This document is a memo from the "Global Populisms and their International Diffusion Conference" held at Stanford University on March 1-2, 2019.
This is a work in progress. DO NOT cite without checking with the authors first.
In the honor of publication of Larry Diamond's "Ill Winds: Saving Democracy from Russian Rage, Chinese Ambition, and American Complacency" Foreign Affairs are providing past the paywall article "Democracy Demotion: How the Freedom Agenda Fell Apart" by Larry Diamond. Read here.
A new study by Stanford economists shows that giving fathers flexibility to take time off work in the months after their children are born improves the postpartum health and mental well-being of mothers.
In the study, slated for release by the National Bureau of Economic Research on June 3, Petra Persson and Maya Rossin-Slater examined the effects of a reform in Sweden that introduced more flexibility into the parental leave system. The 2012 law removed a prior restriction preventing a child’s mother and father from taking paid leave at the same time. And it allowed fathers to use up to 30 days of paid leave on an intermittent basis within a year of their child’s birth while the mothers were still on leave.
The policy change resulted in some clear benefits toward the mother’s health, including reductions in childbirth-related complications and postpartum anxiety, according to their empirical analysis.
“A lot of the discussion around how to support mothers is about mothers being able to take leave, but we often don’t think about the other part of the equation — fathers,” says Rossin-Slater, an assistant professor of health research and policy.
“Our study underscores that the father’s presence in the household shortly after childbirth can have important consequences for the new mother's physical and mental health,” says Persson, an assistant professor of economics.
Rossin-Slater and Persson are both faculty fellows at the Stanford Institute for Economic Policy Research.
Among their main findings of effects following the reform: Mothers are 14 percent less likely to need a specialist or be admitted to a hospital for childbirth-related complications — such as mastitis or other infections — within the first six months of childbirth. And they are 11 percent less likely to get an antibiotic prescription within that first half-year of their baby’s life.
There is also an overall 26 percent drop in the likelihood of any anti-anxiety prescriptions during that six-month postpartum period — with reductions in prescriptions being most pronounced during the first three months after childbirth.
What’s more, the study found that the average new father used paid leave for only a few days following the reform — far less than the maximum 30 days allowed — indicating how strong of a difference a couple of days of extra support for the mother could make.
“The key here is that families are granted the flexibility to decide, on a day-to-day basis, exactly when to have the dad stay home,” said Persson. “If, for example, the mom gets early symptoms of mastitis while breastfeeding, the dad can take one or two days off from work so that the mom can rest, which may avoid complications from the infection or the need for antibiotics.”
These indirect benefits from giving fathers workplace flexibility are not trivial matters when you consider the health issues mothers often face after childbirth and after they get home from the hospital, says Rossin-Slater, who is also a faculty member of Stanford Health Policy.
Infections and childbirth complications lead to one out of 100 women getting readmitted to the hospital within 30 days in the United States, according to the study.
Meanwhile, postpartum depression occurs for about one out of nine women, and maternal mortality has also been a rising trend over the past 25 years in the U.S.
The study comes as a growing number of lawmakers in the United States vocalize support for paid family leave but have failed to pass federal legislation.
Washington, D.C., and six states have adopted various paid family leave laws, but the U.S. remains the only industrialized nation in the world that does not have a national mandate guaranteeing a certain amount of paid parental leave.
Some federal lawmakers are working on family leave measures and have proposed such legislation over the past few years — including The Family Act, The New Parents Act — but none of them have ever gained enough traction to proceed in Congress.
This new study can help broaden the policy discussions, the researchers say.
The larger context around paid family leave policies is often framed today as a way to help narrow the gender wage gap by giving women more workplace flexibility and fewer career setbacks.
This study, however, shines a light on maternal health costs and how a policy on paid family leave — that includes workplace flexibility for the father — offers more benefits than previously thought, Rossin-Slater says.
“It's important to think not only about giving families access to some leave, but also about letting them have agency over how they use it,” she says.
And when it comes to concerns that fathers might use paid parental leave to goof off instead of spending the time as intended, the researchers say their study should assuage those worries.
“It's not like fathers are going to end up using a whole month to just stay home and watch TV. We don't find any evidence of that,” Rossin-Slater says. “Instead they only use a limited number of days precisely when the timing for that seems most beneficial for the family.”
