Tobacco now kills 90 times more people each year than HIV/AIDS in China. China's tobacco industry is closely tied to the global industry, and the Asia Health Policy Program is working to establish a new field of research on its history, beginning with a Mar. 2012 conference at the new Stanford Center at Peking University. Robert Proctor, a Stanford historian and author of a groundbreaking new book on the global tobacco industry, will take part.

Asia’s demographic landscape is changing in a big way. Japan’s population is shrinking, as people are living longer, marrying later, and choosing to have fewer or no children. Korea is moving in the same direction, while China and the countries of South and Southeast Asia face similar issues in the coming decades. As this takes place, more people are moving to, from, and across Asia for job, education, and marriage opportunities.

These demographic changes present policymakers with new challenges and questions, including: What are the interrelationships between population aging and key macroeconomic variables such as economic growth? How will it impact security? What are the effects on employment policy and other national institutions? How have patterns of migration affected society and culture? What lessons can Asia, the United States, and Europe learn from one another to improve the policy response to population aging?

The Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) focused its third annual Stanford Kyoto Trans-Asian Dialogue on addressing the possible economic, social, and security implications of Asia’s unprecedented demographic transition. Thirty scholars, government figures, journalists, and other opinion leaders from Stanford, the United States, and countries across the Asia-Pacific region gathered September 8–9, 2011, in Kyoto, Japan, to discuss key issues related to the question of demographic change.

Comparative Demographics and Policy Responses

Japan’s shrinking workforce calls for labor policy changes, stressed presenters during the opening Dialogue session. Stanford Center for Population Research director Shripad Tuljapurkar stated that Japan’s population could decrease by as much as 25 percent and that its government has a window of approximately 40 years in which to act. In describing Japan’s demographic shift, Ogawa Naohiro, director of the Nihon University Population Research Institute, also emphasized the importance of good financial education for individuals as life expectancy increases.

Macroeconomic Implications

Economists Masahiko Aoki and Cai Fang addressed changes to East Asia’s economic landscape. Aoki, an FSI senior fellow, spoke of the transition from agriculture to industry that has occurred at different stages in Japan, Korea, and China and of the increasing cost of human capital that has followed. Cai, a Chinese Academy of Social Sciences labor and population expert, stated that after several decades of industrial growth China is now at a turning point in terms of its global competitiveness.

Labor and Migration

Scott Rozelle, codirector of Stanford’s Rural Education Action Program (REAP), opened the next day with a discussion of China’s rural human capital investment. Offering Mexico’s situation after the mid-1990s peso crisis as a comparison, he emphasized the immediate need for allocating more health and education resources to China’s rural areas. Ton-Nu-Thi Ninh, president of Tri Viet University, discussed the socioeconomic and cultural aspects of labor migration—a growing trend in Asia—and advocated that governments factor it more into their foreign policy development.

Security

The security impact of Asia’s demographic transition will take several decades to understand, but it will eventually lead to the need for significant policy re-strategization, stated Yu Myung Hwan, Korea’s former minister of foreign affairs and trade, during the closing Dialogue session. He suggested focusing on impacts that could result from the major changes taking place in fertility, urbanization, and migration. Concurring with many of Yu’s views, Stanford’s Shorenstein Distinguished Fellow Michael H. Armacost also noted the current lack of literature on the link between security and demography. In addition, he emphasized the need for the United States to continue pursuing good relations with China and Russia during this time of transition.

“Low fertility rates are not because women are all out there working. In fact, a number of countries have lots of females in the labor force and have achieved a resurgence of fertility. Achieving work-life balance is important, not just for women, but for men as well, and might play a role in lessening the gap in life expectancy between men and women.”

-Karen Eggleston, Director, Asia Health Policy Program

Throughout the event, Dialogue participants unanimously acknowledged the serious challenges facing policymakers as they look for ways to meet the evolving needs of individuals, families, and organizations. The demographic outlook is not entirely gloomy, however. Numerous participants also pointed to the potential for exciting advances and innovations in technology and international cooperation.

As in previous years, the event concluded with a lively public symposium and reception attended by students from Stanford and local universities, Shorenstein APARC guests and affiliates, and members of the general public. Speaking during the reception, Kadokawa Daisaku, mayor of Kyoto, and Kim Hyong-O, member and former speaker of the Korean National Assembly, acknowledged the significance of the Stanford Kyoto Trans-Asian Dialogue as a forum for addressing issues of mutual importance to the United States and Asia.

