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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Space is more important than ever for the security of the United States, but it’s almost like the Wild West in terms of behavior, a top general said today.

Air Force Gen. John Hyten, commander of the U.S. Strategic Command, spoke Jan. 24 at Stanford’s Center for International Security and Cooperation. His talk was titled, “U.S. Strategic Command Perspectives on Deterrence and Assurance.”

Hyten said, “Space is fundamental to every single military operation that occurs on the planet today.” He added that “there is no such thing as a war in space,” because it would affect all realms of human existence, due to the satellite systems. Hyten advocates “strategic deterrence” and “norms of behavior” across space as well as land, water and cyberspace.

Otherwise, rivals like China and Russia will only threaten U.S. interests in space and wreak havoc for humanity below, he said. Most of contemporary life depends on systems connected to space.

Hyten also addressed other topics, including recent proposals by some to upgrade the country’s missile defense systems.

“You just don’t snap your fingers and build a state-of-the-art anything overnight,” Hyten said, adding that he has not yet spoken to Trump administration officials about the issue. “We need a powerful military,” but a severe budget crunch makes “reasonable solutions” more likely than expensive and unrealistic ones.

On the upgrade front, Hyten said he favors a long-range strike missile system to replace existing cruise missiles; a better air-to-air missile for the Air Force; and an improved missile defense ground base interceptor.

‘Critically dependent’

From satellites to global-positioning systems (GPS), space has transformed human life – and the military – in the 21st century, Hyten said. In terms of defining "space," the U.S. designates people who travel above an altitude of 50 miles as astronauts.

As the commander of the U.S. Strategic Command, Hyten oversees the control of U.S. strategic forces, providing options for the president and secretary of defense. In particular, this command is charged with space operations (such as military satellites), information operations (such as information warfare), missile defense, global command and control, intelligence, surveillance, and reconnaissance, global strike and strategic deterrence (the U.S. nuclear arsenal), and combating weapons of mass destruction.

Hyten explained that every drone, fighter jet, bomber, ship and soldier is “critically dependent” on space to conduct their own operations. All cell phones use space, and the GPS command systems overall are managed at Strategic Command, he said.

“No soldier has to worry about what’s over the next hill,” he said, describing GPS capabilities, which have fundamentally transformed humanity’s way of life.

Space needs to be available for exploration, he said.

“I watch what goes on in space, and I worry about us destroying that environment for future generations.” He said that too many drifting objects and debris exist – about 22,000 right now. A recent Chinese satellite interception created a couple thousand more debris objects that now circle about the Earth at various altitudes and pose the risk of striking satellites.

“We track every object in space” now, Hyten said, urging “international norms of behavior in space.”

He added, “We have to deter bad behavior on space. We have to deter war in space. It’s bad for everybody. We could trash that forever.”

But now rivals like China and Russia are building weapons to deploy in the lower levels of space. “How do we prevent this? It’s bigger than a space problem,” he said.

Deterring conflict in the cyber, nuclear and space realms is the strategic deterrence goal of the 21st century, Hyten said.

“The best way to prevent war is to be prepared for war,” he said.

Hyten believes the U.S. needs a fundamentally different debate about deterrence. And it all starts with nuclear weapons.

“In my deepest heart, I wish I didn’t have to worry about nuclear weapons,” he said. Hyten described his job as “pretty sobering, it’s not easy.”

But he also noted the mass violence of the world prior to 1945 when the first atomic bomb was used. Roughly 80 million people died from 1939 to 1945 during World War II. Consider that in the 10-plus years of the Vietnam War, 58,000 Americans were killed. That’s equivalent to two days of deaths in WWII, he said.

In a world without nuclear weapons, a rise in conventional warfare would produce great numbers of mass casualties, Hyten said. About war, he said, “Once you see it up close, no human will ever want to experience it.”

