Jointly with partners throughout Asia, the Asia Health Policy Program (AHPP) at Shorenstein APARC has developed comparative research on health care use, medical spending, and clinical outcomes for patients with diabetes in the region and other parts of the world as a lens for understanding the economics of chronic disease management. Karen Eggleston, AHPP director and APARC deputy director, recently traveled to South Korea, where she led three project-related events.

On November 29, a workshop on Net Value Diabetes Management was held at Seoul National University (SNU) School of Medicine. This was the third such workshop convened through the project, following two previous ones held in Beijing at the Stanford Center at Peking University. Another workshop, on diabetes modeling, hosted by the Mt. Hood Diabetes Challenge Network, was held at Chung Ang University on December 1. Finally, on December 5, Eggleston held an information session, titled Comparative Economics Research on Diabetes, during the 2019 International Diabetes Federation (IDF) at BEXCO in Busan. These events were also made available through video conferencing to enable remote participation by collaborators who were unable to travel to Korea.

[Learn more about AHPP’s Net Value in Diabetes Management research project]

Diabetes Net Value Workshop

The workshop brought together team members from multiple health systems — including South Korea, Japan, Taiwan, Hong Kong, Thailand, India, the Netherlands, and the United States — to discuss comparative research on the economics of diabetes control. Eggleston shared the results of a study outlined in a working paper on the net value of diabetes management in Japan, the Netherlands, Taiwan, and Hong Kong. This research is part of a broader series of studies aimed to help address the policy challenge of finding the best strategies to improve health through cost effective prevention and healthcare productivity in chronic disease management.

The key to this research was to measure changes in quality or health outcomes over time by predicting mortality risk using blood pressure, blood sugar, and other factors amenable to patient and provider control and improvement (controlling for age and duration of diabetes diagnosis). The research seeks to understand how we can control cost and eliminate waste without cutting out the things that are valuable and improving people’s quality of life. Further studies probe determinants of relative net value of a pay-for-performance program in Taiwan, adherence to medications and vertical integration in Japan, and net value based on a randomized controlled trial in India.

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Young Kyung Do of SNU reported that according to his evaluation project for diabetes care, the quality of care and treatment in South Korea has improved and is similar to Hong Kong and Singapore. The goal of the program is to provide more comprehensive care to diabetes patients.

Talitha Feestra of the Netherlands net value team presented her proposal for joint research to develop new prediction models for specific populations as a core component of health economics decision models in Diabetes. Feestra will take the lead to develop the plan and time frame for the continuation of this research in 2020.

Several additional comparative studies were proposed and discussed. Participants who attended the workshop and contributed to discussion included Junfeng Wang from the Netherlands net value team; Jianchao Quan and Carmen Ng from Hong Kong University; Daejung Kim from the Korea Institute for Health and Social Affairs (KIHASA); Taehoon Lee, Eun Sil Yoon, and Hongsoo Kim from SNU; Piya Hanvoravongchai from Chulalongkorn University; and Gregory Ang from National University of Singapore. Remote participants included Vismanathan Baskar from Madras Diabetes Research Foundation; Wasin Laohavinij from Chulalongkorn University (visiting Stanford University autumn quarter); and Rachel Lu from Chang Gung University.

Mt. Hood Diabetes Challenge Workshop on Diabetes Modeling

Philip Clarke from the Health Economics Research Center, University of Oxford, presented the history of insulin as a cure for diabetes and discussed in detail methods for economic modeling of diabetes, including quality of life and diabetes cost, drawing from his rich experience developing the UK Prospective Diabetes Study outcomes model. The second presenter was Andrew Palmer of University of Tasmania, Australia. His presentation included many additional economic modeling pointers, especially regarding drawing in the literature for building models.

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We are grateful to Professors Clarke and Palmer for graciously allowing the AHPP network researchers to join the workshop both in person and remotely, adding to their chronic disease modeling skills, and for inviting Karen Eggleston to present a keynote at the Mt Hood conference that took place before the modeling workshop.

Information Session: Comparative Economics Research on Diabetes

The third and final component of the diabetes research events was held on December 5 as part of the International Diabetes Federation congress in Busan, Korea, and presented the network to clinicians and public health researchers. Participants from China, India, and Australia attended. They shared updates on their individual projects and discussed methods and ideas for future collaboration.

The science of cyber risk looks at a broad spectrum of risks across a variety of digital platforms. Often though, the work done within the field is limited by a failure to explore the knowledge of other fields, such as behavioral science, economics, law, management science, and political science. In a new Science Magazine article, “Cyber Risk Research Impeded by Disciplinary Barriers,” cyber risk experts and researchers at Stanford University make a compelling case for the importance of a cross-disciplinary approach. Gregory Falco, security researcher at the Program on Geopolitics, Technology, and Governance, and lead author of the paper, talked recently with the Cyber Policy Center about the need for a holistic approach, both within the study of cyber risk, and at a company level when an attack occurs.