The Dialogue is made possible through the generosity of the City of Kyoto, FSI, and Yumi and Yasunori Kaneko. To read the final report from this and previous Dialogues, visit the event series page below.

The November 17 Liberation Technology Seminar was co-hosted by the Stanford Institute for Economic Policy Research (SIEPR), a nonpartisan economic policy research organization that unites remarkable economic talent from all parts of Stanford University. This seminar featured four student-led design projects that were created in the Designing Liberation Technologies course taught each spring at Stanford's Hasso Plattner Institute of Design (d.school) by professors' Josh Cohen and Terry Winograd. The class works in partnership with the University of Nairobi's School of Computing and Informatics to develop user-based designs that address outstanding challenges in the slums of Nairobi, Kenya. 

Josh Cohen described the three main elements of the design school class:

(1) There is a focus on user/human-centered design. Projects are designed based on a close engagement with end users: the people who will be using the solutions. (2) Courses are inter-disciplinary. The idea is to take people who are deeply embedded in a certain discipline and put them together with people from other disciplines. In order to come up with a solution to a real problem, team collaboration is necessary and (3) The approach to problem solving is about practice, not about theory. It is necessary to fail early and fail often in the process of creating workable solutions.

The panelists consisted of students who were working with partners in Kenya on how mobile technology could be used to address various social issues. A multidisciplinary team of students work in close collaboration with partners in Kenya, and some of these ideas are now being tested on the ground.

The first project that was described was M-maji (mmaji.wordpress.com). Sangick Jeon described how water in Kibera is scarce, costly and contaminated. Their aim is to use the nearly ubiquitous mobile technology to improve access to water. Vendors are able to advertise their water and then buyers can ask questions and provide feedback. This saves the time and resources that it takes to find clean water.

Nishuari, the second project, addresses the problem of inaccurate advice and rumors which lead to risky sexual behavior and often HIV and AIDS. They provide a mobile counseling service whereby individuals can submit health questions and receive responses from trained counselors using text messages. This helps to break down logistical and social barriers.

The third, Makmende considered the issue of serious crime in Kibera. Their aim is to look at how individuals can get safely from Point A to Point B. They set up walking groups so that people would not have to walk alone. Over 90% of people had a mobile phone and this was seen to be an effective way of building timely communication, so that groups of people can coordinate to walk more safely to reach their destinations.

The final project was Take Taka, which was the one project that was not focused on using computer technology. The team took up sanitation as the project and decided early on that the use of mobile phones adds no value to the issue. The focused instead of designing a special sanitary bucket that could be used instead of a toilet inside the home, and on developing a system of transmitting the deposits to a biogas unit. This project however has not been carried forward.

Two Stanford graduates with close ties to FSI’s centers have been named 2012 Rhodes Scholars. A third was selected as a Mitchell Scholar.

Anand Habib was a graduate of the 2011 CISAC honors program in international security studies and a 2010 Dachs undergraduate intern. Habib and Katherine Niehaus – who is now a research assistant for a CHP/PCOR project evaluating whether HIV medication increases the risk of cardiovascular disease – will study at the University of Oxford in England under the Rhodes program. 

Philippe de Koning, who will study in Ireland as a Mitchell fellow, wrote a manuscript about Japan’s defense and financial crisis with Shorenstein APARC faculty member Phillip Lipscy. Lipscy, a political scientist, was de Koning’s advisor through his undergraduate career and also advised him on his senior thesis. De Koning was also a 2010 CISAC honors student.

More about the scholars:

Anand R. Habib, 22, of Houston, Texas, is a 2011 graduate of Stanford, where he earned a bachelor's degree in biology, with honors in international security studies. He plans to pursue a master's degree in public policy and in medical anthropology at Oxford.

Habib is working on community health programs at St. Joseph's Clinic in Thomassique, Haiti, under a one-year global health fellowship awarded by Medical Missionaries. The nonprofit organization is a volunteer group of more than 200 doctors, nurses, dentists, and others who work to improve the health of the poor in the United States and throughout the world.

In 2011, he won a Deans' Award for Academic Accomplishment, which honors extraordinary undergraduate students for "exceptional, tangible" intellectual achievements. One of the professors who nominated him for the award described him as a "superb critical thinker" whose work is characterized by "creative genius" and "mature insights," adding that he "exemplifies exactly the kind of deeply informed, pragmatic and caring leadership that the world needs and Stanford enables."

