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Background: China has one of the highest rates of antibiotic resistance. Existing studies document high rates of antibiotic prescription by primary care providers but there is little direct evidence on clinically inappropriate use of antibiotics or the drivers of antibiotic prescription.

Methods: To assess clinically inappropriate antibiotic prescriptions among rural primary care providers, we employed unannounced standardized patients (SPs) who presented three fixed disease cases, none of which indicated antibiotics. We compared antibiotic prescriptions of the same providers in interactions with SPs and matching vignettes assessing knowledge of diagnosis and treatment to assess overprescription attributable to deficits in diagnostic knowledge, therapeutic knowledge and factors that lead providers to deviate from their knowledge of best practice.

Results: Overall, antibiotics were inappropriately prescribed in 221/526 (42%) SP cases. Compared with SP inter- actions, prescription rates were 29% lower in matching clinical vignettes (42% versus 30%, P,0.0001). Compared with vignettes assessing diagnostic and therapeutic knowledge jointly, rates were 67% lower in vignettes with the diagnosis revealed (30% versus 10%, P , 0.0001). Antibiotic prescription in vignettes was in- versely related to measures of diagnostic process quality (completion of checklists).

Conclusions: Clinically inappropriate antibiotic prescription is common among primary care providers in rural China. While a large proportion of overprescription may be due to factors such as financial incentives tied to drug sales and perceived patient demand, our findings suggest that deficits in diagnostic knowledge are a major driver of unnecessary antibiotic prescriptions. Interventions to improve diagnostic capacity among providers in rural China are needed.

 

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Journal of Antimicrobial Chemotherapy
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Anemia in children impairs physical growth and cognitive development, reducing their overall human capital accumulation. While much research has been conducted on anemia prevalence in the primarily poor and rural western provinces in China, little is known about anemia in the more developed provinces of central China. The overall goal of this study is to assess the extent of anemia in central China and determine the effect of anemia on the academic performance of students. Using data collected from fourth grade students in 25 primary schools, we find that 16–27% of sample children are anemic. Female students and students with mothers who have not migrated for work are more likely to be anemic. Importantly, using both regression analysis and matching methods, we find that students with anemia (and those with low hemoglobin levels) are more likely to perform poorly on standardized mathematics exams. These findings suggest that, over the long term, untreated anemia will perpetuate poverty by restricting the human capital development of affected children.

 

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China Economic Review
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Scott Rozelle
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The goal of this paper is to describe and analyze the relationship between ability tracking and student social trust, in the context of low-income students in developing countries. Drawing on the results from a longitudinal study among 1,436 low-income students across 132 schools in rural China, we found a significant lack of interpersonal trust and confidence in public institutions among poor rural young adults. We also found that slow-tracked students have a significantly lower level of social trust, comprised of interpersonal trust and confidence in public institutions, relative to their fast-tracked peers. This disparity might further widen the gap between relatively privileged students who stay in school and less privileged students who drop out of school. These results suggest that making high school accessible to more students may improve social trust among rural low-income young adults.

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School Effectiveness and School Improvement
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Prashant Loyalka
Scott Rozelle
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On 11/29/18 a group of leading experts on China and American foreign policy released “Chinese Influence and American Interests: Promoting Constructive Vigilance,” a report documenting Chinese efforts to influence American society. The report examines China's efforts to influence American institutions, including state and local governments, universities, think tanks, media, corporations, and the Chinese-American community, and differentiates between legitimate efforts--like public diplomacy--and improper interference, which demands greater awareness and a calibrated response.

In this special roundtable, two of the report’s co-editors, Orville Schell and Larry Diamond, and a Taiwanese scholar, Ji-Jen Hwang, will discuss the findings of the report and compare the forms and effects of Chinese “sharp power” in the United States with its practice in and toward Taiwan.

This event is co-sponsored by the US-Asia Security Initiative in the Asia-Pacific Research Center, and the Center on Democracy, Development, and the Rule of Law.  

