CDDRL Director Larry Diamond addresses concerns of an intensifying democratic recession in a piece in The Atlantic. Despite recent turmoil in Ukraine and democratic breakdowns in Thailand and Turkey, among others, Diamond emphasizes the critical role economic development, globalization and the growth of civil society will play in the long-run inducement of democratic change worldwide.

President Barack Obama’s trip to four Asian nations – Japan, South Korea, Malaysia and the Philippines – set out to address an ambitious agenda, including trade negotiations, territorial disputes, and the threat of North Korea. Scholars at the Shorenstein Asia-Pacific Research Center in the Freeman Spogli Institute provided commentary to local and international media about the state tour.

Ambassador Michael Armacost, a distinguished fellow at Shorenstein APARC, evaluated the goals of the trip, saying it aimed to deliver a message of reassurance to East Asia that the U.S. rebalance is intact. Armacost highlighted the efforts to negotiate a 12-nation trade pact, the Trans-Pacific Partnership (TPP) as the centerpiece of the Obama trip to Asia. He was interviewed by Weekly Toyo Keizi, a Japanese political economy magazine. An English version of the Q&A is available on Dispatch Japan.

Many foreign policy issues shadowed the outset of President Obama’s Asia trip, the crisis in Ukraine and Syria, among others. Daniel Sneider, associate director of research at Shorenstein APARC, said in Slate that Asian nations notice where the United States focuses its time. Obama’s commitment to the region may have come across as distracted given the breadth of his current foreign policy agenda.

Sneider also spoke with LinkAsia on Obama’s stop in Tokyo. President Obama met with Japanese Prime Minister Shinzo Abe; the two leaders addressed issues surrounding territorial disputes and attempted to reach an agreement on outside market access issues in the TPP negotiations.

Donald Emmerson, director of Shorenstein APARC’s Southeast Asia Forum, offered an assessment of America’s ‘pivot to Asia’ and on the significance of the Malaysia and Philippines visits. He said the trip most notably reinforced America’s efforts to upgrade security commitments and promote freer trade negotiation in that region. The Q&A was carried by the Stanford News Service.

Emmerson spoke with McClatchyDC on two occasions about the Philippines leg of the tour. He commented on Obama’s statement reaffirming the United States’ security commitment to Japan, which recognized Japan’s administrative control over the Senkaku Islands. Emmerson suggested the greater context of claims in the South China Sea must be considered, including Manila’s. He also said maintenance of the security alliance is a positive step, but trade is a an essential part of the the pivot's sustainablility.

Donald K. Emmerson, director of Shorenstein APARC's Southeast Asia Program and FSI senior fellow emeritus, offers insight on U.S. President Barack Obama's Asian tour. He says the trip most notably reinforces America's 'rebalance' efforts to upgrade security commitments and promote freer trade negotiation in that region.

When President Barack Obama this week began a high-profile visit to Asia, it called into question how effective the "Asian pivot" in America's foreign policy has been. A few years ago, Obama announced that a rebalancing of U.S. interests toward Asia would be a central tenet of his legacy. Now he is visiting Japan, South Korea, Malaysia and the Philippines to reassert the message that America is truly focused on Asia – despite finding itself repeatedly pulled away by crises in Ukraine and the Middle East, and political battles in Washington, D.C.

Stanford political scientist Donald K. Emmerson, an expert on Asia, China-Southeast Asia relations, sovereignty disputes and the American "rebalance" toward Asia, sat down with the Stanford News Service to discuss Obama's trip. Emmerson is a senior fellow emeritus at the Walter H. Shorenstein Asia-Pacific Research Center in the Freeman Spogli Institute for International Studies.

President Obama started his Asian pivot a few years ago. Have problems in Ukraine, Syria, Iran and at home detracted from this new approach?

The pivot as practiced continues unabated. The pivot as perceived has suffered from its displacement on various attention spans by superseding events and concerns, both foreign and domestic. President Obama's current trip to Asia is itself a reflection of these distractions. Originally planned for October, it was postponed by extreme political discord in Washington. But the chief elements of the pivot remain in place and in progress. They are most notably the upgrading of American security commitments and the effort to negotiate freer trade.

Why does this rebalancing in U.S. foreign policy make sense – or not?