“For all these reasons,” Persson says, “giving households flexibility in how to use paternity leave makes a lot of sense.”
“For seven decades our thinking about Indo-Asia-Pacific security and international cooperation issues has been underpinned by the narratives of a U.S.-led international order centered around the rule of law, economic openness, and multilateralism. Now this post-WWII order is being challenged.”
With that summation, APARC Director Gi-Wook Shin opened the symposium The Past, Present, and Future International Order in East Asia. Sponsored and organized by the Japan Institute for International Affairs (JIIA) and APARC’s Japan Program and U.S.-Asia Security Initiative , the day-long event gathered 20 experts across multiple fields, including international relations, political and diplomatic history in Asia, American foreign policy and history, Japan-PRC relations and politics, security interests in the Indo-Pacific region, and U.S.-Asia regional engagement.
Japan Program Director, Takeo Hoshi (above, one of the Symposium leaders, launched the panel discussions by first expressing his gratitude to the participants and sponsors on behalf of the organizers and then by encouraging the audience to engage in the discussions following each panel.
At the Symposium, the participants explored the circumstances that shaped the establishment of the security architecture in East Asia; considered the forces that propelled its evolution; and debated possible futures for East Asia and the greater Indo-Pacific region.
“Is the international order crumbling? Or, are the challenges it is undergoing a tentative deviation that can be fixed?” - Ambassador Kenichiro Sasae , JIIA President (pictured above).
The symposium’s first panel reviewed the evolution of diplomatic and security arrangements in East Asia, starting with the Versailles-Washington System, the international settlement inaugurated after World War I through the treaties signed in Paris in 1919-20 along with those signed in Washington in 1921-2. After World War II, the “San Francisco System,” the process of alliance formation and security cooperation that was initiated at the San Francisco Conference in September 1951, became the foundation of the U.S.-led regional order through the remainder of the twentieth century and continued to dominate international relations through the first two decades of the twenty-first.
Stanford historian David Kennedy explained that both systems are the products of Wilsonianism—a liberal internationalist ideology that has anchored the tradition of American diplomacy over the past century. The spirit of “Wilsonianism” is reflected in President Woodrow Wilson’s proclamation that “the world must be made safe for democracy,” a statement that he delivered in remarks presented in 1917 as he appeared before a joint session of Congress to ask for a declaration of war against Germany. The global cataclysm of World War II, said Kennedy, afforded the United States the capacity to shape the political will that would make the Wilsonian dream of an international order possible. This pivotal point in American history is referred to as a “Grotian moment” (named after Dutch jurist Hugo Grotius), a time when “new rules and doctrines emerged in rapid succession and with greater acceptance than previously possible.”
China figured prominently in both the Versailles-Washington System and the San Francisco System. Shin Kawashima of the University of Tokyo spoke about the Nine-Power Treaty, part of the 1922 Washington Conference, that affirmed China’s sovereignty, independence, and territorial integrity. Hsiao-ting Lin of the Hoover Institution stated that the treaty marked an internationalization of the U.S. open door policy regarding China, but that many in China viewed it and the broader framework of the Versailles-Washington System as Western imperialism.
In the aftermath of World War II, and particularly following the establishment of the People’s Republic of China and the outbreak of the Korean War, the United States became increasingly involved in East Asia. The signing of the peace treaty with Japan at the San Francisco Conference marked the beginning of the U.S. network of bilateral alliances, agreements, partnerships, and commitments in the region. The San Francisco System (also known as “hub and spokes” architecture) allowed the United States to develop exclusive relationships with the Republic of Korea, Japan, Taiwan (the Republic of China), and other Asian nations in the face of Communist forces. As Dr. Lin noted in his remarks, the U.S. regional security agreements and security cooperation arrangements also enabled the Republic of China (Taiwan) to gain independence and international recognition.
In his keynote address, Shorenstein APARC Fellow Michael Armacost , who previously served as U.S. ambassador to Japan and the Philippines, spoke of the promise that the possible resurgence of the “Quad” might bring to increasing the stability of the Indo-Pacific region. The “Quad” is an informal grouping of maritime democracies that includes Australia, India, Japan, and the United States. The four countries collectively provided relief following the Indian Ocean tsunami in 2004 and met for a summit in 2007 only to dissolve a year later, due to Australia’s abrupt departure after the PRC expressed displeasure about the partnership.
