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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Siegfried S. Hecker
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On February 23, 1992, less than two months after the dissolution of the Soviet Union, I landed on the tarmac in Sarov, a city the government had removed from maps to keep secret its status as a nuclear weapons center. I was then director of the Los Alamos National Laboratory and­­ accompanied by two senior scientists from my own lab plus three colleagues from the Lawrence Livermore National Laboratory. The six of us were about to walk through the birthplace of the Soviet nuclear bomb, the technological and intellectual powerhouse behind the sophisticated arsenal that had been pointed at our country for the previous 40 years.

Shockingly, after an hour-long flight from Moscow, we stepped out of the Aeroflot turboprop into the open arms of our Russian hosts: Yuli Borisovich Khariton, the scientific leader of the Soviet nuclear program, and other senior lab staff who had waited in the chilly wind to welcome us. Just as remarkable was the fact that this wasn’t the first time we met our Russian counterparts. Two weeks earlier, directors of the Russian nuclear weapons labs, VNIIEF in Sarov and VNIITF in Snezhinsk, had for the first time in history set foot in our labs in Livermore and Los Alamos. This exchange of visits a quarter century ago marked a new turn in relations between the world’s two nuclear weapons superpowers.

The road to Sarov

Our first meeting on Russian soil would have been deemed improbable just a few months earlier. The encounter on the Sarov tarmac grew out of both persistence by determined individuals and larger historical forces. As the Soviet Union scrambled to adjust domestic and international policy in the face of mounting economic and social challenges in the late 1980s, Soviet leader Mikhail Gorbachev reached across the political divide to US President Ronald Reagan to take steps toward nuclear disarmament. One such step was the Joint Verification Experiment of 1988, in which the Soviet Union and the United States asked their nuclear weapons scientists to conduct parallel nuclear-explosion yield measurements at testing grounds in Nevada and Semipalatinsk, located in what is now Kazakhstan. The experiment helped overcome a stumbling block related to verification procedures needed to ratify the 1974 Threshold Test Ban Treaty (TTBT). The 1988 nuclear tests enabled the two sides to sign a new ratification protocol in Geneva in June 1990, and the TTBT entered into force in December 1990.

As history would have it, an unintended outcome of the TTBT ratification effort proved to be the most momentous. Viktor Mikhailov, head of the Soviet team that took part in the Joint Verification Experiment and later Russian minister of atomic energy, was right when he said that “the main result of the Joint Verification Experiment was not the development of procedures and extent of nuclear test monitoring of the joint development of technical verification means, but the chance for interpersonal communications with the American nuclear physicists.”

Indeed, it was working side by side at each other’s test sites that gave rise to deep-rooted affinity and built trust. Over the years, we had only caught glimpses of our Soviet nuclear scientist counterparts at a few international conferences where they disguised their institutional affiliations, saying they were part of the Soviet Academy of Sciences. It was through months of collaboration at our test sites that the contours of their true home institutions—the nuclear weapons labs VNIIEF and VNIITF—began to emerge. As we would discover eventually, these Soviet labs were remarkably similar to our own. We realized that in addition to nuclear weapons work, they were conducting outstanding fundamental science. We became consumed with curiosity to learn more about it first-hand. The Russians were curious about our work as well.

We were all interested in cooperation, but the Russians even more so because they sensed before we did just how dramatically the Soviet Union was changing. Lev D. Ryabev, who headed the atomic ministry at the time, told me years later that Russian nuclear weapons scientists were so eager to work with their American counterparts because “we arrived in the nuclear century all in one boat—movement by any one will affect everyone. We were doomed to work together.”

It was during a 1990 trip to Moscow by Los Alamos and Lawrence Livermore lab scientists for technical discussions supporting the Geneva test ban talks that Mikhailov extended an impromptu invitation to visit the USSR’s secret nuclear city Sarov (then called Arzamas-16) for the first time.

The American scientists returned with specific proposals from the VNIIEF director and his senior scientists for collaboration with the US labs, along with an invitation to Lawrence Livermore Director John Nuckolls and me to visit the secret Russian cities.

Convinced by my Los Alamos colleagues that this was a great opportunity to collaborate scientifically in important areas of research, I tried a number of avenues in Washington to get approval for exploring potential cooperation. I got little traction until the second half of 1991, after the Soviet Union had begun to disintegrate. As it did so, President George H.W. Bush became concerned that brain drain from the Soviet nuclear complex could lead to the spread of knowledge about how to build these weapons of mass destruction.

