Something as simple as, "Are you taking your medications?" could conceivably prolong a life.

The study, detailed in a new working paper released this week by the National Bureau of Economic Research, was co-authored by Petra Persson, an assistant professor of economics; Maria Polyakova, an assistant professor of health economics at Stanford School of Medicine and core faculty at Stanford Health Policy; and Yiqun Chen, a doctoral student in health economics at Stanford School of Medicine. Persson and Polyakova are both faculty fellows at the Stanford Institute for Economic Policy Research (SIEPR).

Their study tackles the issue of health inequality and specifically examines the effects of having access to informal health expertise by having a doctor or nurse in the family. It finds that those with relatives in the health profession are 10 percent more likely to live beyond age 80. They are also significantly less likely to have chronic lifestyle-related conditions, such as heart attacks, heart failure and diabetes.

Younger relatives within the extended family also see gains: They are more likely to have been vaccinated, and they have fewer hospital admissions and a lower prevalence of drug or alcohol addiction.

In addition, the closer the relatives are to their familial medical source – either geographically or within the family tree – the more pronounced the impact of the health benefits, according to the findings.

The researchers used data from Sweden, where lotteries were used in the early 2000s to break ties among equally qualified applicants for admission into medical schools. The researchers then compared the health of the family members of lottery winners against lottery losers – a setup similar to a randomized control trial.

The strong findings of health benefits funneled from a familial sphere of medical knowledge suggest it would be worth ramping up access to health expertise in our health care system, the researchers say.

A doctor, for instance, could prescribe statins – a type of drug known to lower the risk of heart attacks – but whether the patient continues taking it from day to day is a decision made at home.

“Our work shows that there is a lot of value in trying to improve people’s decisions about their investment in their own health,” Persson says.

“If the government and health care system, including public and private insurers, could mimic what goes on inside families, then we could reduce health inequality by as much as 18 percent,” she says, referring to a main finding of the study.

Intra-family transmissions of health-related expertise might encompass frequent nagging to adhere to prescribed medications, get vaccinations or refrain from smoking during pregnancy, and “these behavioral changes are – from a society’s perspective – simple and cheap,” the study states.

Disparity despite access

The study also reveals limitations to the impact of equal access to medical care, underscoring the importance of other health efforts.

The researchers compared mortality data of Sweden – where there is universal access to health care – to the United States. They found the overall mortality was lower in Sweden but the level of health inequality largely mirrored that of the United States. In Sweden, despite its extensive social safety net, the rich also live longer and the poor die younger. Specifically, among people alive at age 55, more than 40 percent of individuals at the bottom of the income distribution in Sweden will have died by age 80 – as opposed to fewer than 25 percent for those at the top of the distribution.

“This health inequality appears to be extremely stubborn,” Persson says. “We can throw a universal health insurance system at it and yet substantial inequality persists. So, is there anything else that can help us close that health gap between rich and poor?”

According to their latest research, yes.

Health effects from having a medical professional in the family were substantial and occurred across the income spectrum, according to the study. And because the effects from the exposure to medical expertise was often even stronger for those at the lower half of the income distribution, the researchers estimated that information-driven behaviors could make a significant difference in getting rid of health disparities.

Closer ties, less churn

The study did not examine the complexity of family dynamics or specific actions that led to the positive health effects, but the researchers hypothesize that the mere presence of a medical professional in the family translates somehow to either a heightened health culture or, at least, having a coach of sorts to encourage healthy, good-patient behavior.

Although general public health campaigns (e.g., “Get Your Flu Shot Today!”) may not carry the same level of influence as intimate dinner-table discussions or persistent prodding among family members, there could be other ways society can improve its exposure to medical expertise to lead to healthier, longer lives, the researchers say.

Community health worker or nurse outreach programs can perhaps lead to more targeted, personalized communication efforts, they say. Digital nudges delivered through mobile phone apps could potentially make healthy dents.

Reminders of preventive care can also come by way of closer patient-doctor relationships and more consistent, longer-term ties to the same doctor.

“The idea of continuity of care and developing a true relationship with your doctor, who becomes someone who pays attention to you as an individual and sees you and your family over a long period of time, is well known,” Polyakova says. “Today, it’s what they might call old-fashioned primary care, where the whole family goes to the same doctor for many years. Many countries, the U.S. included, appear to be moving increasingly away from this model, and our results suggest that we might want to do the reverse.”

The finding of how a closer family connection or closer proximity leads to even stronger health outcomes helps substantiate the potential difference a closer bond between any doctor and patient could make – improvements that would be hard to glean from rushed and infrequent medical appointments, Persson and Polyakova say.