Orville Schell

Orville Schell is the Arthur Ross Director of the Center on U.S.-China Relations at Asia Society in New York. He is a former professor and Dean at the University of California, Berkeley’s Graduate School of Journalism. Schell was born in New York City, graduated Magna Cum Laude from Harvard University in Far Eastern History, was an exchange student at National Taiwan University in the 1960s, and earned a Ph.D. (Abd) at University of California, Berkeley in Chinese History. He worked for the Ford Foundation in Indonesia, covered the war in Indochina as a journalist, and has traveled widely in China since the mid-70s.

Schell is the author of fifteen books, ten of them about China, and a contributor to numerous edited volumes. His most recent books are: Wealth and Power, China’s long March to the 21st Century; Virtual Tibet; The China Reader: The Reform Years; and Mandate of Heaven: The Legacy of Tiananmen Square and the Next Generation of China’s Leaders. He has written widely for many magazine and newspapers, including The Atlantic MonthlyThe New YorkerTime, The New RepublicHarpersThe NationThe New York Review of BooksWiredForeign Affairs, the China Quarterly, and the New York Times, the Washington Post and the Los Angeles Times.

He is a Fellow at the Weatherhead East Asian Institute at Columbia University, a Senior Fellow at the Annenberg School of Communications at USC and a member of the Council on Foreign Relations. Schell is also the recipient of many prizes and fellowships, including a Guggenheim Fellowship, the Overseas Press Club Award, and the Harvard-Stanford Shorenstein Prize in Asian Journalism.

Larry Diamond

Larry Diamond is a senior fellow at the Hoover Institution and at the Freeman Spogli Institute for International Studies. For more than six years, he directed FSI’s Center on Democracy, Development, and the Rule of Law, where he now leads its Program on Arab Reform and Democracy and its Global Digital Policy Incubator. He is the founding co-editor of the Journal of Democracy and also serves as Senior Consultant at the International Forum for Democratic Studies of the National Endowment for Democracy. His research focuses on democratic trends and conditions around in the world, and on policies and reforms to defend and advance democracy.  His 2016 book, In Search of Democracy, explores the challenges confronting democracy and democracy promotion, gathering together three decades of his writing and research, particularly on Africa and Asia.  He has just completed a new book on the global crisis of democracy, which will be published in 2019, and is now writing a textbook on democratic development.

Karl Eikenberry

is Director of the U.S.-Asia Security Initiative and faculty member at the Shorenstein Asia-Pacific Research Center, faculty member of the Center for International Security and Cooperation, and Professor of Practice at Stanford University. He is also an affiliate with the FSI Center for Democracy, Development, and Rule of Law, and The Europe Center.

Prior to his arrival at Stanford, he served as the U.S. Ambassador to Afghanistan from 2009 until 2011. Before appointment as Chief of Mission on Kabul, Ambassador Eikenberry had a thirty-five year career in the United States Army, retiring in April 2009 with the rank of Lieutenant General. His military operational posts included commander and staff officer with mechanized, light, airborne, and ranger infantry units in the continental U.S., Hawaii, Korea, Italy, and Afghanistan as the Commander of the American-led Coalition forces. He held various policy and political-military positions, including Deputy Chairman of the North Atlantic Treaty Organization (NATO) Military Committee in Brussels, Belgium; Director for Strategic Planning and Policy for U.S. Pacific Command at Camp Smith, Hawaii; U.S. Security Coordinator and Chief of the Office of Military Cooperation in Kabul, Afghanistan; Assistant Army and later Defense Attaché at the United States Embassy in Beijing, China; Senior Country Director for China, Taiwan, Hong Kong and Mongolia in the Office of the Secretary of Defense; and Deputy Director for Strategy, Plans, and Policy on the Army Staff.