But much has changed in the ensuing decade, Armacost observed, with the argument in favor of the Quad now more compelling than ever. Armacost said that in bringing together the four democracies with their naval capabilities and convergence around norms of freedom of navigation, maritime law, international security, and nuclear cooperation, there could be a path forward towards more comprehensive cooperation in the Indo-Pacific region at a time of increased geopolitical uncertainty and as a counterpoint to China’s aggressive expansion throughout this region. Armacost also wondered, however, if Japan was in fact ready to take a greater leadership role, and who could sustain leadership beyond Prime Minister Abe’s time in office.
Ken Jimbo, Keio University
The afternoon sessions shifted focus to current Japanese, American, and Chinese interests and security concerns. APARC’s Oksenberg-Rohlen Fellow David M. Lampton discussed the intensifying U.S.-China rivalry, noting that the deterioration of the security relationship between the two countries is metastasizing into the economic, educational, and diplomatic spheres. Alliance management is bound to become increasingly important to the United States, he concluded, should the tension with the PRC intensifies further.
Tetsuo Kotani of JIIA described some ambivialence in Japan regarding the recently revised U.S. policies towards China. On the one hand, Japan welcomes America’s tougher approach to the People’s Republic of China; on the other hand, it is not pleased by the trade war between the two countries. Even while Japan recognizes that China is challenging the established international order, argued Kotani, it was still necessary for Japan to maintain engagement with its neighbor. He expressed his hope that the United States and Japan could reconcile their expectations of the PRC in East Asia and collaborate with other nations to strengthen regional stability.
James Schoff of the Carnegie Endowment for International Peace noted that United States had ample opportunity to address some of the more negative elements related to China’s rise, but that it chose instead to prioritize other issues and benefit from China’s economic growth. The United States ought to strengthen its alliances with Asian nations, said Schoff. Comparing alliance management to an anchor and chain, the U.S. national policies, he claimed, should be crafted and deployed in a manner that best fits the issue – i.e., an anchor and chain of different lengths for different areas. For instance, longer alliance anchor lines should be extended in the spheres of economy and diplomacy, while shorter lines are set in the areas of security and the intersection of economy, new technologies, and warfare.
Tom Christensen, Columbia University
The Symposium concluded with an examination of alternative East Asia and Indo-Pacific security systems. Ryo Sahashi of the University of Tokyo presented four models that could replace the current arrangement: an enhancement of the San Francisco System, with U.S. continued commitment to the region, but with Japanese and Australian increased security roles; a “group of hedging nations,” where the U.S.-based architecture was not dissolved but lesser powers operated with greater autonomy; an “emerging Japan-China rivalry,” where, following U.S. retrenchment, Japan was to defend its vital interests through defense; and “Sinicization and resistance,” where a U.S. retrenchment coupled with Japan’s backing down resulted in China’s leadership prevailing in its illiberal order-building.
The panelists agreed that China’s regional economic dominance for the foreseeable future was undeniable. However, they noted that the implications of its continued influence were up for debate. Ambassador Sasae conveyed his hope that the region might yet see positive outcomes, while other panelists expressed their concern that the present trend of turbulence and threats to multilateralism would likely continue.
U.S.A.S.I. Director Karl Eikenberry provided closing remarks, taking time not only to underscore the significance of the current situation in Indo-Pacific security, but to reflect as well on the value of events like the Symposium to increase understanding of the region's possible futures.
"Whether or not we’re at the Grotian moment [i.e., a point of transformatio in wrold relations]," Ambassador Eikenbery said, "we do know there’s been some very significant changes over the last several decades—especially regarding the distribution of power in the Indo-Pacific and throughout the world. We are seeing a steady erosion of values and norms that we took for granted…”
“It is not clear if the San Francisco System will endure. I think it’s incumbent upon us to bring people like [the Symposium panelists] together…and consider possible alternatives.”
A complete symposium report will be made available in the coming months.
