In December 2009, the Asia Health Policy Program celebrates the first anniversary of the launch of the AHPP working paper series on health and demographic change in the Asia-Pacific. The series showcases research by AHPP’s own affiliated faculty, postdoctoral fellows, and visiting scholars, as well as selected works by other scholars from the region.

To date AHPP has released eleven research papers in the series, by authors from China, South Korea, Thailand, Taiwan, Pakistan, and the US, with more on the way from Japan and Vietnam. Topics range from “The Effect of Informal Caregiving on Labor Market Outcomes in South Korea” and “Comparing Public and Private Hospitals in China,” to “Pandemic Influenza and the Globalization of Public Health.”  The working papers are available at the Asia Health Policy website.

AHPP considers quality research papers from leading research universities and think tanks across the Asia-Pacific region for inclusion in the working paper series. If interested, please contact Karen Eggleston.

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.

Martha Crenshaw, a senior fellow at the Center for International Security and Cooperation (CISAC), has been awarded $500,000 by the National Science Foundation to identify patterns in the evolution of terrorist organizations and to analyze their comparative development.

The three-year grant is part of the Department of Defense's Minerva Initiative launched in 2008, which focuses on "supporting research related to basic social and behavioral science of strategic importance to U.S. national security policy."

Crenshaw's interdisciplinary project, "Mapping Terrorist Organizations," will analyze terrorist groups and trace their relationships over time. It will be the first worldwide, comprehensive study of its kind-extending back to the Russian revolutionary movement up to Al Qaeda today.

"We want to understand how groups affiliate with Al Qaeda and analyze their relationships," Crenshaw said. "Evolutionary mapping can enhance our understanding of how terrorist groups develop and interact with each other and with the government, how strategies of violence and non-violence are related, why groups persist or disappear, and how opportunities and constraints in the environment change organizational behavior over time."

According to Crenshaw, it is critical to understand the organization and evolution of terrorism in multiple contexts. "To craft effective counter-terrorism strategies, governments need to know not only what type of adversary they are confronting but its stage of organizational development and relationship to other groups," Crenshaw wrote in the project summary. "The timing of a government policy initiative may be as important as its substance."

"Mapping Terrorist Organizations" will incorporate research in economics, sociology, business, biology, political science and history. It will include existing research to build a new database using original language sources rather than secondary analyses. The goal is to produce an online database and series of interactive maps that will generate new observations and research questions, Crenshaw said.

The results, for example, could reveal the structure of violent and non-violent opposition groups within the same movements or conflicts, and identify patterns that explain how these groups evolve over time. Such findings could be used to analyze the development of Al Qaeda and its Islamist or jihadist affiliates, including the Taliban in Afghanistan and Pakistan, she said.

The findings may also shed light on what happens when a group splits due to leadership quarrels or when a government is overturned, Crenshaw said. "Analysis that links levels of terrorist violence to changes in organizational structures and explains the complex relationships among actors in protracted conflicts will break new ground," the summary noted.

Extensive information on terrorist groups already exists, but it has been difficult to compile and analyze. Despite such obstacles, Crenshaw said, violent organizations can be understood in the same terms as other political or economic groups. "Terrorist groups are not anomalous or unique," she wrote. "In fact, they can be compared to transnational activist networks."

Crenshaw should know. Widely respected as a pioneer in terrorism studies, the political scientist was one of a handful of scholars who followed the subject decades before the attacks of Sept. 11, 2001. She joined CISAC in 2007, following a long career at Wesleyan University, where she was the Colin and Nancy Campbell Professor of Global Issues and Democratic Thought. In addition to her research at Stanford, Crenshaw is a lead investigator at START, the Consortium for the Study of Terrorism and the Response to Terrorism at the University of Maryland.

End goal

Crenshaw wants to use the findings to better analyze how threats to U.S. security evolve over time. "Terrorist attacks on the United States and its allies abroad often appear to come without warning, but they are the result of a long process of organizational development," she wrote. "Terrorist organizations do not operate in isolation from a wider social environment. Without understanding processes of development and interaction, governments may miss signals along the way and be vulnerable to surprise attack. They may also respond ineffectively because they cannot anticipate the consequences of their actions." The project seeks to find patterns in the evolution of terrorism and to explain their causes and consequences. This, in turn, should contribute to developing more effective counter-terrorism policy, Crenshaw said.

