Global health disparities were the topic of a special event November 11th co-sponsored by the Asia Health Policy Program of the Shorenstein Asia-Pacific Research Center and the Center for Health Policy / Primary Care and Outcomes Research.

Sir Michael Marmot, internationally renowned Principal Investigator of the Whitehall Studies of British civil servants (investigating explanations for the striking inverse social gradient in morbidity and mortality), spoke about research on the social determinants of health and taking action to promote policy change. Pointing out the extreme disparities in life expectancy for peoples in different parts of the world – including the “haves” and “have-nots” within the high-income world – he presented an overview of “Closing the gap in a generation: Health equity through action on the social determinants of health” (http://www.who.int/social_determinants/en/). That report was commissioned by the World Health Organization (WHO) and released last year; Sir Marmot served as the Chair of the Commission on Social Determinants of Health.

Criticizing those who justify initiatives in global health solely on economic grounds, Sir Marmot argued that addressing the social determinants of health is a matter of social justice.

He presented data and discussed the report’s three primary recommendations: 1. Improve daily living conditions; 2. Tackle the inequitable distribution of power, money, and resources; and 3. Measure and understand the problem and assess the impact of action.
Stating that the World Health Assembly resolution on the social determinants of health was only meaningful as a first “baby step,” Marmot urged the audience to consider how research and policy advocacy can address the social determinants of health so that all individuals can lead flourishing lives.

Examples from Asia include

• the high risk of maternal mortality (1 in 8) in Afghanistan;
• the steep gradient in under-5 mortality in India (with the rate almost three times higher for the poorest quintile than for the wealthiest quintile);
• less than half of women in Bangladesh have a say in decision-making about their own health care;
• a large share of the world’s population living on less than US$2 a day reside in Asia;
• social protection systems like pensions are possible in lower and middle-income countries, with Thailand as an example;
• more can be done to address the millions impoverished by catastrophic health expenditures, such as in southeast Asia; and
• conflict-ridden areas and internally displaced people, such as in Pakistan and Myanmar, are among the most vulnerable.

He also responded to questions about the role of freedom and liberty in social development – contrasting India and China – and commented on the peculiar contours of the US health reform debate.

Professor Marmot closed by noting that, in exhorting everyone to strive for social justice and close the gaps in health inequalities all too apparent in our 21st century world, he hoped he was not too much like Don Quixote, going around “doing good deeds but with people all laughing at him.” 
Professor Sir Michael Marmot MBBS, MPH, PhD, FRCP, FFPHM, FMedSci, is Director of the International Institute for Society and Health and MRC Research Professor of Epidemiology and Public Health at University College, London. In 2000 he was knighted by Her Majesty The Queen for services to Epidemiology and understanding health inequalities.

CISAC Co-Director Scott D. Sagan has been named The Caroline S.G. Munro Memorial Professor in Political Science. A member of Stanford's faculty since 1987, Sagan's research focuses on nuclear security and the emerging terrorist threat; nuclear proliferation, particularly in South Asia; ethics and international relations; and accidents in complex organizations. Before coming to Stanford, Sagan was a lecturer in the Department of Government at Harvard University and served as a special assistant to the Director of the Organization of the Joint Chiefs of Staff in the Pentagon. He has served as a consultant to the Office of the Secretary of Defense and the Los Alamos National Laboratory.

Sagan is the author of Moving Targets: Nuclear Strategy and National Security (Princeton University Press, 1989), The Limits of Safety: Organizations, Accidents, and Nuclear Weapons (Princeton University Press, 1993) and, with co-author Kenneth N. Waltz, The Spread of Nuclear Weapons: A Debate Renewed (W.W. Norton, 2002). He is co-editor with Peter R. Lavoy and James L. Wirtz of Planning the Unthinkable (Cornell University Press, 2000) and the editor of Inside Nuclear South Asia (Stanford University Press, 2009). His most recent publications include "The Case for No First Use" in Survival (June 2009) and "Good Faith and Nuclear Disarmament Negotiations" in George Perkovich and James A. Acton's (eds.) Abolishing Nuclear Weapons: A Debate (Carnegie Endowment, 2009).

Sagan received Stanford's Hoagland Prize for Undergraduate Teaching in 1996, and the Dean's Award for Distinguished Teaching in 1998. As part of CISAC's mission of training the next generation of security specialists, he established Stanford's Interschool Honors Program in International Security Studies. He earned a bachelor's degree with high honors in government from Oberlin College and holds a doctorate in political science from Harvard University.

The Caroline S.G. Munro Memorial Professorship in Political Science

The Caroline S.G. Munro Chair was established by the Board of Trustees in 1981 in recognition of Mrs. Munro's farsighted commitment to strengthening scholarship and teaching at Stanford.