Driven by that concern, US Energy Secretary James D. Watkins approved my request for the laboratory directors’ exchange visits, and two months after Gorbachev’s formal dissolution of the Soviet Union on December 25, 1991, we entered the surreal world of the Soviet Los Alamos.

A tradition worth sustaining 

Our visits to Sarov and Snezhinsk shattered our Cold War preconceptions of the Soviet nuclear program. We were particularly impressed by the depth of scientific talent. Although they lacked modern computers and electronics, their computational achievements were remarkable, and their experimental facilities were innovative and functional. We found the scientists’ dedication to their mission deeply patriotic, and their attention to nuclear weapons safety reassuring. During our briefings and tours, Russian scientists described leading-edge research in the fundamental science that underpinned their nuclear weapons program. The visits convinced me that our US nuclear labs should collaborate with their Russian counterparts, not only to help solve immediate problems like proliferation and loose nukes, but also because in doing so we would benefit scientifically.

Our Russian colleagues were prepared with proposals for cooperation in a surprisingly broad range of areas. During a daylong session in Chief Weapon Designer Boris Litvinov’s office in Snezhinsk, watched by portraits of Lenin and Igor Kurchatov, one of the fathers of the Soviet Bomb, we hammered out a protocol for cooperation that we would take back to our governments. We came up with a long list problems we wanted to work on together. It included enhancing the security and safety of nuclear weapons during reduction and dismantlement; preventing the proliferation of nuclear weapons knowledge; promoting the conversion and diversification of nuclear facilities; preventing non-nuclear states and terrorists from obtaining nuclear weapons; developing joint mechanisms for emergency response; enhancing the safety of nuclear arsenals; preventing unauthorized use of remaining weapons; and promoting protection and cleanup of the environment at nuclear weapons facilities.

It turned out that we scientists were far ahead of what the US government was prepared to authorize at the time. We heard that when members of the National Security Council staff, which coordinated interagency government issues with Russia, received a copy of the protocol, they declared it did not exist and threw it in the waste paper basket. However, Nuckolls and I presented the protocol to Watkins and received approval to proceed, though only in fundamental science cooperation.

By May 1992, even though the US Energy and State Departments had only agreed to general principles, the former had provided us with the necessary financial support and the latter with the required permissions for travel to Russia. Just as importantly, we had defined what we wanted to do first in the collaboration we called lab-to-lab. We planned for joint experiments in high-energy-density physics and conferences on computer modeling and simulation.

In spite of the initial US government concerns, we would eventually end up cooperating in almost all the areas outlined in the initial protocol. A spirit of collaboration prevailed for nearly a quarter century, and was essential to successfully mitigating the dangers resulting from the dissolution of the Soviet Union. Unfortunately, that cooperation has all but come to an end during the past few years as relations between Moscow and Washington have soured. But the benefits of future cooperation are potentially enormous, as a new report from the Nuclear Threat Initiative makes clear. The US and Russian governments, as well as the two countries’ scientists, should seize any opportunities that arise to rekindle nuclear cooperation.

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This picture shows the 1992 visit of U.S. nuclear weapon labs directors to the Russian nuclear weapons institutes in Sarov and Snezhinsk. On the left, in a white sweater is the Russian physicist Alexander Pavlovsky. Next to him is "Russia’s Oppenheimer" Yuly Khariton, almost 88 at that time. The second and third persons on the right are Sig Hecker, director of the Los Alamos National Laboratory, and John Nuckolls, director of the Lawrence Livermore National Laboratory.
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About the Event: Despite much current talk about “America First,” the United States has a vital interest in global health that is rooted in both practical necessity and humanitarian traditions.  There is growing recognition of the complex problem of direct and indirect threats to the health and security of U.S. populations and people around the globe related to the state of health in all countries, the risk of disease spread into this country, the reality of emerging or resurging infections, most recently Ebola, Zika or a pandemic flu, and the growing possibility that biological agents might be deliberately used to do harm.  Perhaps less well-recognized are the significant health and safety risks posed by the growing number of products that flow across borders. In our increasingly globalized world, the benefits of a global marketplace can be seen in greater choice for consumers and new opportunities for business and innovation, but it has also created many new challenges for product oversight and protection of complex supply chains. Harmful products result from poor quality manufacturing, production, and distribution, contamination, and even from intentional adulteration, fraud and counterfeiting. Success in protecting the public now depends on reaching beyond our borders, and working effectively with regulatory authorities, industry, and intergovernmental and international organizations to build a global product safety net for consumers and patients around the world.  

