In countries far along in the demographic transition, rapidly aging populations are colliding with a severe shortage of health care and elder care workers. Japan may be the most pertinent case study of this and other impacts of demographic disruption. The country’s fertility rate is decreasing faster than projected, and as of 2025, 30% of its population was aged 65 or older. These trends have contributed to a persistent gap between surging demand for elder care and a shrinking care workforce.

To cope with this crisis, the Japanese government has implemented several programs to promote the use of robots in nursing home care. These care robots (or “kaigo robots”) assist care workers and support residents with daily needs. But how does their adoption affect workflows, staff retention, and overall staffing of long-term care facilities? Few studies have empirically examined these questions.

Shedding light on the debate surrounding new automation technologies and their impact on workers, a recent study, published on August 6 in the inaugural issue of the journal Health Affairs Review, finds that care robots help address challenges posed by population aging and care-labor shortages without necessarily displacing workers or lowering care quality.

The study, titled Robots and Labor in the Service Sector: Evidence from Nursing Homes, is part of a collaborative effort driven by the Asia Health Policy Program (AHPP) at the Walter H. Shorenstein Asia-Pacific Research Center. The study’s co-authors are Stanford health economist Karen Eggleston, the director of AHPP; Toshiaki Iizuka of the University of Tokyo’s Graduate School of Economics, a former AHPP visiting scholar; Yong Suk Lee of the University of Notre Dame’s Keough School of Global Affairs, formerly the SK Center Fellow at Stanford’s Freeman Spogli Institute for International Studies; and Ellie Xi, a rising junior at Stanford studying biomedical computation on the pre-med track and a former research assistant to Dr. Eggleston.

“One of the aspects of the paper that I found most interesting is its attempt to move beyond simply documenting where robots are being adopted and instead ask what their adoption may actually do to the long-term care workforce, especially given the sector’s high turnover rates and physically demanding working conditions,” says Xi.

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Lessons from Early Diffusion of Robotics in the Long-Term Care Sector

The researchers grouped the robots prevalent in Japanese nursing homes into three main categories:

• Transfer aids: Wearable and non-wearable devices that assist staff with lifting frail residents from beds to wheelchairs, significantly reducing back strain, a leading cause of caregiver burnout.
• Mobility robots: Assistive systems that help residents move, use the restroom, or bathe more independently.
• Monitoring and communication systems: Sensors that alert staff when a resident has slipped out of bed or fallen, as well as social robots designed to offer companionship and cognitive stimulation.

To examine early diffusion of these robots, the researchers used 2017 survey data on long-term care work across approximately 860 Japanese nursing homes. A second source of data is their compilation of prefecture-level care robot subsidy availability, using regional variation in robot subsidies as an instrumental variable. Think of this as a natural experiment driven by a “geographic nudge.” Starting in 2015, Japan’s central government began providing prefectural governments with funds to subsidize the cost of adopting care robots. Because different prefectures introduced these subsidies at different times and with varying levels of generosity, nursing homes in some regions had a much easier path to acquiring and deploying robots than those in neighboring areas.

By comparing staffing trends between nursing homes that received this external, subsidy-driven "nudge" to adopt robots and those that did not, the researchers could confidently isolate the technology’s causal effects on the caregiving workforce.

The results indicate that nursing homes that adopted robots saw a significant decrease in staffing retention problems. Robot adoption was also associated with a 28% increase in care workers and a 39% increase in nurses, resulting in approximately 26% higher total employment at the facility level. Importantly, this employment growth occurred entirely among non-regular employees – that is, staff members on flexible, often part-time, contracts. The findings also suggest that robot adoption may improve continuity and quality of care while mitigating careworker shortages.

“Using nationally representative data from Japan and an instrumental-variable strategy, the study provides evidence suggesting that robots can complement rather than simply replace care workers, including by alleviating retention difficulties in a sector facing persistent labor shortages and potentially supporting quality of care,” explains Xi. “The paper’s central finding is that robot adoption is associated with reduced retention difficulties and increased employment of care workers and nurses under flexible contracts.”

