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As incomes rise around the world, health experts expect a more troubling figure to increase as well: the number of diabetics in developing countries.

In China and India – two of the world’s most populous nations with fast-paced economies – the prevalence of diabetes is expected to double by 2025. Between 15 and 20 percent of their adult population will develop the disease as household budgets increase, diets change to include more calories and new health problems emerge.

But China, India and other developing countries are not fully prepared to deal with the rising trend of diabetes. And a growing number of diabetics aren’t getting the care they need to prevent serious complications, Stanford researchers say.

Even with insurance, many diabetics don’t have essential medications that could help them manage their conditions. In many cases, people are spending a great deal of their household incomes to pay for their treatment, said Jeremy Goldhaber-Fiebert, an assistant professor of medicine who led the research team.

“Public and private health insurance programs aren’t providing sufficient protection for diabetics in many developing countries,” said Goldhaber-Fiebert, a faculty member at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies. “People with insurance aren’t doing markedly better than those who don’t have it. Health insurance and health systems need to be re-oriented to better address chronic diseases like diabetes.”

Findings from the study are online and will be published in the Jan. 24 edition of Diabetes Care, the journal of the American Diabetes Association. The journal article was co-authored by Jay Bhattacharya, an associate professor of medicine and Stanford Health Policy faculty member; and Crystal Smith-Spangler, an instructor at Stanford’s Department of Medicine and an investigator at the Palo Alto VA Health Care System.

Failure to adequately manage diabetes will lead to more severe health problems like blindness, heart disease and kidney failure. It also harms the otherwise healthy, Goldhaber-Fiebert said.

Diabetes often strikes people at an age when they’re taking care of children and elderly parents. To sideline these primary caretakers as dependants will lead to a heavy burden for communities and create an obstacle for economic growth, he added.

Using responses to a global survey conducted by the World Health Organization in 2002 and 2003, Goldhaber-Fiebert and his colleagues examined data from 35 low- and middle-income countries in Asia, Latin America, Africa and Eastern Europe to determine whether diabetics with insurance were more likely to have medication than those without insurance.

They also wanted to know whether insured diabetics have a lower risk of “catastrophic medical spending,” a term the researchers define as spending more than 25 percent of a household income on medical care.

“Surprisingly, diabetics with insurance were no more likely to have the medications they need than uninsured diabetics,” Goldhaber-Fiebert said. “They were also no less likely to suffer catastrophic medical spending.”

There are many reasons why health insurance may not protect diabetics in developing countries against high out-of-pocket spending. In some cases, there’s a lack of sufficient medication – such as insulin – that regulate glucose levels. Without those drugs, there’s a greater risk of complications that often lead to more hospitalizations and more expenses.

In other cases, co-payments and deductibles are too high. Sometimes, drugs and medical services to prevent diabetes complications are not covered. And doctors and hospitals don’t always accept insurance.

“Better policies are needed to provide sufficient protection and care for diabetics in the developing world,” Goldhaber-Fiebert said.

Without medications to manage diabetes and prevent secondary complications, the condition will worsen and the burden of catastrophic spending will increase, he said.

“It’s important to get ahead of the curve and prepare so there’s an infrastructure in place to deal with these health and cost issues,” he said.

While preventing diabetes in the first place would be ideal, programs and policies must be established to care for the many cases that will surely continue to exist.

“There isn’t a single country that’s managed to entirely arrest or reverse the trend of diabetes,” he said. “Programs that focus on primary prevention are extremely important, but the reality is that the developing world faces hundreds of millions of diabetes cases that are unlikely to all be prevented.”

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Anthony Bogues is currently the Harmon Family Professor of Africana Studies and affiliated Professor of Political Science and Modern Culture and Media at Brown University, and a Visiting Professor at the Rhode Island School of Design. He is also a Honorary Professor at the Center for African Studies at the University of Cape Town, South Africa  and Visiting Professor of the Humanities at Addis Ababa University, Ethiopia.

His books are: Caliban’s Freedom: The Early Political Thought of C.L.R. James (1997); Black Heretics and Black Prophets: Radical Political Intellectuals (2003); and Empire of Liberty: Power, Freedom and Desire ( 2010).  He is the editor of two volumes of Caribbean intellectual history, After Man - The Human: Critical Essays on the Thought of Sylvia Wynter (2006); and The George Lamming Reader: The Aesthetics of Decolonization (2011). He has published over 60 essays in the fields of intellectual history, political theory, cultural and literary history and is an associate editor of the journal Small Axe and member of the editorial collective of the journal Boundary 2.

