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Antibiotics have represented the primary line of defense for treating bacterial infections since 1935 when the first sulfur-containing compounds were introduced. Many antibiotic compounds are produced naturally by microorganisms while some more recently developed antibiotics are chemically designed based on a knowledge of susceptible biochemical pathways or physiological processes in pathogenic bacteria. Ciprofloxacin (“cipro”), a synthetic broad-spectrum antibiotic, functions by interfering with DNA replication.

Increased use and mis-use of antibiotics has led to increased numbers of pathogenic bacteria that are resistant to one or more antibiotics. Some resistant microbes possess mechanisms that allow continued growth in the presence of multiple antibiotics. These multiply drug-resistant pathogenic bacteria may also possess pathogenic properties that result in significantly more severe disease than their drug-sensitive cousins. Medical misuse of antibiotics – prescribing antibiotics for viral infections, failure of patients to complete treatment with the full regiment of antibiotics, or application of antibiotics based on inaccurate or incomplete tests can lead to selection of antibiotic resistant bacteria that can then cause infections that cannot be treated with the antibiotic(s) to which they are resistant. Multiple drug resistance can quickly reduce or eliminate all antibiotic-based treatment options. Infections caused by antibiotic resistant bacteria are very difficult to treat and can sometimes lead to death of the patient.

Antibiotic resistance can also result from selection based on exposure to antibiotics present in the environment. More than 70% of the antibiotics sold in the U.S. are used as supplements to animal feed. The intestinal bacteria in the animals provided with such feed often show resistance to the antibiotics in the feed and, in some documented cases, have transferred this resistance to pathogenic microbes with which they share the environment.

A brief of history of antibiotic use and the medical and public policy factors that are, in part, responsible for increased antibiotic resistance in pathogenic microbes and for a decrease in the development of new antibiotics will be presented. An introduction to new directions that are being taken to develop a next generation of antibiotic compounds will also be provided.


Speaker Biography:

Paul Jackson received his Bachelor's of Science degree from the University of Washington in Cellular Biology and his Ph.D. from the University of Utah in Molecular Biology. He became a CISAC Visiting Scholar in September 2011. He was previously a CISAC affiliate.

For the past 18 years he has been studying bacterial pathogens, first working to develop DNA-based methods of detecting these microbes and their remnants in environmental and laboratory samples, then developing methods to differentiate among different strains of the same pathogenic species. Research interests include the study of different methods of interrogating biological samples for detection and characterization of content, and development of bioforensic tools that provide detailed information about biothreat isolates including full interrogation of samples for strain content and other genetic traits.

Methods he developed have been applied to forensic analysis of samples and aid in identifying the source of disease outbreaks. He contributed to analysis of the Bacillus anthracis present in the 2001 Amerithrax letters and conducted detailed analyses of human tissue samples preserved from the 1979 Sverdlovsk anthrax outbreak, providing evidence that was inconsistent with Soviet government claims of a natural anthrax outbreak.

His current work continues to focus on development of assays that rapidly detect specific signatures including antibiotic resistance in threat agents and other pathogens. More recent activities include identification and characterization of new antimicrobial compounds that are based on the pathogens' own genes and the products they encode. These include development of such materials as therapeutic antimicrobials, their application to remediate high value contaminated sites and materials, and their use to destroy large cultures and preparations of different bacterial threat agents. Efforts to address issues of antibiotic resistance and treatment of resistant organisms have recently been expanded to look at non-threat agent pathogens that cause problematic nosocomial or community-acquired infections of particular interest to the military.

Paul spent 24 years as a Technical Staff Member at Los Alamos National Laboratory where he was heavily involved in development of the biological threat reduction efforts there. He was appointed a Laboratory Fellow at Los Alamos in recognition of his efforts. He moved to Lawrence Livermore National Laboratory in 2005 where he is presently Senior Scientist in the Global Security and Physical and Life Sciences Directorates. In addition to his work at the National Laboratories, he has served on the FBI's Scientific Working Group for Microbial Forensics, on NIH study sections and review panels, and continues to serve on steering and oversight committees for other federal agencies.

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Paul J. Jackson Visiting Scholar Speaker CISAC
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The production and distribution of counterfeit medications has become a significant global public health issue. Though not as rampant in the United States, the Food and Drug Administration (FDA) has seen a 10 fold increase in the number of cases investigated, particularly a rise in illegally imported and diverted medications entering our legitimate drug supply. In order to curb these illegal activities, California and the federal government have introduced various pieces of legislation to address this. In addition, international entities, State Boards of Pharmacy and the FDA have begun promoting utilization of radio frequency identification technology and other technology to effectively track the medication supply. In a recent California survey, pharmacists felt strongly that the presence of counterfeit medications poses a problem in their pharmacy practice, but they still face several challenges in identifying counterfeit medications, counseling their patients, and forging their role in implementing legislative requirements.

This presentation will aim to provide an introduction to the international and domestic counterfeit drugs situation, discuss possible factors facilitating patient exposure to counterfeit medications, examine potential sources for counterfeit medications in the United States, identifiy federal legislation issues, discuss various forms of technology being used to combat counterfeit medications, and recognize the role of pharmacists and the challenges they face in dealing with counterfeit medications.