About the Speaker: Dr. Hamburg is an internationally recognized leader in public health and medicine. As Foreign Secretary of the National Academy of Medicine, the health arm of the National Academy of Sciences, Engineering and Medicine, Dr. Hamburg serves as senior advisor on international matters and is the liaison with other Academies of Medicine around the world. She is also President-elect of the American Association for the Advancement of Science

Dr. Hamburg earned her A.B. from Harvard College, her M.D. from Harvard Medical School and completed her medical residency at Weill Cornell Medical Center. Following completion of her formal medical training, Dr. Hamburg went to Washington to explore the world of health policy. She soon took on the role of Assistant Director of the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH).

In 1991, Dr. Hamburg was named Commissioner of the New York City Department of health. During her six-year tenure there, she implemented rigorous public health initiatives that tackled the city’s most pressing crises head-on — including improved services for women and children, an internationally recognized tuberculosis control program, a needle-exchange program to combat HIV transmission, and the nation’s first public health bio-terrorism preparedness program.       

In 1997, President Clinton named Dr. Hamburg Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, the lead policy position in the Department. She later became founding Vice President for Biological Programs at the Nuclear Threat Initiative, a foundation dedicated to reducing the threat to public safety from nuclear, chemical, and biological weapons.

In 2009, President Obama nominated Dr. Hamburg for the post of FDA Commissioner. In that role, Dr. Hamburg emphasized the critical need for innovation in meeting medical care and public health needs. As Commissioner, she provided leadership on many groundbreaking activities, including: new authority to regulate tobacco products; implementation of the Food Safety Modernization Act designed to transform food safety to a preventive system rather than simply responding when outbreaks occur; and modernization of the system for the evaluation and approval of medical products. Dr. Hamburg also worked hard to reposition FDA as an agency prepared for the challenges of globalization and was very active in efforts to establish new mechanisms for global governance of regulatory systems, including enhanced communication, collaboration and regulatory harmonization.

Dr. Hamburg currently sits on a number of Boards, including for the Commonwealth Fund, the Simons Foundation, the Parker Institute for Cancer Immunotherapy,  the Global Alliance for Vaccines and Immunization, the Urban Institute, and the American Museum of Natural History. She is also a member of the Harvard University Global Advisory Council, the Harvard Medical School Board of Fellows, the World Dementia Council and the Global Health Scientific Advisory Committee for the Bill and Melinda Gates Foundation. Dr Hamburg formerly served on the Boards of the Rockefeller Foundation, the Rockefeller University, the Nathan Cummings Foundation, Conservation International and Henry Schein Inc. Dr. Hamburg is an elected member of the Council on Foreign Relations and the National Academy of Medicine, and a Fellow of the American Association for the Advancement of Science and the American College of Physicians. She is the recipient of multiple honorary degrees and numerous awards.

 

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The Shorenstein Asia-Pacific Research Center (APARC), in pursuit of training the next generation of scholars on contemporary Asia, has selected two postdoctoral fellows for the 2017-18 academic year. The fellows will begin their year of academic study and research at Stanford this fall.

Shorenstein APARC has for more than a decade sponsored numerous junior scholars who come to the university to work closely with Stanford faculty, develop their dissertations for publication, participate in workshops and seminars, and present their research to the broader community.

The 2017-18 cohort includes two Shorenstein Postdoctoral Fellows; they carry a broad range of interests from labor migration policy in China to regional institutions in East Asia. Their bios and research plans are listed below:


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H. Seung Cho is completing his doctorate at Columbia University’s Department of Political Science. He researches U.S. and Chinese foreign policy toward East Asia’s regional institutions with a broader interest in U.S.-China relations, the political economy of East Asia and qualitative research methods. His dissertation probes the popular narrative that United States and China are competing over East Asia’s regional architecture, arguing that mutual misperception and security dilemma dynamics also play out in the politics of regional institution building. To explore this phenomenon, Seung has conducted extensive fieldwork in Beijing, Jakarta, Seoul and Washington, D.C. At Shorenstein APARC, Seung will be developing his dissertation into a book manuscript while looking to further examine the relationship between the politics of East Asia’s multilateral security institutions and their perceived lack of effectiveness. Previously, Seung was a predoctoral fellow at Peking University’s School of International Studies from 2014-16. Prior to starting his doctoral studies, he also served in South Korean military intelligence as part of the two-year national service. Seung holds a Bachelor of Science in government and economics and Master of Science in international relations from the London School of Economics and Political Science (LSE).