He recently co-curated a national exhibition on Haitian Art, titled, Reframing Haiti –Art, History and Performativity.  He is currently working on three major projects, a political/philosophical project on questions of the human, freedom, human emancipation and the black intellectual tradition; co-curating a major exhibition on Haitian art for 2014 in Paris and Cape Town, South Africa; and an intellectual/political biography of Michael Manley and Jamaican postcolonial politics.

Professor Bogues served as chief of staff to then Jamaican Prime Minister Michael Manley.

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Anthony Bogues Harmon Family Professor, Professor of Africana Studies, Brown University Speaker
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Christopher Painter has been on the vanguard of cyber issues for twenty years. Most recently, Mr. Painter served in the White House as Senior Director for Cybersecurity Policy in the National Security Staff. During his two years at the White House, Mr. Painter was a senior member of the team that conducted the President's Cyberspace Policy Review and subsequently served as Acting Cybersecurity Coordinator. He coordinated the development of a forthcoming international strategy for cyberspace and chaired high-level interagency groups devoted to international and other cyber issues.

Mr. Painter began his federal career as an Assistant U.S. Attorney in Los Angeles where he led some of the most high profile and significant cybercrime prosecutions in the country, including the prosecution of notorious computer hacker Kevin Mitnick. He subsequently helped lead the case and policy efforts of the Computer Crime and Intellectual Property Section in the U.S. Department of Justice and served, for a short time, as Deputy Assistant Director of the F.B.I.'s Cyber Division. For over ten years, Mr. Painter has been a leader in international cyber issues. He has represented the United States in numerous international fora, including Chairing the cutting edge G8 High Tech Crime Subgroup since 2002. He has worked with dozens of foreign governments in bi-lateral meetings and has been a frequent spokesperson and presenter on cyber issues around the globe. He is a graduate of Stanford Law School and Cornell University.

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Christopher Painter Coordinator for Cyber Issues Speaker US State Department
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The 2012 Republic of China presidential and legislative elections to be held on January 14th mark the fifth presidential and seventh national legislative direct elections in Taiwan. Incumbent ROC President Ma Ying-jeou of the Kuomintang (KMT) enjoyed a landslide victory in 2008 over Democratic Progressive Party (DPP) candidate Hsieh Chang-ting, winning by over 2.2 million votes. Subsequent revelations of corruption by former President Chen Shui-bian of the DPP and various members of his administration further damaged the DPP's public image and electoral prospects.

In the intervening years, however, current DPP candidate Tsai Ing-wen and other members of the DPP have worked to revitalize their party's image, and as chairperson of the DPP Tsai established a special internal investigative committee to root out corruption in the party. A potentially complicating new factor in the race is the first-ever presidential bid by the People's First Party (PFP), led by candidate James Soong. Polling results to date have indicated the potential for a very close race between Ma and Tsai, with Soong also pulling a substantial portion of the vote that may affect the electoral outcome.

On the legislative side, the KMT won 81 out of 113 total seats in the Legislative Yuan in the 2008 elections, a circumstance that has facilitated the passage of various controversial measures supported by the Ma administration, including in particular the Economic Cooperation Framework Agreement (ECFA) with mainland China, and a significant shift in the composition of this body is likely to have a pronounced impact.

Regardless of the outcome, the results of the 2012 elections promise to offer much insight into the popular attitudes of the Taiwanese people and the prospects for future democratic consolidation and development in Taiwan. Ten days following the elections, Professors Shelly Rigger and Eric Chen-hua Yu will join us for a panel discussion to analyze the outcomes of these elections and discuss their relevance to the US and the world.