A Human-Robot Collaborative Future for Elder Care

Caregiving is a physically demanding and high-stress occupation. The study’s findings indicate that, by introducing robots to ease staff burdens and monitor residents, nursing homes were able to promote more flexible work, either by increasing the tasks performed by non-regular employees or potentially encouraging part-time work. This type of work structure is encouraged by the Japan Nursing Association as a means for reducing stress, preventing burnout, and promoting a healthier work-life balance.

“Given recent debates about AI use in healthcare and the future of work, I found it especially interesting that this research highlights the potential for technology to augment caregivers, particularly by supporting physically demanding or indirect tasks, while preserving the human aspects of care that are more difficult to reproduce,” says Xi.

The study's findings are relevant for policymakers seeking evidence on the social value of collaborative robots and their impacts on staffing and care delivery, particularly as aging societies facing demographic pressures similar to Japan consider how to meet growing demand for long-term care.

A Mentorship Story

The study is part of Eggleston’s Innovation for Healthy Aging research track, which investigates how East Asian economies adopt and adapt to emerging technologies, design incentives, and adjust their workforces to support older adults. It builds on an earlier research project focused on the impact of robots on nursing home care in Japan.

For Xi, co-authoring the paper represents an academic milestone. "As someone deeply interested in geriatrics, I first began working with Dr. Karen Eggleston as a research assistant during the summer after my freshman year," Xi recalls. "Last spring, we decided to continue working together through a directed reading."

During that directed reading, Xi was invited to help revise and update a project that had previously circulated as an Asia Health Policy Program working paper. She worked to update the research, framing the original findings within the rapidly shifting landscape of care robotics and artificial intelligence in long-term care.

"I worked on situating the original findings within more recent research and developments in care robotics and considering what Japan’s experience can tell us about the role of these technologies in aging societies today," Xi says. "It was an incredible opportunity to work closely with Dr. Eggleston, Professor Toshiaki Iizuka, and Professor Yong Suk Lee. I was especially grateful to see firsthand how a collaborative project evolves and to contribute to that process as the paper moved from a working paper toward publication.”

The following reflection is a guest post written by Sunny Park, a Fall 2020 alumna of Stanford e-Entrepreneurship Japan, which is currently accepting applications for Fall 2026.

A “smart” high school student is often defined by strong grades, perhaps alongside a few extracurricular activities to strengthen university applications. Before encountering Stanford e-Entrepreneurship Japan (SeEJ), that was largely how I viewed myself. 

I came across SeEJ during the COVID-19 pandemic through a Facebook advertisement. Like many students at the time, I was looking for something more engaging beyond school. I didn’t expect how much it would reshape the way I think about learning, ambition, and possibility. 

What made SeEJ distinct was its focus on people rather than definitions. Each session featured entrepreneurs from different industries, sharing not just what they built, but how they navigated uncertainty, failure, and personal ambition. Seeing such varied paths made me realize that entrepreneurship isn’t a fixed route; it’s a way of thinking. And that was probably the moment when things shifted for me. Until then, I had always thought of my future in fairly narrow terms: choose a subject, go to university, and follow a path that already exists. SeEJ made me realize that there are far more ways to build a life, and that entrepreneurship is less about starting a company and more about taking ownership of what you want to pursue. 

Since then, I’ve found myself saying yes to things I would have hesitated to try before. I’m now in my final year of studying Biology at Imperial College London, and I co-founded a biotech startup called Eidolon Therapeutics. At Eidolon, we’re pioneering microbial protein combinations to combat immunotherapy resistance and inflammation-driven toxicity in cancer. It was through my Year-in-Research program where I met my Co-Founders (i.e., my professor and post-doc supervisor), and I was so fascinated by the research they were conducting I couldn’t help but impatiently suggest building a company out of it. Since then, we’ve been working incredibly hard on making Eidolon real, including joining accelerator programs such as the Cancer Tech Accelerator, Venture Catalyst Challenge, and Conception X. Through building an early-stage startup, I’ve had the chance to meet people I once found intimidating, pitch ideas in front of large audiences, and build relationships that started from simple conversations. 

I don’t think any of that came from a single moment of confidence. If anything, it came from gradually becoming more comfortable with not knowing exactly what I’m doing… and trying it anyway. Based on my journey so far, here are a few reflections for students exploring a similar path:

1. Be intentional about the opportunities you choose.

There are so many opportunities available as a student! SeEJ, in particular, showed me the value of learning environments where you actively engage with ideas and people. There are many programs available, but depth matters more than quantity. Choose opportunities where you can contribute, ask questions, and grow. 

