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A three-week seminar focused on digital health innovation and entrepreneurship in China came to a close last week, culminating in the final pitch presentations from four cross-cultural, entrepreneurial student teams. The winning team, LiveBright, presented a way to improve access to personal counseling in China using digital, peer-to-peer methods, with the mission of reducing stress among students and young professionals.

Sponsored by the Stanford Center at Peking University (SCPKU), the course was developed by Dr. Robert Chang, digital health inventor and Assistant Professor of Ophthalmology at Stanford University, and Ravi Pamnani, medical technology executive and alumnus of Stanford’s Biodesign Innovation Fellowship, a pioneering training program in biomedical innovation.

The hands-on course paired Stanford students with Peking University students in collaborative teams and immersed them in the Chinese healthcare system. Students shadowed physicians and interviewed patients to identify unmet needs and market opportunities. Students then brainstormed solutions and developed rapid prototypes to test their ideas and obtain user feedback. Next, they selected business models to ensure the sustainability of their solutions. Along the way, students got feedback from physicians, digital health entrepreneurs, and investors who evaluated their ideas in real-world contexts.

 

rob and ravi compressed SCPKU seminar instructors, Dr. Robert Chang and Ravi Pamnani.

SCPKU seminar instructors, Dr. Robert Chang and Ravi Pamnani
Courtesy of Stanford University

 

 

Other teams focused on a telemedicine approach to physical therapy, a more convenient way to obtain eyeglasses prescriptions at home, and a novel subscription box service to promote women’s health education.

“We have been really impressed with the outside-the-box thinking that the students have employed to identify new opportunities,” said Dr. Chang. “China has seen tectonic changes in the mobile and consumer internet sectors. With this in mind and given the unique characteristics of the Chinese healthcare system, a digital health revolution is inevitable, and in many ways has already begun. The rest of the world can learn a lot by observing how digital technologies will transform healthcare here in China over the next five years.”

For more information about the seminar, visit http://www.dhealthchina.com/.

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China's tight control over its economy is one reason why it is facing an economic slowdown of global implications, Stanford scholars say.

China's stock market fall is now in its third week, and share prices have lost a third of their value since mid-June, though the market is still higher than a year ago. China has the world's second-largest economy, with deep financial links to the United States.

Nicholas Hope, director of the China Program at the Stanford Center for International Development, which is part of the Stanford Institute for Economic Policy Research, said the simple answer behind the slowdown is that "nothing grows at 10 percent forever."

However, the dropoff is sharper than the government of China expected or desires, he noted.

Hope said the deceleration is due to the effects of slow growth globally on international trade, slower progress than hoped in rebalancing the Chinese economy toward spending more on consumption and less on investment, and the inefficiency of much of Chinese investment. Another big problem is the debt load of local and regional governments.

Hope does not think the steep fall of China's stock market is comparable to the American crash of 1929 – "so long as the Shanghai market index remains comfortably above where it was a year ago."

Yet the "frighteningly sharp correction" over the past few weeks highlights the fragility of the Chinese financial system, he said. It also serves as a cautionary tale for the many small investors who speculated on high returns with borrowed money.

"Borrowed funds have financed many risky economic investments in infrastructure by subnational [regional and local] governments as well as stock purchases by unwise investors," he said. "The result threatens to be an unwanted increase in non-performing loans in the banking system as borrowers are unable to repay."

Hope believes China can overcome its problems if it adopts economic reforms aimed at fostering more private enterprise and less state control over the market. Back in 1993, China's Communist Party announced those reforms and updated them in 2013, so they are technically on the books.

"Paradoxically, current weaknesses could be a longer-term source of strength, as the shares of income and consumption in Chinese GDP rise, investment is increasingly more efficiently allocated by a transformed financial system and all factors of production – land, capital and labor – are put to more productive uses," he said.

To counteract the market drop, the government ordered state-owned companies to buy shares, hiked the amount of equities insurance companies can hold and offered more credit to finance trading. Hope said this may cause a problem.

"It is introducing considerable moral hazard by attempting to bail out small investors because of the concern over the potential for social unrest if too many of those investors lose all of their savings," he said.