Speaker Biography:

Dr. Elaine Law is currently a Clinical Pharmacist specializing in Adult General Surgery at UCSF Medical Center and an Assistant Clinical Professor in the UCSF School of Pharmacy. She received a B.S. in Molecular, Cell and Developmental Biology from UCLA, earned a Doctor in Pharmacy from UCSF School of Pharmacy and completed a General Practice Pharmacy Residency at UCSF Medical Center. She holds a Board Certification in Pharmacotherapy and her research interests include roles pharmacists can play in public health issues including counterfeit medications and pharmacist-based immunization programs. She is an advocate of patient care in underserved areas and reaches out regularly to the Tenderloin communities and elderly populations of San Francisco through pharmacy health outreach programs.

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Elaine Law Assistant Clinical Professor Speaker UCSF School of Pharmacy
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We sat down with recipient of the FSI Global Underdevelopment Action Fund, Professor Beatriz Magaloni to learn more about her research plans and how her work will address the larger issues of poverty and governance in Latin America and beyond.

Beatriz Magaloni, associate professor of political science at Stanford, senior fellow at the Freeman Spogli Institute (FSI), and director of the Program on Poverty and Governance (PovGov) at the Center on Democracy, Development, and the Rule of Law, was recently awarded a grant through FSI's Global Underdevelopment Action Fund. Over the past ten years, Professor Magaloni has pioneered cross-national comparative research focused primarily on Latin America and Mexico. Leading the PovGov program, Professor Magaloni launched research projects examining political incentives for heath improvements, the role of women and family-planning decisions, public goods provisions in indigenous communities, and drug-related violence in Mexico.

We sat down with Professor Magaloni to learn more about her research plans and how her work will address the larger issues of poverty and governance in Latin America and beyond.

Professor Magaloni, tell us more about the work you are conducting with the support of the FSI Global Underdevelopment Action Fund?

We are using the support of the FSI Action Fund to expand a governance project that we started in Oaxaca, Mexico in 2009 to the Chiapas region. The Oaxaca research project focused on examining the effects of political institutions on public goods provision. In 1995, the state of Oaxaca allowed indigenous communities to decide if they wanted a form of traditional indigenous governance called “Usos y Costumbres,” or party governance. Our team studied the variations in these two forms of municipal governance and how they shape the provision of welfare-enhancing public goods, such as clean water, sanitation and sewage, and roads. The findings in Oaxaca showed that traditional governance leads to higher levels of civic engagement in collective decision-making and better provision of public goods. However, one key finding revealed that women enjoyed significantly lower levels of participation in civic life and governance overall. 

Why might this be?

More traditional structures of governance in indigenous communities were disempowering for women but the research carried out in Oaxaca revealed a positive effect on social and political participation among recipients of conditional cash transfers through Oportunidades.

For those of us unfamiliar with the Oportunidades program, please tell us more.

Oportunidades is a social program funded by the Mexican federal government that provides conditional cash transfers to poor women in exchange for their direct engagement in activities related to child nutrition, health, and education.

Why are you expanding the study to Chiapas?

A policy prescription that emerged from our results in Oaxaca led us to re-evaluate the possibility of establishing “Usos y Costumbres” beyond Oaxaca, and this grant will allow us to study the state of Chiapas. The state of Chiapas is traditionally party dominated but has a strong blend of traditional forms of governance. The baseline survey will be designed in Chiapas to understand how traditional governance practices are integrated into the party governance. We will ask if poor indigenous communities are better or worse off by choosing to govern themselves through customary law and participatory democracy, versus delegating decisions concerning the provision of public goods to political parties. This will allow us to identify how governance and patterns of civic engagement differ in both of these states and the effect on provision of local goods.

Stanford graduate students and post-doctoral scholars will be integral to our efforts to administer the survey and perform subsequent analysis.

How will women be central to your study in Chiapas?

The main addition to the survey will be a substantial segment devoted to the role of women in civil society with the goal of answering a number of questions regarding civic and political participation. Conducted at the household level, it is designed to gain a fuller picture of how women in Chiapas are influenced and shaped by the Oportunidades program.

In addition, our study in Chiapas will examine the following factors pertaining to women and governance:

1. The dynamics of governance in Mexico's indigenous regions and the ways in which women participate in collective decision-making and influence the distribution and access to public goods and services in the community.

2.  The relationship between Oportunidades and women's decision-making role in the provision of public goods.

3. The effects on health and educational outcomes that may be associated both with conditional cash transfer programs and women's participation in collective decision-making.

4. The policy implications for economic development and promoting human capital.

Who are you collaborating with on this project?

Ewen Wang is the co-investigator on this project. She is an associate professor of Surgery/Emergency Medicine at the Stanford School of Medicine and will be instrumental in collecting new data on health and education for children who are recipients of the Oportunidades program. We also are engaging inter-institutional collaborators from our partner universities, including; Alberto Díaz-Cayeros, Associate Professor of International Studies at the Center for U.S.-Mexican Studies, University of California, San Diego; and Vidal Romero, Assistant Professor of Political Science at Instituto Tecnológico Autónomo de México (ITAM).

What are the expected results or outcomes of this study?

