Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Congratulations to CISAC honors program Class of 2017! On June 16, students in the CISAC Interschool Honors Program in International Studies graduated in a conferral of honors ceremony on the front lawn of Encina Hall. 

We are proud to add our 12 new graduates to our expanding list of graduates from the program since it began in 2001. In total, CISAC has 193 alumni in honors. For the students, their graduation reflects an intellectual adventure that included a two-week honors college program in Washington D.C., tours of government agencies, meetings with influential policy makers, and weekly seminars with CISAC faculty. Honors students are also required to research and complete an original thesis on an important national security issue.

The 2017 program was co-directed by Martha Crenshaw and Chip Blacker. Crenshaw said, "We stress hard work, independent thinking, intellectual honesty, and courtesy and civility.  Our students are critical without being disrespectful, open to new ideas and ways of thinking, and self-made experts in the subjects they have chosen."

In his remarks, Blacker said several features of the CISAC program make it distinctive. "These include the diversity of the disciplines represented by the student's major fields of study, which range this year from political science, history and international relations, on the one hand, to computer science, energy systems engineering, and materials science and engineering, on the other. ..." 

While each project is different, "they all share the unifying and overarching themes of advancing the international security agenda and having value and utility in policy terms," Blacker said. The program, he added, places a "premium on knowledge of the real world, and of the art and science of policymaking in particular, coupled with intensive training in research and writing."

During the conferral ceremony, CISAC honors teaching assistant Shiri Krebs read statements from the students' thesis advisors regarding their final papers. Read below for those comments:


Ken Ben ChaoKen-Ben Chao

A New Journey to the West: The Shanghai Cooperation Organization and Chinese Foreign Policy

Thesis Advisor: Coit. D. Blacker

"What is the Shanghai Cooperation Organization and, to be blunt, why should we care? In essence, this is the question that Ben Chao seeks to answer in this thoughtful, comprehensive and well-written senior thesis. Ben’s answer, like the question, comes in two parts. The Shanghai Cooperation Organization, he tells us, is neither an emerging alliance nor a diplomatic “talk shop.” Rather, it has been – and it continues to be – a subtle instrument of Chinese foreign policy that has waxed and waned in importance since its creation in 2001 depending on Beijing’s assessment of the international security environment. In Ben’s judgment, this is reason enough for us to care and for us to pay attention. Ben’s thesis is a superior piece of scholarship that tells us a great deal about something most of us know little about and does so in an informed and wonderfully entertaining way."


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Marina Elmore
Marina Elmore

When Things Are Not What They Seem: Explaining the Success of Countering Violent Extremism in Los Angeles

Thesis Advisor: Martha Crenshaw

"A policy of countering violent extremism and radicalization, known as “CVE,” was a hallmark of the Obama Administration as it struggled to respond to the threat of “homegrown” jihadist terrorism. But what is CVE? And is it effective? These questions motivated Marina Elmore’s fascinating inquiry into the apparent success of the Los Angeles program, highly praised as a model on the national level. Marina probed deeply into the case to discover that special circumstances predetermined the outcome and that the model was not easily transferable to other cities. For one thing, Los Angeles did not actually face a challenge of violent extremism because it lacked a population susceptible to the appeal of jihadist propaganda. For another, the city had already implemented most of the newly prescribed CVE “best practices,” such as community policing, in efforts to solve earlier social and political problems. Marina’s conclusions are astute, balanced, and fair, and she persuasively demonstrates both how important it is to test commonly held assumptions and how difficult it is to establish standards for policy effectiveness in the counterterrorism field."


Gabbi FisherGabbi Fischer

Towards DIUx 2.1 or 3.0? Examining DIUx’s Progress Towards Procurement Innovation

Thesis Advisors: Herb Lin, Dan Boneh

"In 2015, Secretary of Defense Ashton Carter announced the creation of Defense Innovation Unit Experimental (DIUx).  Through some great case-based work, Gabbi cuts through the complexity of the traditional acquisition system to observe that DIUX fills two important niches in the defense innovation ecosystem: it facilitates connections between DoD users and the tech community and it exercises non-traditional acquisition authority (called Other Transaction Authorities (OTAs)) to expedite contracting.  But she also cautions that the use of OTA may not be compatible in the long run with the traditional acquisition system, and suggests that future DIUX efforts may have to take advantage of other existing acquisition authorities (which do exist but which are rarely used) to make further progress in improving the coupling between the tech sector and the DoD.  She makes also substantive recommendations that DIUX should take seriously if it wants to survive in the long term."


