In October 2006, only a few short months after John Everard, a former Pantech Fellow with Stanford’s Korean Studies Program, arrived in Pyongyang to serve as the British ambassador, North Korea conducted its first-ever nuclear test. Everard spent the next two-and-a-half years meeting with North Korean government officials and attending the official events so beloved by the North Korean regime. During this complicated period he provided crucial reports back to the British government on political developments.

He also traveled extensively throughout North Korea, witnessing scenes of daily life experienced by few foreigners: people shopping for food in Pyongyang’s informal street markets, urban residents taking time off to relax at the beach, and many other very human moments. Everard captured such snapshots of everyday life through dozens of photographs and detailed notes.

Only Beautiful, Please: A British Diplomat in North Korea, released in June from the Shorenstein Asia-Pacific Research Center, recounts Everard’s experiences during his stay in North Korea. The book goes beyond official North Korea to unveil the human dimension of life in that hermetic nation. Everard recounts his impressions of the country and its people, his interactions with them, and his observations on their way of life. He provides a picture as well of the life of foreigners in this closed society, considers how the DPRK evolved to its current state, and discusses the failure of current approaches to tackle the challenges that it throws up. The book is illustrated with striking and never-before-seen photographs taken by Everard during his stay in North Korea.

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• June 25, 2012, 2:00 p.m. to 3:30 p.m. 
  Brookings Institution, Falk Auditorium, Washington, DC 
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• June 19, 2012, 6:00 p.m. to 8:00 p.m. 
  Korea Society headquarters, New York City 
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The provision of public goods and services - education, healthcare, sanitation, potable water and other government benefits - are linked to issues of governance. The Program on Poverty and Governance at the Center on Democracy, Development and the Rule of Law (CDDRL) together with the Center for Latin American Studies will host a conference on May 18-19 at Stanford University to explore how governance impacts the provision of public goods and services throughout the world.

The conference will bring together an interdisciplinary group of economists, political scientists, policymakers, and public health researchers to present on-going research on the links between governance and public goods provisions. The conference will also focus on government corruption, electoral clientelism and the critical role of external actors in the provision and delivery of public goods.

According to Beatriz Magaloni, the director of the Program on Poverty and Governance at CDDRL, “A goal of the conference is to present pioneering research on the major issues facing public goods provision in developing economies and to explore a variety of institutional, political, and international factors that work to improve or hinder government capacity and accountability in service delivery.”

Conference speakers include: Stephen D. Krasner, professor of international relations and deputy director of the Freeman Spogli Institute at Stanford University, commenting on external actors and the provision of goods in areas of limited statehood; Stuti Khemani, senior economist at the World Bank, who will speak about information access and public health benefits; Miriam Goldman, visiting research scholar from Princeton University, who will examine corruption and electricity in India; Edward Miguel, director of the Center for Effective Global Action at UC Berkeley, who will present on institutional reform through minority participation; and James D. Fearon, professor of political science at Stanford University and CDDRL affiliated faculty, and David Laitin, professor of political science and Center for International Security and Cooperation (CISAC) affiliated faculty who will both serve as distinguished discussants.

All sessions will be held in the CISAC Conference room, 2^nd floor of Encina Hall Central, and are free and open to the public. To view the complete agenda and RSVP to the conference, please click here.

The government’s far-reaching health care foreign aid program has contributed to a significant decline in adult death rates in Africa, according to a new study by Stanford researchers. 

Between 2004 and 2008, the U.S. President’s Emergency Plan for AIDS Relief was associated with a reduction in the odds of death of nearly 20 percent in the countries where it operated. The researchers found that more than 740,000 lives were saved during this period in nine countries targeted by the program, known by its acronym, PEPFAR.

“We were surprised and impressed to find these mortality reductions,” said Eran Bendavid, an affiliate at Stanford Health Policy, part of the university’s Freeman Spogli Institute for International Studies.

“While many assume that foreign aid works, most evaluations of aid suggest it does not work or even causes harm,” said Bendavid, an assistant professor of medicine at Stanford’s School of Medicine. “Despite all the challenges to making aid work and to implementing HIV treatment in Africa, the benefits of PEPFAR were large and measurable across many African countries.”