The outcomes of this work have both theoretical and policy-relevant implications. The data we collect on the effect of participatory governance in indigenous regions in Mexico and how conditional cash transfer programs enable civic participation of women will have much broader application beyond Mexico's borders. A lot of other governments are experimenting with the use of conditional cash transfer programs and the result of this study should help inform public policy.

In Mexico, a policy brief highlighting the results of the survey will be prepared and presented to policymakers to describe the effects of local governance, civic engagement, and their impact on economic development. Policy recommendations will be presented to advise Chiapas (as well as other states in southern Mexico with a high prevalence of indigenous populations) on constitutional reform that gives autonomy to indigenous communities with respect to municipal collective decision-making.

Finally, a book-length project will be under development that describes how traditional governance in indigenous regions of Mexico shapes civic engagement, participation of women, and impacts the provision of public goods and services. The new data generated by this study will present new findings on how governance shapes the status of maternal and child health services in Chiapas, having much broader implications in the field of health policy.

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The Asia Pacific Observatory (APO) on Health Systems and Policies was established in June 2011. It is a collaborative partnership of interested governments, international agencies, foundations, civil society, and the research community. Modeled on the European Observatory of the same name, the APO has as its main function the collection and analysis of information and research evidence on health care systems, policies, and reforms, with the aim of making this knowledge widely available and easily accessible throughout the Asia Pacific Region; it will also draw cross-country lessons and disseminate these in formats that can be directly used for policymaking.

This presentation will trace the history underlying the creation of the Observatory and indicate its objectives, organizational structure, and proposed modes of operation. It will describe the challenges of attempting to bring a wide range of stakeholders together in support of a regional collaborative research effort. It will also touch on ways that research entities located outside the Asia Pacific region might interact with the APO.

L. Richard Meyers was employed by the World Bank for two decades managing teams that carried out World Bank health sector projects and analytical work in a number of countries in East Asia. He directed a team that produced the first comprehensive health sector review for Vietnam, as well as the first Vietnam National Health Survey.  He also led a team that produced the most comprehensive and empirically-based external analysis to date of the rural health sector in China. More recently he has worked with the European Health Observatory, the Asian Development Bank, the World Bank, the WHO Western Pacific and South Asia regional offices, and other stakeholders to facilitate the creation of the Asia Pacific Observatory.

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L. Richard Meyers Consultant Speaker World Bank
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With a sharp divergence between justifications for global health funding and the countries and diseases to which funding is disbursed, this study conducts a quantitative analysis of the determinants of U.S. financing for the 171 countries receiving development assistance for health in 2009. The project seeks to identify the key drivers for U.S. global health financing by country and facilitate research on how to make global health financing work better.

Walter P. Falcon Lounge

Encina Commons, Room 102,
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Stanford, CA 94305-6019

(650) 723-0984 (650) 723-1919
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Professor, Medicine
Professor, Health Policy
Senior Fellow, by courtesy, Freeman Spogli Institute for International Studies
Senior Fellow, Woods Institute for the Environment
eran_bendavid MD, MS

My academic focus is on global health, health policy, infectious diseases, environmental changes, and population health. Our research primarily addresses how health policies and environmental changes affect health outcomes worldwide, with a special emphasis on population living in impoverished conditions.

Our recent publications in journals like Nature, Lancet, and JAMA Pediatrics include studies on the impact of tropical cyclones on population health and the dynamics of SARS-CoV-2 infectivity in children. These works are part of my broader effort to understand the health consequences of environmental and policy changes.

Collaborating with trainees and leading academics in global health, our group's research interests also involve analyzing the relationship between health aid policies and their effects on child health and family planning in sub-Saharan Africa. My research typically aims to inform policy decisions and deepen the understanding of complex health dynamics.

Current projects focus on the health and social effects of pollution and natural hazards, as well as the extended implications of war on health, particularly among children and women.

Specific projects we have ongoing include:

  • What do global warming and demographic shifts imply for the population exposure to extreme heat and extreme cold events?

  • What are the implications of tropical cyclones (hurricanes) on delivery of basic health services such as vaccinations in low-income contexts?

  • What effect do malaria control programs have on child mortality?

  • What is the evidence that foreign aid for health is good diplomacy?

  • How can we compare health inequalities across countries? Is health in the U.S. uniquely unequal? 

     

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Eran Bendavid assistant professor of medicine; faculty affiliate in FSI/Center for Health Policy/Primary Care Outcomes Research Speaker

300 Pasteur Drive
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CDDRL Affiliated Scholar 2011-2012
Resident Physician in Internal Medicine, Stanford Medical Center
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Rajaie Batniji is a resident physician in internal medicine at Stanford and a CDDRL affiliate. His research examines the selection of priority diseases and countries in global health, and he is interested in global health financing and the priority-setting process of international institutions.  His work has also examined social determinants of health in the Middle East.  At FSI, Dr. Batniji is co-investigator on Global Underdevelopment Action Fund projects explaining U.S. global health financing and political causes of public health crisis.

Dr. Batniji received his doctorate in international relations (D.Phil) from Oxford University where he studied as a Marshall Scholar. He also earned a M.D. from the University of California, San Francisco School of Medicine and M.A. and B.A. (with distinction) degrees in History from Stanford University.   Dr. Batniji was previously based at Oxford's Global Economic Governance Program, and he has worked as a consultant to the World Health Organization. 

