Southeast Asia, home to over 640 million people across 10 countries, is one of the world’s most dynamic and fastest growing regions. APARC just concluded the year 2019 with a Center delegation visit to two Southeast Asian capital cities, Hanoi and Bangkok, where we spent an engaging week with stakeholders in the academic, policy, business, and Stanford alumni communities.

Led by APARC Director Gi-Wook Shin, the delegation included APARC Deputy Director and Asia Health Policy Program Director Karen Eggleston, Southeast Asia Program Director Donald Emmerson, and APARC Associate Director for Communications and External Relations Noa Ronkin. Visiting Scholar Andrew Kim joined the delegation in Bangkok.

With a focus on health policy, our first day in Hanoi included a visit to Thai Nguyen University, a meeting with government representatives at the Vietnam Ministry of Health, and a seminar on healthy aging and innovation jointly with Hanoi Medical University.

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Throughout the day, Eggleston presented some of her collaborative research that is part of two projects involving international research teams: one that assesses public-private roles and institutional innovation for healthy aging and another that examines the economics of caring for patients with chronic diseases across diverse health systems in Asia and other parts of the world. We appreciated learning from our counterparts about the health care system and health care delivery in Vietnam.

Shifting focus to international relations and regional security, day 2 in Hanoi opened with a roundtable, “The Rise of the Indo-Pacific and Vietnam-U.S. Relations,” held jointly with the East Sea Institute (ESI) of the Diplomatic Academy of Vietnam (DAV). Following a welcome by ESI Director General Nguyen Hung Son, the program continued with remarks by Shin, Emmerson, ESI Deputy Director General To Anh Tuan, and Assistant Director General Do Thanh Hai.

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The long-ranging conversation with DAV members included issues such as the future of the international order in Asia; the U.S. withdrawal from multilateralism; the concern about a lack of U.S. engagement in Southeast Asia, sparked by President Trump’s absence from the November 2019 summit of the Association of Southeast Asian Nations (ASEAN) at a time when China is bolstering its influence in the region and when ASEAN hopes to set a code of conduct with China regarding disputed waters in the South China Sea; the priorities for Vietnam as it assumes the role of ASEAN chair in 2020; and the challenges for the Vietnam-U.S. bilateral relationship amid the changing strategic environment in Southeast Asia.

In the afternoon we were joined by members of the American Chamber of Commerce in Hanoi at an AmCham-hosted Lunch ‘n’ Learn session on Vietnam's challenges and opportunities amid the U.S.-China rivalry. The event featured Emmerson in conversation with AmCham Hanoi Executive Director Adam Sitkoff.

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Moving to Bangkok, delegation members Shin, Eggleston, Emmerson, and Kim spoke on a panel for executives of the Charoen Pokphand Group (C.P. Group), one of Thailand’s largest private conglomerates, addressing some of the core issues that lie ahead for Southeast Asia in 2020 and beyond in the areas of geopolitics, innovation, and health.

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We also enjoyed a tour at True Digital Park, Thailand’s first startup and tech entrepreneur’s campus. Developed by the C.P. Group, True Digital Park aspires to be an open startup ecosystem that powers Thailand to become a global hub for digital innovation.

The following day, Shin and Emmerson participated in a public forum hosted by Chulalongkorn University’s Institute of Security and International Studies (ISIS Thailand), "Where Northeast Asia Meets Southeast Asia: The Great Powers, Global Disorder and Asia’s Future.” They were joined by ISIS Thailand Director Thitinan Pongsudhirak and Chulalongkorn University Faculty of Political Science Associate Dean for International Affairs and Graduate Studies Kasira Cheeppensook. The panel was moderated by Ms. Gwen Robinson, ISIS Thailand senior fellow and editor-at-large of the Nikkei Asian Review.