Though America has “crazy enemies” right now, in many ways the world is more safe than during WWII, Hyten said. The irony is that nuclear weapons deterrence has kept us from the type of mass killings known in events like WWII. But the U.S. must know how to use its nuclear deterrence effectively.

Looking ahead, Hyten said the U.S. needs to think about space as a potential war environment. An attack in space might not mean a response in space, but on the Earth.

Hyten describes space as the domain that people look up at it and still dream about. “I love to look at the stars,” but said he wants to make sure he’s not looking up at junk orbiting in the atmosphere.

‘Space geek’

Hyten has served in the Air Force for 35 years. He originally wanted to be an astronaut, but his eyesight was too bad. He got a waiver, and graduated Harvard in 1981 with an engineering degree on a ROTC scholarship. He entered the Air Force thinking he would only do four years. But then he had a close-up view of what a young Air Force officer could find in the last frontier of space as satellites and military space science were booming.

“God, I love space,” he said.

In introducing Hyten, Amy Zegart, co-director of CISAC, described him as a person of unwavering dedication and profound insights who understands the gravity of situations. “A self-described space geek,” she said.

Hyten lauded CISAC for its research and educational work on national security, and said he enjoyed being around people willing to test out new ideas and discuss potential solutions for vexing problems.

Earlier in the day on campus, Hyten met with William J. Perry, a former U.S. Secretary of Defense and senior fellow at CISAC; George Shultz, a former U.S. Secretary of Defense and senior fellow at the Hoover Institution; and Condoleezza Rice, a senior fellow at the Freeman Spogli Institute for International Studies and Hoover Institution.

General Hyten was nominated for reassignment to head the U.S. Strategic Command on Sept. 8, 2016. He commanded Air Force Space Command from 2014 to 2016.

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

MEDIA CONTACTS

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

 

 

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Air Force Gen. John Hyten, commander of the U.S. Strategic Command, spoke Jan. 24 at Stanford’s Center for International Security and Cooperation.
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Improving the U.S.-China relationship is a focus at the Center for International Security and Cooperation.

CISAC continued this tradition in co-sponsoring the 8th Sino-U.S. Security Relations and Cooperation Conference in Beijing from Dec. 14-15, 2016. The conference was hosted and co-sponsored by the Foreign Ministry's China Institute of International Studies (CIIS).

Ambassador Su Ge, president of CIIS, attended the conference and delivered an opening remark. FSI’s Thomas Fingar and Teng Jianqun from CIIS chaired the conference.

Fingar said, “Although held at a time of uncertainty about the future of U.S.-China relations, the conference included constructive exchanges on strategic stability, obstacles to cooperation in space, and other sensitive topics.”

He added, “The exchanges were frank and constructive because they built on the foundation of understanding and trust developed through years-long exchanges between CISAC and CIIS. In the next phase, small teams of American and Chinese experts will develop joint blueprints to enhance understanding of issues critical for nuclear stability and space cooperation.”

CISAC co-founder John W. Lewis has been active for many years encouraging and supporting better ties between the U.S. and China. He is an expert on Chinese politics, U.S.-China relations, China's nuclear weapons program, U.S. policy toward Korea and health security issues in northeast Asia.

During this most recent Beijing conference, scholars and security experts from both the U.S. and China held in-depth discussions on topics including cybersecurity, outer space cooperation, maritime dispute management, missile defense, grey zone cooperation, and China-U.S. nuclear issues.

The American attendees included scholars from CISAC (Fingar, Brad Roberts, and Joseph Torigian); Brad Roberts, director, Center for Global Security Research, Lawrence Livermore National Laboratory; Major General Roger W. Burg, former commander, 20th Air Force; Vice Admiral Michael Connor (retired), U.S. Navy; Lieutenant General Susan J. Helms (retired), U.S. Air Force general and former NASA astronaut; Lieutenant General James M. Kowalski (retired), U.S. Air Force general; Steven M. Benner,chief, Strategy and Campaign Division, U.S. Strategic Command, among others.