Conflicts to be mapped

• Russian revolutionary organizations, 1860s-1914.
• Anarchist groups in Europe and the United States, 1880s-1914. (Note: although the anarchist movement is typically regarded as completely unstructured, there was more organization than an initial survey might suppose, and the transnational dispersion of the movement is frequently cited as a precedent for Al Qaeda.)
  
• Ireland and Northern Ireland, 1860s-present.
  
• Algeria, 1945-1962 and 1992-present
  
• Palestinian resistance groups, 1967-present.
  
• Colombia, 1960s-present.
  
• El Salvador, 1970s-1990s
  
• Argentina, 1960s-1980s
  
• Chile, 1973-1990
  
• Peru, 1970-1990s
  
• Brazil, 1967-1971
  
• Sri Lanka, 1980s-present
  
• India (Punjab), 1980-present
  
• Philippines, 1960s-present
  
• Indonesia, 1998-present
  
• Italy, 1970s-1990s
  
• Germany, 1970s-1990s
  
• France/Belgium, 1980-1990s
  
• Kashmir, 1988-present
  
• Pakistan, 1980-present
  
• United States, 1960s-present (especially far right movement)
  
• Spain, 1960s-present
  
• Egypt, 1950s-present
  
• Turkey, 1960s-present
  
• Lebanon, 1975-present
  
• Al Qaeda, 1987-present

The coming to power of a new party in Japan, with a strong mandate to rule, is unprecedented in the postwar era. In the aftermath of the Japanese elections in August of this year, there has been much discussion, particularly in the Japanese media, about the foreign policy orientation of the new Democratic Party of Japan (DPJ)-led administration. Some commentators see an “anti-American” tilt—evidenced by differing views on the relocation of U.S. bases in Okinawa and the renewal of Japanese naval refueling operations in the Indian Ocean.

This viewpoint misses the foreign policy forest for its trees. The paradigm-shifting potential of this change lies much more in the DPJ’s desire to re-center Japan’s foreign policy on Asia. Across the spectrum of the DPJ, from former socialists on the left to those who came out of the conservative Liberal Democratio Party (LDP), there is broad agreement on the need to put much greater emphasis on Japan’s ties to the rest of Asia, particularly to China and South Korea.

The new Asianism in Japanese foreign policy was on display at the October 10 triangular summit of the Chinese, South Korean, and Japanese leaders, held in Beijing. It was only the second time these three have met on their own and the meeting was substantive, covering everything from coordinating on North Korea and economic stimulus policy to taking initial steps toward formation of a new East Asian Community. “Until now, we have tended to be too reliant on the United States,” Prime Minister Yukio Hatoyama told reporters after the meeting, adding that “The Japan-U.S. alliance remains important, but as a member of Asia, I would like to develop policies that focus more on Asia.”

The dominant foreign policy camp in Japan has been what Hitoshi Tanaka, a former senior foreign ministry official and close advisor to the DPJ, calls “alliance traditionalists,” whom he defines as those who “place the maintenance of a robust alliance with the United States above all other foreign policy priorities.” In the view of some DPJ policy advisors, the previous conservative governments mistakenly tried to cope with the challenge of a rising China by getting as close to the United States as possible. The decision to send troops to Iraq and the Indian Ocean was prompted not by any deep support for those causes but rather by the belief that this would ensure U.S. support in any tensions with China, and with North Korea.

All this took place as Sino-Japanese relations descended into their most troubled phase in the postwar period, prompted by former Prime Minister Koizumi’s provocative visits to Yasukuni Shrine, which honors Japan’s war dead. High-level contacts with China were frozen, tensions rose over territorial issues in the East China Sea, and rising nationalism on both sides culminated in the outbreak of government-sanctioned anti-Japanese riots in 2005 and a Chinese campaign to block Japan’s permanent membership in the United Nations Security Council.

There was an attempt by Koizumi’s conservative successors to roll back some of these tensions. But those signals were always mixed with the persistence of anti-Chinese views and the powerful camp of rightwing nationalists in and around the LDP who cling to a revisionist view of Japan’s wartime role, some even indulging in a vigorous defense of Japanese imperialism.

In the view of DPJ policy advisers, this pseudo-containment strategy is doomed to failure. Given the increasing economic interdependence between the United States and China, and their overlapping strategic interests, the United States will never form an anti-China front. Japan cannot rely solely, these advisers argue, on the U.S.-Japan security alliance to deal with China’s bid for regional hegemony.