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As part of that discussion, Emmerson speculated that – driven by deepening Chinese economic and migrational involvement in Southeast Asia’s northern tier – Cambodia and Laos, less conceivably Myanmar, and still less conceivably Thailand could become incorporated de facto into an economically integrated “greater China” that could eventually reduce ASEAN to a more-or-less maritime membership in the region’s southern tier. Emmerson’s speculation was made in the context of his critique of ASEAN’s emphasis on its own “centrality” to the neglect of its lack of the proactivity that would serve as evidence of centrality and of a desire not to be rendered peripheral by the growing centrality-cum-proactivity of China. The event was covered by the Bangkok Post (although that report’s headline and quote of Emmerson are inaccurate, as neither the panel nor Emmerson predicted the “break-up of ASEAN.”)

Our delegation visit in Bangkok concluded with a buffet dinner reception and panel discussion jointly with the Stanford Club of Thailand.

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Moderated by Mr. Suthichai Yoon, a veteran journalist and founder of digital media outlet Kafedam Group, the conversation focused on the changing geopolitics of Southeast Asia, innovation and health in the region, and the opportunities and challenges facing Thailand-U.S. relations. It was a pleasure to meet many new and old friends from the Stanford and IvyPlus alumni communities.

APARC would like to thank our partners and hosts in Hanoi and Bangkok for their hospitality, collaboration, and the stimulating discussions throughout our visit. We look forward to keeping in touch!

Brett McGurk served as Special Presidential Envoy for the Global Coalition to Counter ISIL from Oct. 23, 2015 to Dec. 31, 2018. He was appointed to the post by former President Barack Obama, but the Donald Trump administration kept McGurk in the position until his resignation in the wake of Trump’s decision to withdraw troops from Syria. McGurk has worked in diplomacy for the past 15 years, including a stint from October 2014 to January 2016 as deputy assistant secretary of state for Iraq and Iran. He is currently a lecturer at the Freeman Spogli Institute. 

The Daily sat down to talk to McGurk about his career and his thoughts on the Middle East in the wake of the withdrawal of U.S. troops from Syria and ISIL leader Abu Bakr al-Baghdadi’s death.

The Stanford Daily (TSD): Could you talk a little bit about your transition from working in the government to lecturing at Stanford?

Brett McGurk (BM): I had the unique experience of serving at fairly senior levels with President Bush, Obama and then two years of President Trump — three very different presidents. I resigned from the Trump administration at the end of last year following his decision to abruptly abandon Syria, which was very contrary to what our established policy was. 

Read the Rest at The Stanford Daily

The toll from gun violence at schools has only escalated in the 20 years since the jolting, horrific massacre at Columbine High.

By December 2019, at least 245 primary and secondary schools in the United States had experienced a shooting, killing 146 people and injuring 310, according to The Washington Post.

At least 245 primary and secondary schools in the United States have experienced a shooting — killing 146 people and injuring 310 — since the country's first mass school shooting at Columbine High School in April 1999.

Now, new Stanford-led research sounds an alarm to what was once a silent reckoning: the mental health impact to tens of thousands of surviving students who were attending schools where gunshots rang out.

A study has found that local exposure to fatal school shootings increased antidepressant use among youths.

Specifically, the average rate of antidepressant use among youths under age 20 rose by 21 percent in the local communities where fatal school shootings occurred, according to the study. And the rate increase – based on comparisons two years before the incident and two years after – persisted even in the third year out.

“There are articles that suggest school shootings are the new norm – they’re happening so frequently that we’re getting desensitized to them – and that maybe for the people who survive, they just go back to normal life because this is just life in America. But what our study shows is that does not appear to be the case,” said Maya Rossin-Slater, a core faculty member at Stanford Health Policy and faculty fellow at the Stanford Institute for Economic Policy Research (SIEPR). “There are real consequences on an important marker of mental health.”

The study is detailed in a working paper published Monday by the National Bureau of Economic Research. It was co-authored by Rossin-Slater, an assistant professor of health policy in the Stanford School of Medicine; Molly Schnell, a former postdoctoral fellow at SIEPR now an assistant professor at Northwestern University; Hannes Schwandt, an assistant professor at Northwestern and former visiting fellow at SIEPR; Sam Trejo, a Stanford doctoral candidate in economics and education; and Lindsey Uniat, a former predoctoral research fellow at SIEPR now a PhD student at Yale University.