Wyatt HoranWyatt Horan

Evaluating the U.S. Foreign Policy Institutions in Permitting a Coercive Russian Energy Policy

Thesis Advisor: Coit D. Blacker

"Following the twin “oil shocks” of the 1970s, the U.S. Government moved effectively to reduce the potential economic and political impact of any future such events by reorienting and reshaping key foreign policy institutions. When, thirty years later, the Russian government under Vladimir Putin began to manipulate Russian deliveries of natural gas to its customers in Europe, the U.S. failed to respond in a focused, deliberate and coordinated way. In this provocative senior thesis, Wyatt asks whether the clumsy American response to Russia’s manipulation of this vital energy resource contributed to Moscow’s alarming behavior. He answers in the affirmative and by so doing forces us to think hard about how seemingly obscure organizational issues impact the effectiveness of U.S. foreign policy. Wyatt’s thesis is bold and a little unsettling. It also reads like a detective novel, which is a tribute to the author’s willingness to run risks in search of a good story."


Tori KellerTori Keller

The Rise and Fall of Secular Politics in Iraq

Thesis Advisor: Lisa Blaydes

"As you know from interacting with Tori over the past year(s), she is a passionate – almost obsessively curious – student of contemporary Iraqi politics. Her drive to understand the case has led her to write a normatively-motivated, policy-relevant thesis on the failure of democratic consolidation in Iraq. Her research suggests that a non-sectarian political future for Iraq was possible; the historical antecedents for such a vision existed. But as a result of a combination of US missteps, Iranian interference and, most importantly, the way these factors manifested into an insecure security environment, secular parties never really had a real chance to succeed even if a plurality of voters supported such an outlook. To write this thesis, Tori invested in her own human capital development in impressive ways. She studied Arabic, learned ArcGIS mapping software, collected original data, and undertook statistical analysis – deploying the skills she had acquired in her four years at Stanford with the goal of answering this research question. In the end, I believe she has the right answer as well. If there was any doubt left in her mind about whether she got it “right,” I feel confident that she would still be puzzling through the research today."


Alexander LubkinAlexander Lubkin

Plutonium Management and Disposition in the United States: History and Analysis of the Program

Thesis Advisor: Rod Ewing

"Alex’s thesis examines the issues related to the failure of the U.S. program for the disposition of excess plutonium from dismantled nuclear weapons. Based on his survey of the literature and interviews with key actors in this program, Alex analyzed the U.S. program and has made a number of important observations and conclusions concerning the causes for the failure of the U.S. program. His most significant conclusion is that one of the major causes of failure was that the U.S. program to use irradiated MOX fuel for the disposition of the plutonium was not consistent with U.S. nuclear policy. The U.S. is pursuing an open nuclear fuel cycle, and thus has limited experience with large scale processing of radioactive materials and the fabrication of MOX fuel. Alex was able to identify a number of other issues, such as over reliance on cost and schedule estimates of the different strategies and a failure to utilize advances in materials science for the development of actinide waste forms. I am very impressed with Alex’s dedication to this research project, and his persistence in the review of an often confusing and obscure literature. We have met regularly over the past year. I outline broad areas that he might investigate, but then he took these ideas and developed them according to his on evaluation of a variety of different sources. He also did an exceptional job of synthesizing the information from the interviews into an interesting and informative chapter in his thesis. Alex’s research will be the basis for a publication, but most importantly, he has opened the door to a whole series of policy issues that require more detailed analysis. He has certainly educated me on a number of these issues."


Jian Yang LumJian Yang Lum

To Bomb or Stab? The Impact of Ideology and Territorial Control on Rebel Tactics

Thesis Advisors: Joseph Felter, Jeremy Weinstein

“Lumpy” as we know him- explores how rebel groups’ ideology and degree of territorial control affect the type of violence they choose to employ in pursuit of their aims. Using fine grained conflict data and case studies from thirty-six years of insurgency and counterinsurgency in the Philippines, Lumpy finds both quantitative and qualitative evidence in support of the predictive model he develops in his thesis. In sum, rebel groups with weaker ideological commitment and more limited control of the territory they operate in are more likely to initiate indiscriminate attacks such as bombings and employment of improvised explosive devices. More ideologically committed rebels, and those exercising greater territorial control, initiate violence that is comparatively more discriminate such as targeted raids and assassinations. The human toll and economic costs incurred by civil war and insurgency around the world are staggering and continuing to mount. There is an urgent need for policy relevant scholarship that increases our understanding of the local level violence associated with these deadly conflicts and how states can better anticipate and respond to these threats. Lumpy’s thesis makes a significant contribution to these important ends."


Elizabeth MargolinElizabeth Margolin

Should I Retweet or Should I Go? Pro-ISIS Twitter Communities and American Decapitation Strategy

Thesis Advisors: Martha Crenshaw, Justin Grimmer

"There are many studies of the U.S. Government’s use of military force in “decapitation” strikes against terrorist leaders, particularly the effects of these strikes on levels of violence and degree of organizational cohesion. Researchers have also analyzed the relationship between social media and terrorism generally. But the specific question of the social media reactions of jihadist sympathizers to decapitation strikes directed against Islamic State leaders was neglected until the idea occurred to Eli Margolin, who took it up as the subject of her honors thesis. This difficult, demanding, and often frustrating research project required Eli to master new cutting-edge analytical methodologies and struggle to acquire elusive data from the archived Twitter accounts of now banned users, obstacles that she overcame with impressive ability, determination, and sophistication. After extensive and thoughtful consideration of three carefully selected cases, she found that Twitter followers of jihadist causes react quite differently to the deaths of different types of terrorist leaders. Her intellectual ambition and tenacity produced a thesis that is excellent in terms of conceptualization, analytical rigor, and empirical foundation."