The Chinese experts came from a variety of institutions – CIIS, China Academy of Engineering Physics, the People’s Liberation Army (PLA) Rocket Force, Rocket Force College, China Defense Science and Technology Information Center, PLA Navy Academy of Military Science, PLA South Command, Chinese Academy of Social Science, Renmin University of China, National Defense University, Tsinghua University, etc. 

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

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India is a focus of colloquia at the Shorenstein Asia-Pacific Research Center during the next few months. A seminar series entitled “A New India? The Impact of 25 Years of Reform” will explore the country’s economic growth and efforts to revitalize its foreign relations.

The colloquia, co-sponsored by Stanford’s Center for South Asia, will include lectures from scholars, policymakers and other thought leaders on India’s democratic system and society, and provide a forum to discuss how the country can overcome obstacles to long-term prosperity.

Kathleen Stephens, the William J. Perry Fellow at Shorenstein APARC and former U.S. ambassador to the Republic of Korea, has organized and will moderate the colloquia. She served as the chargé d'affaires at the U.S. Embassy in New Delhi in 2014.

Stephens said, “Now is the right time and Stanford is the right place for a renewed focus on India, its daunting challenges and its extraordinary potential. This series will consider the strategic bet U.S. policymakers have made on India's rise, and India's own aspirations to play a bigger global role, particularly in Asia.

“In this series and beyond, we want to knit together the expertise and resources at Stanford and in Silicon Valley with policy leaders from India and elsewhere to expand our understanding of India in all its contemporary complexity and importance.”

From 1999 to 2013, Shorenstein APARC had a prolific initiative that supported scholarly work related to South Asia. The center envisions the colloquia will be some of many activities about the region going forward.

A listing of the seminars and related multimedia can be accessed here; more information will be added as it becomes available.

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"Most civilian casualties in war are not the result of direct exposure to bombs and bullets; they are due to the destruction of the essentials of daily living, including food, water, shelter, and health care."

 

So begins the abstract for an essay in the Winter 2017 edition of Daedalus by Stanford Health Policy’s Paul Wise, the Richard E. Behrman Professor of Child Health and Society and professor of pediatrics at the Stanford School of Medicine.

Wise argues in his essay, “The Epidemiologic Challenge to the Conduct of Just War: Confronting Indirect Civilian Casualties of War," that the death of any child is always a tragedy. But the death of a child from preventable causes is particularly unjust.

“This is, of course, as true in peacetime as it is in war,” he writes. “My argument is that the dramatic growth in our ability to prevent death and disability from the indirect effects of war generates not only humanitarian impulses, but also just war demands for the provision of this capability to populations affected by war.”

The American Academy of Arts & Sciences devoted its Fall 2016 and Winter 2017 issues of its journal, Daedalus, to the theory of Just War. It held its 204th annual meeting at Stanford University in November, with Wise reviewing the main points of his essay. Other speakers included Stanford President Marc Tessier-Lavigne and FSI's Scott Sagan and Joe Felter.

(Videos of all their talks can be found on this page. And you can listen to their conversations in this World Class podcast, "Ethics in War," by the Freeman Spogli Institute for International Studies.)

 

Just War is a theory dating back to the early Christian theologians, who called on warring parties to justify their use of force and to protect noncombatants and innocent civilians.

The statisticians of war and genocide typically look at the total number of deaths due to combat or murder: 5 to 6 million Jews were exterminated in the Holocaust; the Second Congo War from 1998-2003 is estimated to have claimed more than 3 million civilian lives in direct combat.

More recently, the nonprofit organization, I Am Syria, estimates that 450,000 civilians, 50,000 of whom were children, have been killed in the Syrian civil war that erupted up March 2011. But how many will have died in the eventual aftermath due to lack of medical care, food and shelter?

It is estimated that 2 million Congolese, for example, died from starvation and lack of food and medical care in the years following its civil war.