Ji-Jen Hwang

Dr. Ji-Jen Hwang is a Research Scholar in the Institute for East Asian Studies (IEAS) at UC Berkeley. Before that, he was a Professor & Program Director of the International Master Program in Strategic Studies at the National Defense University in the Republic of China (Taiwan). In 2014-15, Dr. Hwang was a visiting fellow with the Freeman Chair in China Studies at the Center for Strategic & International Studies (CSIS) located in Washington D.C. He also completed an internship at the United States Library of Congress while doing his Master’s coursework. A native of Taiwan, he holds a Ph.D. in politics from the University of Newcastle upon Tyne in the U.K., as well as a Masters in Library Science & Information Studies from the University of North Carolina. He has been working for a non-profit Think Tank based in Washington D.C. area as a Deputy Managing Director since April 2018. His current research is focused on relations between the United States, China, and Taiwan, in which he particularly aims to study how social media and the features in cyberspace have political impacts on these relations. He is well-known known as an expert in this area and been invited as a special lecturer to think tanks such as CSIS in Washington D.C., ASPI in Canberra, NATO, GlobalSec in Europe, and INSS in Seoul.

 

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Larry Diamond
Ji-Jen Hwang
Karl Eikenberry
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Shorenstein APARC's annual overview of the Center's 2017-18 activities  is now available to download

Feature sections look at the Center's seminars, conferences, and other activities in response to the North Korean crisis, research and events related to China's past, present, and future, and several Center research initiatives focused on technology and the changing workforce.

The overview highlights recent and ongoing Center research on Japan's economic policies, innovation in Asia, population aging and chronic disease in Asia, and talent flows in the knowledge economy, plus news about Shorenstein APARC's education and policy activities, publications, and more.

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ketian_zhang.jpg Ph.D.

Ketian Vivian Zhang joined the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as the 2018-2019 Shorenstein Postdoctoral Fellow in Contemporary Asia. Ketian studies coercion, economic sanctions, and maritime territorial disputes in international relations and social movements in comparative politics, with a regional focus on China and East Asia. She bridges the study of international relations and comparative politics and has a broader theoretical interest in linking international security and international political economy. Her book project examines when, why, and how China uses coercion when faced with issues of national security, such as territorial disputes in the South and East China Seas, foreign arms sales to Taiwan, and foreign leaders’ reception of the Dalai Lama. Ketian's research has been supported by organizations such as the Belfer Center for Science and International Affairs at the Harvard Kennedy School, Institute for Security and Conflict Studies at George Washington University, the Smith Richardson Foundation, and the Chiang Ching-kuo Foundation.

At Shorenstein APARC, Ketian worked on turning parts of her book project into academic journal papers while conducting fieldwork for her next major project: examining how target states of Chinese coercion respond to China's assertiveness, including the business community and ordinary citizens.

Ketian received her Ph.D. in Political Science at the Massachusetts Institute of Technology in 2018, where she is also an affiliate of the Security Studies Program. Before coming to Stanford, Ketian was a Predoctoral Research Fellow in the International Security Program at the Belfer Center for Science and International Affairs at the Harvard Kennedy School. Ketian holds a B.A. in Political Science and Sociology from the University of Wisconsin-Madison and was previously a research intern at the Institute for Policy Studies in Washington, D.C., where she was a contributor to its website Foreign Policy in Focus.

2018-2019 Shorenstein Postdoctoral Fellow in Contemporary Asia
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This article argues that China’s rise and its growing military power have intensified the Sino-Indian security dilemma. For a long time after the 1962 war, India’s military posture along the India–China border was mostly defensive in nature and could be characterized as imposing “deterrence by denial.” However, over the last decade, China’s growth trajectory coupled with rapid modernization of its military called into question the efficacy of this approach. India now feels much more vulnerable to China’s increasing military power both on the land frontier as well as in the maritime domain. The increasing intensity of this security dilemma has informed a consequent shift in India’s military strategy vis-à-vis China to one of “deterrence by punishment.” Theoretically, this article examines how changes in the severity of a security dilemma can lead to changes in military strategy. While doing so it explains India’s current military strategy to deal with the challenge posed by China.

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A group of 8 Stanford graduate and undergraduate students entered the gates of Stanford Center at Peking University (SCPKU) on September 21st. They are participating in the inaugural fall quarter of China Studies in Beijing, an overseas, pilot program being offered by the Freeman Spogli institute for International Studies in partnership with Peking University. Jay Gonzalez, a Stanford junior, already described his experience as “life-changing” – “exactly what I dreamed of and more.”