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Samantha Vortherms is a doctoral candidate in the University of Wisconsin – Madison Department of Political Science. Her research focuses on comparative political economy, development, social welfare and research methodology. Her dissertation examines subnational variation in access to citizenship rights in China through the household registration system. Her research has been supported by the National Science Foundation, the U.S. Department of Education through the Fulbright-Hays Doctoral Dissertation Research Abroad and the Social Science Research Council's Dissertation Proposal Development Fellowship, among others. At Shorenstein APARC, Sam will work on converting her dissertation to a book manuscript and advance her post-dissertation project on the role of the firm in labor migration policies. Before going to Wisconsin, Sam received her Master of Arts in international relations at the University of Chicago, Artium Magister in public policy from University of Chicago's Harris School of Public Policy, and a Bachelor of Arts from the University of Richmond. From 2014-16, she was a visiting research fellow at the National School of Development's China Center for Health Economics Research at Peking University.

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Stanford University has expressed its views on the recent executive order on immigration, and is offering resources for students who could be affected. News accounts indicate that as many as 17,000 students across the country fall into this category. On Jan. 27, President Trump signed an executive order restricting travel to the United States of people from seven largely Muslim countries -- Syria, Iran, Iraq, Libya, Somalia, Sudan and Yemen.

Amy Zegart, co-director of the Center for International Security and Cooperation, said CISAC's "mission is generating knowledge to build a safer world. We bring scholars, ideas from everywhere. And always will."

Looking ahead, Stanford is planning campus events and initiatives on this issue. Some information already to note: 

• Stanford launched a new website on immigration issues for students and scholars. This includes centralized campus information about international travel guidance and other information. Stanford will continue to add content to this site.

• A letter to the campus community from Stanford president Marc Tessier-Lavigne, provost John Etchemendy, and incoming provost Persis Drell affirming the university's support for international students. "As events unfold, the university intends to continue vigorously advocating before Congress, the Executive Branch, and beyond for policies consistent with its commitment to members of our community who are international, undocumented and those who are impacted by the recent executive order."

• A letter to the White House by Tessier-Lavigne and 47 other higher education leaders describing the impact the travel ban will have on students and scholars from those seven countries. "We write as presidents of leading American colleges and universities to urge you to rectify or rescind the recent executive order closing our country’s borders to immigrants and others from seven majority-Muslim countries and to refugees from throughout the world. If left in place, the order threatens both American higher education and the defining principles of our country."
 
• The Bechtel International Center remains an ongoing resource for international students and scholars at Stanford who have questions or concerns. Vaden Health Center’s Counseling and Psychological Services (CAPS) is collaborating with the Bechtel International Center and with the Markaz Resource Center. They will offer special drop-in hours for the next six Friday afternoons for students and scholars. Both student and scholar advisors will be present to offer guidance. Here is the schuedule:
Location: Bechtel International Center
Time: 2-4 p.m.
When: Feb. 10, in the Assembly Room; Feb. 17, in the Assembly Room; Feb. 24, in the Conference Room; March 3, in the Conference Room; March 10, in the Assembly Room; and March 17, in the Assembly Room.
 
• A statement by Stanford regarding its principles of immigration. "As an academic institution and as a community, Stanford welcomes and embraces students and scholars from around the world who contribute immeasurably to our mission of education and discovery."
 
• A Q&A with Stanford law professors Jayashri Srikantiah and Shirin Sinnar discussing the implications of the travel ban.
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Elena Lucchese is a Ph.D. student in Economics at the University of Bologna (Italy). She is currently doing research at Stanford University in the Center for Health Policy and the Center for Primary Care and Outcomes Research (CHP/PCOR). Her research interests are applied micro-economics, health economics and economics of education. In 2016, she was awarded a "Young Researcher Best Paper Award" by the Italian Health Economics Association for her work on the Effect of Ambulance Response Time on Cardiovascular Severity. In 2014, she also received a 14,000 euros grant from Eurizon Capital SGR as a Principal Investigator for her research project on the Efficiency of Public Spending in Europe. She is the president of the association "L'Osteria Volante", funded by the University of Padova, which promotes debates on economics, politics, and environmental issues (www.losteriavolante.it).

