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This paper describes the qualitative results of the mixed-methods study by Eggleston and her colleagues. For the quantitative results of the study, read the April 2021 paper in the journal BMC Public Health. Also, watch and read our full story and interview with Eggleston.

Objective

People with chronic conditions are known to be vulnerable to the COVID-19 pandemic. This study aims to describe patients’ lived experiences, challenges faced by people with chronic conditions, their coping strategies, and the social and economic impacts of the COVID-19 pandemic.
 

Design, Setting, and participants

We conducted a qualitative study using a syndemic framework to understand the patients’ experiences of chronic disease care, challenges faced during the lockdown, their coping strategies and mitigators during the COVID-19 pandemic in the context of socioecological and biological factors. A diverse sample of 41 participants with chronic conditions (hypertension, diabetes, stroke, and cardiovascular diseases) from four sites (Delhi, Haryana, Vizag, and Chennai) in India participated in semistructured interviews. All interviews were audio-recorded, transcribed, translated, anonymized and coded using MAXQDA software. We used the framework method to qualitatively analyze the COVID-19 pandemic impacts on health, social and economic well-being.
 

Results

Participant experiences during the COVID-19 pandemic were categorized into four themes: challenges faced during the lockdown, experiences of the participants diagnosed with COVID-19, preventive measures taken, and lessons learned during the COVID-19 pandemic. A subgroup of participants faced difficulties in accessing healthcare while a few reported using teleconsultations. Most participants reported the adverse economic impact of the pandemic which led to higher reporting of anxiety and stress. Participants who tested COVID-19 positive reported experiencing discrimination and stigma from neighbors. All participants reported taking essential preventive measures.
 

Conclusion

People with chronic conditions experienced a confluence (reciprocal effect) of COVID-19 pandemic and chronic diseases in the context of difficulty in accessing healthcare, sedentary lifestyle, and increased stress and anxiety. Patients’ lived experiences during the pandemic provide important insights to inform effective transition to a mixed realm of online consultations and ‘distanced’ physical clinic visits.

 

Karen Eggleston 4X4

Karen Eggleston, PhD

Senior Fellow at FSI, Director of the Asia Health Policy Program at Shorenstein Asia-Pacific Research Center
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A Qualitative Study
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BMJ Open
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Karen Eggleston
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2021;11:e048926
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An Indian Army soldier stands in front of a group of People’s Liberation Army troops during joint drills

In May 2020, China launched several near-simultaneous incursions across the Line of Actual Control (LAC) in Ladakh, into territory hitherto controlled by India. Both sides reinforced their positions with tens of thousands of troops, engaged in a deadly skirmish, and reportedly came close to war. An agreement to disengage troops was announced in February 2021, but implementation has been halting. Regardless of how disengagement progresses, the crisis poses significant challenges for India’s long-term strategic competition with China.

As a result of the Ladakh crisis, India faces a new strategic reality in which China is a clear and abiding adversary. For India, the political relationship is now defined by hostility and distrust, and the LAC will remain more heavily militarised and violence-prone. Given this new reality, India is likely to further defer military modernisation and maritime expansion into the Indian Ocean. In the face of unremitting Chinese naval expansion, India risks losing significant political and military leverage in the Indian Ocean. At the same time, China appears to have escaped significant harm. Its better-resourced military could better absorb the material costs of the mobilisation. It may have been more concerned by the prospect of an increasingly hostile India, but the disengagement agreement has limited even those modest political costs.

The central policy challenge for India is balancing the heightened Chinese military threat on the northern border with the rapidly growing Chinese military presence in the Indian Ocean. It can manage this challenge by focusing on military strategies of denial rather than punishment, focusing on imposing political rather than material costs on China, and accepting more risk at the LAC in exchange for long-term leverage in the Indian Ocean region. How India responds will shape not only its strategic competition with China, but also the interests of likeminded partners including Australia, which depend on an increasingly capable and active India.
 

Key Findings

  • The still-unresolved Ladakh crisis has created a new strategic reality for India, marked by renewed political hostility with China, and an increased militarisation of the Line of Actual Control.
  • This new strategic reality imposes unequal costs on India and China. India is likely to defer much-needed military modernisation and maritime expansion into the Indian Ocean — which would impair its ability to compete strategically with China.
  • In contrast, China incurred only marginal material costs; it was probably more concerned with the prospect of continued deterioration in its relationship with India. Even that cost was more threatened rather than realised, and largely reduced when the disengagement plan was agreed.