CPC: Your recent perspective paper in Science Magazine highlights the issue of terminology when it comes to how organizations and institutions define a cyber attack. Why is it so important to have consistent naming when we are talking about cyber risk?

Falco: With any scientific discipline or field, there is a language for engaging with other experts. If there’s no consistent language or at least dialect for communication around cyber risk, it’s difficult to engage with scholars from different disciplines. For example: The phrase “cyber event” is contested and the threshold for what an organization considers to be a cyber event varies substantially. Some organizations consider someone pinging their network as a cyber event, others only consider something a cyber event once an intrusion has been publicly disclosed. So there’s a disparity when comparing metrics of cyber events from organization to organization because of the different thresholds of what’s considered an event.

CPC: We’ve all been sent one of those emails letting us know our data may have been compromised and your paper points out it’s nearly impossible to put foolproof protections into place; attacks are inevitable. Given that, how should companies weigh the various ways they can protect themselves?

Falco: The first exercise each organization should go through when they decide to be serious about cyber risk is to prioritize their assets. What is business critical? What is safety critical? Then, like all other risks, a cost-benefit analysis must be done for each asset based on its priority. If the asset is safety-critical, then resources should be allocated to help protect that asset or at least ensure its resilience. Trade-offs are inevitable, no company has unlimited resources. But starting with an understanding of where the priorities are, is critical.

CPC: In companies, cyber security often falls entirely to the Chief Information Security Officer (CISO). Your paper argues that’s shortsighted. What is gained when a company takes a more holistic approach?

Falco: Distributing responsibility across the organization catalyzes a security culture. A security culture is one where there is a constant vigilance or at least broad awareness of cybersecurity concerns throughout the organization. Fostering a security culture is often suggested as a mechanism to help reduce cyber risk in organizations. The problem with not distributing responsibility is that when something happens, it’s too easy to resort to finger-pointing at the CISO, and that’s counterproductive. Efforts after an attack should be on responding and being resilient, not finding the scapegoat.

CPC: Cyber risk largely focuses on prevention, but your paper argues that it’s what happens after an attack in that needs greater attention. Why is that?

Falco: Every organization will be attacked. However organizations can differentiate themselves from a cyber risk standpoint by appropriately managing the situation after an attack. Some of the most significant damages to organizations can be reputational if communication after an attack is unclear or botched. Poor communication after an attack can result in major regulatory fines or valuation adjustments as seen in cases like Yahoo and that can have major business implications. Communications aren’t the only important element of post-attack response. A thorough post-mortem of the organization’s response to the attack can be an important learning experience and a way to plan for future attacks.

CPC: Protecting against cyber attacks and the losses that go with them can obviously be costly for companies. You make a case for collaboration among different fields, say among data scientists and economists. How can that be encouraged?

Falco: We argue that cross-disciplinary collaboration rarely happens organically. Therefore, we call on funding agencies like the NSF or DARPA to specify a preference for cross disciplinary research when funding cyber risk projects. Typically, this isn’t currently a feature of calls for proposals, but for cyber risk programs it should be. We encourage researchers to explore cyber risk questions at the margins of their discipline. Those questions may lend themselves to potential overlap with other disciplines and foster a starting point for cross-disciplinary collaboration.

For more on these topics, see a full list of recent publications from the Cyber Policy Center and the Program on Geopolitics, Technology, and Governance.

"Ideologically, today’s autocrats are a more motley and pragmatic crew. They generally claim to be market friendly, but mainly they are crony capitalists, who, like Putin in Russia, Orban in Hungary, and Erdogan in Turkey, are first concerned with enriching themselves, their families, and their parties and support networks. Increasingly, they raise a common flag of cultural conservatism, denouncing the moral license and weakness of the “the liberal West” while advancing a virulent antiliberal agenda based on nationalism and religion," writes Larry Diamond. Read here. 

On October 20-22, the Stanford Center at Peking University hosted the 6^th meeting in the series of Nuclear Risk Reduction Project workshops organized by Stanford University and China Arms Control and Disarmament Association and the Center for Strategic Studies of the China Academy of Engineering Physics (CAEP).  The Stanford team included CISAC’s Dr. Siegfried Hecker, Elliot Serbin, Dr. Larry Brandt and Nick Hansen as well as young nuclear scientists from the UC Berkeley and Sandia National Laboratories.

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The workshop was focused on the North Korean nuclear situation and provided an excellent opportunity to compare both technical and political assessments of the current state of North Korea’s nuclear program and potential paths forward. The US participants presented their research with the latest analyses of open-source imagery of the North Korea’s nuclear and missile program. The Chinese specialists provided their own analysis of the current state of the North’s nuclear facilities and their operations.