Lauren NewbyLauren Newby

From Zero to Sixty: Explaining the Proliferation of Shi’a Militias in Iraq after 2003

Thesis Advisor: Martha Crenshaw

"Why has there been a sharp increase in the number of Shia militias in Iraq, a troubling development that may jeopardize Iraqi progress toward stability and democracy? Lauren Newby could not find a good answer in her review of the theoretical literature, so she proposed an original one of her own. Most scholars attribute the proliferation of violent non-state actors to the fragmentation of existing groups through splintering and splitting, whereas Lauren shows that in Iraq the increase is due to the emergence of new groups. Researchers typically focus on groups directly opposing the state, whereas the Iraqi militias side with the incumbent government. Most studies are limited to groups operating in a single bounded conflict zone, whereas the politics of Iraq and Syria are linked. Lauren concludes that the Syrian civil war has been a major impetus for the formation of Shia militias in Iraq and that most are established by Iraqi political parties. Her thesis is exemplary in making a clear and convincing claim, contrasting it to alternative explanations, and providing new supporting evidence from primary sources."


AAnhViet NguyennhViet Nguyen

Territorial Disputes in Court: Power, Compliance, and Defiance

Thesis Advisor: Kenneth Schultz

"In the wake of the arbitration ruling over the China-Philippines dispute in the South China Sea, AnhViet wanted to understand what the prospects were for this ruling to help resolve the conflict. To do so, he placed this case in the context of other territorial disputes that have involved great powers or states who were significantly more powerful than their adversaries. This led to the central research questions: why and under what conditions do great powers comply with adverse court rulings over territorial issues? The thesis draws nicely on the existing literature to articulate several hypotheses and then tests these hypotheses using a variety of methods. Case studies of the US-Mexico dispute over the Chamizal tract and the Nigeria-Cameroon dispute over the Bakassi Penninsula show that great powers who initially reject adverse court decisions might later find these rulings to be a convenient basis for settlement. He also makes a very important and sophisticated point that great power compliance with court rulings may reflect their ability to keep high salience issues off the agenda. The conclusion is mildly optimistic about the prospects for (eventual) compliance while remaining appropriately clear-eyed about the limits of international law in this context. Overall, AnhViet does an admirable job blending theoretical material, historical case studies, and large n data to develop his argument. Moreover, his application of these lessons to the contemporary case of the South China Sea dispute is nuanced and compelling. In short, AnhViet’s thesis represents an excellent example of how academic research can be made relevant to current policy issues."


Thu-An PhamThu-An Pham

On Treaties and Taboos: U.S. Responses to International Norms in the NPT and Genocide Convention (1945-1999)

Thesis Advisor: David Holloway

"Thu-An Pham has written an outstanding thesis on the role of norms in international relations. The United States has not tried strenuously to enforce the Genocide Convention of 1948, which calls for the prevention and punishment of genocide. It has, however, actively sought to enforce the nonproliferation norm expressed in the Nuclear Nonproliferation Treaty of 1968. What explains the difference? On the basis of a subtle theoretical analysis and detailed empirical research, Thu-An offers three answers. First, the Nonproliferation Treaty is better supported than the Genocide Convention by institutions that monitor and enforce compliance. Second, the United States has regarded the norm of nuclear nonproliferation as more important for its national security than the ban on genocide. And third, the nonproliferation norm supports the current international order, which is based on the primacy of states in international relations. The Genocide Convention, by contrast, threatens to weaken the foundations of that order by challenging the primacy of states. Thu-An’s thesis suggests that there are limits on the role that international norms can play in a system of states. This is a wonderful thesis on a crucial issue in international security."


Jack WellerJack Weller

Counting the Czars: Extra-Bureaucratic Appointees in American Foreign Policy

Thesis Advisor: Amy Zegart

"White House czars are frequently discussed in the press, but most people don’t really know what they are and very few scholars have studied them. Yet the use of czars has serious implications for the presidency—signaling when the regular bureaucracy cannot get the job done. Jack Weller’s thesis provides a novel and important contribution to the study of the American presidency. He compiles an original dataset of every foreign policy czar created during the past 100 years and examines alternative explanations for why some presidents used czars more than others. He finds something surprising: czar creation is NOT driven by the individual management style of the president. Instead, it is driven by the external threat environment. Presidents facing simultaneous wars – as FDR did in World War II and George W. Bush did after 9/11 – are more likely to create czars than others. Jack’s thesis is beautifully written and masterfully argued, earning him the honor of being Stanford’s czar of czars."