Charlotte Lee, associate director of the China Program at Stanford's Walter H. Shorenstein Asia-Pacific Research Center, says it is too early to tell if the market fall will diminish the credibility of the government and Communist Party in the eyes of the people. China's President, Xi Jinping, does want to maintain his popularity.

"The government's management of the economy is, however, one of the pillars of its credibility," Lee said.

She described this as a "small dent" in that credibility, as the government has many other ways it aids the Chinese people.

Opening up the economy

Stanford Professor Darrell Duffie says that it will be hard for China to maintain its past high growth rates.

"China's growth rate is still very high, but it is less high than it was because most of the giant pool of cheap and underutilized labor that China had 20 years ago has by now been put to work relatively productively," said Duffie, the Dean Witter Distinguished Professor of Finance at the Graduate School of Business.

"Additional sources of productivity gains are harder to find," he added.

Duffie is concerned about excessive leverage in China's equity markets.

"Chinese investors have borrowed a lot of money to invest in equities. This margin financing was used too aggressively. China's corporations and local governments are heavily indebted, and that will be a drag on future growth," he said.

He suggests that China would do well to continue on its current course of opening up its economy to cross-border capital flows and reducing its economy's reliance on state-owned enterprises.

If China's economy slows down, the country will decrease its demand for American goods and services, he added. American businesses that plan to operate in China should learn as much as possible about how China's economy and government works.

And Duffie advised, "Whenever possible work with trusted partners in China."

Asian power games?

With China ramping up its military in recent years, what are the risks to U.S. national security if China's economy plunges?

Amy Zegart, co-director of Stanford's Center for International Security and Cooperation, said it is possible that a slowing economy might make China behave differently in terms of its hard and soft power.

"For all the worry about a rising China, a fragile China is bad for the United States. The Chinese Communist Party's legitimacy rests on a promise of economic prosperity. The more China's growth falters, the more party leaders will be driven to stoke the fires of nationalism to secure domestic support," said Zegart, who is also a senior fellow at the Hoover Institution.

She added, "We've seen this movie before. It stars Vladimir Putin behaving recklessly abroad to win political support at home as his economy stalls."

Clifton Parker is a writer for the Stanford News Service.

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Hua Tang, Stanford Associate Professor of Genetics, visited SCPKU as a faculty fellow in March 2015.  Below are the highlights of a conversation Professor Tang had with SCPKU in which she shares more details about her research and the contributions SCPKU made to her work in China.

 

Q: Describe your research and its connection to China

My research aims to develop statistical and computational methods for elucidating the genetic basis of human complex diseases. My current focus is on two related themes: identifying disease risk factors by integrating functional genomic information, and understanding factors that contribute to differential disease prevalence across human populations. My SCPKU faculty fellowship has given me the opportunity to explore new dimensions related to both themes.  Through connections I have made with scholars at Peking University (PKU), I will be able to combine biological knowledge and population-based association evidence in my efforts to identify genetic risk factors for complex diseases.  I also plan to compare epidemiologic data based on the East Asian population in the U.S. and epidemiological studies in China to understand the role of life-style risk factors, such as diet and physical activities, in ethnic health disparity.

 

Q: What got you interested in the study of human complex diseases?

I have always enjoyed mathematics, but it is very important to me that my work has direct benefit to people. Luckily, in college and during graduate school, I discovered that statistical and population genetics are areas in which I could use mathematical tools to gain insights relevant to human health. We are living in an era of big data; combining novel statistical models, efficient computational tools and large-scale biomedical data offers fantastic opportunities to make real contributions to medicine and public health.

 

Q: Why did you decide to apply for an SCPKU Faculty Fellowship?

I wanted to connect better with the scientific community in China.  I had already started communicating remotely with a PKU professor at PKU, whose research shares common goals with mine but who takes complementary approaches. The SCPKU faculty fellowship would allow me to travel to China and strengthen ties with faculty at PKU.  I also look forward to the opportunities of interacting with students at PKU.

 

Q: How valuable was SCPKU's team in supporting your fellowship at SCPKU?

Extremely valuable!   I got a nice office on the courtyard level, great IT and staff support. Also, I had the opportunity to interact with faculty from other departments for collaborations.

 

Q: What were your fellowship objectives and were they met?  Also, if applicable, aside from the fellowship, how did SCPKU help you to achieve your objectives?