We are thrilled to welcome Dr. HyoJung Jang back to the SPICE team! Jang holds a Ph.D. in Educational Theory and Policy as well as in Comparative and International Education from Penn State University, and an M.A. in East Asian Studies from Stanford University. She has returned to SPICE as an instructor for the Sejong Korean Scholars Program, an intensive online course on Korea for high school students across the United States.
Prior to pursuing her doctoral studies, Jang worked at SPICE developing extensive lesson plans for high school and college classrooms. She is co-author of several East Asia-focused curriculum units, including Inter-Korean Relations: Rivalry, Reconciliation, and Reunification, China in Transition: Economic Development, Migration, and Education, and Colonial Korea in Historical Perspective.
“It’s so wonderful to be back at SPICE, where my passion for education issues was sparked,” reflects Jang. “And it’s always inspiring to work with our young Sejong Scholars. Their sharp, inquisitive minds and sincere interest in Korea make me feel optimistic about the future of U.S.–Korean relations.”
Stay informed of SPICE news by joining our email list or following us on Facebook and Twitter.
“But as I read what the communist party, what President Xi says, I don't see the same fervor to the ideological dimension of what China is doing around the world...[compared to what] the Soviets were doing.”
It was during the 2019 Oksenberg Conference that FSI Director Michael McFaul made the preceding assessment. Titled On the Brink: A New Cold War with China, the conference sought to explore the causes underlying today’s intensified conflict between the United States and China. McFaul was joined on stage by APARC's Oksenberg-Rohlen Fellow David M. Lampton and China Program Director Jean Oi. Their panel followed an earlier fireside chat featuring keynote speaker Dr. Condoleezza Rice.
Rice, the 66th U.S. Secretary of State, opened the program with a wide-ranging conversation with Oi regarding our rapidly deteriorating trade relations with China. Among other topics, Secretary Rice drew contrasts between our current tensions with China and the Soviet-era Cold War; the potential sources of China’s increasing nationalism; and what the appropriate U.S. policy responses could be.
Condoleezza Rice (right) listens on as Jean Oi addresses the audience
Dr. Jean Oi (left) and Dr. Condoleezza Rice
Audio recordings and transcripts of the formal remarks by McFaul and Lampton are available below.
The annual Oksenberg Conference honors the legacy of Professor Michel Oksenberg. A renowned China scholar and senior fellow at Shorenstein APARC, Professor Oksenberg served as a key member of President Jimmy Carter’s National Security Council, guiding the United States towards normalized relations with China and consistently urging that the U.S. engage with Asia in a more considered manner.
People today can generally expect to live longer and, in some parts of the world, healthier lives. The substantial increases in life expectancy underlying these global demographic shifts represent a human triumph over disease, hunger, and deprivation, but also pose difficult challenges across multiple sectors. Population aging will have dramatic effects on labor supply, patterns of work and retirement, family and social structures, healthcare services, savings, and, of course, pension systems and other social support programs used by older adults. Individuals, communities, and nations around the world must adapt quickly to the demographic reality facing us and design new approaches to financing the many needs that come with longer lives.
This imperative is the focus of a newly published special issue of The Journal of the Economics of Ageing, entitled Financing Longevity: The Economics of Pensions, Health and Long-term Care. The special issue collects articles originally written for and discussed at a conference that was dedicated to the same topic and held at Stanford in April 2017 to mark the tenth anniversary of APARC’s Asia Health Policy Program (AHPP). The conference convened top experts in health economics and policy to examine empirical and theoretical research on a range of problems pertinent to the economics of aging from the perspective of sustainable financing for long lives. The economics of the demographic transition is one of the research areas that Karen Eggleston, APARC’s deputy director and AHPP director, studies. She co-edited the special issue with Anita Mukherjee, a Stanford graduate now assistant professor in the Department of Risk and Insurance at the Wisconsin School of Business, University of Wisconsin-Madison.
The Financing Longevity conference was organized by The Next World Program, a Consortium composed of partners from Harvard University, Fudan University, Stanford University, and the World Demographic and Aging Forum, and was cosponsored by AHPP, the Stanford Institute for Economic Policy Research, and the Stanford Center on the Demography and Economics of Aging.