 

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(From left to right): Lucas Hornsby (sophomore), Jenny Zhao (SCPKU’s Beijing program coordinator), Isaac Kipust (junior), Cathy Dao (sophomore), Minhchau Dinh (second year, Master’s in International Policy), Jenn Hu (sophomore), and Jay Gonzalez (junior) walking towards SCPKU for China Studies in Beijing orientation.

China Program faculty from different Stanford departments and two Peking University faculty are offering intensive courses on contemporary Chinese society, politics, international relations and economic development. And each of the students brought their energy, curiosity and long-standing interest in China to the fall program. With an array of exposure to China – from one whose Chinese begins and ends with “ni hao (hello)” to another who calls China his adoptive home -- their interests vary from a passionate interest in the Belt Road Initiative; China-Africa relations; geopolitics; technology and Chinese entrepreneurs; Chinese domestic politics; and, literally, “anything China.” Many recognize China’s central role in the world and the critical importance of acquiring a nuanced understanding of this global power.

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(Clockwise, from left to right): Isaac Kipust, Jay Gonzalez, Prof. Andrew Walder, Lucas Hornsby, Prof. Thomas Fingar, Josh Cheng (Executive Director, SCPKU), Jenny Zhao, Prof. Jean Oi, Jenn Hu, Cathy Dao, and Minchau Dinh



Each of the Stanford China Program faculty teaching in the overseas program has dedicated his or her professional life to engaging with and understanding China. These students have unparalleled access to foremost China experts like Prof. Thomas Fingar, Shorenstein APARC Fellow and former chairman of the National Intelligence Council who has devoted himself to U.S.-China relations since the “ping-pong diplomacy” days in the early 1970’s. Prof. Jean Oi, Director of the China Program and the William Haas Professor in Chinese Politics in the department of political science; and Prof. Andrew Walder, Denise O’Leary & Kent Thiry Professor in the Department of Sociology, were among the first group of U.S. scholars to conduct fieldwork in China after Deng Xiaoping’s Open Door policy was announced in 1978. Prof. Scott Rozell, Senior Fellow at FSI and Co-director of the Rural Education Action Program is the recipient of numerous awards and recognitions, including in 2008 of the Friendship Award, the highest award given to a non-Chinese by China’s Premier.

 

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(Clockwise, from left to right): Prof. Thomas Fingar, Isaac Kipust, Prof. Scott Rozelle, Prof. Andrew Walder, Jennifer Choo (Associate Director, Stanford China Program), Lucas Hornsby, Drew Hasson (second year, Master’s in International Policy), Jenn Hu, and Prof. Jean Oi on the Yalu River looking over at North Korea.



The program is simultaneously exposing students to China’s contemporary politics, society and economy in the classrooms and pairing them with lived experiences -- through real-life conversations with PKU professors and PKU classmates; ordinary citizens of Beijing; and through visits to diverse parts of China. To date, the group has traveled to historic Chengde (承德); a mining equipment factory in Jinzhou city (锦州); the China-North Korean border in Dandong (丹东); and the strategic port city of Dalian (大连). Each of these areas embed layers of history and reveal artifacts from different eras: the Manchus who ruled the Han Chinese during the Qing Dynasty (Chengde); the SOE restructuring in the 1990’s that devastated China’s Northeastern “rust belt” (Jinzhou); massive human casualty suffered by the Chinese during the Korean War (Dandong); and the Sino-Russo-Japanese tug-of-war that marked Dalian’s fate throughout the 19th and 20th century. Through these experiences, students are gaining insights into how the world might look to their counterparts in China and elsewhere.

Below are pictures and reflections from students’ own experiences at Jinshanling (金山岭) Great Wall, Chengde as well as in China’s Northeast (东北) region.