The pivot certainly serves U.S. interests. Americans cannot afford to deny themselves, or be denied by others, the opportunities for trade and investment that Asia's most dynamic economies will continue to generate. The U.S. also needs to work with China and its neighbors to help ensure that China's rise serves the wider security interests of Americans, Chinese, Asians and the world, however dissonant the day-to-day advocacy of those interests may be. Ironically, by obliterating Obama's proposed reset of U.S.-Russia relations, Vladimir Putin has become an unintentional friend of the rebalance toward Asia. His aggression in Crimea and eastern Ukraine has made all the more urgent the need for Washington to pursue mutually beneficial relations with Beijing and the rest of Asia that could moderate China's willingness and ability to force its ownfaits accomplis in the East and South China Seas.

Do Chinese leaders view Obama's Asian pivot as a de facto containment approach to a rising China?

China's leaders do question U.S. intentions. But one ought not ignore the dozens and dozens of venues and ways in which the two countries' governments continue to cooperate on multiple fronts. In domestic terms it is politically convenient for Chinese hardliners to disparage American motives. As with the pivot itself, however, perception and practice are not the same thing.

Are Asian countries more rattled than ever by China's behavior in places like the South and East China Seas?

Concerned, yes; rattled, no. There are six or seven different claimants to contested land features and/or sea space in the South China Sea, not to mention the territorial tensions that also bedevil interstate relations in Northeast Asia. East Asian leaders are not lined up in a united front against Beijing. They are themselves divided. The more assertive China becomes, the more pushback it can expect. But most of the states in Southeast Asia do not want to ally with the U.S. against China, or with China against the U.S.

The U.S. and the Philippines are poised to sign a treaty that will expand America's military presence in the island country. What's the significance of the treaty?

Articles 4 and 5 of the treaty commit Washington and Manila to "act to meet the common dangers" implied by "an armed attack in the Pacific Area" on the "metropolitan territory" of either party, or on the "island territories under its jurisdiction," or on "its armed forces, public vessels or aircraft in the Pacific," and to do so "in accordance with its constitutional processes." But these provisions are hardly self-implementing; they require interpretation. Even if China were to forcibly evict the Philippine marines who now occupy Second Thomas Shoal in the South China Sea, the treaty would not automatically trigger an American military response. Applied to that scenario, the treaty would not instantly entrap the U.S. in a war with China. But the treaty would require some action or statement on the part of Washington. In Manila, Obama will try to reassure his Philippine host in this regard without enraging its Chinese neighbor.

Obama will be the first U.S. president in five decades to visit Malaysia. What does that visit mean for that country?

Of the four countries that Obama is visiting, it is in Malaysia that the pivot's third face after security and economy – namely democracy – will be most visible. Obama will be careful not to appear to enter into the domestic political turbulence Malaysia is experiencing, but his visits with civil society actors and university students in Kuala Lumpur will send the nonpartisan message that America remains committed to democratic values for itself and for Asians as well.

Clifton Parker is a writer for the Stanford News Service.

In a recent report, CDDRL Postdoctoral Fellow Amr Adly, with the support of the Center for International Private Enterprise, provides insight on post-revolution entrepreneurship in Egypt and Tunisia. He suggests that in order to advance their economies, governments must carry out comprehensive reforms that provide greater accessibility to formal institutional structures for the broadest base of private sector enterprises, namely, small business owners, rural enterprises, and female entrepreneurs.

Foreign aid for health care is directly linked to an increase in life expectancy and a decrease in child mortality in developing countries, according to a new study by Stanford researchers.

The researchers examined both public and private health-aid programs between 1974 and 2010 in 140 countries and found that, contrary to common perceptions about the waste and ineffectiveness of aid, these health-aid grants led to significant health improvements with lasting effects over time.

Countries receiving more health aid witnessed a more rapid rise in life expectancy and saw measurably larger declines in mortality among children under the age of 5 than countries that received less health aid, said Eran Bendavid, MD, an assistant professor in Stanford Medical School's Division of General Medical Disciplines and lead author of the study. If these trends continue, he said, an increase in health aid of just 4 percent, or $1 billion, could have major implications for child mortality.

“If health aid continues to be as effective as it has been, we estimate there will be 364,800 fewer deaths in children under 5,” he said. “We are talking about $1 billion, which is a relatively small commitment for developed countries.”

Does it work?