Publications

Protecting Health: Thinking Small. Sidhartha Sinha and Rajaie Batniji. Bulletin of the World Health Organization 2010; BLT.09.071530  http://www.ncbi.nlm.nih.gov/pubmed/20865078

Health as human security in the occupied Palestinian territory. Rajaie Batniji, Yoke Rabai’a, Viet Nguyen-Gillham, Rita Giacaman, Eyad Sarraj, Raija Leena Punamaki, Hana Saab, and Will Boyce. Lancet 2009 373:1133-43  http://www.ncbi.nlm.nih.gov/pubmed/19268352

Misfinancing global health: the case for transparency in disbursements and decision making. Devi Sridhar and Rajaie Batniji. Lancet 2008; 372: 1185-91  http://www.ncbi.nlm.nih.gov/pubmed/18926279

Coordination and accountability in the World Health Assembly. Rajaie Batniji. Lancet 2008; 372: 805 http://www.ncbi.nlm.nih.gov/pubmed/18774416

Barriers to improvement of mental health services in low-income and middle-income countries.  Benedetto Saraceno, Mark van Ommeren, Rajaie Batniji, Alex Cohen, Oye Gureje, John Mahoney, Devi Sridhar and Chris Underhill. Lancet 2007; 370:1164-74     http://www.ncbi.nlm.nih.gov/pubmed/17804061

An Evaluation of the International Monetary Fund's Claims about Public Health. David Stuckler, Sanjay Basu, Rajaie Batniji, Anna Gilmore, Gorik Ooms, Akanksha A. Marphatia, Rachel Hammonds, and Martin McKee. International Journal of Health Services 2010; 40:327-32  http://www.ncbi.nlm.nih.gov/pubmed/20440976

Reviving the International Monetary Fund: concerns for the health of the poor. Rajaie Batniji. International Journal of Health Services 2009; 39: 783-787    http://www.ncbi.nlm.nih.gov/pubmed/19927415

Mental and social aspects of health in disasters: relating qualitative social science research and the sphere standard. R Batniji, M van Ommeren, B Saraceno. Social Science & Medicine 2006; 62:1853–1864  http://www.ncbi.nlm.nih.gov/pubmed/16202495

Averting a crisis in global health: 3 actions for the G20. Rajaie Batniji & Ngaire Woods, 2009. Global Economic Governance Programme, http://www.globaleconomicgovernance.org/wp-content/uploads/averting-a-crisis-in-global-health.pdf.

Report of a High-Level Working Group, 11-13 May 2008. Rajaie Batniji, Devi Sridhar and Ngaire Woods, Global Economic Governance Programme, 2008, http://www.globaleconomicgovernance.org/project-health

Rajaie S. Batniji Rajaie Batniji, postdoctoral fellow, department of medicine Speaker
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Francis Fukuyama
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In the May-June edition of The American Interest, Francis Fukuyama traces the contemporary history of U.S. development policy and its failure to incorporate Huntingtonian-style theory, which emphasizes the interconnectedness of economy, politics, and society. Using Egypt as an example, Fukuyama calls for policymakers to break down their silos to more holistically examine and support democratic transitions.

While academic political science has not had much to tell policymakers of late, there is one book that stands out as being singularly relevant to the events currently unfolding in Tunisia, Egypt and other Middle Eastern countries: Samuel Huntington’s Political Order in Changing Societies, first published over forty years ago.1 Huntington was one of the last social scientists to try to understand the linkages between political, economic and social change in a comprehensive way, and the weakness of subsequent efforts to maintain this kind of large perspective is one reason we have such difficulties, intellectually and in policy terms, in keeping up with our contemporary world.

Huntington, observing the high levels of political instability plaguing countries in the developing world during the 1950s and 1960s, noted that increasing levels of economic and social development often led to coups, revolutions and military takeovers rather than a smooth transition to modern liberal democracy. The reason, he pointed out, was the gap that appeared between the hopes and expectations of newly mobilized, educated and economically empowered people on the one hand, and the existing political system, which did not offer them an institutionalized mechanism for political participation, on the other. He might have added that such poorly institutionalized regimes are also often subject to crony capitalism, which fails to provide jobs and incomes to the newly educated middle class. Attacks against the existing political order, he noted, are seldom driven by the poorest of the poor; they instead tend to be led by rising middle classes who are frustrated by the lack of political and economic opportunity—a phenomenon noted by Alexis de Tocqueville in his masterful analysis of the origins of the French Revolution and raised again in the early 1960s by James Davies’s well known “J-curve” theory of revolution.2

Something like this Huntingtonian process has unfolded in recent months in both Tunisia and Egypt. In both cases, anti-government protests were led not by the urban poor or by an Islamist underground, but by relatively well-educated middle-class young people used to communicating with each other via Facebook and Twitter. It is no accident that Wael Ghonim, Google’s regional head of marketing, emerged as a symbol and leader of the new Egypt. The protesters’ grievances centered around the fact that the authoritarian regimes of Ben Ali and Mubarak offered them no meaningful pathway to political participation, as well as failing to provide jobs befitting their social status. The protests were then joined by other groups in both societies—trade unionists, Islamists, peasants and virtually everyone else unhappy with the old regimes—but the driving force remained the more modern segments of Tunisian and Egyptian society.