As a Stanford student, Habib worked on behalf of politically and medically disenfranchised people in India, Mexico and Guatemala. His field research internship in Guatemala’s indigenous region during summer 2010 was carried out under the supervision of Paul Wise, professor of pediatrics and FSI senior fellow, as part of FSI’s Dachs mentored undergraduate research program.  On campus, he turned the Stanford tradition of the annual Dance Marathon into a vehicle dedicated to addressing the HIV/AIDS pandemic by engaging not only Stanford students but also local communities and corporations, raising more than $100,000. His exceptional work was recognized by his participation in the Clinton Global Initiative University Conference in April, 2011.

Katherine "Kate" Niehaus, 23, of Columbia, S.C., earned a bachelor's degree in biomechanical engineering in 2010 and a master's degree in bioengineering in 2011 – both at  Stanford. Her class and research work focused on biomechanics and her interests lie in its applications to high technology entrepreneurship.

She plans to pursue a doctorate of philosophy in systems approaches to biomedical science at Oxford.

At Stanford, Niehaus captained Stanford's varsity track and cross country teams, won the Pac-10 5,000 meters, and won Academic-All American status. She also served as a mentor and tutor for students in low-income families.

Working with faculty in the Center for Health Policy, Kate led a project to evaluate how well newer HIV antiretroviral drugs work compared with older drugs.  Her work was among the first to evaluate comprehensively all of the trials of new drugs in treatment of experienced patients, and showed that these drugs have substantial benefits.

Philippe de Koning, 22, of Paris, France, earned a bachelor's degree in international relations at Stanford in 2010. He plans to pursue a master's degree in international security and conflict resolution at Dublin City University.

He is a Herbert Scoville Jr. Peace Fellow at the Nuclear Threat Initiative in Washington, D.C. The nongovernmental organization works to prevent nuclear, chemical, and biological threats from materializing. De Koning is researching nuclear materials security and the U.S.-China dialogue on nuclear issues.

De Koning, who earlier was awarded a Fulbright Scholarship, spent the 2010-2011 academic year at Hiroshima University in Japan. He examined various components of Japanese security policy, with emphasis on current evolution of Japanese Self-Defense Forces, policies on nuclear issues and approaches toward peacekeeping.

In 2009, he was a member of the Stanford delegation to the United Nations Climate Change Conference in Copenhagen.

Congratulations to Anand Habib, selected this weekend for a Rhodes Scholarship. Habib, 22, of Houston, Texas, is a 2011 graduate of Stanford, where he earned a bachelor's degree in biology, with honors in international security studies. He plans to pursue a master's degree in public policy and in medical anthropology at Oxford.

Habib is currently working on community health programs at St. Joseph's Clinic in Thomassique, Haiti, under a one-year global health fellowship awarded by Medical Missionaries. The nonprofit organization is a volunteer group of more than 200 doctors, nurses, dentists, and others who work to improve the health of the poorest of the poor in the United States and throughout the world.

In 2011, he won a Deans' Award for Academic Accomplishment which honors extraordinary undergraduate students for "exceptional, tangible" intellectual achievements. One of the professors who nominated him for the award described him as a "superb critical thinker" whose work is characterized by "creative genius" and "mature insights," adding that he "exemplifies exactly the kind of deeply informed, pragmatic and caring leadership that the world needs and Stanford enables."

As a Stanford student, Habib worked on behalf of politically and medically disenfranchised people in India, Mexico and Guatemala. On campus, he turned the Stanford tradition of the annual Dance Marathon into a vehicle dedicated to addressing the HIV/AIDS pandemic by engaging not only Stanford students but also local communities and corporations, raising more than $100,000. His exceptional work was recognized by his participation in the Clinton Global Initiative University Conference in April, 2011.

From Haiti, Habib discussed his current position, his plans in Oxford, and how his CISAC thesis relates to his work. 

What are you currently working on? 

I am currently working on a global health fellowship with an NGO that operates a clinic in Haiti's Central Plateau. As part of the fellowship I am helping to manage a number of community and public health projects including fortified salt (to counter iodine deficiency and filariasis), a point-of-use potable water system, a malnutrition intervention program, and a small system of community health committees and community health workers. For the past two months, I've taken on a number of administrative functions along with my co-fellow, who is also a recent college graduate. I started the fellowship shortly after graduation at the end of June 2011 and I am slated to be in Haiti until the end of June 2012.

What will you do at Oxford?