Bendavid noted that there is much debate around foreign aid. Critics question whether it’s used effectively and reaches its intended recipients. They often argue that it discourages local development and displaces domestic resources that might otherwise be devoted to health. So the researchers devised a statistical tool to address the basic unanswered question: Do investments in health really lead to health improvements?

Bendavid said there are many reasons to suspect the answer would be no, though the findings proved just the contrary, with health-related aid leading to direct, beneficial outcomes.

“I think for many people, that will be surprising,” he said. “But for me, it fits with other evidence of the incredible success of public health promotion in developing countries.” In a previous study, for instance, he found that hundreds of thousands of lives were saved through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, in which the U.S. government invested billions of dollars in antiretroviral treatment and other AIDS-related prevention and treatment initiatives.

In the latest study, the two investigators used data from the Creditor Reporting System of the Organization for Economic Cooperation and Development, the world’s most extensive source of information on foreign aid. While aid programs for health grew during the 36-year study period, the largest period of growth occurred between 2000 and 2010, they found.

Stepped-up investments

It was during this decade that many governments and private groups stepped up their investments in health, including PEPFAR; the World Bank; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Gates Foundation; and the GAVI Alliance, among others, he said.

As a result, while health aid in 1990 accounted for 4 percent of total foreign aid, it now amounts to 15 percent of all aid, he said. And it’s become an important part of health budgets in recipient countries, accounting for 25-30 percent of all health-care spending in low-income countries, Bendavid said.

The researchers found that these funds were used effectively, largely because of the targeting of aid to disease priorities where improved technologies — such as new vaccines, insecticide-treated bed nets for malarial prevention and antiretroviral drugs for HIV — could make a real difference.

They observed the greatest health impacts between 2000 and 2010, when donor investments were at their peak. During the decade, under-5 child mortality declined from a mean of 109.2 to 72.4 deaths per 1,000, or 36.8 fewer deaths among those children in the countries that received the most health aid, the researchers found (a 34 percent reduction). In the countries receiving the least, under-5 mortality fell from 31.6 to 23.2 deaths per 1,000, or 8.4 fewer deaths per 1,000 live births (a 26 percent reduction), the researchers reported.

Life expectancy increases

During that period, life-expectancy figures also grew faster in countries with a greater infusion of health aid, Bendavid said. Life expectancy rose from 57.5 to 62.3 — an increase of 4.8 years — among the countries receiving the most aid. Among the countries receiving the least health aid, life expectancy increased by 2.7 years, from 69.8 to 72.5 years.

Bendavid said previous experience has shown that, on average, life expectancy has increased by nearly one year every four years in developed countries. But health-aid programs literally cut in half the time it took to reach this goal in developing countries. “In that same four-year span, they increased life expectancy by two years, rather than one year,” he said.

He said the results are not surprising if one considers some of the new health technologies made available to developing nations as a result of foreign aid. Childhood vaccines, including those for diphtheria, tetanus, polio and measles, have all but wiped out what used to be among the top killers of young children in the developing world. Health aid directed to providing insecticide-treated malarial bed nets also has been credited in recent studies with reducing malarial deaths among young children, he noted.

Among both adults and children, aid that has expanded the availability of antiretroviral drugs in the developing world has had a major impact on reducing deaths and improving overall life expectancies, he said. For instance, in a study published in 2012, Bendavid and colleagues found that PEPFAR’s health aid resulted in more than 740,000 lives saved between 2004 and 2008 in nine countries.

The researchers also found that the benefits of aid have a lasting effect: The telltale signs of aid’s relationship to reducing under-5 mortality were detectable for three years following the distribution of aid. The correlation between health aid and longer life expectancy overall was detectable for five years after the aid was distributed.

With aid commitments flattening amid the economic downturn, Bendavid said donors will have to be that much smarter in how they invest future dollars, focusing on the most cost-effective interventions and technologies.

“To date, there has been little consideration of how to use development aid in the most cost-effective manner,” he said. “That will have to change now that the funding level has reached a plateau.”

The study was funded by the George Rosenkranz Fellowship for Health Policy Research in Developing Countries and by the National Institutes of Health (grant K01AI084582).

Information about Stanford’s Department of Medicine, which also supported the work, is available at http://medicine.stanford.edu.

Ruthann Richter is the director of media relations at the Stanford School of Medicine.