Speaker Bios:

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Shelley Rigger is the Brown Professor of East Asian Politics and Chair of Political Science at Davidson College in Davidson, North Carolina. She has a PhD in Government from Harvard University and a BA in Public and International Affairs from Princeton University. She has been a visiting researcher at National Chengchi University in Taiwan (2005) and a visiting professor at Fudan University in Shanghai (2006). Rigger is the author of two books on Taiwan’s domestic politics, Politics in Taiwan: Voting for Democracy (Routledge 1999) and From Opposition to Power: Taiwan’s Democratic Progressive Party(Lynne Rienner Publishers 2001). In 2011 she published Why Taiwan Matters: Small Island, Global Powerhouse, a book for general readers. She has published articles on Taiwan’s domestic politics, the national identity issue in Taiwan-China relations and related topics. Her current research studies the effects of cross-strait economic interactions on Taiwan and Mainland China. Her monograph, “Taiwan’s Rising Rationalism: Generations, Politics and ‘Taiwan Nationalism’” was published by the East West Center in Washington in November 2006.

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Eric Chen-hua Yu is an assistant research fellow of the Election Study Center and

jointly appointed as an assistant professor of political science at National Chengchi University in Taiwan. Before he returned to Taiwan to serve in his Alma mater in 2009, he has been a research fellow and program manager of Center on Democracy, Development, and the Rule of Law at Stanford’s Freeman Spogli Institute for International Studies since 2006. His research interests include public opinion, electoral politics, quantitative methods, and American politics. He also participates in a number of joint survey projects such as Taiwan Election and Democratization Studies (TEDS) and World Value Survey. Yu recently published academic articles on Taiwan’s domestic politics in
Taiwan Political Science Review, Journal of Electoral Studies, Review of Social Sciences, and Japanese Journal of Electoral Studies. Yu received a MS (2000) in Public Policy Analysis from the University of Rochester, and a Ph.D. in political science (2006) from Columbia University.

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Shelly Rigger Professor of East Asian Politics and Chair of Political Science Speaker Davidson College

616 Serra St.
Encina Hall
Stanford, CA 94305

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Eric Yu was a research fellow and program manager for the Democracy in Taiwan program at CDDRL. His research interests included public opinion, electoral politics, federalism, and quantitative methods. He worked with Election Study Center at National Chengchi University (Taiwan) on a multi-year research project examining the relationship between public opinion and policy output at the local level in Taiwan. This project aimed to explore the extent to which local policy-makings respond to public opinions across a variety of policy dimensions. His recent studies also include the development of Taiwanese public attitudes toward cross-strait relations, the emergence of the third force under the new "single-district, two-ballot" electoral system for Taiwan's legislative elections, and mass policy preferences and their implications for political parties in Taiwan.

Yu received a BA (1995) in Political Science from the National Chengchi University in Taiwan, a MS (2000) in Public Policy Analysis from the University of Rochester, and a Ph.D. (2006) in Political Science from Columbia University.

Research Fellow and Program Manager for the Democracy in Taiwan Program
Eric Chen-hua Yu Assistant Research Fellow and Assistant Professor of Political Science Speaker Election Study Center; National Chengchi University
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At present, the tobacco industry produces some six trillion cigarettes worldwide every year. Six trillion cigarettes per annum, each ready to release smoke filled with highly addictive nicotine and powerful carcinogens. A third of all these sticks were produced in China last year. In 2011, the world’s largest cigarette maker by volume, the China National Tobacco Corporation, contributed an all-time high of U.S. $214 billion in profits and taxes to the Chinese government, up 22 percent year-on-year. Currently the greatest cause of preventable death in the world, the cigarette is likely to kill ten times as many people in the 21st century as it did in the 20th century, epidemiologists tell us, with China bearing the largest burden. Until now, much global health research and intervention has focused with limited success on the cigarette consumer—addressing how one or another variable prompts people to take up or quit smoking, whether the cue for the consumer is biological, psychological, spatial, financial or symbolic. What though of the industrial sources of tobacco-related diseases? Where are the six trillion cigarettes that are released into circulation each year manufactured? Where are they rolled, wrapped, and boxed for shipment? This presentation will introduce the Cigarette Citadels Project, an innovative application of participatory GIS. With special attention given to China’s network of cigarette factories, Matthew Kohrman will explain how the Cigarette Citadels Project not only reveals conceptual roadblocks in public health policy but also lacuna in social theory pertaining to the state and the politics of life.