Societies lacking institutions that could accommodate new social actors produced a condition Huntington labeled praetorianism, in which political participation took the form of strikes, demonstrations, protests and violence. The military often seized power in such circumstances because it was the only organized actor in society capable of running a government. The Egyptian Republic’s first autocrat, Gamal Abdel Nasser, came to power in precisely this manner back in July 1952, when his Free Officers movement represented the rising Egyptian middle class. The tragedy of modern Egypt is that there has been scarcely any meaningful political development in the more than half-century since then—meaning, in Huntington’s terms, the rise of modern institutions that could peacefully channel citizen participation.

Socioeconomic development, meanwhile, has proceeded apace: Between 1990–2010 Tunisia’s Human Development Index (a composite measure of health, education and income compiled by the UN) rose 30 percent, while Egypt’s rose 28 percent. Both countries produced tens of thousands of college graduates with no discernable future and a lopsided income distribution in which a disproportionate share of the gains from growth went to a small group of politically connected insiders. Huntington’s analysis of Egypt in the 1950s and 1960s thus remains eerily relevant today.

In Political Order Huntington was also making a broader point about the process of development itself. The significance of his book needs to be seen against the backdrop of post-World War II modernization theory, which in turn drew on classic 19th-century European social theory articulated by academics like Edward Shils, Talcott Parsons and Walt W. Rostow. American modernization theory argued that development was a single, seamless process. Economic development, changing social relationships like the breakdown of extended kinship groups and the growth of individualism, higher and more inclusive levels of education, normative shifts toward values like “achievement” and rationality, secularization and the growth of democratic political institutions, were all seen as an interdependent whole.

By pointing out that the good things of modernity did not necessarily go together, Huntington played a key role in killing off modernization theory. Political development was a separate process from socioeconomic development, he argued, and needed to be understood in its own terms. The conclusion that flowed from this point of view seemed at the time counterintuitive to the point of stunning: Without political development, the other aspects of modernization could lead to bad results—to tyranny, civil war and mass violence.

There were other reasons why Western modernization theory fell into disrepute by the 1970s: It came to be regarded as too Eurocentric—indeed, as too Americentric insofar as it seemed to posit American society as the pinnacle of modernization. It failed to recognize the possibility that countries like Japan and China might take roads to modernity that would look very different from the ones pioneered by Britain and the United States. But even if one agreed that the end point of development should be some form of industrialized liberal democracy, Huntington made it clear that arriving at the desired destination was far more elusive and complicated than modernization theorists believed.

The central piece of policy advice that emerged out of Huntington’s work was the concept of the “authoritarian transition.” If political systems opened up to democratic contestation too early, before the development of political parties, labor unions, professional associations and other organizations that could structure participation, the result could be chaotic. Authoritarian regimes that could maintain order and promote economic growth, Huntington argued, might oversee a more gradual institutionalization of society, and make a transition to democracy only when broad participation could be peacefully accommodated. This form of sequencing, in which economic development was promoted before a democratic opening, was the path followed by Asian countries like South Korea and Taiwan, which made democratic transitions in the late 1980s only after they had succeeded in turning themselves into industrialized powerhouses. It was also the development strategy recommended by Huntington’s former student Fareed Zakaria, as well as by the leaders of many authoritarian governments, who liked the idea of economic growth better than the idea of democratic participation.3 We will return to the question of how well that strategy worked in the Middle East later.

Development in Silos 

As interesting and important as Huntington’s work was, it lay outside of mainstream thinking about development, which from the start was a highly Balkanized academic field that was dominated by economists. Few scholars have sought to understand development as an inter-connected process with political, economic and social parts. Few scholars have sought to understand development as an inter-connected process with political, economic and social parts.Development economists looked primarily at economic factors like capital, labor and technology as sources of economic growth, and thought neither about the consequences of growth for politics nor the relationship of political institutions to growth. The Harrod-Domar growth model that was dominant in the 1950s suggested that less-developed countries were poor primarily because they lacked capital, which then led development agencies like the World Bank to try to kick start growth with generous infusions of capital for physical infrastructure. It was only when steel plants and shoe factories in sub-Saharan Africa went idle due to corruption or lack of organizational capacity that they were forced to go back to the drawing board.

The political scientists, for their part, scaled back their ambitions from large Huntingtonian-style theory and focused primarily on political phenomena. Beginning in the 1980s, there was increasing interest in the problem of transitions into and out of democracy; with democratic transitions in Spain, Portugal and nearly all of Latin America, this became a particularly pressing issue. There was some revival of interest in the democracy-development linkage, but it never led to a clear consensus on the causal links connecting the two phenomena.

The academic interest in transitions corresponded to the burgeoning of democracy promotion as a distinct field of international practice, both on the part of the United States and of other democracies around the world. The idea was planted during the 1970s, when the institutes linked with the German political parties played a key role in beating back an attempted Communist takeover in Portugal and facilitating that country’s transition to democracy. The 1980s saw the establishment of the National Endowment for Democracy (NED), a taxpayer-funded but quasi-independent organization devoted to support of pro-democracy groups around the world. One of the NED’s early successes was its funding of the Solidarity trade union in Poland before the collapse of communism. The 1990s saw the growth of a host of international organizations capable of monitoring elections and the funding of the Democracy and Governance branch of the U.S. Agency for International Development to the tune of almost $1.5 billion annually.