2. Focus on genuine connections!

One of the most valuable parts of SeEJ was the access to people with diverse experiences. What I learned is that meaningful connections come from curiosity and sincerity, not from trying to impress. When you approach people with a willingness to learn, they are often more open than you expect. 

3. Stay engaged beyond the program.

The real impact of SeEJ extended beyond the sessions themselves. Following up with people, continuing conversations, and sharing your own progress helps turn short-term interactions into long-term relationships. Small, consistent effort makes a difference!

4. Reflect as you go. 

Exploring entrepreneurship alongside academics can be exciting but also overwhelming. Taking time to reflect on what you enjoy, what challenges you, and what kind of path you want to build helps you stay grounded and intentional.

Looking back, SeEJ was a turning point not because it provided a single opportunity, but because it changed how I see opportunities altogether. It reminded me that there isn’t one path to follow, but many that you can create. 

Stanford e-Entrepreneurship Japan is currently accepting applications for Fall 2026. Apply at https://forms.gle/5gkHrhm3X4sycZGG8.

Stanford e-Entrepreneurship Japan is one of several online courses offered by SPICE.

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This essay first appeared in The Diplomat.

For decades, South Korean strategy rested on a stable hierarchy within the international order. The alliance with the United States provided security; Seoul then managed relations with Japan, Europe, China, and regional institutions around that anchor. The alliance remains indispensable, but Seoul can no longer assume that this foundation will stay stable.

The evidence is visible in the way Washington now deals with allies. In 2025, the United States initially announced sharply differentiated “reciprocal” tariffs on South Korea, Japan, and the European Union. Negotiations later produced a 15 percent baseline framework for all three, but the process mattered as much as the final rate. Trade access, industrial investment, defense procurement, and alliance politics were increasingly handled as one bargaining package. Allies were not exempt from economic pressure because they were allies.

At the same time, Europe and Asia have been building connections that would have seemed highly ambitious a decade ago. The European Union signed security and defense partnerships with Japan and South Korea in November 2024. This year, the EU and Japan launched a defense-industry dialogue, while the EU and South Korea signed a digital trade agreement and began implementing cooperation on maritime security, cyber and hybrid threats, information manipulation, space, and the defense industry. The strategic map is becoming more networked. 

The network, however, remains uneven. Japan already has a mature economic partnership with the EU and rapidly expanding defense-industry ties. EU-South Korea relations are deepening, but they still lack the density and regular strategic consultation found in EU-Japan ties. A trilateral format would therefore do more than add another meeting: it would reduce asymmetry among three partners whose capabilities are increasingly complementary.

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South Korea, Japan, and the EU now face four converging challenges and pressures.

The first is demographic. South Korea is aging faster than any other OECD society; Japan’s working-age population has been shrinking for decades; and the EU’s fertility rate reached a new low in 2024. Demography is not a social-policy sidebar. It affects defense recruitment, industrial capacity, fiscal room, technological adoption, and the ability to sustain long-term commitments. Each actor is experimenting with immigration, automation, workforce policy, and welfare reform, but the security implications remain largely compartmentalized.

The second is concentrated economic dependence. None of the three can or should decouple from China. Yet South Korea’s experience after the THAAD deployment, Europe’s debates over economic coercion, and China’s export controls on gallium, germanium, and other strategic inputs have shown that interdependence can be converted into leverage. De-risking therefore requires more than national stockpiles. It requires shared risk maps, compatible certification, co-investment in alternative suppliers, and advance consultation before export controls or industrial subsidies create collateral damage among partners.

The third challenge is U.S. volatility. The United States is still the only actor capable of providing extended nuclear deterrence to South Korea and Japan, and NATO remains central to European defense. But dependence on U.S. power now coexists with uncertainty about U.S. policy. The classic alliance dilemmas of abandonment and entrapment are no longer opposite ends of a spectrum. Today, U.S. allies fear both being left out and being drawn into bargains or contingencies they did not shape.