My first visit to SCPKU in March was very productive and I was able further my research on the two themes I mentioned earlier.  I also taught a lecture in a concurrent SCPKU graduate seminar, through which I got to know the work of Professor Randall Stafford from the Stanford Prevention Research Center.  Professor Stafford was also an SCPKU faculty fellow and taught a graduate seminar at SCPKU this past spring focused on chronic disease in China.  I was able to participate in the seminar and establish new ties with instructors and participants of this  multidisciplinary seminar including Chinese scholars, health practitioners and government representatives from the Chinese Center for Disease Control and other health-related organizations. 

Being physically at SCPKU this past spring really helped to stimulate my research program. The fellowship has opened up many possibilities for interacting with scholars at Peking University and the broader scientific community in Beijing. I hope to expand these relationships by making several more trips to SCPKU. I am also very interested in organizing an SCPKU graduate seminar for the near future.
 

Q: Describe some highlights of your stay in China/SCPKU. 

Aside from meeting with my PKU contacts to further my research, I enjoyed participating in (both as an observer and teaching a lecture) Dr. Stafford’s graduate seminar on chronic diseases in China. I made many new connections in the Beijing science community and will host a visiting student in early 2016.  I also attended an SCPKU-hosted happy hour which included a Chinese rice wine tasting and musical performance on a Chinese zither or “guzheng.”

 

Q: List at least THREE words or thoughts that come to mind which best describe your experience at SCPKU. 

Adventure, exploration, collaboration.
 

Q: Any future plans in China? 

I plan to use the remaining funds from my SCPKU fellowship in the fall, and continue interaction with faculty at PKU and SCPKU.

 

Photo courtesy of Stanford University

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Demographic change is fast becoming one of the most globally significant trends of the 21st century. Declining fertility rates and rising life expectancy -- two of the patterns triggering demographic change -- will cause vast socioeconomic strains, especially in the Asia-Pacific region, which has some of the world's most populous countries. Stanford health researcher Karen Eggleston says comparison and cross-collaboration are needed to induce creative solutions.

In an interview with the Office of International Affairs, Eggleston discusses her research approaches and partnerships in the study of healthcare systems and health policy in the Asia-Pacific region. She leads a multiyear research initative that examines comparative policy responses to demographic change in East Asia. Eggleston says the goal is to help move global health policy to a place where everyone has an "equal opportunity for a healthier and longer life."

The Q&A may be viewed in full by clicking here.

Analyzing demographic change in China, Japan and South Korea is the focus of the book Aging Asiaan outcome of a conference between the Walter H. Shorenstein Asia-Pacific Research Center and the Stanford Center on Longevity.

Eggleston also coedited a special issue of the Journal of the Economics of Ageing with David Bloom, a professor at Harvard University, looking at a range of economic issues related to population change in China and India.

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Karen Eggleston (left) confers with a healthcare worker at a primary care clinic in Hangzhou, China. | Robin Yao
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For Matthew Kohrman and his students, the war against tobacco needs a new communications strategy.

After all, he noted, three times as many cigarettes are currently manufactured and sold worldwide than were in the 1960s. And the global cigarette industry is the greatest cause of preventable death on the planet today.

That’s why the Stanford associate professor of anthropology decided to teach an introductory seminar this spring, Anthro 182N, titled Smoke and Mirrors in Global Health. Kohrman led his 10 students on a journey into the “strange optics” that the global tobacco industry uses – and what to do about them.

As noted in the syllabus, “entrenched challenges” to global health require society to develop “new methods” to communicate the real truth about tobacco.

Just what are those “new methods?” At the culmination of the class, the students presented some variations on that theme. Their end-of-the-quarter projects were web-based efforts profiling various features of global tobacco. They included exposés on how academicians in China assist the industry in that country, humorous parodies and critiques of Philip Morris, and flawed approaches to tobacco control in South Korea.

They tackled big-picture questions, Kohrman said. For example, they asked what exactly constitutes cigarette manufacturing and how new strategies could help slow the spread of tobacco-related diseases worldwide.

Kohrman, the director of Stanford’s Cigarette Citadels project, envisioned his class as a way for students to offer some thought-provoking and original ideas grounded in solid data. After viewing the student projects, he was astounded – and proud.

