Stanford University

Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

Trauma and Healing in Stricken Japan

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The triple disasters in Japan in March 2011 have created overwhelming trauma in the stricken areas for people of all ages. The mental health needs are immense, both immediate and long term, and ripple out into Japanese society. Members of the Nichibei Care Network, a group of mental health professionals in the Bay Area who organized to assist relief activities, will offer their reflections on the trauma suffered. They will also report on the heroic efforts that are taking place daily as people rebuild lives through compassion and caring.

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Special Japan Studies Program and CEAS Series: Winter-Spring 2011-12

Looking Back, Looking Forward: Japan's March 11 Disasters One Year Later

The earthquake, tsunami, and nuclear disaster that hit Japan in March 2011 had both immediate catastrophic consequences and long term repercussions. Fundamental areas of Japan’s environment, economy, society, and collective national psyche were deeply affected, giving rise to a broad range of urgent issues. These include economic debates about how to meet the country’s energy demands with nuclear power plants offline, and what path to take for the country’s energy future; political crises, including criticism of the government’s disaster response; the psychological challenges of coping with trauma and grief; a daunting environmental clean-up; and social developments, including a new wave of civil society activism. This series brings together scholars and activists from a wide range of specialties to take stock of how the Japanese have been affected by the disasters, and to assess the efforts of residents, volunteers, and policy makers to recover and move forward.

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William Masuda Reverend Speaker Palo Alto Buddhist Temple
Stephen Murphy-Shigematsu Speaker Stanford School of Medicine
George Kitahara Kich, PhD Psychologist and Litigation Consultant and Adjunct Faculty Speaker California Institute of Integral Studies
Mio Yamashita Art Therapist/Marriage and Family Therapist Speaker
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Multi-Country Analysis of Palm Oil Consumption and Cardiovascular Disease Mortality for Countries at Different Stages of Economic Development: 1980-1997

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Background

Cardiovascular diseases represent an increasing share of the global disease burden. There is concern that increased consumption of palm oil could exacerbate mortality from ischemic heart disease (IHD) and stroke, particularly in developing countries where it represents a major nutritional source of saturated fat.

Methods

The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and an interaction between palm oil consumption and country economic development level. Analyses examined changes in country-level outcomes over time employing linear panel regressions with country-level fixed effects, population weighting, and robust standard errors clustered by country. Sensitivity analyses included further adjustment for other major dietary sources of saturated fat.

Results

In developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant. For historically high-income countries, changes in IHD and stroke mortality rates from palm oil consumption were smaller (IHD: 17 deaths per 100,000 (95% CI [5.3-29]); stroke: 5.1 deaths per 100,000 (95% CI [-1.2-11.0])). Inclusion of other major saturated fat sources including beef, pork, chicken, coconut oil, milk cheese, and butter did not substantially change the differentially higher relationship between palm oil and IHD mortality in developing countries.

Conclusions

Increased palm oil consumption is related to higher IHD mortality rates in developing countries. Palm oil consumption represents a saturated fat source relevant for policies aimed at reducing cardiovascular disease burdens.

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Getting to the roots of the tobacco industry

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Tobacco now kills 90 times more people each year than HIV/AIDS in China. China's tobacco industry is closely tied to the global industry, and the Asia Health Policy Program is working to establish a new field of research on its history, beginning with a Mar. 2012 conference at the new Stanford Center at Peking University. Robert Proctor, a Stanford historian and author of a groundbreaking new book on the global tobacco industry, will take part.
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Beauty and smoking are paired in this vintage-style cigarette poster in China, Nov. 2005. | Flickr/Yeap Ku
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Gabriela Calderón

Encina Hall
616 Serra Street
Stanford, CA 94305-6055

(650) 724-2996
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CDDRL Postdoctoral Fellow 2012-13
Calderon_HS.jpg PhD

Gabriela Calderon holds a Ph.D. in Economics from Stanford University. Her research interests include policies that affect gender differences in developing countries, policy evaluation, violence in Latin America and the effect of institutions and governance on the provision of public goods and health/education outcomes. She did her master's degree in economic theory and bachelor's degree in economics at the Instituto Tecnológico Autónomo de México. Currently, in the Program on Poverty and Governance, her research analyzes the way institutions and democracy affect the provision of public goods, and the impact they have on health outcomes like infant mortality trends. She is also studying the effects of government interventions that combat  drug-trafficking organizations over violence in Mexico. 

