Adrian Bonifacio, a second generation Filipino-American from Chicago, is one of the recipients of the Program on Human Rights and the McCoy Family Center for Ethics in Society's 2012 Human Rights Fellowship.  The Program on Human Rights at the Center on Democracy, Development, and the Rule of Law together with the McCoy Family Center for Ethics in Society offer four annual summer fellowships in human rights open to Stanford undergraduates interested in working for organizations, government agencies, NGOs or international organizations that promote or defend human rights.

This summer, Bonifacio will work with the Asian Pacific Mission for Migrants, a non-governmental organization based in Hong Kong that promotes and defends the rights of migrant workers, a majority of whom are Filipino. Filipino immigrants in Hong Kong work predominately as domestic workers. The situation of Filipino diasporas is very complex with more than 10% of the Filipino population abroad, and over 4,000 Filipinos leaving the country every day.

Passionate about Filipino and Filipino-American issues relating to human rights such as migration, exploitation, and servitude, Stanford undergraduate Bonifacio has joined Filipino groups such as Stanford’s Pilipino American Student Union (PASU) and Anakbayan Silicon Valley, a youth organization based in Santa Clara County. He is currently pursuing a major in international relations with a minor in economics as well as co-term masters degree in sociology.

In the 1970s, Filipino dictator Ferdinand Marcos began the Labor Export Policy (LEP), a deliberate policy to send Filipino workers abroad. “This became a vicious cycle, the Philippines tried to achieve economic development based on remittances but because it sends both high skill and low skill workers abroad, and because the remittances they send are not usually put towards investment and long term development, there is not much progress happening in the country," explained Bonifacio. "Every president since Marcos has continued to promote the LEP in the name of national development.”

Last summer, Bonifacio worked for HURIGHTS OSAKA, a human rights non-profit organization, where he conducted research related to Filipino migrants in Japan to understand the link between human rights and remittances. “Although it was difficult integrating with the community in such a limited timeframe, a lot of different opportunities presented themselves—celebrating Philippine Independence Day, cooking Filipino food for events, even performing traditional dances," said Bonifacio. "My supervisor at work and all the migrants I have come to know made my transition into life in Japan, as well as my research, much easier.”

Japan and agencies in the Philippines that facilitate labor migration are notorious for abusing “entertainment visas” which allowed young women to be trafficked into Japan. Many Filipino women were promised jobs in high-end hotels as singers or dancers, but upon arrival in Japan, were trafficked into bars, with some entering prostitution rings and red light districts... Starting in the mid-1980s, many Japanese men in rural areas began to “import” Filipino women as mail-order brides, to solve the demographic problem of low birth rates caused largely by women moving out to cities to pursue professional careers.

Although the mail-order bride phenomenon has died down and Japan has since abolished the entertainment visa in 2006, there are still cases of abuse and human trafficking. Moreover, Filipino men have a history of working in construction, often as day laborers with insecure sources of income and housing. According to Bonifacio, “It is hard to determine the proportion of remittances that come from exploitation, but if you look at general trends and the types of employment Filipinos have all over the world—for example as “entertainers” in Japan or domestic workers in Hong Kong, Saudi Arabia, and even the United States—one could say that remittances and exploitation are closely connected.”

In preparation for his fellowship in Hong Kong Bonifacio says, “I was humbled by what I saw in Japan. I think that one of the best things one can do to educate oneself - and something that does not always happen in a classroom - is to understand the community we want to serve. We need to learn about the issues these communities face before considering fighting for change.”

Students interested in applying to the human rights fellowship for the summer of 2013 should contact Nadejda Marques to learn about the selection process and deadline for submission.

China’s demographic landscape is rapidly changing, and the government has responded by launching ambitious social and health service reforms to meet the changing needs of the country’s 1.3 billion people. This week, officials approved a five-year plan to develop a comprehensive nationwide social security network.

Karen Eggleston, the Asia Health Policy Program (AHPP) director and a Stanford Health Policy fellow, discusses the success of China’s health care reforms—including its recently established universal health care system—and the long road still ahead.

Why is the overall health and wellbeing of China’s population important globally?

There are many reasons why the health of China’s citizens matters within a larger global context. On the most basic level, China represents almost 20 percent of humanity. But it is also a major player in the world economy and it depends on having a healthy workforce, especially now that its population is aging more. The government’s ability to meet the needs of its underserved citizens contributes to a more productive and stable China, and works towards closing the huge gaps we see in human wellbeing across the world.

China also potentially offers a model for other developing countries, such as India, that may want to figure out how to make universal health coverage work at a tenth of the income of most of the countries that have put it into place before.

What are some of the biggest changes in China’s health care system since 1949?

One of the most significant changes is that China has achieved very basic universal health insurance coverage in a relatively short period of time.  

Throughout the Mao period (1949–1978) there was a health care system linked to the centrally planned economy, which provided a basic level of coverage via government providers with a lot of regional variation. When economic reform came in 1980, large parts of the system—particularly financing for insurance—collapsed. The majority of China’s citizens were uninsured during the past few decades of very rapid social and economic development.

China’s overall population is changing quite dramatically, which means it has different health care needs, such as treating chronic disease and caring for an increasingly elderly population. The central government is trying to establish a system of accessible primary care—a concept that China’s barefoot doctors helped to pioneer but that fell into disarray—and health services that fit these new needs. 

How does China’s basic health care system work? Are there segments of the population still not receiving adequate coverage and care?

China has had a system where people can select their own doctors. Patients usually want to go to clinics attached to the highest-reputation hospitals, but of course, when you are not insured you almost always by default go to where you can afford the care. “It is difficult to see the doctor, and it is expensive” has been the lament of patients in China, so an explicit goal of the health care reforms has been to address this.

The term “universal coverage” has different definitions. China initially put in place a form of insurance that only covers 20 or 30 percent of medical costs for the previously uninsured population, especially in rural areas. Benefits have expanded, but remain limited. As with the previous system, disparities in coverage still exist across the population. China not only has a huge population with huge economic differences, but within that there is a large migrant worker population. It is a challenge to figure out how to cover these citizens and how to provide them with access to better care. The government is quite aware there are segments of the population not receiving equal coverage, and it continues to strive to resolve the issue.  

What are the greatest innovations in China’s health care system in recent years?

One of the most remarkable things China has achieved is really its new health insurance system. Even if the current coverage is not particularly generous it is nearly universal, and mechanisms are put in place each year to provide more generous coverage. China is also working on strengthening its primary care and population health services, infusing a huge sum of government money into these efforts. It is the only developing country of its per-capita income that has achieved such results so far.

Interestingly, a lot of people assume China achieved its universal coverage by mandate, while in fact the central government did so by subsidizing the cost for local governments and individuals. This reduces the burden, for example, on poorer rural governments and residents, and is one innovative way China is trying to eliminate the disparity in access to care.

Eggleston has recently published a working paper on China’s health care reforms since the Mao era on the AHPP website, as well as an article in the Milken Institute Review.

Gordon Liu, a Chinese government advisor on health care and the executive director of Peking University’s Health Economics and Management Institute, spoke at Stanford on May 29 on the future of China’s health care system.