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Karl Eikenberry M.A. ’94 has had a distinguished military and diplomatic career. Prior to his current position as the Payne Distinguished Lecturer at the Freeman Spogli Institute for International Studies (FSI), he spent 35 years in the United States Army. As U.S. ambassador to Afghanistan from May 2009 to June 2011, he led President Obama’s civilian surge, which occurred in conjunction with a 30,000-troop surge.
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OBJECTIVE To assess the individual financial impact of having diabetes in developing countries, whether diabetic individuals possess appropriate medications, and the extent to which health insurance may protect diabetic individuals by increasing medication possession or decreasing the risk of catastrophic spending.

RESEARCH DESIGN AND METHODS Using 2002–2003 World Health Survey data (n = 121,051 individuals; 35 low- and middle-income countries), we examined possession of medications to treat diabetes and estimated the relationship between out-of-pocket medical spending (2005 international dollars), catastrophic medical spending, and diabetes. We assessed whether health insurance modified these relationships.

RESULTS Diabetic individuals experience differentially higher out-of-pocket medical spending, particularly among individuals with high levels of spending (excess spending of $157 per year [95% CI 130–184] at the 95th percentile), and a greater chance of incurring catastrophic medical spending (17.8 vs. 13.9%; difference 3.9% [95% CI 0.2–7.7]) compared with otherwise similar individuals without diabetes. Diabetic individuals with insurance do not have significantly lower risks of catastrophic medical spending (18.6 vs. 17.7%; difference not significant), nor were they significantly more likely to possess diabetes medications (22.8 vs. 20.6%; difference not significant) than those who were otherwise similar but without insurance. These effects were more pronounced and significant in lower-income countries.

CONCLUSIONS In low-income countries, despite insurance, diabetic individuals are more likely to experience catastrophic medical spending and often do not possess appropriate medications to treat diabetes. Research into why policies in these countries may not adequately protect people from catastrophic spending or enhance possession of critical medications is urgently needed.

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Jeremy Goldhaber-Fiebert
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The Center on Democracy, Development, and the Rule of Law (CDDRL) congratulates Landry Signé for his recent awards in recognition of his pioneering work to advance democratic causes and community leadership in North America. Signé is a 2011-2013 Banting Postdoctoral Fellow at CDDRL where he researches the conditions that create, maintain and sustain democracies and economic development. His Banting fellowship is supported by the Social Sciences and Humanities Research Council of Canada. Prior to joining CDDRL, Signé was a visiting scholar at the Stanford Center on African Studies.

On May 19, Signé received the Outstanding Visionary Leadership Award during the 2012 African Network Conference in San Jose, California. Signé was recognized by The African Network for his pioneering role in promoting entrepreneurial opportunities, accountable governance, and economic development for Africa in the Silicon Valley and North America. Signé has been helping to redefine Africa as a continent of economic opportunity through an innovative course he teaches at Stanford Continuing Studies bringing Silicon Valley executives and Stanford students together to spur business and investment strategies.

A week earlier, Signé was awarded the Jury’s Favorite Award for Vision and Inspiration by the African Business Network during their Excellence Vision and Inspiration Gala in Montreal, Canada. Signé was bestowed with this award for his work with the Political Commission of Montreal, the United Nations Association of Canada-Montreal, and the United Nations Missions Committee in New York to champion projects to advance political, economic and social development. One of the projects he supported reinforced the importance of art for economic development, and resulted in a $26 million grant allocated to the Montreal Museum of Fine Art by the Government of Quebec and the Government of Canada.

Signé dedicated the award to, “All the people and institutions who - undercover or in the spotlight - contribute through their visionary actions to improve citizen involvement, to create more individual and collective opportunities, and to generate a better and happier life for the current and next generations.”

Signé completed his PhD in political science in 2010 with the Award of Excellence from the University of Montreal, and has been bequeathed the Award for Best International PhD Dissertation of 2011 by the Center for International Studies and Research. Signé is a member of the Stanford University Provost's Advisory Committee on Postdoctoral Affairs and is the co-chair of the Stanford University Postdoctoral Association whose mission is to represent and advocate for the interests of the postdoctoral scholar community, and to enrich their experience at Stanford University.