Their collaborative research – accelerated by their simultaneous stints at SIEPR – is the largest study to date on the effects of school shootings on youth mental health.

The study comes as the issue of gun safety continues to stoke political wrangling and public debate. And the researchers say their findings suggest policymakers should take a wide lens to their decision-making process.

“When we think about the cost of school shootings, they’re often quantified in terms of the cost to the individuals who die or are injured, and their families,” Rossin-Slater noted. “Those costs are unfathomable and undeniable. But the reality is that there are many more students exposed to school shootings who survive. And the broad implication is to think about the cost not just to the direct victims but to those who are indirectly affected.”

A Driver for Antidepressant Use

More than 240,000 students have been exposed to school shootings in America since the mass shooting in Columbine in April 1999, according to The Washington Post  data used in the study. And the number of school shootings per year has been trending up since 2015.

Yet despite this “uniquely American phenomenon” – since 2009, over 50 times more school shootings have occurred in the U.S. than in Canada, Japan, Germany, Italy, France and the United Kingdom combined – little is known about the effects of such gun violence on the mental health of the nation’s youth, the study stated.

“We know that poor mental health in childhood can have negative consequences throughout life,” Schwandt said. “At the same time, children are known to show significant levels of resilience, so it really wasn’t clear what we would find as we started this project.”

The researchers examined 44 shootings at schools across the country between January 2008 and April 2013. They used a database that covered the near universe of prescriptions filled at U.S. retail pharmacies along with information on the address of the medical provider who prescribed each drug. They compared the antidepressant prescription rates of providers practicing in areas within a 5-mile radius of a school shooting to those practicing in areas 10-to-15 miles away, looking at two years prior and two to three years after the incident.

Of those 44 school shootings, 15 of them involved at least one death. The 44 shootings occurred in 10 states: Alabama, California, Connecticut, Florida, Nebraska, North Carolina, Ohio, South Carolina, Tennessee and Texas.

Researchers found a marked increase in the rate of antidepressant prescriptions for youths nearby, but only for the shootings that were fatal. They did not see a significant effect on prescriptions for youths exposed to non-fatal school shootings.

“The immediate impact on antidepressant use that we find, and its remarkable persistence over two, and even three years, certainly constitutes a stronger effect pattern than what we would have expected,” Schwandt said.

Meanwhile, adult antidepressant use did not appear to be significantly impacted by local exposure to school shootings.

Layers of Costs, More Unknowns

The researchers also analyzed whether the concentration of child mental health providers in areas affected by fatal school shootings made a difference in the antidepressant rates, and they drilled a further comparison between the prevalence of those who can prescribe drugs, such as psychiatrists and other medical doctors, and those who cannot prescribe drugs, such as psychologists and licensed social workers.

Increases in antidepressant rates were the same across areas with both high and low concentrations of prescribing doctors, the researchers found. But in areas with higher concentrations of non-prescribing mental health providers, the increases in antidepressant use were significantly smaller – indicating perhaps a greater reliance on non-pharmacological treatments or therapy for shooting-related trauma.

The researchers also found no evidence that the rise in antidepressant usage stemmed from mental health conditions that were previously undiagnosed prior to the shootings.

In totality, the researchers say the results in the study clearly pointed to an adverse impact from a fatal shooting on the mental health of youths in the local community. Furthermore, the results capture only a portion of the mental health consequences: Non-drug related treatments could have been undertaken as well.

“Increased incidence of poor mental health is at least part of the story,” Schnell said.

Though their analysis included only 44 schools and 15 fatal school shootings, Rossin-Slater noted how the trend of school shootings is growing. She believes the mental health impact found on the local communities they studied “can be generalizable to other communities’ experiences.”

That’s all the more reason why policymakers should consider the overall negative effects of school shootings, and how further research will be needed to gauge other societal consequences, the researchers said.

“Think of it as layers of costs,” Rossin-Slater said. And when it comes to evaluating gun violence at schools, “we think our numbers say, ‘Hey, these are costly things, and it’s costlier than we previously thought.’”