I proposed two one-year Masters programs: a masters in public policy from Oxford's new Blavatnik School of Government, and an M.Sc. in medical anthropology. As of now, I'm thinking of sticking with my proposed programs -- probably pursuing the medical anthropology degree first as it is a bit more theoretical. I think it would be better to have the more "academic" experience first before gaining the practical tools that an MPP will hopefully afford me. After a short send-off in Washington, D.C., at the end of September 2012, I will fly with the other American Rhodes Scholars-elect to Oxford the first week of October with term beginning shortly thereafter.

How does your work in the CISAC Honors program relate to what you are currently doing, your plans for Oxford, or what you'll be doing afterward? 

My honors thesis has allowed me to contextualize my experiences in Haiti in some fairly amazing ways. Two very persistent issues in Haiti are that of poor governance -- e.g. lack of strong regulatory structures, lack of government effectiveness, etc. -- and ineffective aid modalities, or the ways in which aid is delivered. My thesis was situated exactly at this nexus: how to deliver aid more effectively in order to improve governance. Ninety-nine percent of relief aid after the 2010 earthquake in Haiti was funneled to non-state organizations and only 12 percent of recovery aid went toward supporting government activities. In Haiti, I've witnessed how detrimental a patchwork system of NGO activity can be with little coordination between NGOs and little harmonization of NGO activities with government objectives. It becomes very frustrating at times, because, if my thesis is any indication, things need not be this way if both NGOs and states were engaged in collaborative partnerships -- along the lines of what Dr. Paul Farmer, deputy U.N. special envoy to Haiti, calls "accompaniment."

My initial interest in the topic of global health financing was spurred by work out of Oxford's Global Economic Governance Project. The director of the project, Dr. Ngaire Woods, was actually named the Dean of the Blavatnik School of Government through which the MPP is offered. I'd love to continue exploring the issues broached in my thesis at Oxford -- especially issues of aid effectiveness and sustainable systems of delivering development aid for health. In the future, I hope to become a physician-policymaker, helping to not only deliver care to individuals in difficult conditions around the world, but also in fostering more robust global health governance.

- Interview by Michael Freedman

 

When Siyan Yi was a medical student in Cambodia 12 years ago, he volunteered with a collaborative government-NGO project to provide young women at high risk for HIV/AIDS—the victims of sexual exploitation—with housing, vocational training, medical care, and psychological support. Cambodia at that time had one of Asia’s highest HIV-infection rates.

That rate has dropped by half, thanks to government policy measures, international NGO support, and the efforts of medical professionals like Yi. Cambodia’s government must now find ways to curb HIV infection in new segments of the population, says Yi, who is the Shorenstein Asia-Pacific Research Center’s inaugural Developing Asia Health Policy Fellow. Sustaining funding for the long-term care of HIV-infected individuals also poses a future challenge, he explains, and new health issues associated with development are beginning to crop up.

Cambodia’s first HIV case was detected in 1991 in a blood donor, and the rate of HIV/AIDS increased dramatically throughout the decade. HIV/AIDS hit Thailand slightly earlier, and was spread through the commercial sex trade. The epidemic reached an even greater scale there than it ever did in Cambodia.

Thailand’s government struck back with a 100-percent condom use promotion program, which Cambodia successfully adopted in the late 1990s. Brothels are illegal in Cambodia, but the government worked cooperatively with owners to provide basic HIV/AIDS education to sex workers. These efforts significantly reduced the transmission of HIV.

Since then, a more indirect form of prostitution has sprung up in places such as karaoke halls, massage parlors, restaurants, and even in factories. HIV prevalence remains high among some sentinel groups such as female sex workers, beer promoters, men who have sex with men (MSM), injected-drug users, and migrant workers.

Yi advocates that the government expand the scope of its HIV/AIDS prevention programs to encompass these new at-risk populations. He even suggests that the government consider creating a system of licensed brothels such as previously existed in Hong Kong and Taiwan. “It would provide the government with an easier means of controlling prostitution, and allow it to work with brothel owners to control HIV-infection rates,” states Yi.

HIV increases the risk of contracting or developing symptoms of tuberculosis; a large proportion of Cambodia’s population carries the disease but shows no signs of it. Tuberculosis went largely undetected during the decades of the Khmer Rouge regime, but with the advent of HIV/AIDS it has become more prevalent. Yi has been involved in government-NGO projects to provide tuberculosis screening for HIV patients, including a tuberculosis control project with the Japan International Cooperation Agency.