Her research has focused on the topics of development, public finance, and the evaluation of public policy programs in Mexico. For example, during the summers of 2009/2010, she conducted a field experiment in Zacatecas, Mexico with Giacomo de Giorgi, an assistant professor from Stanford University, and Jesse Cuhna, a former Stanford student. The main task was to evaluate the impact of financial literacy classes on underprivileged women entrepreneurs in the region. To successfully complete an evaluation in an untreated region, they proposed collaborating with the Mexican NGO CREA on a joint project. They contacted local interviewers, trained them, and identified all women entrepreneurs in the 17 communities, in which we conducted the experiment.  Preliminary results suggest that the female entrepreneurs who were randomly assigned to treatment earned higher profits, had larger revenues, and served a greater number of clients. They also found that they were more likely to implement formal accounting techniques.

She has also studied  programs that are not randomly assigned as an experiment. For example, she has analyzed the effects of a national policy in Mexico of child care services, called Estancias Infantiles para apoyar a Madres Trabajadoras (EI), using administrative, census and household data.  Her empirical research strategy identifies the effects of the program on both the men and women who were eligible for the program. She used time, location and eligibility variation, and considered a major threat to identification of the actual effects: for example, a manufacturer who moves into a municipality at approximately the same time as the EI program and who happens to disproportionately demand the skills of women who were eligible to the program happened to have. To ensure that such scenarios do not affect her results, she chose not triple difference strategy, in which all ineligible people are treated as “controls” for the EI-eligible families. Instead, she employs Synthetic Control Methods, using the same methodology as Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) to ensure that her control group has the same mix of skills and preferences as the EI-eligible group. She adapted the Synthetic Control Method to analyze repeated cross-sectional household data, which are data that are typically available in developing countries

Economic, social, and security implications of East Asia's demographic transition

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Asia’s demographic landscape is changing in a big way. Japan’s population is shrinking, as people are living longer, marrying later, and choosing to have fewer or no children. Korea is moving in the same direction, while China and the countries of South and Southeast Asia face similar issues in the coming decades. As this takes place, more people are moving to, from, and across Asia for job, education, and marriage opportunities.

These demographic changes present policymakers with new challenges and questions, including: What are the interrelationships between population aging and key macroeconomic variables such as economic growth? How will it impact security? What are the effects on employment policy and other national institutions? How have patterns of migration affected society and culture? What lessons can Asia, the United States, and Europe learn from one another to improve the policy response to population aging?

The Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) focused its third annual Stanford Kyoto Trans-Asian Dialogue on addressing the possible economic, social, and security implications of Asia’s unprecedented demographic transition. Thirty scholars, government figures, journalists, and other opinion leaders from Stanford, the United States, and countries across the Asia-Pacific region gathered September 8–9, 2011, in Kyoto, Japan, to discuss key issues related to the question of demographic change.

Comparative Demographics and Policy Responses

Japan’s shrinking workforce calls for labor policy changes, stressed presenters during the opening Dialogue session. Stanford Center for Population Research director Shripad Tuljapurkar stated that Japan’s population could decrease by as much as 25 percent and that its government has a window of approximately 40 years in which to act. In describing Japan’s demographic shift, Ogawa Naohiro, director of the Nihon University Population Research Institute, also emphasized the importance of good financial education for individuals as life expectancy increases.

Macroeconomic Implications

Economists Masahiko Aoki and Cai Fang addressed changes to East Asia’s economic landscape. Aoki, an FSI senior fellow, spoke of the transition from agriculture to industry that has occurred at different stages in Japan, Korea, and China and of the increasing cost of human capital that has followed. Cai, a Chinese Academy of Social Sciences labor and population expert, stated that after several decades of industrial growth China is now at a turning point in terms of its global competitiveness.