The science of cyber risk looks at a broad spectrum of risks across a variety of digital platforms. Often though, the work done within the field is limited by a failure to explore the knowledge of other fields, such as behavioral science, economics, law, management science, and political science. In a new Science Magazine article, “Cyber Risk Research Impeded by Disciplinary Barriers,” cyber risk experts and researchers at Stanford University make a compelling case for the importance of a cross-disciplinary approach. Gregory Falco, security researcher at the Program on Geopolitics, Technology, and Governance, and lead author of the paper, talked recently with the Cyber Policy Center about the need for a holistic approach, both within the study of cyber risk, and at a company level when an attack occurs.

CPC: Your recent perspective paper in Science Magazine highlights the issue of terminology when it comes to how organizations and institutions define a cyber attack. Why is it so important to have consistent naming when we are talking about cyber risk?

Falco: With any scientific discipline or field, there is a language for engaging with other experts. If there’s no consistent language or at least dialect for communication around cyber risk, it’s difficult to engage with scholars from different disciplines. For example: The phrase “cyber event” is contested and the threshold for what an organization considers to be a cyber event varies substantially. Some organizations consider someone pinging their network as a cyber event, others only consider something a cyber event once an intrusion has been publicly disclosed. So there’s a disparity when comparing metrics of cyber events from organization to organization because of the different thresholds of what’s considered an event.

CPC: We’ve all been sent one of those emails letting us know our data may have been compromised and your paper points out it’s nearly impossible to put foolproof protections into place; attacks are inevitable. Given that, how should companies weigh the various ways they can protect themselves?

Falco: The first exercise each organization should go through when they decide to be serious about cyber risk is to prioritize their assets. What is business critical? What is safety critical? Then, like all other risks, a cost-benefit analysis must be done for each asset based on its priority. If the asset is safety-critical, then resources should be allocated to help protect that asset or at least ensure its resilience. Trade-offs are inevitable, no company has unlimited resources. But starting with an understanding of where the priorities are, is critical.

CPC: In companies, cyber security often falls entirely to the Chief Information Security Officer (CISO). Your paper argues that’s shortsighted. What is gained when a company takes a more holistic approach?

Falco: Distributing responsibility across the organization catalyzes a security culture. A security culture is one where there is a constant vigilance or at least broad awareness of cybersecurity concerns throughout the organization. Fostering a security culture is often suggested as a mechanism to help reduce cyber risk in organizations. The problem with not distributing responsibility is that when something happens, it’s too easy to resort to finger-pointing at the CISO, and that’s counterproductive. Efforts after an attack should be on responding and being resilient, not finding the scapegoat.

CPC: Cyber risk largely focuses on prevention, but your paper argues that it’s what happens after an attack in that needs greater attention. Why is that?

Falco: Every organization will be attacked. However organizations can differentiate themselves from a cyber risk standpoint by appropriately managing the situation after an attack. Some of the most significant damages to organizations can be reputational if communication after an attack is unclear or botched. Poor communication after an attack can result in major regulatory fines or valuation adjustments as seen in cases like Yahoo and that can have major business implications. Communications aren’t the only important element of post-attack response. A thorough post-mortem of the organization’s response to the attack can be an important learning experience and a way to plan for future attacks.

CPC: Protecting against cyber attacks and the losses that go with them can obviously be costly for companies. You make a case for collaboration among different fields, say among data scientists and economists. How can that be encouraged?

Falco: We argue that cross-disciplinary collaboration rarely happens organically. Therefore, we call on funding agencies like the NSF or DARPA to specify a preference for cross disciplinary research when funding cyber risk projects. Typically, this isn’t currently a feature of calls for proposals, but for cyber risk programs it should be. We encourage researchers to explore cyber risk questions at the margins of their discipline. Those questions may lend themselves to potential overlap with other disciplines and foster a starting point for cross-disciplinary collaboration.

For more on these topics, see a full list of recent publications from the Cyber Policy Center and the Program on Geopolitics, Technology, and Governance.