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Syria's civil war has taken a devastating toll on children.

Stanford freshman Emma Abdullah puts a young human face on that tragedy with her book, The Blue Box, which details the plights of Syrian children during the country’s six-year civil war. Published in 2014, the work is a collection of short stories and poems, and all proceeds go to charity. Abdullah estimates she’s raised $80,000 for the cause. Abdullah, who was raised in Kuwait, has relatives and friends from her father’s side of the family in Syria who have died or gone missing.

As many as 470,000 people and 10,000 children have been killed in the war, according to published accounts and the United Nations.

“My goal is to raise awareness about what these children are going through,” said Abdullah, who spoke at a recent staff meeting at Stanford's Center for International Security and Cooperation. “It’s important for me to bring this situation to light.”

She’s found receptive minds among her fellow classmates, though many of them were not aware of the scope of horror in Syria. “Other students have been good, and people are willing to listen once you talk to them about it. It’s been very positive at Stanford, and there is a lot to do on campus.”

Her 86-page book includes a child who writes stories about people in Syria. “She feeds the box with her thoughts; she puts in everything she has. She doesn't know it but her box becomes powerful. It takes up every word, every smile and every heartbeat and slowly, quietly, it grows. It grows into something so much bigger and more profound than she is. She’s just a child. She’s just a child who promised she’d save another but who doesn't know how. But one day, she looks at her box and she understands,” writes Abdullah, who will major in political science.

'It's a sad picture'

The Syrian civil war began in March 2011; the politics involved were not understandable to Abdullah. Would things return to normal? They did not, and have not since. She soon began losing friends – she estimates at least 20 people -- as thousands of children were tortured and killed.  She wanted to do something and make a difference, and not just be a bystander staying silent. So Abdullah began expressing her thoughts and feelings in story form.

Regarding the book’s front cover, Abdullah recalled that when she told the child who drew it how beautiful it was, the child replied, “Don’t lie, it’s a sad picture.” Despite the bright colors, one sees children in that drawing crying and a military airplane flying overhead dropping bombs. And, one of the girls pictured, Nour, is lost forever, likely dead, noted Abdullah. 

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In one story, “Call of the Jasmine,” a little boy named Karim writes an early letter to Santa Claus, worried that he may not be alive come December. “I know where I live is not very pretty and I know there’s not much in it for you, but mama says we’re beautiful where it counts.”

In another account, a child is given an injection of lethal poison. “Everything subsequently goes dark but I close my eyes anyway. The darkness will protect me.”

Some quotes from the book include, “When you write something down, it stays forever. It's like a little part of you that you're giving to the universe.” Abdullah also writes, “We live in a world where some people have already lost the game before having begun.”

As she describes the experience of war on children, “There is no Richter scale to measure pain; it leaves you vulnerable. It's not pain you can get used to, not sorrow that you can tame. It leaves you broken, broken but alive.”

Ultimately, one of her characters said, “Maybe life just wants to be noticed, like a sulking toddler, so it will keep throwing things our way until we finally give it the attention it deserves.”

Disconnected world

Abdullah says literature and art allow us to connect with each other in ways that any other medium would really struggle to match.

“We tend to think of refugees as statistics; death tolls in faraway lands we will never live in. We see children of war and never picture our own for we assume that we will never find ourselves packing up our lives and everything we know only to cross oceans for new homes that do not want us,” she said.

That disconnect is the greatest part of the problem. “We allow ourselves to feel distanced from these events and these people. I wonder how many people stop to think ‘this could be me,’” she said.

Abdullah said that when people read a story or watch a play, they are able to think beyond their own lives and feel what another’s pain is like.

“If stories and theater allow us all to live the harrowing life of a refugee, if only for just an hour, maybe we could all carry a little part of them inside of us and maybe then we’d want to push for change,” she added.

‘Community and unity’

President Trump’s recent travel ban for Muslims from seven different Middle Eastern countries has focused attention on Syrian refugees, Abdullah said. Now, media outlets are interviewing refugees and doing in-depth stories on them. She believes the protests and activism around the country and on campus reflects the desire by many to take a closer look at the victims of the Syrian war.