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Young technical professionals on both sides exchanged their views on the challenges and potential methods for verification, an area critical for moving ahead with denuclearization of the Korean peninsula. Both sides agreed that this was an excellent area of future cooperation. It is viewed as one of the most important priorities for future meetings, along with continuing cooperation in the broader field of nuclear security.

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The annual award, which carries a US $10,000 cash prize, is sponsored by Stanford University’s Walter H. Shorenstein Asia-Pacific Research Center. It recognizes outstanding journalists and journalism organizations for excellence in coverage of the Asia-Pacific region. News editors, publishers, scholars, journalism associations, and organizations focused on Asia research and analysis are invited to submit nominations for the 2020 award through Friday, February 14.

STANFORD, CA, December 3, 2019 — The Walter H. Shorenstein Asia-Pacific Research Center (APARC), Stanford University’s hub for interdisciplinary research, education, and engagement on contemporary Asia, invites nominations for the 2020 Shorenstein Journalism Award. The award recognizes outstanding journalists who have spent their careers helping audiences around the world understand the complexities of   the Asia-Pacific region. The 2020 award will honor a journalist whose work has mostly been conveyed through American news media. The deadline for nomination submissions is Friday, February 14, 2020.

An annual tradition since 2002, the Shorenstein Journalism Award is sponsored by APARC and carries a cash prize of US $10,000. It honors the legacy of APARC benefactor, Mr. Walter H. Shorenstein, and his twin passions for promoting excellence in journalism and understanding of Asia. “In the face of a shifting geopolitical landscape and amid global declines of democracy, political rights, and civil liberties, it is more crucial than ever before to support independent journalism that seeks accuracy, deep reporting, and nuanced U.S.-Asia dialogue,” said APARC Director Gi-Wook Shin.

Over the course of its history, the award has recognized world-class journalists who push the boundaries of coverage of the Asia-Pacific region and help advance mutual understanding between audiences in the United States and their Asian counterparts. Recent honorees include Maria Ressa, Anna Fifield, Siddharth Varadarajan, Ian Johnson, and Caixin Media. The award alternates between recipients whose work has mostly been published through Asian news media and those whose work has mostly been conveyed through American news media. The 2020 award will recognize a recipient from the latter category.

For the award, the Asia-Pacific region is defined broadly to include Northeast, Southeast, South, and Central Asia and Australasia. Both individual journalists with considerable body of work and journalism organizations are eligible for the award. Nominees’ work may be in traditional forms of print or broadcast journalism and/or in new forms of multimedia journalism. The Award Selection Committee, whose members are experts in journalism and Asia research and policy, presides over the judging of nominees and is responsible for the selection of honorees.

APARC is seeking 2020 award nomination submissions from news editors, publishers, scholars, journalism associations, and entities focused on researching and interpreting the Asia-Pacific region. The Center will announce the winner by April 2020 and present the award at a public ceremony at Stanford in autumn quarter of 2020.

Nominations are accepted electronically through Friday, February 14, 2020 at 11:59 PM PST. For information about the nomination procedures and to submit nominations please visit the award nomination entry page.

Please direct all inquiries to aparc-communications@stanford.edu.

About the Walter H. Shorenstein Asia-Pacific Research Center
The Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) addresses critical issues affecting the countries of Asia, their regional and global affairs, and U.S.-Asia relations. As Stanford University’s hub for the interdisciplinary study of contemporary Asia, APARC produces policy-relevant research, provides education and training to students, scholars, and practitioners, and strengthens dialogue and cooperation between counterparts in the Asia-Pacific and the United States. Founded in 1983, APARC today is home to a scholar community of distinguished academics and practitioners in government, business, and civil society, who specialize in trends that cut across the entire Asia-Pacific region. Learn more about APARC and about the Shorenstein Journalism Award.

David M. Kennedy, the Donald J. McLachlan Professor of History Emeritus at Stanford University, award winning teaching and author of more than a dozen, including Freedom From Fear: The American People in Depression and War, which won the Pulitzer Prize in history, spoke to a packed audience on October 22^nd, 2019.  Kennedy used the outcome of the 2016 American presidential election, which surprised many observers, to reflect on both its historical and current determinants. Professor Kennedy explored some of the deep structural features that have long characterized the American political system, as well as the social, economic, technological, and cultural issues that are shaping American politics today.

Professor Kennedy spoke about the process of “disintermediation,” where different branches of government lose part of their role in the policymaking process.  He used this concept to analyze the long-standing struggle between congress and the president that continues today.   Particularly insightful for current day understanding is how presidents increasingly succeeded in using the public to go around congress in pursuing their policy interests. Franklin D. Roosevelt redefined the president’s relationship with the public with his famous “fireside chats,” making use of the radio, reaching beyond Woodrow Wilson who had to rely on printed newspapers.   John F. Kennedy took this even further via televised news conferences.  The internet and social media have taken disintermediation to the extreme.

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