The fourth pressure is the collapse of the old geographic separation between European and Asian security. North Korean munitions, missiles, and troops have supported Russia’s war against Ukraine. Moscow, in turn, has provided Pyongyang with political cover, economic support, and the prospect of military know-how. What happens on a European battlefield is changing the military balance on the Korean Peninsula. A regional response to a cross-regional threat is structurally inadequate.

This is the case for an EU-Japan-South Korea strategic dialogue. This framework should not be described as strategic autonomy, equidistance, or a hedge against the United States. A better term would be institutionalized hedging: risk diversification through standing, rule-based consultation among allies and partners that remain anchored in the broader U.S.-led system.

The proposal is more feasible than ever before. Japan-South Korea relations have improved significantly in recent years. The January 2026 summit in Nara and the reciprocal summit in South Korea in May demonstrated continuity across leadership changes in both countries since June 2025. The EU already has free-trade, digital, green, and security frameworks with both countries. The task is not to invent three new bilateral relationships; it is to connect existing ones.

The dialogue should begin modestly, through a Track 1.5 process involving officials, experts, and industry. Its early agenda must be concrete and specific: a joint critical minerals and supply chain risk assessment; consultation on export controls and investment screening; cooperation on AI, cyber resilience, and digital standards; exchanges on demographic and defense workforce adaptation; and shared monitoring of North Korea-Russia military cooperation. Successful projects could then be elevated to ministerial working groups.

Two design choices are essential. First, the initiative must remain function-driven. It is not NATO, not the Quad, and not an anti-China coalition. Its purpose is to reduce vulnerability without demanding economic separation. Second, it should be complementary to relations with Washington and transparent about that purpose. Horizontal networks strengthen alliances when they help allies absorb shocks, coordinate positions, and arrive at consultations with greater capacity.

For South Korea, the need is particularly acute. Japan already has the G7, a mature economic partnership with the EU, and expanding European defense ties. Seoul’s international weight has grown faster than its institutional depth. An EU-Japan-South Korea dialogue would help close that gap.

Horizontalizing alliances is not a vote of no confidence in the United States. It is insurance for the moments when the United States wavers, overreaches, or changes course. The postwar hierarchy cannot simply be preserved by demanding more reassurance from Washington. Its resilience will depend on whether allies can build connective tissue among themselves before the next crisis forces them to improvise.

SPICE offers several local programs for students in Japan, including regional programs at the city and prefectural levels. Developed through collaborations between SPICE and local governments across Japan, these online programs encourage students to engage with complex global issues while deepening their understanding of U.S. society, culture, and U.S.–Japan relations through critical thinking and research.

With the 2025–2026 session now finished, each participating program has recognized two outstanding students for their exceptional achievements throughout the course, including the quality of their final research projects. These student honorees will travel to Stanford University in August 2026, where they will present their research during a series of recognition ceremonies. The events will welcome distinguished guests from the Stanford community, the Consulate General of Japan in San Francisco, and members of the Japanese community throughout the Bay Area.

SPICE proudly congratulates the following students for their outstanding academic accomplishments.

Stanford e-Fukuoka (Instructor: Kasumi Yamashita)

Student Honoree: Konoha Inoyusu
School: Fukuoka Daichi High School

Student Honoree: Haruki Kenyon
School: Kurume High School

Stanford e-Hiroshima (Instructor: Rylan Sekiguchi)

Student Honoree: Konatsu Haga
School: Fukuyama Akenohoshi Girls’ High School

Student Honoree: Momoka Nagayama
School: Hiroshima Inokuchi High School

Stanford e-Kagoshima City (Instructor: Amy Cheng)

Student Honoree: Nayuta Nei
School: Kagoshima Gyokuryu High School

Student Honoree: Shiori Nishizono
School: Kagoshima Girls’ High School

Stanford e-Kawasaki (Instructor: Maiko Tamagawa Bacha)

Student Honoree: Mio Suzuki
School: Kawasaki High School

Student Honoree: Rio Hojo
School: Tachibana High School

Stanford e-Kobe (Instructor: Alison Harsch)

Student Honoree: Sakura Oe
School: Kobe Municipal Fukiai High School

Student Honoree: Shotaro Take
School: Kobe Municipal Fukiai High School

Stanford e-Oita (Instructor: Kasumi Yamashita)