A series of gifts during her lifetime and a bequest endowing the William Bennett Munro Memorial Fund in 1973 in honor of her late husband--a professor of history and government at Harvard and the California Institute of Technology--were sufficient to support the William Bennett Munro Professorship in Political Science; the William Bennett Munro Memorial Lectures; and the Caroline S.G. Munro Memorial Professorship.

Caroline Sanford Gorton and William Bennett Munro were married in 1913. They had one child, William Bennett Munro, Jr., who graduated from Stanford in 1937. Their granddaughter, Jane Bruce Munro, was a member of the Class of 1968.

In accordance with Mrs. Munro's preferences, the professorship may be awarded in either political science or history.

Tapan Parikh, of UC Berkeley School of Information, spoke about a number of projects that are using mobile phone based technology to give small businesses the information they need to improve productivity. He argued that voice technology has distinct advantages over text, because it overcomes challenges of illiteracy while responding to a strong need people feel to be heard. 

Information is key for economic development and empowerment. But information is worthless unless it is also useable (leads to decisions the business owner can actually take), trusted (comes from a source he respects) and relevant (speaks about the issues he is facing). For information to be really empowering, it must also be two way: there must be ways for individuals to create content themselves.

Tapan described three current projects he is involved in:

Hisaab: Microfinance groups in India often suffer from poor paper based record keeping, making it difficult for the group to track loans and repayments. The Hissab software was designed with an interface suitable for those who may be illiterate and/or new to computing. The use of voice commands and responses in the local language, Tamil, prevented the software from feeling remote and inaccessible and contributed to the success of this initiative. 

Avaaj Otalo: Agricultural extension workers provide advice to farmers on pests, new techniques etc to help improve yields. But often they have limited reach, visiting areas only rarely, or perhaps lacking the expertise to respond to all the problems they encounter. Avaaj Otalo is a system for farmers to access relevant and timely agricultural information over the phone. By dialing a phone number and navigating through simple audio prompts, farmers can record questions, respond to others, or access content published by agricultural experts and institutions. The service has been hugely popular, with farmers willing to spend time listening to large amounts of material to find what they want. The opportunity to be broadcast was a major attraction, reflecting the desire to be heard and to create media rather than be a passive consumer of it.

Digital ICS: Smallholders' compliance with organic, fair-trade and quality requirements is usually measured via paper based internal inspections. The data uncovered by these is vital but often lost. Digital ICS is a mobile phone based application that allows inspectors to fill out the survey digitally, enhance it with visual evidence (e.g. from camera phones) and upload it onto a web application. This is being piloted with coffee farmers in Mexico. A key finding from the work is that farmers want to know who ends up drinking their coffee, what they pay for it and what they think about it. Greater links between producers and consumers may therefore be another area for this project to investigate.  

Anticipating Opportunities: Using Intelligence to Shape the Future
"We spend $45 billion annually to reduce uncertainty, to help us combat threats to our nation, our people, and our security," said Payne Distinguished Lecturer Thomas Fingar in his third Payne lecture on October 21, devoted to anticipating the future -- "not for purposes of prediction but for purposes of shaping it."  Noting that strategic intelligence treats the future neither as "inevitable or immutable," Fingar employed real-life examples from his career in national intelligence (most recently as deputy director of national intelligence for analysis and chairman of the National Intelligence Council) to explore concrete ways intelligence can be used to move developments in a more favorable direction.

Global Trends 2025: A Transformed World examined the trends which will "drive, shape and constrain" individuals, governments, and nations around the world. Among prominent trends, he cited globalization, which will provide unprecedented prosperity but greater inequality; the rise of the BRIC countries - Brazil, Russia, India, and China; the rise of new powers such as Indonesia, Turkey, and Iran; and the coming demographic boom, which will add 1.2 billion people to the world, with less than 3 percent of that occurring in the West.

The Geopolitical Implications of Climate Change.  Instructed by the Congress to provide an assessment of the impact of global climate change, given controversy about the imminence of the threat and man's role in it, the NIC studied which regions and countries would be most dramatically affected by climate change, with a focus on water, food production, and changes in weather patterns. The results remain classified, because of the potential impact on vulnerable countries. 

The 2007 National Intelligence Estimate on Iran's Nuclear Intentions and Capabilities. This estimate, attacked from both the right and the left, concluded with a moderate to high degree of confidence that Iran had not obtained sufficient fissile material from external sources (to make a bomb) and that its fastest route to produce a nuclear weapon would be through domestic production of enriched uranium. The NIE also judged that Iran had halted the weaponization portions of its nuclear program in 2003, but had retained the option to pursue a weapon and whether to do so was a "political decision" which could be made at any time.