Communication-focused health initiatives don’t have to come with hefty price tags either, they say.

“We pour a lot of resources into getting even fancier machines inside hospitals, but the things that are making a difference here are not that expensive,” Persson says of their findings. “These are cheap, easily scalable preventative investments that are translating to gains in longevity, which is remarkable.”

Sweden’s medical school lotteries

Using large-scale data from Sweden, the researchers focused on quantifying the role of informal exposure to health expertise via a medical professional in the family while avoiding results that would be muddled with other differences between individuals with and without a doctor in the family.

The researchers used two different approaches. First, they took advantage of the fact that in some years, lotteries were used to break ties among equally qualified applicants to Sweden’s medical schools. This allowed the researchers to use medical school application records and track the health of family members of applicants who won and lost the lottery.

The researchers looked at more than 30 years of continuous health and tax records spanning four generations of family members, and examined health-related outcomes of the extended family members of newly trained doctors and nurses – including their siblings, parents, grandparents, children, aunts, uncles, cousins and in-laws.

Second, researchers sought to double-check whether higher income and higher social status associated with the medical profession had anything to do with the positive health benefits they found.

One of the ways they did this was to draw a comparison to lawyers, a similarly paid profession. The parents of doctors, they found, were 16 percent more likely to be alive than the parents of lawyers 20 years after their children matriculated. The parents of doctors also faced lower prospects of lifestyle-related chronic diseases.

In addition to the higher likelihood of their parents living past age 80 and the lower likelihood of heart diseases, the relatives of health professionals showed higher levels of preventive behaviors, including purchases of heart and blood-thinning medications, and vaccinations for HPV, or human papillomavirus. Younger family members also had fewer hospital admissions and addiction cases.

“People with health professionals in the family essentially make preventative investments that everyone should be doing,” Persson says.

 

 

On February 21–22, faculty and fellows from Stanford University traveled to Oahu, Hawaii for an orientation visit at the United States Indo-Pacific Command (INDOPACOM), the U.S. military command responsible for the conduct of the U.S. military’s missions throughout the Indian and Pacific Oceans, and Asia.

The visit brought together scholars and researchers from Stanford, the Massachusetts Institute of Technology, the Council on Foreign Relations, and Macquarie University, Australia. Organized by the U.S.-Asia Security Initiative (USASI) and the Shorenstein Asia-Pacific Research Center at the Freeman Spogli Institute for International Studies (FSI), the visit included meetings with the commanders and staffs of INDOPACOM and five of its subordinate commands (U.S. Army Pacific, U.S. Pacific Fleet, U.S. Air Forces Pacific, U.S. Marine Forces Pacific, and U.S. Special Operations Command Pacific), and a tour of Arleigh Burke-class Aegis destroyer USS John Paul Jones (DDG-52).

The visitors also interacted with the U.S. Army’s 25th Infantry Division’s leadership and the unit’s Jungle Training Center. The busy itinerary provided the group a superb opportunity to learn about INDOPACOM’s and its subordinate units’ threat assessments, capabilities, doctrine, regional partnerships, and readiness challenges.

These trips offer great access to America’s armed forces to those whose research focuses on or relates to national security issues, says Karl Eikenberry.

Karl Eikenberry, Director of the U.S.-Asia Security Initiative (USASI), a former U.S. ambassador to Afghanistan and himself a retired U.S. Army lieutenant general said: “USASI has over the past five years organized annual trips to U.S. military commands for Stanford FSI faculty and fellows. These trips offer great access to America’s armed forces to those whose research focuses on or relates to national security issues. The insights gained inform analysis, while the host organizations gain fresh perspectives different from those found within their commands.”

 

Discussions began on February 21st at Camp H.M. Smith, the Headquarters of INDOPACOM. Brigadier General Jonathan Braga, U.S. Army, SOCPAC Commander and his staff discussed his command’s unique capabilities and roles in both conventional and counterterrorist/counterinsurgency warfare operations. Major General Michael Minihan, U.S. Air Force, INDOPACOM Chief of Staff, then hosted a wide-ranging session on his organization’s implementation of the National Security Strategy and National Defense Strategy at a time of dynamic change within the region.

 

This was followed by a working lunch at the INDOPACOM Flag Mess with key staff members of MARFORPAC who explained U.S. Marine force posture and contingency missions throughout the Pacific Region. The Stanford group then proceeded to Hickam Field and met with General Charles Brown, Commander, PACAF, and his Deputy Commander, Major General Russell Mack. General Brown detailed the critical role played by airlift and airpower in the vast Indo-Pacific region, and the development of new concepts for the employment of U.S. Air Force capabilities in joint (inter-service) and combined (inter-allied) operations.