 

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The 2017 CISAC honors program, from top left, second row: Elizabeth Margolin, Jack Weller, Marina Elmore, Alex Lubkin, Thu-An Pham, Lauren Newby. First row, from the left: Gabby Fisher, Tori Keller, Professor Martha Crenshaw, AnhViet Nguyen, substitute instructor Dr. Gil-li Vardi, Jiang Yang Lum, teaching assistant Shiri Krebs, Wyatt Horan, Ken "Ben" Chao, and Professor Chip Blacker.
Rod Searcey
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The 2017 Forum will feature a luncheon keynote address on “Primary Care in the Netherlands: Lessons for China” by Jeroen N. Struijs, Senior Researcher in the Department of Quality of Care and Health Economics, National Institute of Public Health and the Environment, The Netherlands. Additional prominent speakers include Dr. Huncheol Bryant Kim, Cornell University, US, speaking on health policy in South Korea; Dr. Bei Lu, University of New South Wales, Australia, speaking on China’s efforts to integrate long-term care with primary care--Experiences of Qingdao’s Long-term Care Insurance program; Dr. Xiaoyun Liu, Peking University, on China’s primary care workforce; Dr. Jiayan Huang, Fudan University, on a model of integrated care from southern China; and Dr. Qiulin Chen, China Academy of Social Sciences, speaking on “Strengthening China’s primary care: A view from Inner Mongolia.” In addition, select policymakers and providers will introduce China's overall healthcare system reforms as well as discuss challenges to strengthening primary care in China.

Stanford Center at Peking University

Jeroen N. Struijs Senior Researcher in the Department of Quality of Care and Health Economics, National Institute of Public Health and the Environment, The Netherlands
Huncheol Bryant Kim Cornell University, US
Bei Lu University of New South Wales, Australia
Xiaoyun Liu Peking University, China
Qiulin Chen China Academy of Social Sciences, China
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The "Workshop of young leaders in Asia health policy" will take place at SCPKU on June 21, 2017, just prior to the annual primary care Forum. This special event convened in honor of the Stanford Asia Health Policy Program's 10th anniversary. It will feature short research panels by a dozen young health policy experts from Cambodia, China, Indonesia, Korea, Mongolia, Myanmar, Nepal, the Philippines, Thailand, the United States, and Vietnam. The luncheon colloquium will feature comparative perspectives on the major health policy challenges facing Asia as well as specific examples of how evidence-based policymaking can improve lives throughout the Asia-Pacific region.

 

Stanford Center at Peking University

Encina Hall E301616 Serra StreetStanford, CA94305-6055
(650) 724-5321 (650) 723-6530
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darika_saingam.jpg Ph.D.

Darika Saingam joins the Walter H. Shorenstein Asia-Pacific Research Center as the Developing Asia Health Policy Postdoctoral Fellow for the 2015-16 year.  Saingam’s research interests are public health, substance abuse, drug policy and Southeast Asia. While at Shorenstein APARC, she will research the evolution of substance-abuse control measures and related policy in Thailand.  Saingam seeks to identify potentially effective policy directions suitable for Thailand, and other developing countries in Southeast and East Asia.

Saingam completed her doctorate in epidemiology at the Prince of Songkla University in 2012, and has served as a researcher at the University’s epidemiology unit since, as well as a researcher at the Thailand Substance Abuse Academic Network since 2014.

2015-16 Developing Asia Health Policy Postdoctoral Fellow
Faculty of Medicine Prince of Songkla University, Thailand
Ngoc Minh Pham Visiting research fellow at Curtin University, Australia
Director of KHANA Center for Population Health Research, Cambodia

Shorenstein APARC
Encina Hall E332
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5710 (510) 705-2049 (650) 723-6530
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Developing Asia Health Policy Fellow
IMG_4537.jpg MD

Gendengarjaa Baigalimaa joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) during the 2013-2014 acedemic year as the Asia Health Policy Program Fellow. She joins APARC from the Mongolian National Cancer Center, where she serves as a Gynecological Oncologist.

During her appointment as Health Policy Fellow, she will conduct a comparative study of how knowledge of cervical cancer risk factors has influenced behavior changes in Mongolia before and after the introduction of the National Cervical Cancer Program.

Baigalimaa is the Executive Director of Mongolian Society of Gynecological Oncologists and is also a member of the International Gynecological Cancer Society (IGCS) in Mongolia, Russia, and France.

Baigalimaa holds a MD from Minsk Belarussia Medical University. She also received a Masters in Health Science from Mongolian Medical University. She is fluent in both Russian and English.