“We see a greater sense of community and unity, and people who might not have cared about these issues are starting to do so now. People are saying, ‘this is not right’ There is a sense of hope,” she said.

She said that living in constant fear of being hurt by others for what you believe in and in fear of being told you can no longer enter a country like the U.S. is something no one should have to experience.

“Nobody chooses where they are born,” Abdullah said.

“My friends in the Middle East are afraid that all the years they have spent working hard will amount to nothing if their education is interrupted. Those studying in the U.S. wonder whether they will be able to visit their families for the holidays and those in other countries are afraid that maybe the ban will spread to where they are, too.”

Power of writing

Abdullah said she’s always enjoyed writing; she started publishing when she was 13, and has written for student newspapers and magazines in her home country. “I saw that people were being touched, and thought it could have an effect.”

emma abdullahcropped Emma Abdullah
Her family, especially her father, have been highly supportive of her literary talents. In particular, her dad wanted her to reach English-speaking audiences with The Blue Box. “It was important to get it out there to other parts of the world,” she said.

Abdullah went to high school at the New English School in Kuwait. Her book has been adapted as a play by Alison Shan Price. Titled, “The Blue Box: The Memories of Children of War,” it premiered in Kuwait in 2015 and then internationally at the Edinburgh Festival Fringe in Scotland last year. 

For those seeking to help, Abdullah suggests making donations to the Syrian American Medical Society, which has helped with evacuations and humanitarian relief for children and others caught up in the crisis.

“The most important thing is not to forget them and not to allow anyone else to either. It is too easy to become indifferent, she said.

The Syrian war has dragged on for six years now, Abdullah said, and children continue to suffer and die every day.

“On a very small scale, the best thing you can do is talk about them and make sure your friends do, too. Learn more about the war and the refugee crisis so that you can spread the word,” she said.

People can donate to charities and NGOs that work with refugees, volunteer at charities, or even start their own fundraisers.

“Advocacy is crucial,” Abdullah said. “Protest, email or call your representatives and urge your government to increase their assistance to Syrian refugees, and encourage your friends to do the same.”

Follow CISAC at @StanfordCISAC and www.facebook.com/StanfordCISAC.

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Clifton B. Parker, Center for International Security and Cooperation: (650) 725-6488, cbparker@stanford.edu

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Bloomberg quotes REAP's research on China's healthcare system. Read the original article here

The outlines of China’s demographic challenge are well-known: By 2050 almost 27 percent of the population will be 65 or older, up from around 10 percent in 2015. Less recognized is that the crisis will hit hardest in rural villages.

China’s cities attract a disproportionate share of government health spending, along with the best doctors, so rural residents must put up with care that is expensive but shoddy. The average cost of a hospital visit is 50 percent of the annual income of a city dweller; for rural residents it’s 1.3 times annual income. Meanwhile, a 2014 survey by Stanford’s Rural Education Action Program found that patients at village health clinics received an accurate diagnosis only about one-quarter of the time. Overprescription of drugs is rampant. 

About 60 percent of China’s senior citizens live in rural areas, where poverty is widespread and health care is poor.

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Today, the Bulletin of Atomic Scientists’ “doomsday clock” moved 30 seconds forward to 2 and a half minutes to midnight. The closer the minute hand gets to midnight, the closer the bulletin predicts humankind is to destroying itself. The symbolic clock was created in 1947 when Albert Einstein and Robert Oppenheimer (the father of the U.S. nuclear program) founded the publication.

The following experts from the Center for International Security and Cooperation and the Freeman Spogli Institute for International Studies offered these perspectives:

William J. Perry, a former U.S. Secretary of Defense and senior fellow at the Center for International Security and Cooperation (CISAC), said: "Last year the Doomsday clock was set at 3 minutes to midnight, the closest it has been to global 'midnight' since the iciest days of the Cold War. This ominous pronouncement reflected my own fears that we were now in greater danger of nuclear catastrophe than we were during the Cold War, with the growing threat of nuclear terrorism, the continued risk of accidents and miscalculation, and the possibility of regional nuclear war and continued nuclear proliferation around the world."

He added, "Today the Bulletin of Atomic Scientists announced that we have moved closer to global catastrophe, for the first time setting the clock 30 seconds ahead to 2 and a half minutes to midnight, approaching a time not seen since the United States and Soviet Russia first developed the H-bomb. We must heed this dire warning as a call to action. There are concrete steps that we can take to reduce the risk of nuclear annihilation, but we must start today."

