When a state is “shamed” by outsiders for perceived injustices, it often proves counterproductive, resulting in worse behavior and civil rights violations, a Stanford researcher has found.

Rochelle Terman, a political scientist and postdoctoral fellow at Stanford’s Center for International Security and Cooperation (CISAC), recently spoke about how countries criticized by outsiders on issues like human rights typically respond -- and it's contrary to conventional wisdom. Terman has published findings, “The Relational Politics of Shame: Evidence from the Universal Periodic Review,” on this topic in the Review of International Organizations. She discussed her research in the interview below:

What does your research show about state "shaming"?

Shaming is a ubiquitous strategy to promote international human rights. A key contention in the literature on international norms is that transnational advocacy networks can pressure states into adopting international norms by shaming them – condemning violations and urging reform. The idea is that shaming undermines a state’s legitimacy, which then incentivizes elites into complying with international norms.

In contrast, my work shows that shaming can be counterproductive, encouraging leaders in the target state to persist or “double down” on violations. That is because shaming is seen as illegitimate foreign intervention that threatens a state’s sovereignty and independence.  When viewed in this light, leaders are rewarded for standing up to such pressure and defending the nation against perceived domination. Meanwhile, leaders who “give in” have their political legitimacy undermined at home. The result is that violations tend to persist or even exacerbate.

When and where does it work better to directly confront a country’s leadership about such injustices?

At least two factors moderate the effects of international shaming. The first is the degree to which the norm being promoted is shared between the “shamer” and the target. For instance, the West may shame Uganda or Nigeria for violating LGBT rights. But if Uganda and Nigeria do not accept the “LGBT rights” norm, and refuse to accept that homophobia constitutes bad behavior, then shaming will fail. In this case, it is more likely that shaming will be viewed as illegitimate meddling by foreign powers, and will be met with indignation and defiance.

Second, shaming is quintessentially a relational process. Insofar as it is successful, shaming persuades actors to voluntary change their behavior in order to maintain valued social relationships. In the absence of such relationship, shaming will fail. This is especially so when pressure emanates from a current or historical geopolitical adversary. In this later scenario, not only will shaming fail to work, it will likely provoke defensive hostility and defiance, having a counterproductive effect.

Combing these insights, we can say that shaming is most likely to work under two conditions: when the target is a strong ally, and the norm is shared.

What are some well-known cases where "shaming" backfired?

The main example I use in my forthcoming paper is on the infamous “anti-homosexuality bill” in Uganda. When Uganda introduced the legislation in 2009 (which in some versions applied capital punishment to offenders) it provoked harsh condemnation among its foreign allies, especially in the West. Western donor countries even suspended aid in attempt to push Yoweri Musaveni’s government to abandon the bill. According to conventional accounts, the onslaught of foreign shaming, coupled with the threat of aid cuts and other material sanctions, should have worked best in the Uganda case.

And yet what we saw was the opposite. The wave of international attention provoked an outraged and defiant reaction among the Ugandan population, turning the bill into a symbol of national sovereignty and self-determination in the face of abusive Western bullying. This reaction energized Ugandan elites to champion the bill in order to reap the political rewards at home. Indeed, the bill was the first to pass unanimously in the Ugandan legislature since the end of military rule in 1999. Museveni – who by all accounts preferred a more moderate solution to the crisis – was backed into a corner.

A Foreign Policy story quoted Ugandan journalist Andrew Mwenda as saying, “the mere fact that Obama threatened Museveni publicly is the very reason he chose to go ahead and sign the bill.” And Museveni did so in a particularly defiant fashion, “with the full witness of the international media to demonstrate Uganda’s independence in the face of Western pressure and provocation.”

Uganda anti-homosexuality law was finally quashed by its constitutional court, which ruled the act invalid because it was not passed with the required quorum. By dismissing the law on procedural grounds, Museveni – widely thought to have control over the court – was able to kill the legislation “without appearing to cave in to foreign pressure.” But by that time, defiance had already transformed Uganda’s normative order, entrenching homophobia into its national identity.

Does this 'doubling down' effect vary in domestic or international contexts?

Probably. States with a significant populist contingent, for instance, are especially hostile to international pressure, especially when it emanates from a historical adversary, like a former colonial power. Ironically, democracies may also be more susceptible to defiance, because elites are more beholden to their constituents, and thus are less able to “give in” to foreign pressure without undermining their own political power. 

The international context matters a great deal as well. States are more likely to resist certain norms if they have allies who feel the same way. For instance, we see significant polarization around LGBT rights at the international level, with most states in Africa and the Muslim world voting against resolutions that push LGBT rights forward. South Africa – originally a pioneer for LGBT rights – has changed its position following criticism from its regional neighbors. 

Does elite reaction drive this response to state "shaming?"

To be quite honest, this is a question I’m still exploring and I don’t have a very clear answer. My hunch at the moment is no. The “defiant” reaction occurs mainly at the level of public audiences, which then incentives elites to violate norms for political gain.  These audiences can be at either the domestic or international level. For instance, if domestic constituents are indignant by foreign shaming, elites are incentivized to “double down,” or at least remain silent, lest they undermine their own political legitimacy.