“My overall impression has been a feeling of awe,” he said. “Mostly freshmen and sophomores, the students who enrolled in this new course quickly synthesized complex intellectual concepts introduced early in the quarter, conceived their own innovative project ideas, collected relevant data, generously worked with each other, designed apt strategies for evocatively visualizing their messages, and chose and implemented strong interactive media tools – most of which were utterly new to me.”

One of those students was Minkee Sohn, a communication major, who created a video, “Fresh Recruits,” to highlight what he believes is the hypocrisy in the language of some cigarette manufacturers’ recruitment efforts.

“While cigarette manufacturers,” Sohn said, “often frame smoking as an act of free choice, that choice is just an illusion. Free choice is denied to people in all stages of cigarette manufacturing and consumption.”

For example, he explained that children in the African country of Malawi are coerced to work with their families in tobacco fields. “It’s deeply disturbing to hear companies associate freedom with high-paying jobs in cigarette manufacturing.”

For biology major Annabel Chen, the most important thing she learned was to analyze information skeptically. “Industries like big tobacco have influences in unexpected places, so you always need to do sleuthing to find out the truth,” she said.

She chose to examine the links between tobacco and academic research in China. “Seeing as China is the biggest tobacco market in the world, this was a problem we needed to address.”

Kohrman appreciates how students like Sohn and Chen were willing to try an experimental course, never taught before, and which for many was outside of their comfort zone. He said the course will be taught again in 2015-16.

“Looking back, it was the perfect-size group for all the work and one-on-one teaching we did,” he said.

The course was a classic collaboration, according to Kohrman, who also credits Claudia Engel, a lecturer in the Anthropology Department who helped with the technology and his own experiences mentoring undergraduate research, all of which proved instrumental to designing Smoke and Mirrors in Global Health.

“It was a great success today,” he said after seeing the student projects on the last day of class. Tom Glynn, a top adviser to the American Cancer Society, was on hand to see the presentations.

Kohrman added, “Students got tremendous feedback, and there was lots of enthusiasm about how this experimental course unfolded.”

Clifton Parker is a writer for the Stanford News Service.

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This article is part of a 12-part Caixin Magazine column series by REAP co-directors Linxiu Zhang and Scott Rozelle. Read the full series here.

 

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China’s vocational education is training technical workers for skills that will soon no longer be needed.

About ten years ago, policymakers universally agreed on “China’s shortage of skilled workers,” and China invested a large amount of money into vocational education and training. 

The government decided that not only did academic high schools need to expand recruitment, but that a new brand of vocational education should also be spread across the country. The goal was to allow half of students graduating from middle school to enroll in vocational schools and become the skilled workers that enterprises need.
 
Policymakers believe this is already benefitting students, as well as factories and enterprises within China. Therefore, China successively invested several hundred billion dollars in the program.
 
However, we think this was not a wise choice. 
 
We believe that the vocational education and training system is the least effective component within China’s education system. Even if China’s vocational schools could do as well as those in Germany, the current plan for sustaining and expanding vocational education has many flaws. In many places in China, vocational education and training is simply pulling China’s development into decline. 
 
Most importantly, the goal behind China’s push to develop vocational education is fundamentally flawed. 
 
Recently, Harvard University’s William Peterson and Stanford University’s Eric Hanushek published a book emphasizing that many countries, including China and the US, all fall prey to the same errors. For these countries, the goal of education is present advancement or short-term economic development. In contrast, Peterson and Hanushek believe that the purpose of developing education should be to advance economic development in 20 years and to prepare students to work 20 years in the future. 
 
These two scholars point out that countries that have successful education systems are not those countries that vigorously prepare technical workers for today’s economy, but those countries that foresee the economic picture as it will be in 2030.  
 
This does not mean that all vocational education and training systems suffer from myopia. Germany, Denmark, and the Netherlands all have very successful vocational education and a large number of vocational schools. 
 
However, the vocational education systems in Germany and China have fundamental differences. The Germans have known for decades that the role of vocational education is not to develop skilled workers trained for special jobs. Their vocational education system was designed so that students could meet success in the future in a number of areas. Therefore, students are required to comprehensively study many subjects, including math, science, Chinese, integrated circuitry, etc. Most of the jobs that were crucial to the economy 20 years ago no longer exist. Everything changes quickly, thus “learning mastery” is more important than learning a single skill that may change in a short time from being considered specialized to vanishing as a job altogether. 
 
