As incomes rise around the world, health experts expect a more troubling figure to increase as well: the number of diabetics in developing countries.

In China and India – two of the world’s most populous nations with fast-paced economies – the prevalence of diabetes is expected to double by 2025. Between 15 and 20 percent of their adult population will develop the disease as household budgets increase, diets change to include more calories and new health problems emerge.

But China, India and other developing countries are not fully prepared to deal with the rising trend of diabetes. And a growing number of diabetics aren’t getting the care they need to prevent serious complications, Stanford researchers say.

Even with insurance, many diabetics don’t have essential medications that could help them manage their conditions. In many cases, people are spending a great deal of their household incomes to pay for their treatment, said Jeremy Goldhaber-Fiebert, an assistant professor of medicine who led the research team.

“Public and private health insurance programs aren’t providing sufficient protection for diabetics in many developing countries,” said Goldhaber-Fiebert, a faculty member at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies. “People with insurance aren’t doing markedly better than those who don’t have it. Health insurance and health systems need to be re-oriented to better address chronic diseases like diabetes.”

Findings from the study are online and will be published in the Jan. 24 edition of Diabetes Care, the journal of the American Diabetes Association. The journal article was co-authored by Jay Bhattacharya, an associate professor of medicine and Stanford Health Policy faculty member; and Crystal Smith-Spangler, an instructor at Stanford’s Department of Medicine and an investigator at the Palo Alto VA Health Care System.

Failure to adequately manage diabetes will lead to more severe health problems like blindness, heart disease and kidney failure. It also harms the otherwise healthy, Goldhaber-Fiebert said.

Diabetes often strikes people at an age when they’re taking care of children and elderly parents. To sideline these primary caretakers as dependants will lead to a heavy burden for communities and create an obstacle for economic growth, he added.

Using responses to a global survey conducted by the World Health Organization in 2002 and 2003, Goldhaber-Fiebert and his colleagues examined data from 35 low- and middle-income countries in Asia, Latin America, Africa and Eastern Europe to determine whether diabetics with insurance were more likely to have medication than those without insurance.

They also wanted to know whether insured diabetics have a lower risk of “catastrophic medical spending,” a term the researchers define as spending more than 25 percent of a household income on medical care.

“Surprisingly, diabetics with insurance were no more likely to have the medications they need than uninsured diabetics,” Goldhaber-Fiebert said. “They were also no less likely to suffer catastrophic medical spending.”

There are many reasons why health insurance may not protect diabetics in developing countries against high out-of-pocket spending. In some cases, there’s a lack of sufficient medication – such as insulin – that regulate glucose levels. Without those drugs, there’s a greater risk of complications that often lead to more hospitalizations and more expenses.

In other cases, co-payments and deductibles are too high. Sometimes, drugs and medical services to prevent diabetes complications are not covered. And doctors and hospitals don’t always accept insurance.

“Better policies are needed to provide sufficient protection and care for diabetics in the developing world,” Goldhaber-Fiebert said.

Without medications to manage diabetes and prevent secondary complications, the condition will worsen and the burden of catastrophic spending will increase, he said.

“It’s important to get ahead of the curve and prepare so there’s an infrastructure in place to deal with these health and cost issues,” he said.

While preventing diabetes in the first place would be ideal, programs and policies must be established to care for the many cases that will surely continue to exist.

“There isn’t a single country that’s managed to entirely arrest or reverse the trend of diabetes,” he said. “Programs that focus on primary prevention are extremely important, but the reality is that the developing world faces hundreds of millions of diabetes cases that are unlikely to all be prevented.”

Michael A. McFaul, a Stanford political science professor and senior fellow at the university’s Freeman Spogli Institute for International Studies, was confirmed by the Senate to be the next ambassador to Russia. 

McFaul, President Barack Obama’s top advisor on Russia and a Bing Senior Fellow at Stanford’s Hoover Institution, will succeed John Beyrle.

"Mike will bring to his new posting in Moscow the same intensity, clarity of vision and imagination that he demonstrated as President Obama's point person on Russia at the White House," said Coit D. Blacker, FSI’s director and the Olivier Nomellini Professor in International Studies. 

The Dec. 17 voice vote confirming McFaul came on the last day the Senate was in session before its winter break. Sen. Mark Kirk, R-Ill., had held up McFaul's approval over issues with U.S. policies toward Russia.

During confirmation hearings before the Senate Foreign Relations Committee in October, McFaul discussed the overall status of U.S.-Russian relations, missile defense, arms reduction agreements and trade relations.

Since the beginning of the Obama administration, McFaul has been the special assistant to the president for national security affairs and senior director for Russia and Eurasia at the National Security Council.

He served as senior adviser on Russia and Eurasia to Obama during the presidential campaign and continued to advise on foreign policy issues during the transition.

The Obama administration has achieved new momentum in relations with Russia with McFaul's involvement.

The two countries have signed the New Start arms control treaty, which calls for significant cuts in nuclear arsenals; finalized a civilian nuclear cooperation pact; forged agreement on tougher sanctions on Iran; and expanded the supply route to Afghanistan through the territory of the former Soviet Union.

