Shorenstein APARC is pleased to announce that Arzan Tarapore has been appointed a research scholar supporting the Center’s efforts to promote policy-relevant research, education, and public engagement on contemporary South Asia. In addition to conducting research and providing mentorship on South Asia security and geopolitical issues, Tarapore will organize public programming exploring the trends and challenges shaping the region. He will also cultivate cooperative relationships with stakeholders in the academic and policy communities in South Asia. His appointment is effective September 1, 2020.

Tarapore is currently a non-resident fellow at the National Bureau of Asian Research, as well as an adjunct professor with the Security Studies Program at Georgetown University’s School of Foreign Service and an adjunct researcher at the RAND Corporation. His research focuses on security issues in South Asia and the rapidly evolving strategic landscape of the wider Indo-Pacific. Prior to his scholarly career, he served for thirteen years in the Australian Defence Department in various analytic, management, and liaison positions, including operational deployments and a diplomatic posting to the Australian Embassy in Washington, DC.

“We are delighted to have Arzan join APARC,” said Center Director Gi-Wook Shin. “APARC has more than a decade-long record of South Asia research and publishing activities as part of a previous initiative, which we are keen to revitalize. Arzan’s unique experience, combining scholarship with government service and diplomatic assignments, will be a tremendous asset to our community as we advance policy-relevant research and training on South Asia and U.S. strategy in the larger Indo-Pacific. We look forward to welcoming him to Stanford in September.”

Tarapore’s academic work has been published in the Journal of Strategic Studies, The Washington Quarterly, Asia Policy, and Joint Force Quarterly, among others, and his policy commentary frequently appears on platforms such as the Hindu, the Indian Express, The National Interest, the Lowy Institute's Interpreter, the Brookings Institution’s Lawfare, and War on the Rocks.

"I am enormously excited to join Stanford's world-class community of scholars, and especially to be at the forefront of APARC's renewed focus on South Asia,” said Tarapore. “Our work will center on the opportunity – and the pressing need – to deepen our connections with the region, and to meaningfully inform debates on U.S. policy in the wider Indo-Pacific." 

Tarapore holds a PhD in war studies from King's College London, an MSc from the London School of Economics, and a BA (Hons) from the University of New South Wales. His research experience includes previous roles at the East-West Center in Washington and the Observer Research Foundation in New Delhi.

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Noa Ronkin
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Shorenstein APARC

Debak Das, CISAC’s MacArthur Nuclear Security Pre-doctoral Fellow, and his roundtable contributors examine the rising tensions between Pakistan and India and look at what the future might hold for the region. “Political relations in South Asia have hit rough weather,” writes Das. “So where does the nuclear relationship between India and Pakistan stand? Where do the key threats to peace in the region come from?” 

Read the rest at Texas National Security Review

Type 2 diabetes has become a major public health problem in South Asia in recent decades. The region is now home to an estimated 84 million people suffering from diabetes—approximately one-fifth of the world’s 451 million adults with diabetes—a number that is expected to rise by 78% by 2045. Even more concerning, across South Asia the disease burden increasingly occurs in the most productive midlife period. Among Indians, for example, diabetes is estimated to occur on average 10 years earlier than their western counterparts, and almost half of Indian patients with type 2 diabetes are diagnosed before age 40.

How do South Asian health system influence diabetes care? What is the magnitude of the economic impact of diabetes in South Asia? And what can be done to mitigate that economic burden? These are some of the questions that a team of researchers, including Karen Eggleston, APARC’s deputy director and director of the Asia Health Policy Program, set out to answer in a new study published in the journal Current Diabetes Reports.

Eggleston co-authored the study with Kavita Singh of the Public Health Foundation of India and the Centre for Chronic Disease Control in New Delhi, and with M. Venkat Narayan, Professor of Medicine and Epidemiology and Director of the Global Diabetes Research Center at Emory University. They find that diabetes-related complications lead to enormous treatment costs, causing catastrophic medical spending and illness-induced poverty for many households.

The new study is related to a broader research project led by Eggleston, entitled Net Value in Diabetes Management, that compares health care use, medical spending, and clinical outcomes for patients with diabetes as a lens for understanding the economics of caring for patients with complicated chronic diseases across diverse health systems. This international collaborative research convenes teams of clinicians and health economists in ten countries (and growing) across Asia, as well as the United States and The Netherlands. Together, they analyze big data—detailed, longitudinal patient-level information for large samples from each country, including millions of records of clinical encounters, health-check-up, and medical spending—to compare the health care use and patient outcomes for adults with type 2 diabetes in their health systems.

In the new publication, Eggleston and her co-authors first introduce several unique features that characterize the type 2 diabetes epidemic in South Asia. These include a high risk of developing diabetes even at lower levels of body mass index than observed among western populations; a high prevalence of glucose intolerance, low levels of HDL cholesterol, and high levels of triglycerides; a relationship between impaired fetal nutrition, diabetes, and cardiovascular risk; and the likelihood of rapid urbanization impacting the diabetes burden of the wealthy and the underprivileged differently.

Furthermore, South Asian countries face difficult challenges in delivering diabetes care. The health sector in the region has little organized financing, leading to heavy out-of-pocket spending by patients. Limited availability and affordability of anti-diabetic drugs is a major driver of lower use of such medicines. These factors, combined with a general lack of health care professionals and infrastructural resources and low quality of healthcare governance, all contribute to poor health outcomes.

Eggleston and her co-authors assess the current literature on the economic impact of diabetes in South Asia. They show that, compared with the high prevalence of diabetes in South Asian countries, the total health spending as a percentage of GDP in the region has remained low and fairly constant (3-4% in most countries) over the last two decades, with less than 1% of GDP spent on healthcare by the government, and a miniscule 0.2% by pre-paid private insurance, resulting in a large proportion of out-of-pocket healthcare spending. The financial burden of diabetes and its complications can therefore have catastrophic implications for households that are often driven to sacrifice disastrous proportions of their income to cover treatment costs.

Diabetes causes premature mortality, high morbidity, and disability. To mitigate the economic and social welfare burden of the disease, the researchers conclude, policymakers in South Asia must take urgent action “to increase investment in evaluating cost-effective strategies to manage diabetes and preventative approaches.” The team offers a set of policy recommendations, including monitoring the economic burden of diabetes and the quality of care; focusing on the screening and prevention of diabetes and its risk factors; strengthening government health facilities and primary care services; expanding access to affordable, essential medicines, and more.