As a result, students at Germany’s vocational schools spend 80% of their time learning comprehensive knowledge and skills. German vocational schools don’t just teach students specialized skills so that they can immediately go out and find a technical job. Students have a strong grounding in basic skills, ensuring that they can continuously learn. 
 
Compared to Germany’s vocational students, who spend 20% of their time learning “specialized” knowledge, China’s vocational students spend essentially all of their time learning specific skills. Therefore, when China’s vocational students intern, they do nothing more than repeatedly practice the specific skill they have learned. While Germany’s vocational education system is training human capital for the future, China’s vocational education is training skilled workers for requirements that will soon fade away.  

However, new research shows that even farsighted vocational education is still inferior to attending academic high school everyday.  

Another article written by Hanushek and others points out that there are major differences in the long-term labor market between most countries that accept students into vocational education (i.e. Germamy and Denmark) and those countries that require practically every student to attend academic high school (i.e. the US, France, and Canada). The unemployment rate, retirement age, and income for older-age workers in Germany and Denmark are higher, earlier, and lower, respectively, than those in the US, France, and Canada. The most rational reason for this is that workers in Germany and Denmark are not learning enough in vocational school, which impacts their ability to adapt and learn new skills. This in turn influences their ability to take on new work.
 
Considering Germany and Denmark’s combined experience, we can see that even with the best vocational education, the labor market performance of workers graduating from vocational schools is still inferior to that of those with an academic high school education. 
 
In other words, the lesson is the same: what workers need most from education is to develop a solid comprehensive foundation of fundamental skills; otherwise, it will be difficult to adapt and learn new knowledge. In China, education is wrongly treated as part of the economic plan. It is our assessment that China’s government should evaluate the current goals and scope of vocational education and training; otherwise, the pernicious effects of inappropriate policies will be felt in the not so distant future.   
 

 

About this series:

REAP co-directors Scott Rozelle and Linxiu Zhang wrote a ten-part series for Caixin Magazine titled, "Inequality 2030: Glimmering Hope in China in a Future Facing Extreme Despair." See below for more columns in this series:

> Column 1: Why We Need to Worry About Inequality

> Column 2: China's Inequality Starts During the First 1,000 Days

> Column 3: Behind Before They Start - The Preschool Years (Part 1)

> Column 4: Behind Before They Start - The Preschool Years (Part 2) 

> Column 5: How to Cure China's Largest Epidemic

Column 6: A Tale of Two Travesties

>Columns 7 & 8: China's Widest Divide

> Column 9: China's Most Vulnerable Children

> Column 10: Why Drop Out?

> Column 11: The Problem with Vocational Education

> Column 12: Reforming China's Vocational Schools (in Chinese)

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Over one million middle school students in rural China drop out every year. Though the reasons for dropping out are clear, it is difficult to find any way to improve.

Education, especially at the secondary school stage, is considered the most important driver of a country’s economic development. Since World War II, many countries have transitioned from middle-income to high-income countries, and secondary school enrollment rates have increased alongside economic development. However, this is not so for China. Especially in rural China, the proportion of students in impoverished areas that complete secondary school is very low, with less than 40% of students attending high school. In cities, the percentage is 90%.  
 
Although high school is very important, it still does not fall within the category of compulsory education in China. The more serious problem is that the dropout rate of rural Chinese students is also extremely high. The Rural Education Action Program (REAP) research team understands that the dropout rate for middle school students in rural China is much higher than official statistics show. 
 
We have engaged in numerous research projects related to the rural middle school student dropout problem. The results of five large-scale randomized controlled trials conducted at 262 middle schools across 3 provinces, show that the problem is clearly getting worse. Over the past five years, we have interviewed a total of 18,474 middle school students across different grades. In September, we first interviewed students who had just started middle school. 10 months later, in June of the next year, we followed up. Although we frequently encountered challenges, we were able to confirm the whereabouts of every student. The results of the five studies revealed high dropout rates. 
 