The numbers that make it to the history books often do not reflect the indirect deaths that come on the sidelines and aftermath of war, particularly among children 5 years old and younger. During the periods of intense conflict in the Democratic Republic of Congo and Darfur, direct trauma-related mortality accounted for less than 20 percent of all excess deaths among children. The leading causes of the excess deaths on top of direct conflict were fever and malaria, measles, diarrhea and acute respiratory infections. In Syria, many of those children who have survived likely will have medical and mental repercussions that will be debilitating or deadly.

Wise notes that a report published by the Geneva Declaration Secretariat suggests that for every violent death resulting from combat and conflict between 2004 and 2007, four more died from war-associated elevations in malnutrition and disease. Global health scholars reported that about one-third of all deaths in Iraq were due to indirect causes.

This is why health-care workers are “the ultimate inheritors of failed social order,” said Wise, who is also a senior fellow at the Freeman Spogli Institute for International Studies. “Sooner or later, a breakdown in the bonds that define collective peace, indeed that ensure social justice, will find tragic expression in the clinic, on the ward, or in the morgue.”

That is the extremely bad news. But there is also some good.

Technological advances to prevent conflict and protect civilians have expanded dramatically, such as social media platforms that allow victims of war to communicate instantly and globally, and the crowdsourcing and early-warning SMS systems that take advantage of the more than 2 billion cellphone users around the world.

The United Nations is looking at GPS tracking systems to protect peacekeeping convoys on search-and-rescue missions, according to another article in the Fall 2016 issue of Daedalus. In another example, the International Bar Association created the eyeWitness to Atrocities app for smartphone cameras designed to record and authenticate atrocities.

All this new technology is allowing for advances in epidemiologic and demographic measurement out in the field, Wise said.

“In the context of just war, technical innovation means more than the creation of more powerful and precise munitions,” Wise writes. “It also means an enhanced capacity to measure and reduce the human impact of war.

“Innovation in these two technical domains — measurement and mitigation — has been sufficient to rethink the application of Just War theory to the indirect effects of war.”

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Wise runs the Stanford Children in Crisis Initiative, which seeks to save the lives in children who are suffering from conflict and poor governance. Stanford students and local health-care promoters in rural Guatemala have been working with him for decades to try and end death by malnutrition and other causes among young children there.

The initiative last summer launched an app for tablets, which is making it easier to find malnourished children and decrease the training time for new health promoters. The goal is to eventually distribute the application globally.

The international aid community’s growing ability to measure the indirect impact of war, coupled with the ability to prevent or mitigate the indirect human toll of war, is remarkable, Wise said.

“Advances in epidemiology and the technological means of collecting health data have generated a range of new opportunities to assess the immediate and protracted effects of war,” Wise said. “This field is still young and these new technical strategies are creating an unprecedented capacity to assess the impact of war in even remote communities.”

 

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A Syrian boy sits with belongings he collected from the rubble of his house in Aleppo's Al-Arkoub neighbourhood on Dec. 17, 2016, after pro-government forces retook the area from Syrian rebel fighters.
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South Korea, the most rapidly aging society in the world, introduced a public long-term care insurance (LTCI) program with universal coverage in 2008. This presentation will begin with the socioeconomic and political context of the introduction of the LTCI and explain the finance and provision of LTCI in Korea, compared to the LTCIs of Germany and Japan. It will provide recent evidence on the performance of the LTCI along with its prospects and lessons for other countries.

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Hongsoo Kim is an associate professor at the Graduate School of Public Health at Seoul National University (SNU), South Korea, and a 2016-2017 Fulbright Visiting Scholar & Takemi Fellow in International Health at Harvard School of Public Health, United States. Her research areas include aging and health policy, long-term care systems, and health system performance assessment. She is currently involved the Comparative Diabetes Net Value Project led by Dr. Karen Eggleston at Stanford University. She was formerly the scientific committee chair of the Korean Academy of Long-term Care, the Korean Gerontological Society, and the Korean Society of Health Policy and Administration. She received her PhD from New York University, where she worked as assistant professor before she joined SNU. 