 

In the Media

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Arzan Tarapore
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The rapid growth of electricity demand in developing nations, the availability of complementary generation resources, and the emergence of digital technologies have created increased opportunities for the international electricity trade. This paper proposes a framework for cross- border electricity trade (CBET) in the Bangladesh–Bhutan–India–Nepal (BBIN) Region that recognises the governance challenges associated with establishing an international electricity market. We explore the lessons for the BBIN Region derived from different types of CBET models. Specifically, existing markets in Northwest Europe, Latin America, and the United States provide insights into the development of our proposed cost-based CBET framework. We provide recommendations based on our proposed CBET framework to improve efficiency and increase the extent of electricity trade in the BBIN Region.
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Frank Wolak
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The six Asian countries examined in the new book Shifting Gears in Innovation Policy — China, India, Japan, Singapore, South Korea, and Taiwan — have achieved high economic growth in many industrial sectors, but the catch-up phase of their growth is over or ending. These countries can no longer rely on importing or imitating new technologies from abroad. Rather, they must develop their own innovations to maintain growth. The traditional industrial policy tools they often used to advance “innovation” by selecting promising industries and diverting resources to them are no longer effective. Indeed, governments in Asia have recently put forward new policies, such as China’s push for mass entrepreneurship and innovation. It is at this juncture that the authors of Shifting Gears reassess Asia’s innovation and focus on national strategies and regional cluster policies that can promote indigenous entrepreneurship and innovation in the larger Asia-Pacific. In this virtual book launch, contributing chapter authors join Yong Suk Lee to discuss their findings.

SPEAKERS

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Edison Tse
Edison Tse is an Associate Professor in the Department of Management Science & Engineering at Stanford University. He is also the Director of Asia Center of Management Science and Engineering, which has the charter of conducting research on the growth of emerging economy in Asia, with a special focus in China, Korea and India. In 1973, he received the prestigious Donald Eckman Award from the American Automatic Control Council in recognition of his outstanding contribution in the field of Automatic Control. In 2003, he received the Golden Nugget Award from General Motors R & D and Planning. In 2008, he received the Dean’s Award for Industry Education Innovation from School of Engineering, Stanford University. He had served as an Associate Editor of the IEEE Transactions of Automatic Control, and a co-editor of the Journal of Economic Dynamics and Control, which he co-founded. Since 2003, he dedicated his research effort in dynamic entrepreneurial strategy and transformation of Chinese production economy to innovation economy. He wrote a book in Chinese entitled “源创新”on this theory and published in China in 2012. A second edition of this book, with new chapters incorporating some experiences of practicing the theory in China, was published in 2016 by China CITIC Press with a new title “重新定义创新(Redefine Innovation)”. He is now working on the extension of this theory to developing countries. His main thesis is that innovation is cultural dependent. Successful innovation in a developing country must be synergistic to its culture, its political, social and economic environment. Professor Edison Tse received his BS, MS, and Ph.D. in Electrical Engineering from Massachusetts Institute of Technology. 

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Dinsha Mistree
Dinsha Mistree is a Lecturer and Research Fellow in the Rule of Law Program at Stanford Law School. In his research, he examines how formal legal systems sometimes can sometimes stimulate economic development, while at other times these same systems can hold back development. His work considers incentives for innovation and entrepreneurship, meritocracy in public administration and education, and drivers of economic development more broadly. Much of Dr. Mistree’s research focuses on India and other South Asian countries. His work has appeared or is forthcoming at Social Science and MedicineStanford Law Review, and Cambridge University Press. Dr. Mistree holds a PhD and an MA in Politics from Princeton University and an SM in Political Science from MIT.

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Michelle Hsieh
Michelle F. Hsieh is an Associate Research Fellow in the Institute of Sociology, Academia Sinica, Taipei, Taiwan. She received her PhD (in Sociology) from McGill University, Montreal, Canada, and was a Shorenstein Postdoctoral Fellow at the Shorenstein Asia-Pacific Research Center at Stanford University. Her research interests include economic sociology, sociology of development, comparative political economy, and East Asian societies. Her ongoing research explores the variations and consequences of industrial upgrading among the East Asian latecomers. She has done empirical analysis of the different configurations of the state-society linkages for innovation through comparative industry studies on Taiwan and South Korea. Her investigations focus on how technology learning and adaptation take place in a decentralized system of SME network production and the institutional arrangements that can facilitate or hinder coordination and collaboration. Other research interests are the origins of the East Asian developmental state and the connection between technological development and Cold War geopolitics in the latter half of the twentieth century. 