The contributions that originated from the conference and are collected in the Journal’s special issue cover comparative research on more than 30 European countries and 17 Latin American countries, as well as studies on Australia, the United States, India, China, and Japan. They analyze a variety of questions pertinent to financing longevity, including how pension structures may exacerbate existing social inequalities; how formal and informal insurance interact in securing long-term care needs; the ways in which the elderly cope with caregiving and cognitive decline; and what new approaches might help extend old-age financial security to those working outside the formal sector, which is a major concern in low-income countries.
Another challenge of utmost importance is the global pension crisis, caused due to committed payments that far exceed the saved resources. It is a problem that Eggleston and Mukherjee highlight in their introduction to the special issue. By 2050, they note, the pension gap facing the world’s eight largest pension systems is expected to reach nearly US $400 trillion. The problem cannot be ignored, as “the financial security of people leading longer lives is in serious jeopardy.” Indeed four of the eight research papers in the special issue shed light on pensions and inequality in income support for older adults. The other four research papers focus on health and its interaction with labor force participation, savings, and long-term care.
The issue also features two special contributions. The first is an interview with Olivia S. Mitchell, a professor at the University of Pennsylvania’s Wharton School and worldwide expert on pensions and ageing. Mitchell explains the areas offering the most promise and excitement in her field; discusses ways to encourage delayed retirement and spur more saving; and suggests several priority areas for future research. The latter include applying behavioral insights to questions about retirement planning, improving financial literacy, and advancing innovations to help people imagine themselves at older ages and save more for their future selves.
The second unique contribution is a perspective on the challenges of financing longevity in Japan, based on the keynote address delivered at the 2017 Stanford conference by Mr. Hirotaka Unami, then senior Director for policy planning and research of the Minister’s secretariat of the Japan Ministry of Finance and currently deputy director general with the Ministry’s Budget Bureau.
In Japan, decades of improving life expectancy and falling birth rates have produced a rapidly aging and now shrinking population. Data released by Japan’s Statistics Bureau ahead of Children's Day on May 5, 2019 reveal that Japan’s child population (those younger than 15) ranks lowest among countries with a total population exceeding 40 million. In his piece, Unami focuses on the difficult tradeoffs Japan faces in responding to the increase in oldest-old population (people aged 75 and over) and the overall population decline. Japan aspires to do so through policies that are designed to restore financial sustainability for the country’s social security system, including the medical care and long-term care insurance systems.
Unami argues that Japan must simultaneously pursue a combination of increased tax revenues, reduced benefit growth, and accelerated economic growth. He notes that these three-pronged efforts require action in five areas: review Japan’s pension policies; reduce the scope of insurance coverage in low-risk areas; increase the effectiveness of health service providers; increase a beneficiary’s burden according to their means; and enhance policies for preventive health care for the elderly.
The aging of our world’s population is a defining issue of our time and there is pressing need for research to inform policies intended to improve the financial well-being of present and future generations. The articles collected in the Financing Longevity special issue and the ongoing work by APARC’s Asia Health Policy Program point to multiple areas ripe for such future research.
View the complete special issue >>
Learn more about Dr. Karen Eggleston’s work in the area of innovation for healthy aging >>
As China and Russia attack free governments and push strongman rule, the U.S. has gone silent—and a new tide of authoritarianism is gathering, writes Larry Diamond. Read here.
U.S. government aid for treating children and adults with HIV and malaria in developing countries has done more than expand access to lifesaving interventions: It has changed how people around the world view the United States, according to a new study by researchers at the School of Medicine.
Compared with other types of foreign aid, investing in health is uniquely associated with a better opinion of the United States, improving its “soft power” and standing in the world, the study said.
Favorability ratings of the United States increased in proportion to health aid from 2002 to 2016 and rose sharply after the implementation of the President’s Emergency Plan for AIDS Relief in 2003 and the launch of the President’s Malaria Initiative in 2005, the researchers report.
Their findings were published this week in the American Journal of Public Health. The lead author is postdoctoral scholar Aleksandra Jakubowski, PhD, MPH. The senior author is Eran Bendavid, MD, associate professor of medicine and a core faculty member at Stanford Health Policy.
“Using data on aid and opinions of the United States, we found that investments in health offer a unique opportunity to promote the perceptions of the United States abroad, in addition to disease burden relief,” the authors wrote. “Our study provides new evidence to support the notion that health diplomacy is a net win for the United States and recipient countries alike.”