Gynecological Oncologist at ''Mungun Guur'' hospital, Mongolia

Shorenstein APARC
Encina Hall C331
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5656 (650) 723-6530
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2013-2014 Asia Health Policy Postdoctoral Fellow
triyana_photo.jpg PhD

Margaret (Maggie) Triyana’s main research interests are inequality and human capital investments in developing countries. In particular, she is interested in the effects social policy changes on children’s health outcomes. As a Postdoctoral Fellow, she will analyze the effects of rural-urban migration in Indonesia and China, as well as the impact of health insurance expansion in Indonesia and Vietnam.

Triyana received a PhD in Public Policy from the University of Chicago in 2013.

 

Working Papers

“Do Health Care Providers Respond to Demand-Side Incentives? Evidence from Indonesia“

“The Effects of Community and Household Interventions on Birth Outcomes: Evidence from Indonesia”

“The Longer Term Effects of the ‘Midwife in the Village’ Program in Indonesia”

“The Sources of Wage Growth in a Developing Country” (with Ioana Marinescu)

2016-17 Kellogg visiting fellow; Assistant Professor of Economics at Nanyang Technological University, Singapore
Assistant Professor at the School of Economics, University of the Philippines, Diliman

Walter H. Shorenstein
Asia-Pacific Research Center
616 Serra St C335
Stanford University
Stanford, CA 94305-6055

(650) 724-5668 (650) 723-6530
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2011-12 Asia Health Policy Fellow
SunAng_Profile.jpg MA, PhD

Ang Sun joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) from Brown University’s department of economics where she recently received her PhD.

Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families. During her time at Shorenstein APARC, Sun will participate in an interdisciplinary study of the impact of the aging process in Asia on economic growth.

Sun holds a PhD and an MA in economics from Brown University, and an MA from the China Center of Economic Research. She also received a BA in economics and a BS in information and computer science from Beijing University.

Central University of Finance and Economics, Beijing, China

Shorenstein APARC
Stanford University
Encina Hall, Room C335
Stanford, CA 94305-6055

(650) 736-0771 (650) 723-6530
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2011 Shorenstein-Spolgi Fellow in Comparative Health Policy
Qiulin_Chen3x4.jpg MA, PhD

Qiulin Chen is a postdoctoral fellow of Shorenstein APARC and a member of the center's Asia Health Policy Program. His main interest of research is health economics and public finance, focusing on policy and outcome comparison of health care systems and Chinese health reform. His dissertation focused on performance comparison between public (or governmental) and private health care financing, between local and central government responsibility on health care, between contracted and integrated health care system. In particular, his dissertation examined under Chinese-style decentralization, known as fiscal decentralization with political centralization, how economic competition affect local government's behaviour on health investment, and why public contracted system obstructs health performance and provides one channel of such effects in terms of preventive care and public health. He is currently involved in a comparative research project on demographic change in East Asia based on the National Transfer Accounts data and analysis.

Chen's recent publication is "The changing pattern of China's public services" (with Ling Li and Yu Jiang) in Population Aging and the Generational Economy: A Global Perspective (Ronald Lee and Andrew Mason, editors), forthcoming 2011. Before studying in Stanford, he has published more than 10 papers in academic journals in Chinese, such as Jing Ji Yan Jiu (Economic Research) and Zhong Guo Wei Sheng Jing Ji (Chinese Health Economics), and 5 book chapters. He has participated in about 20 research projects, such as A Design of Framework for Healthcare Reform in China which is commissioned by the State Council Working Party on Health Reform, Strategy Planning Study of "Healthy China 2020" which is commissioned by the Minister of Health, and Health Challenge in the Aging Society and It's Policy Implication funded by Chinese National Natural Science Foundation.

Chen earned his Ph.D. in Economics from Peking University in 2010, and earned a B.A. in Business Administration from Nanjing University in 2001. From 2004 through 2008, he was Executive Assistant of the Director of the China Centre for Economic Research at Peking University (CCER). He is also a postdoctoral fellow of National School of Development at Peking University (Its predecessor is CCER).

CV
China Academy of Social Sciences, China
Associate Professor in the Department of Health Policy and Management at Seoul National University College of Medicine, Seoul, South Korea
Seminars
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A growing body of evidence suggests that China’s schooling system, as it stands today, is unable to produce the high-skilled labor that will be needed if the nation is to avoid the middle-income trap. How does poor parenting and inadequate early childhood development attribute to this problem? Prof. Rozelle will discuss his research on cognitive delays among toddlers in rural China, and the national crisis that the country faces due to inadequate childhood development.  

 

Scott Rozelle holds the Helen Farnsworth Endowed Professorship at Stanford University and is Senior Fellow in the Food Security and Environment Program and the Shorenstein Asia-Pacific Research Center, Freeman Spogli Institute (FSI) for International Studies. For the past 30 years, he has worked on the economics of poverty reduction. Currently, his work on poverty has its full focus on human capital, including issues of rural health, nutrition and education. Rozelle has been the chair of the International Advisory Board of the Center for Chinese Agricultural Policy, Chinese Academy of Sciences (CAS) for the past 20 years. He is the co-director of the Rural Education Action Project (REAP). 