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WoonJoon Kim
Wonjoon Kim is the Head of the Graduate School of Innovation and Entrepreneurship, a Professor at the School of Business and Technology Management, KAIST. He is also the Director of KAIST Center for Innovation Strategy and Policy. He has been conducting and publishing numerous researches on the strategic management of innovation of firms, industry, and governments centering on emerging innovation paradigms. His current research interest also covers the changing nature of innovation, including AI and industrial and social change, the convergence of technology as well as the changing nature of the process of entrepreneurship. Currently, he is the President of Asia Innovation and Entrepreneurship Association (AIEA), Organizing Committee Chair for the AIEA-NBER Conference and a Vice President of the Korean Society for Innovation Management and Economics. He is also serving as the Editor of the Journal of Technology Innovation, and an Editorial Board Member for several journals on innovation such as Technovation, Innovation Studies. Before he joined KAIST, he has been an Adjunct-Assistant Professor at the Department of Economics, NYU as and a Research Fellow at the Yale School of Management. He holds a Ph.D. in Economics of Innovation including Science and Technology Policy from Seoul National University. 

MODERATOR 

Yong Suk Lee, SK Center Fellow at the Freeman Spogli Institute for International Studies and Deputy Director of the Korea Program at the Walter H. Shorenstein Asia-Pacific Research Center at Stanford University. 

This event is being held virtually via Zoom. Please register for the webinar via the following link: https://bit.ly/3axXNab

Edison Tse <br><i>Associate Professor in the Department of Management Science & Engineering at Stanford University</i><br><br>
Dinsha Mistree <br><i>Research Fellow and Lecturer at the Program in the Rule of Law at Stanford Law School</i><br><br>
Michelle Hsieh <br><i>Associate Research Fellow in the Institute of Sociology, Academia Sinica, Taipei, Taiwan</i><br><br>
Wonjoon Kim <br><i>Head of the Graduate School of Innovation and Entrepreneurship and Professor at the School of Business and Technology Management at KAIST</i><br><br>
Panel Discussions
Paragraphs

This paper describes and analyzes the quantitative results of the mixed-methods study by Eggleston and her colleagues. For the qualitative results of the study, read the June 2021 paper in the journal BMJ Open. Also, watch and read our full story and interview with Eggleston.

Background

People with chronic conditions are disproportionately prone to be affected by the COVID-19 pandemic but there are limited data documenting this. We aimed to assess the health, psychosocial and economic impacts of the COVID-19 pandemic on people with chronic conditions in India.

Methods

Between July 29, to September 12, 2020, we telephonically surveyed adults (n = 2335) with chronic conditions across four sites in India. Data on participants’ demographic, socio-economic status, comorbidities, access to health care, treatment satisfaction, self-care behaviors, employment, and income were collected using pre-tested questionnaires. We performed multivariable logistic regression analysis to examine the factors associated with difficulty in accessing medicines and worsening of diabetes or hypertension symptoms. Further, a diverse sample of 40 participants completed qualitative interviews that focused on eliciting patient’s experiences during the COVID-19 lockdowns and data analyzed using thematic analysis.

Results

One thousand seven hundred thirty-four individuals completed the survey (response rate = 74%). The mean (SD) age of respondents was 57.8 years (11.3) and 50% were men. During the COVID-19 lockdowns in India, 83% of participants reported difficulty in accessing healthcare, 17% faced difficulties in accessing medicines, 59% reported loss of income, 38% lost jobs, and 28% reduced fruit and vegetable consumption. In the final-adjusted regression model, rural residence (OR, 95%CI: 4.01,2.90–5.53), having diabetes (2.42, 1.81–3.25) and hypertension (1.70,1.27–2.27), and loss of income (2.30,1.62–3.26) were significantly associated with difficulty in accessing medicines. Further, difficulties in accessing medicines (3.67,2.52–5.35), and job loss (1.90,1.25–2.89) were associated with worsening of diabetes or hypertension symptoms. Qualitative data suggest most participants experienced psychosocial distress due to loss of job or income and had difficulties in accessing in-patient services.

Conclusion

People with chronic conditions, particularly among poor, rural, and marginalized populations, have experienced difficulties in accessing healthcare and been severely affected both socially and financially by the COVID-19 pandemic.