That said, elites can also strategize and manipulate these expected public reactions for their own political purposes. For instance, if Vladimir Putin knows that the Russian public will grow indignant following Western shaming, he might strategically promote a law that he knows will provoke such a reaction in order to benefit from the ensuing conflict. This is what likely occurred with Russia’s “anti-gay propaganda” law, which (unsurprisingly) provoked harsh condemnation from the West and probably bolstered Putin’s domestic popularity.

Any other important points to highlight?

One important point I’d like to highlight is the long-term effects of defiance. In an effort to resist international pressure, states take action that, in the long term, work to internalize oppositional norms in their national identity. In this way, shaming actually produces deviance, not the other way around.

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

MEDIA CONTACTS:

Rochelle Terman, Center for International Security and Cooperation: (650) 721-1378, rterman@stanford.edu,

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

Whether it’s WikiLeaks and CIA documents or nuclear thieves, the danger from insiders in high-security organizations is escalating in our Internet age.

But many threats from within go unrecognized or misunderstood, according to Stanford professor Scott Sagan, who co-edited a new book Insider Threats with Matthew Bunn, a professor of practice at Harvard University. Their work analyzes the challenges that high-security organizations face in protecting themselves from employees who might betray them. Sagan, a core faculty member in Stanford's Center for International Security and Cooperation, and Bunn recently participated in an online discussion of the book’s key arguments. They will hold a talk and book signing at 3:30 p.m. on May 16 in the CISAC Central Conference Room.

Sagan and Bunn wrote, “Perhaps the most striking lesson we learned in working with scholars and officials who have dealt with this problem was the sheer scale of the red flags – from explicit statements of support for Osama bin Laden to behavior leading other staff to fear for their lives – that organizations are able to ignore.”

They found that organizations tend to have biases that cause them to downplay insider threats. In particular, organizations with high-security needs face significant risks from trusted employees with access to sensitive information, facilities, and materials. 

The researchers highlight "worst practices" from these past mistakes, suggesting lessons and insights that could improve the security situations at many workplaces. Amy Zegart, co-director of CISAC, has a chapter in Insider Threats that provides a detailed account of the organizational dysfunction that allowed Nidal Hasan to carry out his massacre at Fort Hood.

Other chapters include the following topics and authors:

• An analysis of the similar problems that led Bruce Ivins, who probably carried out the anthrax attacks in 2001, to continue to have access to deadly pathogens (by Jessica Stern, then of Harvard and now at Boston University, and Ron Schouten, of Massachusetts General Hospital and Harvard Medical School);
• An analysis of the rapid rise and subsequent fall of “green-on-blue” attacks in Afghanistan – that is, Afghan soldiers and police officers attacking Americans there to help them (by Austin Long of Columbia University); and 
• An assessment of how casinos and pharmaceutical plants, with a profit incentive to protect against insiders, cope with the problem (by Bunn and Kathryn Glynn, then of IBM Global Business Services and now at the National Nuclear Security Administration). 

Another chapter examines the potential terrorist use of nuclear insiders, offering new data that shows that jihadist writings and postings contain only a modest emphasis on possible nuclear plots, and essentially no mention of the possibility of using nuclear insiders. However, the authors warn this is no reason for complacency – insiders have been largely responsible for past nuclear theft incidents.

MEDIA CONTACTS

Scott Sagan, Center for International Security and Cooperation: (650) 725-2715, ssagan@stanford.edu

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

Non-communicable diseases such as heart and respiratory disease, cancer, obesity and diabetes are now responsible for some two-thirds of premature deaths around the world. And most of those are in low- and middle-income countries.

The United Nations has estimated that on top of the social and psychological burdens of chronic disease, the cumulative loss to the global economy could reach $47 trillion by 2030 if things remain status quo.

“That was a big whopper of a number and got a lot of attention, and that was good because it raised awareness,” said Rachel Nugent, vice president for global non-communicable diseases (NDCs) at the research institute RTI International.

“It’s an issue that is driven by a lot of different factors, “ she said. “And understanding how the larger social and economic factors affect NDCs, at a policy level, very little progress has been made — there’s been very little collaboration.”

Nugent was addressing the fourth annual Global Health Economics Colloquium at University of California San Francisco, with health experts, policymakers, students and researchers from Stanford, Berkeley and UCSF who gather every year to take a deep dive into the economics of a global health issue. More than 200 experts from 10 universities and public health departments attended the conference.

The daylong gathering focused on recent developments in the economics of NDCs, looking at case studies from around the world, and new guidelines for cost-effectiveness analysis and the role of economics in reducing health inequality.

“The donors are not convinced that there are cost-effective things that we can do in these countries; a lot of them are very skeptical that this is affecting the poor,” said Nugent, a member of the World Health Organization’s expert advisory panel on the management of NCDs.

In India, for example, much of the population still defecates outdoors, contaminating water sources and agricultural products, which can lead to malnutrition and physical and cognitive disorders. Many donors would rather see funds go to building latrines as they can see tangible results; NDC prevention is a long-term slog.