Matthew Kohrman joined Stanford’s faculty in 1999. His research and writing bring multiple methods to bear on the ways health, culture, and politics are interrelated. Focusing on the People's Republic of China, he engages various intellectual terrains such as governmentality, gender theory, political economy, critical science studies, and embodiment. His first monograph, Bodies of Difference: Experiences of Disability and Institutional Advocacy in the Making of Modern China, examines links between the emergence of a state-sponsored disability-advocacy organization and the lives of Chinese men who have trouble walking. In recent years, Kohrman has been conducting research projects aimed at analyzing and intervening in the biopolitics of cigarette smoking and production. These projects expand upon analytical themes of Kohrman’s disability research and engage in novel ways techniques of public health.

This event is part of the China's Looming Challenges series

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Stanford University
Department of Anthropology
Building 50, Central Quad
Stanford, California 94305-2034

(650) 723-3421 (650) 725-0605
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Associate Professor of Anthropology
Senior Fellow, by courtesy, at the Freeman Spogli Institute for International Studies
Faculty Affiliate at the Walter H. Shorenstein Asia-Pacific Research Center
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
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Matthew Kohrman joined Stanford’s faculty in 1999. His research and writing bring multiple methods to bear on the ways health, culture, and politics are interrelated. Focusing on the People's Republic of China, he engages various intellectual terrains such as governmentality, gender theory, political economy, critical science studies, and embodiment. His first monograph, Bodies of Difference: Experiences of Disability and Institutional Advocacy in the Making of Modern China, examines links between the emergence of a state-sponsored disability-advocacy organization and the lives of Chinese men who have trouble walking. In recent years, Kohrman has been conducting research projects aimed at analyzing and intervening in the biopolitics of cigarette smoking and production. These projects expand upon analytical themes of Kohrman’s disability research and engage in novel ways techniques of public health.

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Matthew Kohrman Associate Professor of Anthropology and Senior Fellow Speaker FSI
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Abstract:

     While the reelection of Taiwan’s president, Ma Ying-jeou, relieved concerns about an immediate deterioration in cross-Strait relations, the future of ties between Beijing and Taipei remain uncertain. Much will depend on the PRC’s policy. Moreover, calls in the United States either to abandon Taiwan or, conversely, to embrace it ever more closely as a hedge against the Mainland’s growing strength, have yet to play themselves out. Alan D. Romberg will address the implications of the election for these issues, as well as for Sino-American relations and for the region.

Speaker Bio:

     Alan Romberg is the director of the East Asia program at Stimson. 

     Before joining Stimson in September 2000, he enjoyed a distinguished career working on Asian issues, both in and out of government, including twenty years as a US Foreign Service Officer. Romberg was the principal deputy director of the State Department's Policy Planning staff and deputy spokesman of the department. He served in various capacities dealing with East Asia, including director of the Office of Japanese Affairs, member of the Policy Planning staff for East Asia, and staff member at the National Security Council for China. He served overseas in Hong Kong and Taiwan. 

     Additionally, Romberg spent almost ten years as the CV Starr Senior Fellow for Asian Studies at the Council on Foreign Relations, and was special assistant to the Secretary of the Navy. 

     Romberg holds an MA from Harvard University, and a BA from the Woodrow Wilson School of Public and International Affairs at Princeton University.

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Alan Romberg Distinguished Fellow Speaker the Stimson Center
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Since Kim Jong Il’s death on Dec. 17, North Korea has a young new leader: Kim’s 28-year-old son Kim Jong Un. What does the new leadership hold in store for the future of the Korean Peninsula, U.S.-Korea relations, and the stability of Northeast Asia? David Straub, who attended the seventh U.S.-Korea West Coast Strategic Forum in Seoul just days before Kim’s death, shares highlights from the Forum and offers insight into the current North Korea situation.

Straub is associate director of the Korean Studies Program at Stanford University and a retired senior U.S. foreign service official with over 30 years of Northeast Asia experience.

The U.S.-Korea West Coast Strategic Forum is held semi-annually, alternating between Stanford and the Sejong Institute in Seoul.

The West Coast Forum opened with a discussion about the current situation in North Korea. After Kim Jong Il’s death, how much do you think that picture will change?

Most Forum experts believe there will be relative stability in North Korea for some time to come.

The reason Kim Jong Il chose Kim Jong Un as his successor is because he is the least controversial person in North Korea to succeed him. Anyone else would be the object of great suspicion and jealousy within the elite there.