A frequent commentator on issues of African governance and economic development, Signé has appeared in The New York Times, Reuters, and Afrik-News.

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The Honorable Emmanuel Dubourg, Member of Parliament and Parliamentary Secretary to the Quebec Minister of Finance (left) and Landry Signé, winner of the Jury's Favorite Award for Vision and Inspiration (right).
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On Tuesday, December 11, 2012, the Program on Energy and Sustainable Development will host an all-day conference on "The New U.S. Role in Global Fossil Fuel Markets"

As recently as 2007, the United States seemed headed towards ever greater fossil fuel import dependence, as domestic oil and natural gas production dwindled and consumption continued to grow.   Five years later, the landscape looks dramatically different. An explosion in natural gas production from shales has overturned paradigms and sparked bold talk of LNG exports. While less remarked-upon, unconventional oil production has followed suit, helping to boost liquids output 20% from 50-year lows and vaulting North Dakota ahead of Alaska to become the nation’s second-largest oil producer. A new order is emerging in the coal market as well, with efforts underway to ship cheap, low-sulfur coal from the western U.S. to China.

The new role for the U.S. as a hotbed of production and technology development for unconventional resources, a reduced import market, and a possible key exporter of natural gas and coal raises a host of political, economic, and environmental questions. The goal of this conference is to contribute to insightful and data-driven dialogue on these pressing (and often politically-charged) issues by bringing together academics, policymakers, industry experts, and other stakeholder groups.

Register Now

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PESD director Frank Wolak spoke on role of congestion revenue rights (CRRs) and financial transmission rights (FTRs) in improving energy market efficiency at the Energy Risk magazine’s 16th annual 2-day conference.   His talk focused on the question of whether CRRs and FTRs issued by the market operator in Locational Marginal Pricing (LMP) markets improved or degraded wholesale electricity market performance.  

Wolak argued that CRRs and FTRs issued by market participants were more likely to improve market performance than those issued by the market operator.    Frank also participated in a panel on the future of liquefied natural gas (LNG) in the US and around the world given tremendous increase in shale gas production in the United States and likely increase in other parts of the world.

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As recently as 2007, the United States seemed headed towards ever greater fossil fuel import dependence, as domestic oil and natural gas production dwindled and consumption continued to grow. Five years later, the landscape looks dramatically different. An explosion in natural gas production from shales has overturned paradigms and sparked bold talk of LNG exports. While less remarked-upon, unconventional oil production has followed suit, helping to boost liquids output 20% from 50-year lows and vaulting North Dakota ahead of Alaska to become the nation’s second-largest oil producer. A new order is emerging in the coal market as well, with efforts underway to ship cheap, low-sulfur coal from the western U.S. to China.

The new role for the U.S. as a hotbed of production and technology development for unconventional resources, a reduced import market, and a possible key exporter of natural gas and coal raises a host of political, economic, and environmental questions. The goal of this conference is to contribute to insightful and data-driven dialogue on these pressing (and often politically-charged) issues by bringing together academics, policymakers, industry experts, and other stakeholder groups.

Session topics will include: (1) the environmental and economic impacts of proposed exports of Powder River Basin coal to China; (2) which will happen first: major LNG exports from the U.S. or shale gas development at scale outside of the U.S. (and especially in China); (3) the changing role of the U.S. in the global oil market, and its geopolitical and economic implications; (4) the cases for and against pipelines connecting Canada’s oil sands with U.S. refineries; and (5) the trajectory of future natural gas demand from the U.S. transportation and power sectors.  

Each session will feature a presentation by an academic or industry expert summarizing the state of knowledge on the topic and pointing out major unresolved issues. Discussants from the policymaking and stakeholder communities will then provide their perspectives on the presentation. This will be followed by an opportunity for audience comment and discussion.