“But I don’t think we should necessarily think of NDCs as either-or,” said Nugent.  “I think that integration of services and programming is very much at the forefront of what is the right way to go.”

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Cost-effectiveness Analyses

Nugent’s research has shown five cost-effective interventions would avert more than 5 million premature deaths from NCDs by 2030, or a reduction of 28.5 percent in projected mortality from chronic disease around the world. And the average benefit-cost ratio is 9:1, at a global cost of $8.5 billion a year.

The interventions are raising the price of tobacco products by 125 percent through taxation; providing aspirin to 75 percent of those suffering from acute myocardial infarction; reducing salt intake by 30 percent; reducing the prevalence of high blood pressure with low-cost hypertension medication; and providing preventive drug therapy to 70 percent of those at high risk of heart disease.

Gillian Sanders-Schmidler, a professor of medicine at Duke University Medical Center and former assistant professor of medicine at Stanford Health Policy’s Center for Primary Care and Outcomes Research, addressed the colloquium about recommendations of the Second Panel on Cost-Effectiveness in Health and Medicine.

“There is a continued emphasis on transparency and comparability across analyses,” said Sanders-Schmidler. “And of course the big changes are that we’re now asking for a second reference case and using an ‘impact inventory’ table to clarify the scope of the findings.”

The independent panel of non-government scientists and scholars, which also included Stanford Health Policy’s Douglas K. Owens, focused on new ways to deliver health care effectively, yet with a focus on efficiency, as health care spending in the United States has reached 18 percent of GDP, much greater than the global average of 10 percent.

The first panel that convened in 1996 recommended that all cost-effectiveness analyses of health interventions include a reference case that uses standard methodological practices to improve comparability and quality. The second panel, which published its findings in September, now recommends that in addition to the societal perspective recommended by the original panel, that CEAs include a second reference case that looks at the health-care sector impact of an intervention. Additional guidance was given on what to include in the societal perspective reference case.

The panel wrote in its JAMA “special communication” that these societal reference cases should include medical costs “borne by third-party payers and paid out-of-pocket by patients, time costs of patients in seeking and receiving care, time costs of informal (unpaid) caregivers, transportation costs, effects on future productivity and consumption, and other costs and effects outside the health-care sector.”

They found most countries, including the United States, give greater weight to clinical evidence in their cost-effectiveness analyses. The panel now recommends an “impact inventory” that helps analysts and end-users of cost effectiveness analyses look at the impact of interventions beyond the formal health-care sector.

“We’re trying to ask people to be explicit,” said Owens, director of the Center of Primary Care and Outcomes Research and Center for Health Policy at Stanford.

“We want them to look at how to value outcomes in a societal perspective, not just the health-care sector, to look at all these other sectors such as productivity consumption, criminal justice, education, housing and the environment,” he said.

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Case Studies

Several case studies presented at the colloquium indicated that policy changes, government intervention and social factors are key to preventing obesity and diabetes and other NCDs.

Kristine Madsen, an associate professor of public health at UC Berkeley who focuses on childhood obesity, spoke about the nation’s first “soda tax” on sugar-sweetened beverages, which was implemented in Berkeley in March 2015.

The city has seen a 21 percent decline in the drinking of soda and other sugary drinks in low-income neighborhoods after the city levied a penny-per-ounce tax on sodas and sugary drinks. At the same time, according to a study in the American Journal of Public Health, neighboring San Francisco — where a similar soda-tax measure was defeated — and Oakland saw a 4 percent increase in the purchase of sweetened beverages.

“This decline of 21 percent in Berkeley represents the largest public health impact in an intervention that I have ever seen,” said Madsen.

Sergio Bautista of the Mexico National Institute of Public Health and UC Berkeley, said that Mexico’s sugary drinks tax implemented in January 2014 is expected to lead to a 10 percent reduction in sugary drinks consumption and prevent an estimated 189,300 cases of diabetes in a country famed for its sugary bottled cola.

William Dow, a professor of health policy management at UC Berkeley, shared his research on Costa Rica, where on average people live longer than Americans, despite the several times higher income and 10 times higher health expenditures in the United States.

Costa Rican men have a life expectancy of 77 and the women typically live until age 82; in Americans the numbers are 76 and 81, respectively. Obesity is low among Costa Rican men and few of their women smoke. Lung cancer mortality in the United States is four times higher among men and six times higher among women.

“It’s remarkable in so many ways,” Dow said, noting that deaths in the Central American country are due predominantly to infectious disease. “Does Costa Rica have any unique effective programs to emulate, or is there something going on upstream driving those health outcomes?”

He believes Costa Rica’s national health insurance and excellent access to primary care for nearly all its people are key. Having this guaranteed lifetime access to health care also reduces the stress and depression that can so badly harm physical health.

“And I would argue that probably diet is one of the most important things going on here,” said Dow, noting their diets are healthy.

Costa Ricans eat mostly unprocessed foods such as rice and black beans, corn tortilla, yam and squash, with little meat and plenty of fresh fruit.

“They also have the highest remaining life expectancy at age 80 of any country in the world, he said. “What we have learned in Costa Rica would be helpful in many other countries.”