North Korea has already had one succession—from founder Kim Il Sung to his son Kim Jong Il—and that went smoothly. The succession from Kim Jong Il to his youngest son Kim Jong Un is natural within that context—it is a dynastic succession. As with other dynastic successions, the easiest person to accept is normally someone who represents a continuation of the person in power.

Do you foresee possible areas for improvement in relations between North and South Korea or for negotiations over North Korea’s nuclear program?

Apr. 15 is the 100th anniversary of Kim Il Sung’s birth, which is going to be a large celebration. North Korea probably will want to commemorate it without a lot of distractions. The North Korean leadership also wants to provide more food and supplies to its people, and provocations toward South Korea would make it harder to get international aid. 

A number of Forum experts are concerned that North Korea might conduct another nuclear or long-range missile test this year. Most tests so far have not been fully successful, so from a military and technology perspective they probably want to try again. North Korea has been slapped with international trade sanctions for its previous tests, but China has always stepped in to help. Sanctions will probably not deter the North Koreans from conducting future tests.

As far as inter-Korean relations are concerned, it is unlikely that North Korea will take any major new initiatives toward the South. The leadership does not like conservative South Korean President Lee Myung-bak because he came into office saying that he would not continue giving large-scale aid to North Korea until it abandoned its nuclear weapons program. That was contrary to the Sunshine Policy of his two progressive predecessors.

President Lee’s term is almost up, and South Korea will hold a hold a presidential election on Dec. 19 this year. North Korea probably hopes that the progressives will win the election and restore the Sunshine Policy.

Will North Korea be a major issue for debate in South Korea’s upcoming 2012 presidential election?

Current polling shows that North Korea is the top concern of only 8 percent of the South Korean electorate. As in the past, the main issues for voters there are the economy, their standard of living, and social welfare issues. North Korea will not be the top issue unless something very dramatic happens between now and the election. On the other hand, if the race is close, feelings about North Korea policy could help to decide the outcome.

Among South Korean citizens, is there more fear or hope—or maybe a mixture of both—about North Korea’s new leadership?

Recent opinion polls show that 80 percent of South Koreans feel that North Korea will not give up its nuclear weapons. There is not much reason for optimism. That being said, most South Koreans are concerned about North Korea’s 2010 attack of Yeonpyeong Island and hope for improved relations. And, of course, Kim Jong Un is a different leader and most South Koreans hope he will move in a more positive direction. But they feel it is unlikely to happen in the next few years—if ever.

Does uncertainty over the future of North Korea have the potential to impact or strengthen any aspects of the U.S.-South Korea alliance?

This year, the U.S. and South Korean administrations will likely focus on managing the North Korean situation and continue to prioritize the U.S.-South Korea alliance. The two countries closely cooperate on North Korea policy.

The real question for the alliance in terms of North Korea policy will be who is elected as president in both countries. If a progressive South Korean candidate wins, that person will probably pursue some variation of the Sunshine Policy. Especially if a Republican is elected in the United States, we may see echoes of the difficult U.S.-South Korea relationship we had during the George W. Bush administration.

If President Obama is re-elected, another South Korean Sunshine Policy would also pose challenges. The administration has taken a very firm position that the United States will not significantly improve relations with North Korea until it gives up its nuclear weapons program. South Korea’s Sunshine Policy focuses on embracing North Korea in the hope that relations will improve over time and that North Korea will eventually voluntarily give up its nuclear weapons in that long-term context. 

China, the country in Northeast Asia with the most influence over North Korea, recently issued a statement in support of Kim Jong Un. Does this signify any major change in relations between these two countries?

The Chinese government has particular interest in North Korea. China is focused on developing its own economy, including the relatively poor northeastern area that borders North Korea. The last thing China wants is instability on the Korean Peninsula, which would detract from its economic development.

China does not believe it can force North Korea to give up its nuclear weapons without risking instability. In the absence of progress in the Six Party negotiations over North Korea’s nuclear program, China has unilaterally increased economic and diplomatic support for North Korea. Its support is independent of who serves as the North Korean leader.

China tried very hard to get Kim Jong Il to open up the North Korean economy more, but did not succeed, primarily because Kim feared that doing so would also allow in more outside information and undermine his regime. China probably hopes that the younger Kim Jong Un may eventually have not only the power but also the desire to reform the economy.  