By the late 1990s, there was some degree of convergence in the agendas of economists and political scientists. By that point Douglass North and the school of “New Institutional Economics” he founded made economists aware of the importance of political institutions—particularly property rights—for economic growth. Economists increasingly sought to fold political variables like legal systems and checks on executive power into their models. Political science had itself been colonized at this point by economic methodology, and it was natural for such rational-choice political scientists to start looking at the economic impact of political institutions.

The return to a more interdisciplinary approach to development was marked as well by the tenure of James Wolfenson as President of the World Bank from 1995 to 2005.4 Wolfenson early on gave a speech on the “cancer of corruption” and signaled to the institution that, henceforth, political issues like corruption and good governance would be taken seriously. The publication of the 1997 World Development Report, The State in a Changing World, marked an intellectual break with the Washington Consensus focus on economic policy and state downsizing, and the Bank created a new branch devoted to reform of developing country public sectors. These changes constituted an open admission that politics was a critical component of development, and that the state was not simply an obstacle to growth but often a necessary underpinning for it. Increasingly, donor agencies have seen the promotion of democratic accountability as one tool in the fight against corruption.

This modest degree of convergence should not, however, obscure the continuing degree of compartmentalization that exists in the field of development. While paying lip service to the importance of institutions, most economists and field practitioners still see politics as at best an obstacle to the real work of development, which is improvement in incomes, health, education and the like, and not as an independent objective of development strategy. (Amartya Sen is an important exception to this generalization.) The democracy promotion agencies, for their part, spend relatively little time worrying about economic growth, social policy or public health, which in their view are goods often used by authoritarian regimes to buy off populations and prevent democratization.

The intellectual confusion surrounding development has led to severely Balkanized policies both in the United States and in the international community that often work at cross purposes from one another.The intellectual confusion surrounding development has led to severely Balkanized policies both in the United States and in the international community that often work at cross purposes from one another. For example, the authoritarian or semi-authoritarian regimes of Meles Zenawi in Ethiopia, Paul Kagame in Rwanda and Yoweri Museveni in Uganda have been aid darlings over the past decade because of their track records in promoting economic, health and social goals. At the same time, democracy promotion groups have been highly critical of them and have supported opposition groups and civil society organizations seeking accountability and limits on executive power. To be sure, aid agencies don’t object to greater government accountability on the part of these regimes, while the democracy promotion community wouldn’t stand in the way of progress on HIV/AIDS or malaria. Yet no one takes a larger view and asks, for example, whether existing aid programs are helping to keep the regime in power or, conversely, are destabilizing it.

Egypt itself presents a good case of this particular form of policy incoherence. Despite the fact that Egypt ranks as one of the top American aid recipients, it is hard to say that Washington was pursuing development goals of any sort there. The United States was primarily interested in stability. Despite brave speeches on democracy by both Condeleezza Rice and Barack Obama in Cairo, the United States actually pulled its punches in pushing serious democratic reform on Egypt, particularly after the Hamas electoral victory in Gaza in 2006. Nonetheless, U.S. economic aid programs were still pushing education and economic policy reform programs in the country. Had American aid administrators taken the Huntingtonian view that their assistance was covertly designed to promote an expectations gap and delegitimate Hosni Mubarak, this might have been a clever strategy. But no such cleverness existed. Instead, it was simply an example of compartmentalized aid programs doing their thing in ignorance of the interdependent effects of politics and economics.

What Is to Be Done?

Ideas precede action. Before we can hope to generate a coherent set of policies for Egypt, or anywhere else for that matter, we need a better understanding of development—that is, how changes in economy, politics and society over time constitute a set of discrete yet interlinked processes. Whatever the shortcomings of classic modernization theory, it at least began from the insight that the phenomenon under study required development of a master social science that transcended existing disciplinary boundaries. This objective is as far away as ever in academia, where the traditional disciplines keep a chokehold on how younger academics think and do research. Today, the single most popular form of development dissertation in both economics and political science is a randomized micro-experiment in which the graduate student goes out into the field and studies, at a local level, the impact of some intervention like the introduction of co-payments for malaria mosquito netting or changes in electoral rules on ethnic voting. These studies can be technically well designed, and they certainly have their place in evaluating projects at a micro level. But they do not aggregate upwards into anything that can tell us when a regime crosses the line into illegitimacy, or how economic growth is changing the class structure of a society. We are not, in other words, producing new Samuel Huntingtons, with the latter’s simultaneous breadth and depth of knowledge.

On a policy level, we need far more mutual understanding between those who promote socioeconomic development and those who work on democracy promotion and governance.On a policy level, we need far more mutual understanding between those who promote socioeconomic development and those who work on democracy promotion and governance. Traditional development agencies like USAID already think politically to the extent that their aid projects are designed to support U.S. foreign policy. But they, like their counterparts in multilateral organizations like the World Bank, are not trained to do political economy analysis; they do not seek an understanding of the political context within which aid is used and abused, and what is not sought is very rarely found. We call for the liberalization of ports in Haiti, for example, without trying to understand which particular politicians are benefiting from existing arrangements that keep them closed. For their part, democracy promoters focus on democratic transitions, providing help to opposition parties and civil society organizations in authoritarian countries. But once a transition occurs, as it did after the Orange and Rose revolutions in Ukraine and Georgia, they have relatively little to offer new democratic governments in terms of policy agendas, anti-corruption strategies or help in improving the delivery of services that citizens want.