Registration: 

https://www.eventbank.cn/event/9642/

 

Stanford Center at Peking University

 

Scott Rozelle Senior Fellow Freeman Spogli Institute for International Studies
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Emily Tuong-Vi Nguyen, a Stanford student studying human biology, writes about the Asia Health Policy Program’s international conference on diabetes

The Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center hosted the Net Value in Diabetes Management Workshop in March to discuss progress on an international research collaboration. Research teams from Hong Kong, Singapore, China, Taiwan, South Korea and the United States convened at the Stanford Center at Peking University (SCPKU) in Beijing to work on research that compares utilization and spending patterns on diabetes across different countries and to develop a method for measuring the net value of diabetes internationally, based on previous methods discussed in a Eggleston and Newhouse et al. 2009 study with Mayo Clinic Data for Type 2 diabetes.

The research teams from various Asian countries are attempting to calculate the net value of diabetes in those countries by observing the changes in diabetes value and spending. These calculations include monetizing the value of health benefits of new treatments and improvements in health, as well as avoided spending on treatments when prevention was effective, and associated mortality and probability of survival. Previous models used to measure diabetic values and risks, such as the United Kingdom Prospective Diabetes Study (UKPDS) risk engine that was created from U.K. data and populations, are not very relevant for Asian populations. The goal is to create separate risk models specifically suited for populations from Hong Kong, Singapore, China, Taiwan and South Korea.

During the workshop that spanned two days, the research teams had an opportunity to share updates on their individual projects and to discuss methods and ideas for future collaboration.

On the first day, each research team presented its work, describing data sets and explaining the risk models that were used or developed. Karen Eggleston, director of the Asia Health Policy Program, delivered introductory remarks and shared current progress by the Japan and Netherlands research teams on calculating value and risk for diabetes with data from the Netherlands and Japan. The data sets from those two countries were best estimated by the JJ Risk Engine for the Japan data and the UKPDS model for the Netherlands data.

Chao Quan of the University of Hong Kong presented the risk model used for Hong Kong populations. His work primarily looked at how the UKPDS risk engine predicted risk in Hong Kong populations as compared to a local Hong Kong risk engine and how to best calibrate the Hong Kong risk engine. His next step will be to monetize the value for improved survival in diabetes in Hong Kong. He offered to re-estimate the model using the risk factors available on others’ datasets so that the Hong Kong risk model could potentially be used by other teams as well.

Stefan Ma and Zheng Li Yau of the Ministry of Health of Singapore discussed the 5-year prediction model and statistical methods they used for all-cause mortality of Singaporean individuals with diabetes. Their work is based on Singapore’s extensive administrative and claims data as well as data provided by the national health surveys conducted every six years by the National Health Service of Singapore. The researchers plan to look into how their overall risk model compares with models for specific subpopulations, such as Chinese, Malay and Indian populations in Singapore.

Katherine Hastings from the Stanford University team, led by principal investigator Latha Palaniappan, presented preliminary ideas about measuring cardiovascular risk with the Atherosclerotic Cardiovascular Disease Risk Score in analyses of Stanford health system diabetic patients. The researchers are collaborating with a clinical bioinformatics team at Stanford to use machine learning to expedite the analysis.

Min Yu and Haibin Wu of the Zhejiang Center for Disease Control and Prevention shared results from their analysis of health data collected from community health centers for diabetes management, diabetes surveillance data, cause of death data and insurance claims data that showed relationships between different patient characteristics and insurance types. The researchers then estimated the annual cost of Type 2 diabetes and its complications in Tongxiang province, China.

Hai Fang and Huyang Zhang of Peking University worked with claims data of diabetic patients insured by the New Cooperative Medical Scheme in Beijing, and at the workshop, shared regression analyses on the relationship between outpatient visits and inpatient admissions.

Jianqun Dong of the People’s Republic of China Center for Disease Control and Prevention presented ongoing research about diabetes management in China, including preliminary results of a randomized control trial of diabetes self-management strategies.

Wankyo Chung of Seoul National University shared preliminary estimates of a risk model for mortality among diabetic patients in South Korea and discussed next steps for estimating net value of diabetes management using the detailed clinical and claims data available in South Korea.

On the second day, the workshop concluded with a videoconference between workshop participants in Beijing and collaborators at Stanford Graduate Business School, including Stanford professor Latha Palaniappan and Harvard visiting professor Joseph P. Newhouse, using the Highly Immersive Classroom.

The workshop was a good opportunity for the research teams to discuss preliminary models, to offer each other suggestions regarding research methods, and to discuss the future direction of the international collaboration on the net value of diabetes. All research teams are preparing comparative research papers that will be included in the working paper series of the Asia Health Policy Program. A follow-up event will be held at Stanford in November 2017 in recognition of World Diabetes Day.