Jinshangling (金山岭) Great Wall

 

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Jenn Hu and Minchau Dinh (holding up the Stanford banner) at the Great Wall



Chengde City (承德市)

The city of Chengde in Hebei Province, located 155 miles northeast of Beijing, was an imperial summer resort during the Qing Dynasty. Emperor Kang Xi (1662-1723) discovered this rare scenic spot during a hunting trip and turned it into a “Mountain Resort.”

As one student noted, these field trips “supplement academic discussions with . . . diverse representations of China – from historical kingdom to innovation contender (Cathy Dao, Stanford sophomore).”

 

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Prof. Jean Oi and Isaac Kipust engaged in discussion at the imperial summer resort of Chengde



China’s Northeast region (东北)

Jinzhou City (锦州市), Liaoning Province
Jinzhou Mining Machinery (Group) Co., Ltd

 

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Faculty and students enter the factory at Jinzhou Mining Machinery (Group) Co., Ltd. with the company’s senior managers



Stanford students and faculty toured a mining equipment factory in Jinzhou city in Northeast China. Massive worker lay-offs and closures of state-owned enterprises devastated this “rust belt” region throughout the 1990’s and early 2000’s. The company’s senior management sat with students and faculty and described its current reincarnation as a private shareholding company. They also opened up about their difficulties in attracting talent; local tax rates and land use fees; and their inability to enforce contracts and redress payment defaults.

As Jenn Hu (Stanford sophomore) remarked, “One thing I found particularly fascinating [was that]. . . it was not unusual for [the company’s] clients to bail on contractual obligations . . . . [T]he company allowed their client to pay them back in the form of raw materials, essentially engaging in barter trade . . . The fact that an increasing number of clients are unable to pay back, a trend party leaders have dubbed the ‘new normal,’ is also indicative of China’s slowing growth.”

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Jay Gonzalez and Jenny Zhao pose in front of a giant painting of “model workers” at Jinzhou Mining Machinery (Group) Co., Ltd.



Dandong City (丹东市)
War to Resist U.S. Aggression and Aid Korea Railroad Museum (铁路抗美援朝博物馆)

 

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Group photo in front of the old railroad tracks in Dandong, Liaoning province, that helped transport Chinese troops into North Korea during the Korean War


 

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Jenn Hu reading the captions at the “War to Resist U.S. Aggression and Aid Korea” Railroad Museum



Dandong’s small “railroad museum” displayed images, quotes and photos from the Korean War – better known as “War to Resist U.S. Aggression and Aid Korea” in China. Nearly 3 million People’s Liberation Army troops overwhelmed the U.S. troops and allies in 1950; and China tragically lost anywhere from 149,000 to 400,000 soldiers in the war.

Students heard the Chinese perspective on the war, which focused on U.S. aggression and China’s rightful defense. The museum’s guided tour, in fact, ended with an anti-American sing-along that praised China’s bravery and denounced U.S. imperialism. As one student commented on her blog, “[f]rom the ends of the room, [the museum’s visitors’] voices rose in unison, and swelled into a chorus of song -- 抗美援朝鲜,打败美帝野心狼! (‘Resist America, help Korea, defeat the American imperialists with their wolf-like ambitions!’) (Cathy Dao, Stanford sophomore),” giving substance to the reality that history is, indeed, political.

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Prof. Scott Rozelle, Senior Fellow at FSI and faculty member for China Studies in Beijing, engaged in a heated debate with the local guide from Dandong who argued that North Korea’s decision to start the Korean War was to defend its motherland against U.S. military aggression.



 

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Sino-North Korean Friendship Bridge that links Shinuiju, North Korea, to Dandong, China.



Dalian (大连)

Lastly, students traveled to Dalian, the “pearl of the East” founded by the Russians in 1898 and built in the style of European cities at the turn-of-the-century. The site of intense battles during the Russo-Japanese War of 1904, the city now boasts a Sino-Soviet Friendship Monument built in 1996.

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Group photo in front of the Sino-Soviet Friendship Monument in Dalian city



Whether it be “[t]he sheer size of a small city like Jinzhou”(pop: 3.1 million) or the “‘little’ city” of Dalian (pop: 6.2 million), these cities drove home for students the sheer scale of a country like China – its significance, complexity, and import.