Beyond these relatively minor adjustments, a more robust theory of social change might tell us that, in certain circumstances, the best way to destabilize an authoritarian society would be not the funding of civil society groups seeking short-term regime change, but rather the promotion of rapid economic growth and the expansion of educational access.5 Conversely, there are many societies we know will simply waste development assistance dollars because they are ruled by unaccountable authoritarian regimes. In such circumstances, it might be a more efficient use of aid resources to cut development aid entirely and to work only for political change. This is, in effect, what has happened to Zimbabwe under Robert Mugabe, but the country had to sink very far before anyone considered pulling the aid plug.

Huntington got a number of things wrong. The authoritarian transition was not a universally applicable formula for development. It worked reasonably well in East Asia, where there were a number of figures like Lee Kwan Yew, Park Chung-hee or the Chinese Communist Party leadership, who used their autocratic powers to promote rapid development and social change. Arab authoritarians were cut from a different cloth, content to preside over economically stagnant societies. The result was not a coherent development strategy but a wasted generation.

The aspiration of social science to replicate the predictability and formality of certain natural sciences is, in the end, a hopeless endeavor. Human societies, as Friedrich Hayek, Karl Popper and others understood, are far too complex to model at an aggregate level. Contemporary macroeconomics, despite dealing with social phenomena that are inherently quantified, is today in crisis due to its utter failure to anticipate the recent financial crisis.

The part of social change that is the hardest to understand in a positivistic way is the moral dimension—that is, the ideas that people carry around in their heads regarding legitimacy, justice, dignity and community. The current Arab uprising was triggered by the self-immolation of an overeducated 26-year-old Tunisian vegetable seller whose cart was repeatedly confiscated by the authorities. After Mohamed Bouazizi was slapped by a policewoman when he tried to complain, he reached the end of his tether. Bouazizi’s public suicide turned into a social movement because contemporary communications technologies facilitated the growth of a new social space where middle-class people could recognize and organize around their common interests. We will probably never understand, even in retrospect, why the dry tinder of outraged dignity suddenly ignited in this fashion in December 2010 as opposed to 2009, or ten years before that, and why the conflagration spread to some Arab countries but not to others. But we can certainly do a better job in putting together the few pieces we do understand, in a way that would be useful to policymakers coping with the reality of social change.

1Huntington, Political Order in Changing Societies: With a New Forward by Francis Fukuyama (Yale University Press, 2006).

2Davies, “Towards a Theory of Revolution”, American Sociological Review, Vol. 27 (1962).

3Zakaria, The Future of Freedom: Illiberal Democracy at Home and Abroad (W. W. Norton, 2003); see also Zakaria, “A Conversation with Lee Kuan Yew”, Foreign Affairs (March/April 1994).

4For a description of the Wolfenson presidency, see Sebastian Mallaby, The World’s Banker: A Story of Failed States, Financial Crises, and the Wealth and Poverty of Nations (Penguin Press, 2004).

5See Harold James’s retroview, entitled “Growing Pains”, of a classic December 1963 essay by Mancur Olson (“Rapid Growth as a Destabilizing Force”) in The American Interest (September/October 2006).

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Der diesjährige "Freedom in the World"-Bericht des Forschungsinstituts "Freedom House" weist bereits zum fünften Jahr in Folge auf einen alarmierenden Rückgang von Freiheit, Demokratie und Achtung der Menschenrechte weltweit hin. Während die Menschenrechte in den Diktaturen in Nordkorea, im Iran, in Syrien, Libyen und China mit Füßen getreten werden, dominieren den außenpolitischen Diskurs in Europa vor allem zwei Themen: die israelische Blockade des Gazastreifens und der von den USA geführte Krieg gegen Terror.


Die Gaza-Flottillen erhalten in Europa massive mediale Aufmerksamkeit - und dies, obwohl die Grenze zwischen Ägypten und dem Gazastreifen geöffnet ist und der Generalsekretär der Vereinten Nationen die Kampagne als "eine unnötige Provokation" bezeichnet hat. Es segeln keine Flottillen in Richtung Damaskus und Teheran, obwohl Amnesty International von 1400 Toten während des syrischen Aufstands gegen das Assad-Regime berichtet und die Islamische Republik Iran in diesem Jahr bereits 175 Menschen durch öffentliches Hängen oder Steinigung hingerichtet hat, darunter Frauen, Kinder und Homosexuelle. Niemand plant einen Boykott gegen die Türkei, ungeachtet der illegalen Besetzung Nordzyperns durch Ankara und der systematischen Verletzung von Menschenrechten in den Kurdengebieten.