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A group of participants from the workshop, “Net Value in Diabetes Management,” at Stanford Center at Peking University, March 24, 2017, from left to right: Zheng Yi Lau from the Ministry of Health of Singapore; Chao Quan (University of Hong Kong); Jui-fen Rachel Lu (Chang Gung University); Emily Nguyen, Karen Eggleston, and Katie Hastings (Stanford); and Stefan Ma (Ministry of Health of Singapore).
Courtesy of Emily Tuong-Vi Nyugen
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As immigration policy ideas dance around Washington, children’s health rarely enters the discussion. According to Stanford pediatrician Fernando Mendoza, new policies could have a huge impact on the well-being of children with immigrant parents.
 
“If you make them fearful on a day-to-day basis that their parents are going to be taken away, it causes tremendous stress on children and families,” said Mendoza, a professor of pediatrics at the Lucile Packard Children’s Hospital.

Mendoza has gathered experts across Stanford University and throughout California and the United States to address these issues at the Child Health and Immigration Conference on May 25. The panelists will discuss potential impacts at the federal, state and local level and advise communities on how to navigate the effects on children.
 
“All immigrants are having their place in this country challenged,” said Mendoza. “Whether or not you have a parent who is undocumented, that is detrimental to the well-being of the children of all immigrants.”
 
According to a study at the Pew Research Center, one out of every eight children in California lives with an undocumented parent.
 
“Policies that would remove those parents would probably be the biggest social disruption that we’ve seen in this country,” said Mendoza. “We need to have experts discuss these things so that we can have clarity about what the effects of national immigration policies might be.”
 
Immigration experts Jeffrey Passel, a senior demographer at the Pew Research Center, and Bill Hing, a professor of law at the University of San Francisco, will kick off the conference by outlining immigrant family demographics and the legal system for enforcing immigration policy.
 
They will be followed by panels of experts from Stanford and other academic institutions, policy-makers, and leaders in local health and educational systems.
 
U.S. Rep. Zoe Lofgren (D-San Jose) will bring the on-the-ground Washington perspective with a short appearance via video. A former immigration attorney, she will discuss congressional movement on immigration policy.
 
Mendoza said, “We all value children. This conference is trying to create common ground around that American value.”
 
The conference will be held May 25 at Stanford University in Encina Hall’s Bechtel Conference Center from 8:30 a.m. to 5:15 p.m. To attend, please RSVP here.
 
The conference is sponsored by Stanford’s Division of General Pediatrics; the Center for Policy, Outcomes and Prevention; and the Lucile Packard Foundation for Children’s Health.
 


MEDIA CONTACTS:

Fernando Mendoza, General Pediatrics: (650) 725-8314, fmendoza@stanford.edu

Nicole Feldman, Stanford Health Policy: (650) 725-3389, nicoletf@stanford.edu

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The Child Health and Immigration Conference will examine the impact of immigration policy on children.
Zara Abraham
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Vietnam has adopted a public-private mixed health service delivery system for 30 years to mobilize more resources for the health sector. Public hospital physicians are allowed to practice for the private sector outside official working hours; therefore, physician dual practice is very common. This paper investigates the characteristics and dynamics of the phenomenon, focusing on the choices of physicians about whether to engage in dual practice, as well as their performance in their public practice. The analysis is based on a survey at 10 public hospitals in Vietnam with 510 physicians. Half of public hospital physicians reported participating in at least one type of private practice. Personal characteristics (gender, age, position), private practice income, and clinical autonomy are the reasons for dual practice involvement. Dual practitioners spend more time overall in clinical practice than their non-dual-practice counterparts, but reduce the time for public practice to have more time for private practice. They are also more likely to refer public patients to private practice. Nevertheless physicians appear to still be committed to the public sector to enlarge their professional networking, participate in training opportunities, and fulfill their sense of public responsibility.

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Ngan Do is currently a postdoctoral fellow at the Walter H. Shorenstein Asia-Pacific Research Center, Stanford University. Prior to that, she worked as a Health Leadership Development Initiative fellow at the World Health Organization Western Pacific Regional Office. Her research focuses on comparative healthcare systems and health reforms in Asia; payment incentives; physicians’ behaviors, human resources for health, and the public-private partnership in the health sector. She experienced field-work in Cambodia, Lao PDR, Philippines, Korea, and Vietnam. Ngan achieved her Ph.D. degree in health policy and management at Seoul National University College of Medicine. She earned her master degree on public policy at the KDI School of Public Policy and Management, and her bachelor degree on international relations at the Diplomacy Academy of Vietnam.