 

Bechtel Conference Center

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As the U.S. presidential election race heats up, taking a tough stance on China's trade and economic policies has become part of the campaign rhetoric. Daniel C. Sneider speaks with Bloomberg and Medill News Service about Mitt Romney's focus on China.
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Shanghai's Lujiazui finance and trade zone, August 2010.
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Despite accelerating economic growth in India over the last thirty years, India’s structural transformation remains stunted, said economist Hans Binswanger-Mkhize at a May 10 FSE symposium on global food policy and food security. Unlike China, urban migration and labor absorption have been slower than expected, especially in the typically labor-intensive manufacturing sector. Formal sector jobs are few and declining as a share of employment, and agricultural employment (and growth) remains low.

The rural non-farm sector has been left to pick up the slack, and has emerged as the largest source of new jobs in the Indian economy. This will likely remain so over the next few decades given that two-thirds of India’s growing population is projected to live in rural areas. Add to the equation the need to increase crop yields by 50 percent under changing climate conditions and it becomes apparent that improving rural incomes and supporting agricultural growth is essential to decreasing poverty and unemployment in India now and in the future.

“The importance of India's rural non-farm sector shows us that structural transformation does not follow a recipe,” said commentator Marianne Banziger, a senior scientist at the International Maize and Wheat Improvement Center (CIMMYT) in Mexico.

While non-farm jobs offer significantly higher wages than farm labor, most jobs are informal and/or insecure (i.e., no health benefits, unemployment insurance or pensions). These jobs go mostly to men 18-26 years old who have some education, while the illiterate and women struggle to transition into this sector. Retail trade and transport, construction, and services (internet and phone booths, maintenance and repair of motor vehicles, and hotels and restaurants) are growing especially fast, partly due to urban-rural spillovers, but manufacturing is still only 20 percent of non-farm jobs.

“For rural households, non-farm employment is not distress employment, but a profitable diversification strategy,” said Binswanger-Mkhize. “At the same time, it has selectively absorbed young males into wage employment, decreased the number of farmers, and increasingly concentrated women in agriculture, contributing to a progressive feminization of agriculture.” 

As a result, farms on average have declined in both land and household size, and have moved toward the production of higher-valued goods and a modern model of part-time farming. This transformation concerned Banziger.

“Will the urban and land-less poor be held hostage by part-time farmers?” she asked.

Banziger projects in the next 20 years food and energy price inflation will likely exceed the income growth of the urban poor. Food price increases will push net consumers, who spend a third of their income on food staples, back into poverty.

“For food prices to remain constant, farmers yield gains will have to increase by 50 percent on essentially the same land area, with less water, nutrients, energy, labor and as climate changes,” said Banziger. "The more we delay investments, the steeper the challenge.”

Fortunately, small farmers are now better equipped to respond to these challenges, but are still limited by scale. Precision irrigation and fertilization technology coupled with remote sensing and cell phone technology enable better yield predictions that affect nutrient application. Better farm-level nutrient management increases farmer income and nutrient use efficiency.

For an optimistic Indian future to be realized government policy must support ways in which households increase their incomes, said Binswanger-Mkhize. A positive outcome for rural areas depends on continued urban spillovers, and on better agriculture and rural development policies, institutions, and programs.

Productivity growth needs to be sustained at very high levels. This requires more responsive, accountable, and better-financed research systems, more diversification of agriculture, and larger, better financed, and more accountable agricultural extension system. India currently employs one-seventh the number of extension workers as China.

"Rapid policy and institutional change will be required to overcome poor performance of many government programs," said Binswanger-Mkhize. "Current subsidies to fertilizer, electricity, water, and support to crop prices are already large, but are an inefficient means to transfer income to farmers."

Direct payments may be a more efficient way of supporting income growth. This is beginning to happen with fertilizers, but should be extended to electricity and food subsidies, said Binswanger-Mkhize.

“Maybe the people who have been disadvantaged in the past are the core for future change. With appropriate support, smallholder farmers can become the engines for agricultural productivity growth and transform India's growing economy,” concluded Banziger. 

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