 

 

Hongsoo Kim Fulbright Scholar & Takemi Fellow at Harvard School of Public Health, U.S.; Associate Professor at Seoul National University Graduate School of Public Health, South Korea
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This seminar will discuss the marriage distortion and the associated welfare loss caused by the One-Child Policy (OCP) in China. Using the variation in the ethnicity-specific assigned birth quotas and different fertility penalties across provinces over time, we first show that the OCP induced a significantly higher unmarried rate and more interethnic marriages. Using sufficient statistics approach, we then derive a formula for the social welfare loss caused by the OCPinduced lower fertility and marriage distortion, and it only depends on the estimated reducedform elasticities. Our estimates suggest that the associated welfare loss is around 3.7 percent of annual household income, with marriage distortion contributing 30 percent of this. These findings highlight the unintended behavioral responses to public policies and corresponding social consequences.

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Yi Zhou is a PhD candidate in Demography at University of California – Berkeley. His research interests include Economic Demography, Formal Demography and Health Economics. He received a M.A. in Economics and a B.B.A. in Accounting from Peking University."

 
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Yi Zhou Department of Demography, University of California, Berkeley
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Abstract: Globally, infectious diseases are emerging at an increasing rate. Vector-borne diseases in particular present one of the biggest threats to public health globally. Many of these diseases are zoonotic, meaning they cycle in animal populations but can spillover to infect humans. As a result, risk to humans of acquiring a zoonotic or vector-borne disease largely depends on the distribution and abundance of the reservoir hosts—the species of animals that pathogens naturally infect—as well as of the vector species. The ecology of many reservoir hosts and vectors is rapidly changing due to global change, which will fundamentally alter human disease risk in as yet unforeseen ways. In this talk, I will present and discuss three lines of research aimed at identifying drivers of disease emergence and risk at multiple spatial scales including 1) the ecological and environmental drivers of Lyme disease in California, 2) the roles of human behavior and land use in driving human Lyme disease in the northeastern US, and 3) effects of deforestation, land use policy and socio-ecological feedbacks in driving malaria in the Brazilian Amazon.

About the Speaker: Andrew MacDonald is a disease ecologist and a National Science Foundation Postdoctoral Fellow in Biology at Stanford University. He received his PhD from the Department of Ecology, Evolution and Marine Biology at the University of California, Santa Barbara in September 2016. His dissertation focused on the effect of land use and environmental change on tick-borne disease risk in California and the northeastern US. His current work focuses on coupled natural-human system feedbacks and land use change as drivers of mosquito-borne disease, with a focus on malaria in the Amazon basin.

Encina Hall, 2nd floor

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The health gap between rich and poor children in developing countires is staggeringly high, but Assistant Professor of Medicine Eran Bendavid found that it is shrinking. In his pilot project, "Empirical Evidence on Wealth Inequality and Health in Developing Countries," Bendavid discovered that since the mid-2000s, life expectancies for children under five are starting to converge. How can we continue to close the gap? Watch to find out.

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Start the year off by planning for summer 2017! Each summer FSI offers exciting and intensive internship opportunities to Stanford students. Our fully-funded program options include:

  • Global Policy Internships: provides placement, mentorship and a stipend to students engaging in off-campus internships at international policy and international affairs organizations. 
  • Summer Field Research Internships: provides a unique opportunity for groups of 2-8 students to work directly on applied field research projects with Stanford faculty around the world. 

To attend our info session to learn more about each program, RSVP here by Jan. 17th!

Applications are due by February 7th, 2017.

Food will be provided.

 

Reuben Hills Room
Encina Hall, 2nd Floor
616 Serra St
Stanford, CA 94305

 
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As 2017 approaches, the Shorenstein Asia-Pacific Research Center documents highlights from the 2015-16 academic year. The latest edition of the Center Overview, entitled "Challenges to Globalization," includes research, people, events and outreach features, and is now available for download online.

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