 

The visiting faculty and fellows then transited to Pearl Harbor for a tour of USS John Paul Jones led by Commanding Officer, Commander Jesse Mink, United States Navy, and Executive Officer, Commander Robert Watts, USN. Noteworthy was the destroyer’s sophisticated integrated air, surface, and underseas warfare systems, and the emphasis placed on resilience in high-end combat situations. Following the ship tour, the group attended a PACFLT command briefing chaired by the Commander, Admiral John Aquilino.

The dialogue made clear PACFLT’s emphasis on a holistic approach to deterrence and decisive operations, with an eye on future requirements. The first day of the trip ended with a working reception at the historic “Nimitz House” hosted by Admiral Aquilino, offering the attendees a chance to engage in conversations with the Commander and his staff.

The second day of the trip began with an introduction to the Daniel K. Inouye Asia-Pacific Center for Security Studies (APCSS), followed by expert presentations and breakout sessions on select topics including the Chinese One Belt One Road plan, the security of Taiwan, pandemic threats in the Indo-Pacific region, and cyber operations. The Stanford team then traveled to Fort Shafter for a meeting with Brigadier General Pete Andrysiak, U.S. Army and Chief of Staff, USARPAC. BG Andrysiak and the USARPAC staff elaborated on the evolving U.S. Army’s regional doctrine and extensive partnership activities.

A highlight of the group’s time in Oahu came with a visit to the U.S. Army’s 25th Infantry Division at Schofield Barracks, and the 25th ID Jungle Training center via UH-60 Blackhawk Helicopters. There Brigadier General J.B. Vowell, Assistant Division Commander, 25th Infantry Division and U.S. Army Hawaii (himself a former FSI Senior Military Fellow), discussed the division’s extensive missions throughout the region, including in the Korean Peninsula.

 

Faculty and fellows were also able to “get their boots (or at least tennis shoes) muddy” in the U.S. Army’s rugged training area in northern Oahu, with highly skilled soldiers demonstrating jungle warfare tactics and techniques. The trip ended with the participants hosting a reception at the Hale Koa Hotel Warriors Lounge for their many hosts over the past two days.

The trip to INDOPACOM Headquarters provided a rare opportunity for participants to talk directly with senior U.S. military leaders in the most important region of the world and to gain a better understanding of their perspectives and the many challenges that they are addressing. Faculty and fellows interacted with junior leaders at the tactical level, helping them gain an appreciation of the ethos of those serving at the cutting edge. The hosts all commented on the benefit of learning the views of scholars, many of whom have spent their academic careers writing about national security issues.

The trip provided fascinating insights into how the U.S. military views the rapidly evolving national security challenges in the Indo-Pacific region, says Larry Diamond.

“The trip provided fascinating insights into how the U.S. military views the rapidly evolving national security challenges in the Indo-Pacific region, and how it is organized to defend against the threats. You can read about much of this in the media and the journals, but there is just no substitute for being there, seeing our facilities on the ground, and engaging directly with the remarkable men and women (and one thing that struck me is that there are quite a number of women) who are responsible for our defense,” said Larry Diamond, senior fellow at the Hoover Institution and at the Center on Democracy, Development & the Rule of Law (CDDRL) at FSI.

FSI scholars particularly valued the opportunity to connect one-on-one.

“It was invaluable to meet and hear directly from the individuals and organizations who are working so hard to ensure our security,” said Center for International Security and Cooperation (CISAC) Senior Research Scholar Megan Palmer. For CISAC Pre-doctoral Fellow Erik Lin-Greenberg, “the opportunity to interact with decision-makers from tactical to strategic levels was incredibly valuable and helped inform my own research.”

Why does cellist Yo-Yo Ma refer to the Silk Road as the ‘Internet of antiquity’? What is globalization? What is economic interdependence? What are diversity and inclusion? These are some of the questions that high school students from Yokohama Science Frontier High School (YSFH) considered during a visit to the San Francisco Bay Area in January 2019. Alumni of the U.S.-Japan Council’s TOMODACHI Emerging Leaders Program (ELP) and SPICE staff encouraged the students to critically consider the questions during their visits to Facebook, Apple, and Stanford University.