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While Chernobyl, and now Fukushima, are household words, far fewer people have heard of Maiak in the southern Urals and Hanford in eastern Washington State where Soviet and American engineers built plutonium plants to fuel the Cold War nuclear arsenal. Within nuclear "buffer zones," plant managers, who were pushed to produce as much plutonium as quickly as possible, polluted freely, liberally and disastrously. During the plutonium disasters that ensued, each plant issued over 200 million curies of radioactive isotopes into the surrounding environment, at least twice the amount released at Chernobyl. Under cover of nuclear security and powered by generous corporate welfare, plant managers employed influential public relations campaigns, restricted medical research, deployed temporary, migrant workers as ‘"jumpers" for the dirtiest work, and generally denied the existence and hazards of radioactive contamination. This was the house plutonium built. Kate Brown argues these histories are important because they supplied models, staff, blueprints and subsequent ready-made disasters for Chernobyl and Fukushima.

Kate Brown is an associate professor of history at the University of Maryland, Baltimore County. She is the author of a Biography of No Place: From Ethnic Borderland to Soviet Heartland (Harvard 2004), which won the American Historical Association’s George Louis Beer Prize for the Best Book in International European History. Brown is a 2009 Guggenheim Fellow and is working on a book called Plutopolia, a tandem history of the world’s first plutonium cities, to be published by Oxford University Press in 2012.

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Special Japan Studies Program and CEAS Series: Winter-Spring 2011-12

Looking Back, Looking Forward: Japan's March 11 Disasters One Year Later

The earthquake, tsunami, and nuclear disaster that hit Japan in March 2011 had both immediate catastrophic consequences and long term repercussions. Fundamental areas of Japan’s environment, economy, society, and collective national psyche were deeply affected, giving rise to a broad range of urgent issues. These include economic debates about how to meet the country’s energy demands with nuclear power plants offline, and what path to take for the country’s energy future; political crises, including criticism of the government’s disaster response; the psychological challenges of coping with trauma and grief; a daunting environmental clean-up; and social developments, including a new wave of civil society activism. This series brings together scholars and activists from a wide range of specialties to take stock of how the Japanese have been affected by the disasters, and to assess the efforts of residents, volunteers, and policy makers to recover and move forward.

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Kate Brown Associate Professor of History Speaker University of Maryland, Baltimore County (UMBC)
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Abstract

Mobile phone coverage and adoption has grown substantially over the past decade, primarily in sub-Saharan Africa. In the absence of public goods infrastructure in many countries, mobile phone technology has the potential to reduce communication and transaction costs and improve access to information, goods and services, particularly for remote rural populations. Research suggests that mobile phone coverage has had positive impacts on agricultural and labor market efficiency in certain countries, but empirical microeconomic evidence is still limited. This paper presents the results of several mobile phone-related field experiments in sub-Saharan Africa, whereby mobile phones have been used for learning, money transfers and civic education programs. These experiments suggest that mobile phone technology can result in reductions in communication and transaction costs, as well as welfare gains, in particular contexts. Nevertheless, mobile phone technology cannot serve as the “silver bullet” for development, and careful impact evaluations of mobile phone development projects are required. In addition, mobile phone technology must work in partnership with other public good provision and investment to achieve optimal development outcomes. 

Speaker Bio:

Jenny C. Aker is an assistant professor of economics at the Fletcher School and department of economics at Tufts University. She is also a non-resident fellow at the Center for Global Development and a member of the Advisory Board for Frontline SMS.

After working for Catholic Relief Services as Deputy Regional Director in West and Central Africa between 1998 and 2003, Jenny returned to complete her PhD in agricultural economics at the University of California-Berkeley. Jenny works on economic development in Africa, with a primary focus on the impact of information and information technology on development outcomes, particularly in the areas of agriculture, agricultural marketing and education; the relationship between shocks and agricultural food market performance; the determinants of agricultural technology adoption; and impact evaluations of NGO and World Bank projects. Jenny has conducted field work in many countries in West and Central Africa, including Benin, Burkina Faso, Burundi, DRC, The Gambia, Ghana, Liberia, Mali, Mozambique, Niger, Nigeria, Rwanda, Senegal, Sierra Leone and Sudan, as well as Haiti and Guatemala.

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Jenny Aker Assistant Professor of Economics Speaker Tufts University
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