Siegfried Hecker, the former director of the Los Alamos National Laboratory and senior fellow at CISAC, said, "The bulletin’s keepers of the clock made the correct call to move the clock 30 seconds closer to midnight. The disregard for fact-based analysis of issues such as global climate change during the recent presidential campaign is truly alarming. However, my immediate concerns focus on the world having become a more dangerous nuclear place."

He said, "Developments in North Korea top the list: 2016 was a very bad year as Pyongyang greatly expanded its nuclear complex to increase the size of its arsenal to perhaps as many as 20 to 25 weapons, conducted two more nuclear tests to enhance the sophistication of its weapons, and launched two dozen missile tests. All of this while Washington cut all communications with a regime about which we know so little, while continuing the failed policies of sanctions and leaning on China to solve the problem."

"Confrontation," Hecker said, "has replaced cooperation between Russia and the United States. For the first time since the end of the Cold War the specter of a nuclear arms race was raised in 2016. President Putin put the finishing touches on suspending or terminating most of the cooperative nuclear threat reduction programs with the United States. Nuclear safety and security concerns appear to have taken a back seat to nuclear saber rattling and cyber attacks."

He noted, "Tensions between China and the United States have increased substantially over Beijing’s more muscular role in international affairs, particularly with its actions in the South China Sea. Moreover, tensions over Taiwan prompted by President Trump’s comments about the One-China policy renew the possibility of conflict."

"South Asia has inched closer to potential nuclear confrontation between India and Pakistan. India’s expanding economy and its concerns about Chinese military expansion has prompted it to strengthening its nuclear arsenal by moving toward a full triad – land, air and sea-based nuclear weapons. Pakistan, its much smaller and weaker neighbor, feels increasingly threatened by India’s expanding military. It has moved to what is called a posture of full-spectrum nuclear deterrence, which includes very dangerous tactical battlefield nuclear weapons that lower the nuclear threshold," Hecker said.

"Preventing and responding to potential acts of nuclear terrorism require close international cooperation. Unfortunately, all signs point in the opposite direction at a time when the atrocities perpetrated by terrorists are increasing. Greatest among these pullbacks was President Putin’s decision not to participate in the 2016 Nuclear Security Summit held in Washington, DC. With President Obama’s tenure having ended, this very effective collaborative international effort is now in limbo," he said.

MEDIA CONTACTS

Clifton B. Parker, Center for International Security and Cooperation: (650) 725-6488, cbparker@stanford.edu

Chaney Kourouniotis, Freeman Spogli Institute for International Relations: (6650) 724-9842, chaney.kourouniotis@stanford.edu

 

 

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Members of the Bulletin of Atomic Scientists deliver remarks on the 2017 time for the 'Doomsday Clock' Jan. 26, 2017 in Washington, DC. For the first time in the 70-year history of the Doomsday Clock, the Bulletin of Atomic Scientists moved the clock forward 30 seconds to two and a half minutes before midnight, citing 'ill-considered' statements by U.S. President Donald Trump on nuclear weapons and climate change, developments in Russia, North Korea, India and Pakistan.
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The benefits of screening depend on whether information changes individual behaviors. We study the National Health Screening Program in Korea which provides free general health screening to individuals aged over 40. We apply a regression discontinuity design to estimate behavioral responses to information about one’s risk classifications for diabetes, obesity, and high cholesterol. We find evidence of weight loss around the high risk threshold for diabetes, where risk information is combined with prompting for a secondary examination and medical treatment. However, we find no differences around other risk classification thresholds, where risk information is not combined with such prompting.
 
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Hyuncheol Bryant Kim
is an applied micro-economist with broad interests in  health economics, development economics, public economics, education economics, and labor economics. The main goal of Prof.Kim's research is to understand the impact and behavioral responses to the public intervention programs in both developed and developing countries. Prof.Kim has been investigating various public intervention programs such as cancer screening, general health screening, long-term care insurance, girls' education support program, HIV/AIDS prevention programs such as male circumcision and HIV testing, mother and child health program as well as job opportunity and internship program on employment.

 

Hyuncheol Bryant Kim Lois and Mel Tukman Assistant Professor, Department of Policy Analysis and Management (PAM), Cornell University
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