The two powers now turn to the efforts to forge cooperation on missile defense in Europe and to gain Russia's admission to the World Trade Organization, as well as the challenges posed by Iran and Libya.

"This is a complex and sensitive time in the ever-evolving relationship between the United States and the Russian Federation," Blacker said. "Having an ambassador in place who gets the relationship has never been more important. For this reason above all others, Mike is the perfect choice. We are all deeply proud of Mike and all that he has accomplished."

McFaul, who has served as FSI’s deputy director and director of the institute’s Center on Democracy, Development, and the Rule of Law, received a bachelor’s degree in international relations and Slavic languages and an master’s in Slavic and East European studies from Stanford in 1986. He was awarded a Rhodes Scholarship to Oxford, where he completed his PhD in international relations in 1991.

More than 500,000 people live in Mathare, the second-largest collection of slums in Nairobi, Kenya. Crime and disease ravage the population, and shanties have no electricity or running water. But there’s one piece of technology that everyone seems to have, one which promises to bring much-needed improvements: the cell phone.

Cell phones are central to two of the eight most recent Global Underdevelopment Action Fund projects funded by the Freeman Spogli Institute for International Studies. Both projects will be led by Joshua Cohen, a professor of political science, philosophy and law and the Marta Sutton Weeks Professor of Ethics in Society.

The first of Cohen’s projects will examine whether texting private and accurate health advice will increase awareness of risky sexual behavior among Mathare’s younger residents who face high rates of pregnancy and sexually transmitted diseases.

Cohen's second project involves teaching women to use mobile technology to meet up with larger groups while traveling at night, which Cohen believes can led to a decrease in the number of assaults, muggings and rapes. Eventually, the hope is that the program can be taken over by Kenya’s police and expanded.

Cell phone charging station in Mathare

Six other projects are receiving support from the third round of Global Underdevelopment Action Fund awards, amounting to a total of $265,000.

The funds will enable multidisciplinary teams led by Stanford faculty from across the university to perform policy-relevant research focused on global underdevelopment challenges.

The funded projects will have real world impact. They will help target tuberculosis, which kills more than 1 million people a year and hinders economic development in the hardest-hit regions, like parts of India. They evaluate the amount of resources necessary to improve test scores and lower anemia rates among China’s rural schoolchildren. They ensure that health care is accessible to people in the Arab world where countries are undergoing political transitions. And they evaluate the challenges and benefits of bringing solar power to areas in Africa where electricity is a rare commodity.

As varied as the eight projects are, each will train Stanford undergraduate or graduate students, stressing the importance that Stanford and FSI place on training the next generation of researchers and policy influencers.

The projects were selected by a faculty committee chaired by Stephen D. Krasner, FSI’s deputy director and the Graham H. Stuart Professor of International Relations.

The Action Fund is supported by FSI donors, matching funds from the Office of the President and FSI. The fund grew out of the institute’s 2010 conference on Technology, Governance, and Global Development. This year’s follow-up conference further showcased FSI’s commitment to challenges posed by global underdevelopment with a focus on food security and health.

The award-winning projects and their principal investigators are:

• Texting for Sexual Health: Effects of Information Provision and Common Knowledge on Health-Seeking Behavior in Kenya
  Joshua Cohen
  In hopes of increasing awareness that could minimize sexual health risks, the team will promote a mobile health counseling service, which will enable young people in Nairobi’s Mathare slums to receive private and reliable answers from health counselors through text messaging.
• Can Mobile Phones Coordinate Community Action to Improve Women’s Safety in Slums?
  Joshua Cohen
  The program uses mobile technology to measure whether the number of assaults on women will decrease if they travel in groups. The project will evaluate whether this “safety in numbers” program can be taken over by Kenyan police.

• Crime, Violence and Governance in Latin America: Sharing Data and Building a Web-Based Research Network to Expand Knowledge
  Mariano-Florentino Cuéllar
  This project will build a systematically organized repository of research on crime, violence and citizen security in Latin America.
• Tuberculosis Control and its Benefits to the Rural Poor
  Jeremy Goldhaber-Fiebert
  This study will determine the impact of improved TB control effects in India, which accounts for 20 percent of global TB incidence, and project economic outcomes from India’s TB epidemic over the next decade.
• Paying for Performance to Improve Health in Rural China: Does Resource Scarcity Breed Innovation in Service Delivery?
  Grant Miller
  This study will evaluate whether large subsidies are necessary for improving social situations like lowering anemia rates or improving test scores.
• Health and Political Reform in the Arab World
  Paul H. Wise
  Partnering with The Lancet journal and the American University of Beirut, the team will produce a series of articles on war, social change and health in the Arab world with a goal of improving health care in countries undergoing political transition.
• Solar Lighting and Phone Charging in East Africa: Understanding Adoption, Business Models and Development Outcomes
  Frank Wolak
  This project will analyze new solar businesses in East Africa. Electricity is central to industry, health services and education, yet 1.5 billion people worldwide lack access. Recently, low-power solar energy sources in homes have appeared as viable options.
• Understanding the Current Status of Medical Technology in Rural China
  Paul Yock
  This study will evaluate the use of medical technology in rural China in order to establish a baseline for future work and establish partnerships. The long-term goal is an analytical framework within which to understand the role of medical technology in Chinese health care.