Student Honoree: Mao Hieida
School: Nakatsu Minami High School

Student Honoree: Taichi Morikawa
School: Takada High School

Stanford e-Tottori (Instructor: Jonas Edman)

Student Honoree: Una Ishikawa
School: National Institute of Technology, Yonago College

Student Honoree: Asumi Nishimura
School: Tottori Nishi High School

Stanford e-Yamaguchi (Instructor: Jonas Edman)

Student Honoree: Misaki Kobayashi
School: Keishin Senior High School

Student Honoree: Hiroi Tomokawa
School: Iwakuni Senior High School

SPICE commends these students for their intellectual curiosity, academic excellence, and commitment to developing a global perspective. We look forward to recognizing their accomplishments at Stanford University next month.

SPICE also offers online courses to U.S. high school students on Japan (Reischauer Scholars Program), China (China Scholars Program), Korea (Sejong Korea Scholars Program), and entrepreneurship (Stanford e-Entrepreneurship U.S.), and online courses to Chinese high school students on the United States (Stanford e-China) and to Japanese high school students on the United States and U.S.–Japan relations (Stanford e-Japan) and on entrepreneurship (Stanford e-Entrepreneurship Japan).

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The Stanford e-Yamaguchi Program recently concluded its second year, continuing a successful partnership between SPICE and the Yamaguchi Prefectural Board of Education. Designed to provide high school students in Yamaguchi Prefecture with opportunities to strengthen their English communication skills, explore global issues, and engage with Stanford educators and guest speakers, the program offers participants a unique opportunity to develop their global perspectives while interacting with experts from a variety of fields.

This year marked my first year teaching the Stanford e-Yamaguchi course, and it has been a truly rewarding experience. Throughout the program, I was consistently impressed by the students’ intellectual curiosity, thoughtful participation, and willingness to engage with complex global topics in English. Their enthusiasm for learning and openness to new perspectives made every virtual classroom session meaningful and enjoyable.

I would like to express my sincere appreciation to Mia Kimura, who taught the inaugural year of the program and helped establish a strong foundation for its continued success. Her efforts during the program’s first year played an important role in creating a welcoming and engaging learning environment, one that I have sought to emulate in my own teaching.

The course featured a series of outstanding guest speakers who shared their expertise and experiences with students. I would like to thank Dr. Stephen Murphy-Shigematsu, Dr. Elizabeth Baham, Dr. Gary Mukai, and Dr. Mariko Yoshihara Yang for their generous contributions to the program. Through their presentations and discussions, students explored a wide range of topics, including mindfulness in leadership, diversity in leadership, global citizenship, and design thinking. These sessions provided students with opportunities to connect classroom learning to real-world challenges and encouraged them to think critically about the qualities needed to lead in an increasingly interconnected world.

The success of the Stanford e-Yamaguchi course is the result of the efforts of many individuals and organizations. I am especially grateful to Professor Yuko Hayashi, Yamaguchi University, for introducing SPICE to Tsugumasa Muraoka, Governor of Yamaguchi Prefecture. That introduction helped establish the connections and support necessary to make this partnership possible.

I would also like to extend my deepest thanks to Akinobu Tomonari of the Yamaguchi Prefectural Board of Education. Tomonari-sensei has been instrumental in planning, coordinating, and facilitating the program. His dedication and commitment have been essential to the program’s success.

As we conclude another successful year, we celebrate not only the accomplishments of the students but also the strong partnership between SPICE and Yamaguchi Prefecture. We look forward to continuing this collaboration and providing future cohorts of students with opportunities to develop the knowledge, skills, and global perspectives needed to become thoughtful leaders in their communities and beyond.

Stanford e-Yamaguchi is one of SPICE’s local student programs in Japan.

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On March 27, 2026, 16 undergraduate students in Japan joined 50 graduate students in Norway for a virtual exchange focused on local sustainability challenges. The session was part of the SPICE Social Entrepreneurship course offered at Eikei University of Hiroshima (Eikei) and co-organized with the Faculty of Technology, Art and Design at the Oslo Metropolitan University (OsloMet). 

The exchange served as the culminating activity of a course that SPICE has offered at Eikei since 2022, made possible in large part by the vision of Hiroshima’s former Governor Hidehiko Yuzaki. The course guides students through community engagement, local sustainability challenges, and problem-solving using design thinking methods. This year, students tackled topics including rural transportation, migrant worker conditions, seniors' access to AI, and cybersecurity. What distinguished this iteration was the opportunity for students to test their ideas with an international audience whose academic background differed significantly from their own. 