Students have written blog pieces posted on FSI’s Medium site in which one student also described a fascinating solo backpacking trip to Tibetan communities in western Sichuan and, another, the quotidian challenges of everyday life in Beijing. Regardless of their subject matter, however, their words echo the program’s success in enabling students to perceive the world through vastly differing lenses – lenses that often show a place and people that are deeply warm and welcoming and, at other times, reflect a world that proves decentering and unclear. Yet, the complementary experiences in the classroom and outside the curriculum are enabling students to develop an imagination that can encompass the “other” and nurture a humility that can feed a lifetime of questions. As Cathy Dao commented upon visiting the “War to Resist U.S. Aggression and Aid Korea” Railroad Museum, “I realized that such hostility is a function of history. How each country portrays conflicts [such as the Korean War] strongly influences the perceptions that its people have. [But] [s]hould we learn how one another views history, we can see the humanity in what would otherwise be an abstract and incompatible ‘other.’”

 

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(Counter clockwise): Julie Gu (second year, Masters in International Policy), Pan Xue (Beijing program assistant), Jenny Zhao, and Lucas Hornsby taking a group selfie in Dalian city



For information regarding similar opportunities, please visit FSI Student Programs or email Patrick Laboon, FSI’s Academic Program Manager, at plaboon@stanford.edu for all updates regarding the many international student opportunities offered through FSI.

 

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The Freeman Spogli Institute for International Studies (FSI) at Stanford University is pleased to announce that renowned China scholar David Michael (“Mike”) Lampton, Hyman Professor of China Studies and Director of the China Studies Program at the Johns Hopkins School of Advanced International Studies Emeritus, has been appointed the Oksenberg-Rohlen Fellow at FSI. Lampton will be affiliated with FSI’s Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC), where he will conduct research on contemporary China and U.S.-China relations. Currently he is working on a book with two colleagues on the development of high-speed railways from southern China to Singapore.

“We are thrilled to welcome Mike Lampton back to Stanford,” says Gi-Wook Shin, director of Shorenstein APARC. “Mike’s expertise in Chinese politics and his long-time experience on the front lines of efforts to foster constructive U.S.-China engagement will be a tremendous asset to APARC and Stanford, especially at this time when relations between Washington and Beijing are at a state fraught with uncertainties and growing mistrust.”

Lampton, BA ’68, MA ’71, PhD ’74, is the author of a dozen books and monographs, including, most recently, Following the Leader: Ruling China, from Deng Xiaoping to Xi Jinping (University of California Press, 2014). He has testified at multiple congressional and commission sessions and published numerous articles, essays, book reviews, and opinion pieces in many venues popular and academic in both the western world and in Chinese-speaking societies, including Foreign Affairs, Foreign Policy, The American Political Science Review, The China Quarterly, The New York Times, The Washington Post, and many others.

Over the course of his career, Lampton accompanied American public and private sector leaders to China, and Chinese leaders to the United States. Formerly President of the National Committee on United States-China Relations, Lampton consults with government, business, and social sector organizations, and has served on the boards of several non-governmental and educational organizations, including the Asia Foundation for which he serves as chairman. The recipient of many academic awards, he is an Honorary Senior Fellow of the American Studies Institute of the Chinese Academy of Social Sciences and the inaugural winner of the Scalapino Prize in 2010, awarded by the National Bureau of Asian Research and the Woodrow Wilson International Center for Scholars in recognition of his exceptional contributions to America’s understanding of the vast changes underway in Asia.

Michael McFaul, director of FSI, said, “I am delighted to have Mike back at Stanford joining our team. We are looking forward to his contributions to scholarly and policy work on China’s international behavior and to efforts to promote productive relations between the United States and China.”

Lampton expressed his excitement, saying, “I am honored to join Shorenstein APARC and FSI to support Stanford’s research, education, and policy outreach focused on challenges and choices facing China and the international community.”


Media Contact
Noa Ronkin
Associate Director for Communications and External Relations
Shorenstein APARC

 

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