Between the start of the first and second semesters, 4%-13% of students dropped out; between the start of the second and third semesters, 9%; and before graduation a further 4%-9% of students dropped out. Using these statistics, we can estimate the average middle school student dropout rate to be 24%, with an upper bound of 31%. Thus, the average dropout rate for all the areas in our study is estimated to be over 18%. This is much higher than the most recent official middle school dropout rate—2.6%—published by the Chinese government.  
 
Based on our research, over one million rural middle school students in China drop out every year. With their current education, once China enters the next level of development in which wages and the requirements of workers are both higher, they will inevitably lack competitive power in the job market. 
 
Why do middle school students drop out? REAP is the first organization to use progressive quantitative economic tools to conduct an analysis of this issue. Of REAP's five research programs related to middle school drop out, four explored the factors that influence school drop out. These four programs reached consistent conclusions. Students that drop out from school often have four characteristics: poor academic performance, male sex, comparatively older, and poor conditions at home. Additionally, our research also found that middle school students with emotional problems were more likely to drop out of school. 
 
Middle school drop out is a big problem. The majority of students that drop out do not return to school. Their math, Chinese, English, history, and computer skills are very poor.
 
We conducted further one-on-one interviews to better understand the specific factors influencing middle school students' education. We deduced the following notes from our recording tapes and notes.
 
The cost of schooling is an important reason behind why students drop out. “My parents have to work hard in order to pay for my schooling, and because of my low academic performance, attending school is a waste of money. If I don’t study and go to work, even if I cannot earn that much, I will at least be able to support myself.”
 
Some students expressed concern over uncertain costs and said that it was their choice to drop out of school despite the wishes of their family. Looking at our analysis, it could be that low performing students think that the benefits of continuing to attend school are rather low.  They say, “even if I could get a scholarship to cover all the expenses, it is still very difficult to attend high school. My academic performance is too poor and attending high school is a waste of money, so the best course of action is to find work and earn some money.”      
 
The majority of students think that academic performance is the most important reason their classmates choose to drop out. Some students with decent academic performance think the problem lies in the poor quality of the school, saying “I am not happy at this school. The teacher does not care about me at all. No one takes education seriously. No one should attend this school.” 
 
Additionally, we discovered that middle school students also face emotional pressure that could lead them to feel compelled to drop out of school. “I regret the path I chose that day. However, at the same time, I did not know that the work I would get after dropping out would be this bad.”
 
In reality, the main factors leading students to impulsively drop out of school are the emotional pressures and anxiety of attending school. This kind of pressure comes from many places, including the indifferent attitude of teachers, prejudice and playground bullying of classmates, friends urging friends to drop out, a lack of parental guidance, etc.  
 
Our research shows that the reasons behind why middle school students drop out are already clearly developed. Furthermore, because rural parents often have no choice but to part from their children, it is difficult to overcome these obstacles. For the time being, there remains a shortage of quick effective solutions, however these problems are solved. However, if decisive measures are not adopted now, this problem will continue, ultimately leading to human capital shortages in China’s future development that will be difficult to recover from.
 

About this series:

REAP co-directors Scott Rozelle and Linxiu Zhang wrote a ten-part series for Caixin Magazine titled, "Inequality 2030: Glimmering Hope in China in a Future Facing Extreme Despair." See below for more columns in this series:

> Column 1: Why We Need to Worry About Inequality

> Column 2: China's Inequality Starts During the First 1,000 Days

> Column 3: Behind Before They Start - The Preschool Years (Part 1)

> Column 4: Behind Before They Start - The Preschool Years (Part 2) 

> Column 5: How to Cure China's Largest Epidemic

Column 6: A Tale of Two Travesties

>Columns 7 & 8: China's Widest Divide

> Column 9: China's Most Vulnerable Children

> Column 10: Why Drop Out?

> Column 11: The Problem with Vocational Education

> Column 12: Reforming China's Vocational Schools (in Chinese)

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In this fourteenth session of the Strategic Forum, former senior American and South Korean government officials and other leading experts will discuss current developments in the Korean Peninsula and North Korea policy, the future of the U.S.-South Korean alliance, and a strategic vision for Northeast Asia. The session is hosted by the Korea Program at the Shorenstein Asia-Pacific Research Center, in association with Korea National Diplomatic Academy, a top South Korean think tank.

Bechtel Conference Center

Encina Hall, Stanford University

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