effort to identify “megatrends” likely to shape world events a decade or more into the future. Shorenstein APARC Fellow and China expert Thomas Fingar, the then chairman of the NIC, oversaw that report, Global Trends 2025. The unclassified report uses scenarios to illustrate some of the ways in which the factors driving world events – from climate change to demographic decline to changing geopolitical powers – may interact to generate challenges and opportunities for future decisionmakers. One of these scenarios is the emergence of a global pandemic that bears a chilling resemblance to COVID-19.
We sat down with Fingar for an online conversation about the NIC report and its pandemic scenario, the government action it spurred, the United States’ failed initial response to the COVID-19 outbreak, and the implications of the current crisis for U.S.-China relations. Watch:
Twelve years after its publication, the NIC’s "Potential Emergence of a Global Pandemic" scenario (p. 75) has proven to be woefully accurate:
“The emergence of a novel, highly transmissible, and virulent human respiratory illness for which there are no adequate countermeasures could initiate a global pandemic. If a pandemic disease emerges by 2025, […] it probably will first occur in an area marked by high population density and close association between humans and animals, such as many areas of China and Southeast Asia […] Slow public health response would delay the realization that a highly transmissible pathogen had emerged […] Despite limits imposed on international travel, travelers with mild symptoms or who were asymptomatic could carry the disease to other continents. Waves of new cases would occur every few months. The absence of an effective vaccine and near-universal lack of immunity would render populations vulnerable to infection.”
It was not a prediction, recalls Fingar, but rather an attempt to urge policymakers to think “beyond tomorrow,” past the end of their administration, and to stimulate strategic thinking about how to reinforce positive trends and change or ameliorate negative ones. If the report and its global pandemic scenario are precise, he notes, it is because the NIC’s effort involved the best specialists within the U.S. intelligence community and engaged numerous and varied groups of non-U.S. Government experts.
Yet the United States has been unprepared for the COVID-19 pandemic and the crisis is now worsening U.S.-China tensions. To address the crisis, however, argues Fingar, both countries must cooperate in the international fora. “Let that be the way that builds towards a better bilateral relationship.”
Thomas Fingar is a Shorenstein APARC Fellow in the Freeman Spogli Institute for International Studies at Stanford University. From 2005 through 2008, he served as the first deputy director of national intelligence for analysis and, concurrently, as chairman of the National Intelligence Council. His forthcoming edited volume is 'Fateful Decisions: Choices That Will Shape China's Future' (Stanford University Press, May 2020).
Vehicle traffic is almost non-existent on Pennsylvania Avenue as the United States Capitol is reflected in a rainwater puddle during the novel coronavirus pandemic April 13, 2020 in Washington, DC. COVID-19 has sent lawmakers home and brought the business of the nation’s capital to a near-total halt.
Chip Somodevilla/ Getty Images
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In our online conversation, Fingar discusses the 2008 National Intelligence Council report he oversaw and that urged action on coronavirus pandemic preparedness, explains the U.S. initial failed response to the COVID-19 outbreak, and considers the implications of the current crisis for U.S.-China relations.
A Discussion between Matthew Kohrman and Gan Quan, co-editors of Poisonous Pandas: Chinese Cigarette Manufacturing in Critical Historical Perspectives (Stanford University Press, 2018).
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Gan Quan (PhD, Berkeley) is the director of Tobacco Control of the International Union Against Tuberculosis and Lung Disease. His research tackles various topics pertaining to tobacco control in China.
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Matthew Kohrman (PhD, Harvard) is an associate professor in Stanford’s Department of Anthropology and senior fellow by courtesy at APARC/FSI. His research brings anthropological methods to bear on the ways health, culture, and politics are interrelated.
Former Russian President Dmitry Medvedev, who signed the New Strategic Arms Reduction Treaty (New START) with Barack Obama on April 8, 2010, called last week for the United States to agree to extend the treaty. On Friday, a Department of State spokesperson told the Russian news agency TASS in response: “The President has directed us to think more broadly than New START… We stand ready to engage with both Russia and China on arms control negotiations that meet our criteria.”
Unfortunately, nothing suggests President Trump will achieve anything on nuclear arms control.
Kasumi Yamashita
I currently live in Naypyitaw, Myanmar, though I am originally from Japan. Naypyitaw is currently not under shelter-in-place, though the city of Yangon is. In Naypyitaw, restaurants are serving only take-out meals, and most amusement facilities like movie theaters, karaoke boxes, bars, and beauty salons have been closed. There are still a few big department stores open, as well as the public golf course and tennis courts.