Dr. Karen Eggleston

Karen Eggleston, PhD

Senior Fellow at FSI, Director of the Asia Health Policy Program at Shorenstein Asia-Pacific Research Center
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A Mixed Methods Study
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Universities contribute to economic growth and national competitiveness by equipping students with higher-order thinking and academic skills. Despite large investments in university science, technology, engineering and mathematics (STEM) education, little is known about how the skills of STEM undergraduates compare across countries and by institutional selectivity. Here, we provide direct evidence on these issues by collecting and analysing longitudinal data on tens of thousands of computer science and electrical engineering students in China, India, Russia and the United States. We find stark differences in skill levels and gains among countries and by institutional selectivity. Compared with the United States, students in China, India and Russia do not gain critical thinking skills over four years. Furthermore, while students in India and Russia gain academic skills during the first two years, students in China do not. These gaps in skill levels and gains provide insights into the global competitiveness of STEM university students across nations and institutional types.
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Nature Human Behavior
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Prashant Loyalka
Huan Wang
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Book cover showing a robotic hand holding an older human hand.

Demographic transition, along with the economic and geopolitical re-emergence of Asia, are two of the largest forces shaping the twenty-first century, but little is known about the implications for innovation. The countries of East Asia have some of the oldest age structures on the planet: between now and 2050, the population that is age 65 and older will increase to more than one in four Chinese, and to more than one in three Japanese and Koreans. Other economies with younger populations, like India, face the challenge of fully harnessing the “demographic dividend” from large cohorts in the working ages.

This book delves into how such demographic changes shape the supply of innovation and the demand for specific kinds of innovation in the Asia-Pacific. Social scientists from Asia and the United States offer multidisciplinary perspectives from economics, demography, political science, sociology, and public policy; topics range from the macroeconomic effects of population age structure, to the microeconomics of technology and the labor force, to the broader implications for human well-being. Contributors analyze how demography shapes productivity and the labor supply of older workers, as well as explore the aging population as consumers of technologies and drivers of innovations to meet their own needs, as well as the political economy of spatial development, agglomeration economies, urban-rural contrasts, and differential geographies of aging.

Desk, examination, or review copies can be requested through Stanford University Press.

Table of contents and chapter 1, introduction
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Arzan Tarapore
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This piece was originally published by the Lowy Institute's The Interpreter

To break the border stand-off between India and China in the Himalayas, some Indian analysts have advocated going on the offensive against China in the Indian Ocean. But that would be vague, illogical and imprudent, with little chance of success and significant risk of blowback. Instead, India and its partners should prioritize a more effective denial strategy in the Indian Ocean, to deter and counter any potential future coercion there.

Strategies of denial seek to reinforce defensive bulwarks so that potential aggressors are dissuaded from launching an attack – or, failing that, thwarted from succeeding. They are generally considered more effective and reliable than strategies of punishment, which rely instead on the threat of retaliation after the aggressor launches its attack. Punishment was the cornerstone of nuclear deterrence during the Cold War and since, but that strategy is considerably less reliable in the conventional and sub-conventional conflicts which India now faces.

[Subscribe to APARC's newsletters to get the latest commentary and analysis by our scholars.]

The False Promise of Punishment

Since May 2020, Indian and Chinese troops have been locked in a tense – and, at timesviolent – stand-off in the Himalayas, after Chinese incursions into the Indian-controlled territory of Ladakh. This scenario looks likely to last for months, if not years, to come. Some Indian analyses have called for bold action hundreds of kilometers away, in the Indian Ocean. They argue that horizontal escalation would broaden the Himalayas confrontation to an arena where India enjoys clear strategic advantages, allowing it to counter Chinese coercion more effectively.

The idea of taking the fight to the oceans has superficial appeal. India sits astride some of the world’s most vital sea lines of communication in the northern Indian Ocean – on which China, like all of East Asia, depends critically for trade and energy flows. India’s Navy dominates the Indian Ocean and could, the argument goes, apply excruciating pressure on the Chinese economy. This leverage could be applied in times of crisis, such as the ongoing border stand-off, or even in peacetime as a deterrent against Chinese coercion. Surely this would be less bloody than a war between the two largest armies in the world.

Rather than using its advantages to start a war it would lose, a denial strategy would be mindful of India’s limitations and focus on erecting political and military obstacles to Chinese coercion in the region.
Arzan Tarapore

But the concept is unclear. It is often framed as a vague statement of Indian power, without elucidating exactly how force should be used. Should India impose a blockade of all oil tankers bound for East Asia? Board and inspect some Chinese trading vessels? Intimidate a Chinese survey ship in the Bay of Bengal, or sink a Chinese navy ship conducting anti-piracy patrols? Some of these moves would be seen as acts of war – and most would be dramatically escalatory, especially for an Indian government that has been at pains to downplay the current crisis.