 

Ngan Do Kim 2016-2017 Developing Asia Health Policy Postdoctoral Fellow 2016-2017 Developing Asia Health Policy Postdoctoral Fellow
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Women empowerment (WE) is increasingly viewed as an important strategy to reduce maternal and child undernutrition,13 which continues to be a major health burden in low- and middle-income countries causing 3.5 million preventable maternal and child deaths, 35% of the disease burden in children younger than 5 years, and 11% of total global disability-adjusted life years.4,5Global data show that one of the worst affected regions is sub-Saharan Africa (SSA), where about 20% of children are malnourished.6,7 Benin is no exception, as the prevalence of stunting, wasting, and underweight was 37%, 5%, and 17%, respectively, among children aged 6 to 59 months in the 2006 Benin Demographic and Health Survey (DHS),8 while 9% of women had chronic energy deficiency in the 2012 DHS.9 Greater rates were observed in rural areas where stunting was found in 40% of children, underweight in 19%, and wasting in 5%, while 10% of women had chronic energy deficiency.8,9 Additionally, Beninese women and children have a limited dietary diversity score (DDS), with diets predominately composed of starchy staples with little or no animal products and few fresh fruits and vegetables.10,11 Government, United Nation agencies, and nongovernmental organizations in Benin recognize that the state of maternal and child undernutrition requires multiple types of interventions.12

However, women’s low empowerment status in Benin can hinder the improvement in women’s and children’s undernutrition. Indeed, although females accounted for 47% of the economically active population in 2014,13 social and civil legislation is strongly influenced by tradition and customs, as women continue to be required to seek their husband’s authorization in certain areas such as family planning or health services.14 Rural women provided labor to the families’ commercial plots, were responsible for household food production and processing, and also had to work in the cooperative structures set up by the state in addition to their household tasks.14 In a more recent study of productivity differences by gender in central Benin, researchers noted that female rice farmers are particularly discriminated against with regard to access to land and equipment, resulting in significant negative impacts on their productivity and income.15 As in other areas of West Africa, women also have the responsibility of caring for children and preparing food for the household,16 but they may be vulnerable to food insecurity owing to unequal intrahousehold food distribution and their willingness to forego meals in favor of children during times of scarcity.17 Finally, no study to date has examined links between women’s empowerment and nutrition in Benin.

In addition, the evidence backing the effect of women’s empowerment on maternal and child undernutrition is inconsistent.18 Using the Women’s Empowerment in Agriculture Index (WEAI), Malapit et al19 reported positive and significant association between women’s group (WG) membership, control over income, overall empowerment, and women’s health (as measured by body mass index [BMI] and DDS) in Nepal. However, in Ghana, women’s aggregate empowerment and participation in credit decisions were positively correlated with women’s DDS, but not BMI.20 Mixed findings were also observed between women’s empowerment and child anthropometry. Moestue et al21 found a positive association between maternal involvement in social groups and length-for-age z score of 1-year-old children, but De Silva and Harpham22showed a negative association in 6- to 18-month-old children. Shroff et al23 found positive association between decision-making and child weight-for-age z score (WAZ), but Begum and Sen’s24 analysis of Bangladesh DHS data did not reveal any significant associations. Therefore, information about which domains of WE are associated with nutritional status is limited,20 and this lack of knowledge constrains the set of policy options that can be used to empower women and improve nutrition.

In addition to a limited set of studies in SSA, examinations of the effects of WE on nutrition outcomes are constrained due to interstudy differences in population characteristics, settings, or methods/conceptualizations of WE.2527 For example, despite recognition of the complex, multidimensional, and culturally defined nature and influence of empowerment on nutrition,20,26,28,29 only a few studies considered the multidimensional structure of empowerment domains in Africa or examined the varied relationships between each measure of WE and maternal and child nutrition status.30,31 Furthermore, in 2012, the International Food Policy Research Institute developed WEAI constructed from 5 prespecified domains of empowerment,32which may not be equally relevant in all areas. In contrast, in 2015, the United Nations adopted the Sustainable Development Goals (SDG), but the specific indicators for the SDG empowerment targets are largely equality metrics.33 To address the need for multidimensional and contextual examinations of WE and its influence on maternal and child health outcomes, we draw from the concepts put forward in the WEAI and the SDGs but took an approach more along the lines of the World Bank which gathers indicators, both equity and empowerment related, that can be used in contextually appropriate ways.34 The aims of this study were therefore to first explore the structure and domains of WE in Kalalé district of northern Benin and then to examine the effects of these constructs on nutritional status of women and their children in the region.

 

 

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Rosamond L. Naylor
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When one thinks of the casualties of war, it is easy to imagine severed limbs, bullet holes, shrapnel, perhaps even sarin gas or Agent Orange. But in a recent Daedalus essay, Paul Wise argues that the most damaging health impacts of war are often indirect. Losing access to food supplies, medication and electricity can kill more people than battle itself. In this video by the American Academy of Arts and Sciences, Wise, a professor of pediatrics and Stanford Health Policy core faculty member, explains how fatal the indirect costs of war can be.

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