To create that opportunity, SPICE partnered with OsloMet’s master’s program in Applied Computer and Information Technology. Though the two programs differ in size, location, and disciplinary focus – one rooted in liberal arts, the other in STEM – they share a common goal: helping students explore complex social problems through interdisciplinary and cross-cultural collaboration. To prepare for the virtual session, Eikei students created short video presentations introducing the sustainability challenges they had identified in Hiroshima. OsloMet students then reframed those challenges in their own local content and developed technical solutions in response. During the live session, students from both sides met in breakout discussions facilitated by Eikei student assistants, where Oslo teams proposed solutions and Hiroshima teams asked questions and explored implementation. 

For Eikei students, the most significant learning emerged from the reflective activities that followed. Students’ responses centered on two pillars the SPICE course had set from the beginning: intercultural competence and interdisciplinary thinking.

Eikei students reflecting on Japan-Norway student exchange | Photo Credit: SPICE

On the intercultural side, the exchange made clear how deeply local context shapes the way problems are understood and solved. A group working on AI and senior citizens, for instance, found that differing attitudes toward aging in Japan and Norway influenced both how the problem was defined and which solutions seemed viable. One student wrote: 

"The most memorable moment was when the very first prototype shown — from Group 9 — was an AI-generated image of a pizza with wheels, with an elderly person smiling next to it. I felt that our perspectives on social welfare and the public good were fundamentally different. Our conception of government's mission is something close to protecting the vulnerable. Their view, by contrast, were rooted in a focus on individual flourishing and self-actualization. It really took me by surprise."

Another student recalled a similarly unexpected moment:

“I received a lot of basic questions about everyday life in Japan — things like 'Isn't it normal for people in Japanese suburbs to ride electric scooters?' or 'How much do elderly people in Japan actually use smartphones?' I had expected questions about complex solutions, but I realized that even things I take for granted carry invisible assumptions and biases. In a cross-cultural setting, you have to align on the basics before you can go deeper."

These moments pushed students to examine their own assumptions and recognize how context shapes both problems and solutions. 

The interdisciplinary dimension was equally revealing. Eikei students admired how their Norwegian peers translated broad social concerns into concrete, technically grounded proposals. At the same time, the exchange helped them see the value of their own liberal arts education. One student reflected:

“Since the Oslo students each specialize in one field, it seemed like every group felt compelled to apply that expertise — which meant their solutions often ended up looking similar. We, on the other hand, are trained to approach problems from multiple disciplines and to include not just what’s immediately feasible but also future possibilities. Seeing that difference made so concrete was what left the strongest impression.”

Rather than viewing technical expertise as inherently superior, Eikei students came to see stakeholder engagement and contextual sensitivity as equally essential for addressing complex challenges, and concluded that effective solutions require both. This shift in perspective reflects a central aim of STEAM education: integrating a human-centered perspective into the traditional STEM framework (link to a related article). 

This experience reinforced the value of designing courses that connect students across institutions, disciplines, and cultures. The impact, it turns out, extended beyond the participants themselves. One of the Eikei student assistants who helped facilitate the session also reflected on what the experience meant to her (link). Many Eikei students expressed a desire for more sustained collaboration with their Norwegian peers, suggesting that future iterations of such a course could benefit from extending the exchange beyond a single session. More time and more exchanges would create greater space for mutual understanding and deeper engagement with complex "wicked" social problems.

Eikei students in SPICE Social Entrepreneurship course | Photo Credit: SPICE

Acknowledgement: I am deeply grateful to Professor Tulpesh Patel at OsloMet for making this partnership both possible and genuinely rewarding. Since we began working together in August 2025, it has been a true collaboration, the one built on regular conversation, mutual trust, and a shared belief in the value of human-centered, context-sensitive learning, an approach that lies at the heart of STEAM education. Working with Professor Patel has been a personal reminder of why cross-cultural and interdisciplinary collaboration matters. 

SPICE's course on Social Entrepreneurship with Eikei University of Hiroshima is one of SPICE’s local student programs in Japan.

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