Tuberculosis screening and HIV treatment advances may greatly prolong the life—and even improve the health—of patients. But heartening as Cambodia’s success against HIV/AIDS has proven in the past decade, the government largely bears the responsibility for funding the expensive treatment and care for the low-income individuals most affected by it. A critical portion of government funding for its HIV/AIDS prevention programs comes from external organizations. 

“I think that the main issue for the government of Cambodia in the battle against HIV and AIDS is financial sustainability,” says Yi, who worries that donor agencies will withdraw support as the HIV-infection rate continues to improve. Prevention is less expensive, he explains, but long-term care is costly to a developing country such as Cambodia.

Yi, however, feels less concerned now about the HIV/AIDS epidemic and speaks hopefully of working to help the government find ways to measure and treat non-communicable diseases associated with economic development, such as diabetes and hypertension. While he is at Stanford, he will collaborate with Asia Health Policy Program researchers to move his work toward solving Cambodia’s new health challenges.

Blaming leaders in America and abroad for not doing enough to combat climate change, former United Nations Secretary-General Kofi Annan said continued failure to tackle the problem will result in worldwide hunger, social unrest and political turmoil.

“Without action at the global level to address climate change, we will see farmers across Africa – and in many other parts of the world including here in America – forced to leave their land,” the 2001 Nobel Peace Prize winner told a crowd of about 1,400 people at Stanford’s Memorial Auditorium on Thursday. “The result will be mass migration, growing food shortages, loss of social cohesion and even political instability.”

Citing numbers from the World Bank, Annan said rapidly rising food prices since 2010 have “pushed an additional 70 million people into extreme poverty.” He called a lack of food security for nearly 1 billion of the world’s population “an unconscionable moral failing” that is also a stumbling block to a strong international economy.

“It affects everything from the health of an unborn child to economic growth,” he said.

Annan’s talk, “Food Security Is a Global Challenge,” was delivered as part of a daylong conference on global underdevelopment sponsored by Stanford’s Freeman Spogli Institute for International Studies. The event drew the world’s leading experts in the field and featured panel discussions that explored the connections between global security and food supplies, health care and governance. Keynote speeches were delivered by Annan and Jeff Raikes, CEO of the Bill & Melinda Gates Foundation. Former Secretary of Defense Robert Gates also planned to deliver a talk to a private audience.

The conference marked the launch of FSI’s Center on Food Security and the Environment.

“With this facility, and the creative thinkers and inquisitive minds for which Stanford is famous, you are well-equipped to undertake research which advances our knowledge and helps to shape our response to the many global challenges we face,” Annan said. “And with the resources at your disposal, you also have the capacity to actively engage to influence policy, implement solutions and thus improve the lives of the most vulnerable people on the planet.”

Annan also lauded government initiatives such as America’s Feed the Future program that focus on alleviating global hunger. He recently met with Secretary of State Hillary Clinton, Secretary of Agriculture Tom Vilsack and Raj Shah, head of the U.S. Agency for International Development, to discuss ways to address food insecurity.

“If we pool our efforts and resources, we can finally break the back of this problem,” he said.

But he challenged wealthier nations to do more than pay lip service to the problem.

“We need to make sure that promises of extra support from richer countries are kept and involve fresh funds rather than the repackaging of existing financial commitments,” he said.

Annan, who is the chair of the Kofi Annan Foundation, the Africa Progress Panel, and the Alliance for a Green Revolution in Africa, said Africa represents both the greatest problem and the greatest promise when it comes to food security.

The continent is home to 60 percent of the world’s uncultivated arable land, but cannot produce enough food to feed its own people, he said. But if Africa can grow just half the world’s average yield of staple crops like wheat, corn and rice, it would end up with a food surplus.

Transforming Africa into one of the world’s biggest crop producers will take more than supporting farmers, he said. It entails sound environmental stewardship.

 “I hope this is an area where the Center on Food Security and the Environment can make a major contribution to finding solutions,” Annan said.

Without those solutions, the future is bleak.

In Sub-Saharan Africa, where global warming brings the threat of persistent drought, current crop production is expected to be cut in half by the end of the century and 8 percent of the region’s fertile land is expected to dry up.

“Those arguing, here and elsewhere, for urgent action and a focus on opportunities to green our economies still find themselves drowned out by those with short-term and vested interests,” Annan said. “This lack of long-term collective vision and leadership is inexcusable. It has global repercussions, and it will be those least responsible for climate change – the poorest and most vulnerable – that will pay the highest price.”

Annan's speech was sponsored by FSI, Stanford in Government and the Stanford University Speakers Bureau.