Die Einseitigkeit des außenpolitischen Diskurses in Europa ist im Fall Nordkoreas besonders offensichtlich. Laut UN leiden dort 3,5 Millionen der 24 Millionen Einwohner unter akuter Unterernährung. Pjöngjang hat außerdem ein System von Strafgefangenenlagern errichtet, in denen Dissidenten systematischer Folter und Hunger ausgesetzt sind. Fluchtversuche werden mit Folter und Hinrichtung bestraft. Wäre die Gaza-Flottille durch altruistischen Humanismus motiviert, sähen wir auch mit Medizin und Hilfsgütern beladene Boote in Richtung Bengasi segeln. Schiffe mit oppositioneller Literatur und Laptops hätten für die demokratische Opposition in Havanna und Teheran Wunder bewirken können.

Wenn selbst ernannte europäische Menschenrechts- und Friedensaktivisten in Europa Erklärungen im Namen der Menschlichkeit abgeben und dabei die einzige Demokratie im Nahen Osten verurteilen, sollte man lieber genauer schauen, was dahintersteckt. Diese Statements sind mehr als fragwürdig im Hinblick auf die Verbreitung von Demokratie und Menschenrechten auf der Welt.
Daniel Schatz ist Doktorand in Politikwissenschaft an der Humboldt-Universität zu Berlin und Visiting Fellow am Stanford University
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Can social, economic, and policy changes turn a period of growing old-age dependency into one of positive opportunity and growth in China? Qiong Zhang and Asia Health Policy Program director Karen Eggleston explore this challenging question in a recent China Brief article. They look back into several decades of China's history and also consider the current demographic picture of one-child families, gender imbalance, declining fertility rates, and a healthy and prosperous aging population.

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China is now predominantly a country with one-child families.
Stefan Lins
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The Center on Democracy, Development, and the Rule of Law (CDDRL) is pleased to announce that undergraduate senior honors student Yihana von Ritter was awarded The Firestone Medal for Excellence in Undergraduate Research for her outstanding thesis examining HIV/AIDS policy in Papua New Guinea. Von Ritter was presented with the award at a ceremony held on June 11 during commencement weekend at Stanford University.

Larry Diamond with Yihana von Ritter (Firestone awardee)
Von Ritter, a political science major, spent the summer of 2010 on the Papua New Guinea island of Karkar, where she performed extensive field research. She interviewed over 40 government officials, medical personnel, religious and civic leaders, youth, and HIV positive individuals. Her thesis entitled "Between Hope and Despair: An Assessment of HIV/AIDS Policy in Papua New Guinea," underscored the fact that while only 1% of Papua New Guinea's adult population is AIDS-infected, a public health crisis is looming if preventative policies are not swiftly adopted.

According to her thesis co-advisor Professor Emeritus David Abernethy, Von Ritter's thesis received the Firestone Medal­--awarded to the top ten percent of honors theses in social science, science, and engineering--for its remarkable combination of social science analysis and informed policy advocacy.

"Von Ritter provides policy-relevant recommendations in her thesis to enhance interagency communication and encourage active government leadership (in Papua New Guinea)," said Abernethy. Von Ritter also worked closely with Francis Fukuyama, FSI senior fellow and CDDRL faculty member, who provided guidance and support during the thesis writing process.

Purun Cheong and Kamil Dada were both recipients of the CDDRL Undergraduate Honors Program "Best Thesis Award" for their outstanding research and policy-relevant scholarship. Cheong, an international relations major, critically evaluated the failed United Nations state-building efforts in East Timor in his thesis, "When the Blind lead: The United Nations in East Timor-Lessons in State Building."

After spending a summer conducting research in Pakistan, Dada, a political science major, wrote "Understanding International Democracy Assistance: A Case Study of Pakistan," a sobering account of democracy assistance to Pakistan. Cheong and Dada were both advised by CDDRL director Larry Diamond.

CDDRL congratulates the 2011 graduating class of CDDRL Undergraduate Honors

Students:

Purun Cheong

International Relations

"When the Blind Lead: The United Nations in East Timor- Lessons in State Building"

Kamil Dada

Political Science

"Understanding International Democracy Assistance: A Case study of Pakistan"

Sarah Guerrero

International Relations

"Automation Nation: Electronic Elections, Electoral Governance and Democratic Consolidation in the Philippines"

Ayesha Lalji

International Relations

"Unleashing the Cheetah Generation: How Mobile Banking Enables Access to Capital for the Poor in Developing Countries"

Lauren Swartz

International Relations

"Agribusiness as a Means of Economic Development: Case Studies of Chile and Mexico"

Ann Thompson

History

"The Other Side of the Coin: The US Military and Afghan Women in Contemporary Counterinsurgurgency Operations"

Yihana von Ritter

Political Science

"Between Hope and Despair: An Assessment of HIV/AIDS Policy in Papua New Guinea"

Ari Weiss

International Relations

"Israel: Managing Diversity with Democracy"

 Check out more photos of this event on our Facebook Page: http://www.facebook.com/StanfordCDDRL

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More than two-thirds of the population in Africa must leave their home to fetch water for drinking and domestic use. It is estimated that some 40 billion hours of labor each year are spent hauling water, a responsibility often borne by women and children. Cutting the walking time to a water source by just 15 minutes can reduce under-five mortality of children by 11 percent, and slash the prevalence of nutrition-depleting diarrhea by 41 percent.

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