Nor can Japan afford to indulge fantasies of confrontation with China, given its own extensive ties to its economy and society. Rather, the greater threat, in the view of many Japanese analysts, is being abandoned by the United States through the formation of a U.S.-China “Group of Two” that effectively excludes Japan, or relegates it to second-level status in the region.

Japan, those policymakers argue, needs to preempt that threat by engaging Asia on its own—not only China, but the entire region, from India back to Korea. The DPJ’s own policy vision, articulated by Prime Minister Hatoyama, Foreign Minister Katsuya Okada, and party strongman Ichiro Ozawa, remains vaguely defined but has three clear elements:

• The U.S.-Japan security alliance remains the cornerstone, but with limits.
• Japan plays a leadership role in East Asian regionalism.
• The “history” question must be resolved.

What does this mean? There should be little question, particularly after the initial meetings between the new government and the Obama administration, that the DPJ seeks to back away from the security alliance. Over the past fifteen years, the DPJ leadership has not only supported, but even led, the expansion of Japan’s security role, beginning with the passage of the 1992 law permitting Japanese participation
in peacekeeping operations and including the initial dispatch of naval forces to the Indian Ocean in response to 9/11. Though the DPJ has made commitments to reduce the U.S. presence in Okinawa, it is already realizing how difficult that is to accomplish; some kind of compromise on this issue is imminent. Similarly, Foreign Minister Okada’s visit to Afghanistan and Pakistan demonstrated a willingness to contribute, mostly through economic aid, to the security effort in both countries.

Prime Minister Hatoyama presented his somewhat romantic desire to reproduce the European experience to create an East Asian Community in September before the United Nations General Assembly. Hatoyama has indicated that he understands this is a long process, and has been careful to make clear that Japan has no intention of excluding the United States’ role in the region, nor the use of the dollar as a reserve currency. As Hatoyama put in his UN address:

Today, there is no way that Japan can develop without deeply involving itself in Asia and the Pacific region. Reducing the region’s security risks and sharing each other’s economic dynamism based on the principle of “open regionalism” will result in tremendous benefits not only for Japan but also for the region and the international community.

Given the historical circumstances arising from its mistaken actions in the past, Japan has hesitated to play a proactive role in this region. It is my hope that the new Japan can overcome this history and become a “bridge” among the countries of Asia.

I look forward to an East Asian community taking shape as an extension of the accumulated cooperation built up step by step among partners who have the capacity to work together, starting with fields in which we can cooperate—free frade agreements, finance, currency, energy, environment, disaster relief and more. Of course, Rome was not built in a day, so let us seek to move forward steadily on this, even if at a moderate pace.

DPJ policymakers advocate pursuit of an East Asian community as only one of a nest of regional structures, including a regional security system that might grow out of the Six Party talks on North Korea. They also embrace the idea of a Japan-U.S.-China strategic dialogue, based on their own perception that without the combined muscle of the United States and Japan, they cannot bring China to the table on a range of issues from energy to intellectual property.

The last element of the DPJ’s policy vision is to take another major step in clearing away the legacy of the wartime past. Hatoyama personally reaffirmed his government’s adherence to the statement on war responsibility issued by then Prime Minister Murayama in 1995, at the time of the 50th anniversary of the end of the war.

Hatoyama, Ozawa and others in the DPJ leadership are determined to confront the history issue in a way that eases tensions with China and South Korea and also closes doors backward. They will not only refuse to go to the Yasukuni Shrine but also want to remove the Class A war criminals whose “souls” are enshrined there by decision of the shrine authorities, to the consternation of the Emperor, among others. The DPJ led the hue and cry over the unapologetic revisionism of former Japanese air force chief of staff, General Toshio Tamogami, who wrote an essay justifying Japan’s colonialism and wartime aggression, including the attack on Pearl Harbor. Foreign Minister Okada has backed the creation of a joint history textbook by China, Japan and South Korea, based on the model followed by France and Germany. These are stances the LDP has been historically incapable of taking.

The DPJ draws some inspiration from the anti-imperial form of Asianism—“Small Nipponism”—championed by the late Tanzan Ishibashi, who served briefly as premier in the mid-1950s and who was allied to Hatoyama’s beloved grandfather, and former premier, Ichiro Hatoyama.

In the coming months, the Hatoyama government will have numerous opportunities to develop its new policies, particularly in the run-up to Japan’s hosting of the APEC summit next year. Undoubtedly, it will be difficult to implement in practice, but this new Asianism marks a clear turning point in Japan’s postwar foreign policy.