More fundamentally, such moves would have no “theory of success”. How would such pressure create the desired political effect in countering Chinese coercion? A blockade would be tantamount to an act of war – but a painfully slow war that would likely require months of stringent application and be unlikely to decisively strangle the Chinese economy. Short of a long blockade, in any realistic contingency, incremental Indian pressure in the Indian Ocean is unlikely to compel a Chinese regime that has staked its legitimacy on national rejuvenation and regional hegemony.

On the other hand, history suggests that even minor Indian naval offensives against China would invite an escalating retaliation. China would not only unleash its rapidly expanding surface and sub-surface fleet against India’s navy, but it could also impose pain elsewhere. China’s options against the Indian homeland – from long-range missile strikes to cyberattacks to more land grabs on the border – would be militarily feasible and politically devastating to New Delhi. Going on the offensive in the Indian Ocean, therefore, is likely to backfire, probably very badly.

Building “Strategic Leverage” in the Indian Ocean

While the Indian Ocean may not offer a magic bullet to resolve the border crisis, it is intrinsically important for India-China competition. China’s military expansion into the Indian Ocean poses multiple risks for India and its partners such as Australia and the United States. These like-minded partners should build their strategic leverage – political relationships and military capability – to manage these risks.

India enjoys unique advantages in the Indian Ocean, due to its geography and informal networks across the region. But rather than using its advantages to start a war it would lose, a denial strategy would be mindful of India’s limitations and focus on erecting political and military obstacles to Chinese coercion in the region.

India could focus on more actively binding itself to smaller regional states – as it already does by sharing maritime domain awareness and space-based surveillance data. Building strategic interdependence would cultivate smaller states’ desire for continued cooperation with India, and institutional resistance to Chinese attempts to coerce or bribe their political leadership.

India could also enhance its sea denial capabilities. Improving its anti-submarine warfare capabilities and expanding its stock of long-range precision missiles, for example, would help to deter the prospect of Chinese direct military intervention. This could be done at a fraction of the cost of building a small number of large capital ships. The Indian Navy is doctrinally committed to pursuing sea control, which like-minded partners such as Australia should welcome. But rapidly expanding its capabilities for sea denial would serve as a stopgap and hedge against China’s ballooning naval power, which will soon be able to contest India’s dominance in the ocean.

A denial strategy in the Indian Ocean will not resolve the current border crisis in Ladakh. But it would offer a realistic roadmap for building political influence and military power in the region. It would provide the strategic leverage necessary to deter or counter future acts of coercion in the Indian Ocean.

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How to Mitigate the Risks of Chinese Military Expansion in the Indian Ocean Region

China’s expanding military capacity in the Indian Ocean region poses risks for the United States and its partners, writes South Asia Research Scholar Arzan Tarapore in 'The Washington Quarterly,' offering a framework by which the Quad and others can build strategic leverage to curtail China’s capacity to coerce small states or posture for war.
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The Soft War That America Is Losing

The US depends far more on its soft power than authoritarian China does. Once it is lost, it is hard to get back.
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Democracy Challenged: Donald Trump, Min Aung Hlaing, and Indonesia

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The Indian Navy destroyer INS Kolkata alongside guided-missile destroyer USS Street during Exercise Malabar, November 2020.
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The stand-off with China in the Himalayas has raised a broader debate about India’s strategic outlook.

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Senior Fellow at the Freeman Spogli Institute for International Studies
Associate Professor at the Graduate School of Education
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Prashant Loyalka is an Associate Professor at the Graduate School of Education and a Senior Fellow at the Freeman Spogli Institute for International Studies at Stanford University. His research focuses on examining/addressing inequalities in the education of children and youth and on understanding/improving the quality of education received by children and youth in multiple countries including China, India, Russia, and the United States. He also conducts large-scale evaluations of educational programs and policies that seek to improve student outcomes.

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Because higher education serves both public and private interests, the way it is conceived and financed is contested politically, appearing in different forms in different societies. What is public and private in education is a political–social construct, subject to various political forces, primarily interpreted through the prism of the state. Mediated through the state, this construct can change over time as the economic and social context of higher education changes. In this paper, we analyze through the state’s financing of higher education how it changes as a public/private good and the forces that impinge on states to influence such changes. To illustrate our arguments, we discuss trends in higher education financing in the BRIC countries—Brazil, Russia, India, and China. We show that in addition to increased privatization of higher education financing, BRIC states are increasingly differentiating the financing of elite and non-elite institutions.

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