The study is the first to show a decline in all causes of death related to the program. It appears in the May 16 issue of the Journal of the American Medical Association.

Bendavid is the lead author of the study. It was co-authored by Grant Miller and Jay Bhattacharya, who are both core faculty members of Stanford Health Policy and associate professors of medicine. The study was funded by the National Institutes of Health and the Dr. George Rosenkranz Prize for Health Care Research in Developing Countries.

PEPFAR began in 2003 under the Bush administration with a five-year, $15 billion investment in fighting AIDS around the world and a focus on treatment and prevention in 15 countries. It was reauthorized by Congress in 2008 and has expanded its reach to 31 countries.

To measure the impact of the program, Bendavid and his colleagues analyzed health and survival information for more than 1.5 million adults in 27 African countries, including nine countries where PEPFAR has focused its efforts. The researchers examined data available in the Demographic and Health Surveys, a USAID-funded project that involves a representative sampling of in-person interviews among women in which they discuss their health and the health of their family members. These surveys form the foundation of many health measurements in developing countries.

They found the odds of death from any cause among adults were 16 to 20 percent lower in the PEPFAR-targeted countries.

To bolster the results, the scientists did a separate analysis using specific data on PEPFAR programs in Rwanda and Tanzania. They compared regions of the two countries where PEPFAR’s investments led to widespread increases in the number and size of sites providing antiretroviral therapy, with areas where PEPFAR had fewer services available.



“We observed a similar reduction in mortality when exploring PEPFAR’s effects using a different lens,” Bendavid said.

In Tanzania, the odds of death were found to be 17 percent lower and in Rwanda 25 percent lower in the districts with greater support from PEPFAR.

Bendavid speculates that the program’s commitment to building an infrastructure that includes drug distribution systems, clinics, pharmacies, laboratories and testing facilities has been an important factor for its success.

“The scale of PEPFAR’s investment was unprecedented,” Bendavid said. “People working in PEPFAR’s focus countries describe working supply chains, stocked pharmacies and staffed clinics.”



Although the program was targeted to address HIV, these services could have benefitted patients with a variety of other health concerns. For example, one study found that some uninfected, pregnant women in Ethiopia, Rwanda and Tanzania chose to deliver their babies in facilities supported by PEPFAR, Bendavid said.

Some have argued that focusing resources on a specific disease, such as AIDS, may detract efforts from other diseases and activities, undermining some of the benefits of such programs. But the latest study does not support this argument. Rather, it suggests that PEPFAR helped prevent additional deaths from causes other than HIV/AIDS.

“Whether disease-specific programs like PEPFAR have synergies with other health improvement efforts – or instead undermine them, as some have worried – is really an open question,” Miller said. “There are reasons to think either scenario is possible, and more research is needed. We don’t find much evidence of PEPFAR undercutting other initiatives. If anything, we see hints of synergies.”



Bendavid said the program managed to accomplish the reduction in mortality in the face of enormous challenges – from persuading people to go for HIV testing and treatment to dealing with problems of drug shortages and drug resistance.

Historically, few other large-scale health initiatives have succeeded to such an extent. Smallpox, which was eradicated by 1979, is among the rare and more notable examples.

“PEPFAR’s success with HIV … may be considered the clearest demonstration of aid’s effectiveness in recent years,” the researchers concluded.

In 2009, PEPFAR was folded into a new Global Health Initiative that calls for a broader agenda, with some resources redistributed to other programs, such as maternal and child health.

Its budget, which rose dramatically in the early years, has remained relatively flat or declined slightly since then. It peaked at $6.8 billion in fiscal year 2010, then declined to $6.7 billion and $6.6 billion in fiscal years 2011 and 2012, respectively, according to figures from the Kaiser Family Foundation. The Obama administration’s budget request for the 2013 fiscal year is $6.4 billion.

While the program appears to have had an impact within a few years of its implementation, Bendavid noted that reduced investments in fighting AIDS, both through PEPFAR and other international aid programs, could have implications for the future of the epidemic.

“We are transforming the face of the epidemic but funding shortfalls will change the road ahead,” he said.



Ruthann Richter is Director of Media Relations for the Stanford School of Medicine.