The Trump administration, however, has proposed a 23% cut in foreign aid in its 2020 budget, including large reductions to programs that fight AIDS and malaria overseas.
The Stanford researchers believe their study is the first to add heft to the argument that U.S. health aid boosts the “soft power” that wins the hearts and minds of foreign friends and foes.
“Our study shows that investing in health aid improves our nation’s standing abroad, which could have important downstream diplomatic benefits to the United States,” Jakubowskisaid. “Investments in health aid help the United States accumulate soft power. Allowing the U.S. reputation to falter would be contrary to our own interests.”
A Policy Debate
Many politicians and economists consider spending U.S. tax dollars on foreign aid as an ineffective, and possibly harmful, enterprise that goes unappreciated and leads to accusations of American meddling in other countries’ national affairs.
The U.S. government, for the past 15 years, has contributed more foreign health aid than any other country, significantly reducing disease burden, increasing life expectancy and improving employment in recipient countries, the authors wrote. Still, this generosity has historically constituted less than 1% of the U.S. gross domestic product.
“Our results suggest that the dollars invested in health aid offer good value for money,” the researchers wrote. “That is, the relatively low investment in health aid (in terms of GDP) has provided the United States with large returns in the form of improved public perceptions, which may advance the U.S. government’s ability to negotiate international policies that are aligned with American priorities and preferences.”
The researchers used 258 Global Attitudes Surveys, based on interviews with more than 260,000 respondents, conducted by the Pew Research Center in 45 low- to middle-income countries between 2002 and 2016.
Their analysis focused on the health sector, which includes several large programs for infectious disease control, but also support for nutrition, child health and reproductive health programs. They compared health aid to other major areas of U.S. investment: governance, infrastructure, humanitarian aid and military aid. They also constructed a database of news stories that mentioned the President’s Emergency Plan for AIDS Relief or the President’s Malaria Initiative by crawling through the online archives of the top three newspapers by circulation in each of the 45 countries.
They found that the probability of populations holding a very favorable opinion of the United States was 19 percentage points higher in the countries where and years when U.S. donations for health care were highest, compared with countries where and years when health aid donations were lowest. Using another metric, the researchers found that every additional $100 million in health aid was associated with a nearly 6 percentage-point increase in the probability of respondents indicating they had a “very favorable” opinion of the United States.
In contrast, the researchers found, aid for governance, infrastructure, humanitarian and military purposes was not associated with a better opinion of the United States.
Bendavid, an infectious diseases physician and core faculty member of Stanford Health Policy, said that when he set out to conduct this research, he believed it would result “in a resounding thud” — that the “soft power” of health aid would have no impact on public opinion.
“For me, the notion that this program — hatched and headquartered in D.C. — would have impacts among millions in Nairobi and Dakar, seemed farfetched,” Bendavid said. “I was incredulous until all the pieces were in place.”
The ‘America First’ Agenda
The Trump administration’s “America First” agenda is calling for significant cuts to global health aid, particularly to the highly successful AIDS relief program, which was established by President George W. Bush. The administration’s budget, released in March, proposed a $860 million cut to the program; the President’s Malaria Initiative is facing a $331 million reduction in federal funding. That’s a decline of 18% and 44%, respectively.
The U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria would also decline by 17%, or $225 million, according to the Kaiser Family Foundation.
Yet beyond the reputational damage to the United States, such cuts could be a major setback to improving health outcomes in developing countries, the researchers said. After all, HIV knows no borders, and having more resilient health care systems is instrumental when facing public health crises, such as the Ebola outbreak in the Democratic Republic of Congo, Jakubowski said.
“The most direct impact of cutting the United States’ health aid allocations is the potential to undermine or reverse the progress that has been enabled by U.S. aid in curbing mortality and the spread of disease,” Bendavid said. “However, this study suggests there are also repercussions to the United States: the relationships the U.S. has built with recipient nations could also be undermined.”
Other Stanford co-authors are Steven Asch, MD, MPH, professor of medicine, and former graduate student Don Mai.
Stanford’s Department of Medicine supported the work.
Stanford Center at Peking University
5 Yiheyuan Road, Beijing, China