Prior to their arrival, YSFH students shared their goals for the trip. YSFH student Ken Horikoshi, who aspires to become a robotics engineer, noted, “I will need communication skills, skills of thinking deeply, and of course, knowledge about space or robotics to make my dreams come true. So, I’d like to make an effort to improve these skills.” With the students’ goals in mind, ELP Chair and SPICE’s Rylan Sekiguchi organized visits to Apple and Facebook and assisted with a one-day seminar at Stanford.

Derek Kenmotsu talks with students and teachers on Apple campus.

Mana Nakagawa gives students and teachers a tour around Facebook headquarters.

During the seminar at Stanford, SPICE staff introduced the YSFH students to SPICE lessons from Along the Silk Road to illustrate that globalization is not just a modern phenomenon. The staff noted that in some ways, the ancient Silk Road was the first real conduit of globalization, as it connected vast lands into a trade network that spread goods, beliefs, and technologies far from their areas of origin. ELP alumna Naomi Funahashi, instructor of SPICE’s online course on Japan, illustrated this by showing how musical instruments were carried along the Silk Road and gradually adapted to cultural and geographic features of local environments. She mentioned, for example, similarities and differences of lutes that can be found in Europe, China, Korea, and Japan. She also noted a description of the Silk Road by cellist Yo-Yo Ma, founder of Silkroad, who has described the Silk Road as the “Internet of antiquity”; expounding upon this notion, Sekiguchi and SPICE’s Jonas Edman noted that by studying about the Silk Road, we can gain historical insights into how the contemporary stage of globalization is changing our world and our lives.

A highlight of the seminar featured the YSFH students giving presentations on their science-related research to the SPICE staff and visiting scholars at Stanford from Japan. YSFH student Kazuhiro Okada’s presentation on his ambition to design underwater cities stretched the audience’s notions of globalization and interconnectedness. One commented, “It would be interesting if you could someday design a subway stop under the ocean between Aomori Prefecture and Hokkaido.”

The ELP identifies, cultivates, and empowers a new generation of leaders in the U.S.–Japan relationship. Chair Sekiguchi, other ELP alumni, and SPICE staff extended this mission to the generation behind them. YSFH teacher Nobuyo Uchimura described the experiences that they provided her students as very precious ones that expanded their learning beyond the confines of a classroom, and YSFH teacher Yukimasa Uekusa noted his desire to prioritize programs such as this into the future.

President Trump caught the world by surprise once again yesterday with a decision not to sign a deal with his North Korean counterpart, Chairman Kim Jong-un, in Hanoi, Vietnam. While walking away is a common tactic in working-level negotiation, what happened in Hanoi was a rare case and the least expected outcome.

Read the full article on Axios.

Trump and Kim share a common desire for development.

At first glance U.S. President Donald Trump and North Korean leader Kim Jong Un seem like an unlikely pair. A few years back they were calling each other “Rocket Man” and a “dotard,” and tension between the United States and North Korea was escalating rapidly in 2017. But in a few days they are slated to meet for the second time, and according to Trump they had “fallen in love” not long after their first encounter. What could have created such intimate bond between the two? The common interest that brings the two together is the desire for development — economic development in the case of Kim and property development in the case of Trump.

Read the full article on The Diplomat.

Stanford e-Japan is an online course that teaches Japanese high school students about American society and culture and U.S.–Japan relations. The course introduces students to both American and Japanese perspectives on many historical and contemporary issues. It is offered biannually by the Stanford Program on International and Cross-Cultural Education (SPICE). The Fall 2018 cohort was the seventh group of students to complete Stanford e-Japan.

In August 2019, three of the top students of the Fall 2018 Stanford e-Japan distance-learning course will be honored at an event at Stanford University. The three Stanford e-Japan Day honorees—Sakura Hayakawa (Katoh Gakuen Gyoshu Senior High School), Ryotaro Homma (Kaisei Senior High School), and Taiki Yamamoto (Ritsumeikan Uji Senior High School)—will be recognized for their coursework and exceptional research essays that focused respectively on “Importance of Youth Political Participation and Citizenship Education,” “The Abolition of the Electoral College: A Synthesis of the Positive Aspects,” and “The U.S.-Japan Alliance: Is a New Framework Necessary?”

Mayu Fujinami (Keio Girls Senior High School) and Tatsuya Sugiyama (Saitama Prefectural Urawa High School) received Honorable Mentions for their research papers on “The Importance of Paternity Leave for Gender Equality” and “Design Thinking: Lessons from the U.S.,” respectively.

Applications for the next session of Stanford e-Japan (Spring 2019) are currently being accepted through February 24, 2019. More information is available at stanfordejapan.org.

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