Labor and Migration

Scott Rozelle, codirector of Stanford’s Rural Education Action Program (REAP), opened the next day with a discussion of China’s rural human capital investment. Offering Mexico’s situation after the mid-1990s peso crisis as a comparison, he emphasized the immediate need for allocating more health and education resources to China’s rural areas. Ton-Nu-Thi Ninh, president of Tri Viet University, discussed the socioeconomic and cultural aspects of labor migration—a growing trend in Asia—and advocated that governments factor it more into their foreign policy development.

Security

The security impact of Asia’s demographic transition will take several decades to understand, but it will eventually lead to the need for significant policy re-strategization, stated Yu Myung Hwan, Korea’s former minister of foreign affairs and trade, during the closing Dialogue session. He suggested focusing on impacts that could result from the major changes taking place in fertility, urbanization, and migration. Concurring with many of Yu’s views, Stanford’s Shorenstein Distinguished Fellow Michael H. Armacost also noted the current lack of literature on the link between security and demography. In addition, he emphasized the need for the United States to continue pursuing good relations with China and Russia during this time of transition.

“Low fertility rates are not because women are all out there working. In fact, a number of countries have lots of females in the labor force and have achieved a resurgence of fertility. Achieving work-life balance is important, not just for women, but for men as well, and might play a role in lessening the gap in life expectancy between men and women.”

-Karen Eggleston, Director, Asia Health Policy Program

Throughout the event, Dialogue participants unanimously acknowledged the serious challenges facing policymakers as they look for ways to meet the evolving needs of individuals, families, and organizations. The demographic outlook is not entirely gloomy, however. Numerous participants also pointed to the potential for exciting advances and innovations in technology and international cooperation.

As in previous years, the event concluded with a lively public symposium and reception attended by students from Stanford and local universities, Shorenstein APARC guests and affiliates, and members of the general public. Speaking during the reception, Kadokawa Daisaku, mayor of Kyoto, and Kim Hyong-O, member and former speaker of the Korean National Assembly, acknowledged the significance of the Stanford Kyoto Trans-Asian Dialogue as a forum for addressing issues of mutual importance to the United States and Asia.

The Dialogue is made possible through the generosity of the City of Kyoto, FSI, and Yumi and Yasunori Kaneko. To read the final report from this and previous Dialogues, visit the event series page below.

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A worker stands on steel rods at a superblock construction site in Jakarta in February 2010. Increasing urbanization is one of many aspects of Asia's demographic change. | REUTERS/Beawiharta
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Do Different Health Insurance Plans in China Create Disparities in Health Care Utilization and Expenditures?

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China has recently reformed its health care system with the intent of providing universal coverage for basic health care to every Chinese citizen. Three separate health insurance plans have recently been launched to achieve this objective: the rural newly cooperative medical scheme, urban resident health insurance, and urban employee-based health insurance. Each plan differs substantially in terms of insurers, insured population, premiums, and benefits packages. Using data from the 2009 China Health and Nutrition Survey, Hai Fang will discuss a study that investigates whether and to what extend different health insurance plans have created disparities in health care utilization and expenditure.

Hai Fang is an assistant professor in the Department of Health Systems, Management, and Policy at the University of Colorado Denver, and a research associate in the Kennedy School of Government at Harvard University. He earned his doctorate in economics and master of public health from the State University of New York at Stony Brook in 2006. Before joining the University of Colorado Denver, he taught at the University of California, Davis, and the University of Miami. His research interests include health economics, labor economics, and public health.

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Hai Fang Associate Professor, Department of Health Systems, Management, and Policy Speaker University of Colorado Denver
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Divorce, Abortion and Sex Ratio at Birth: The Effect of the Amended Divorce Law in China

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This seminar explores whether and to what extent the relative circumstances of men and women following marital dissolution affect sex selection behavior within marriages. China's new divorce law, which was enacted in 2001, reduced divorce costs, especially for women, by granting the right to divorce and claim damages in the case of domestic violence and extra-marital relationships and by securing women's property rights upon divorce. Ang Sun has modeled the legal change as a decrease in women's divorce costs in a household in which all the marital surplus accrues to the husband. Sun shows: (1) that the new divorce law predicts an increase in divorce rates after the birth of a daughter; (2) that the new law results in fewer sex-selective abortions for the second birth if the first birth produced a daughter; and (3) that the effect of the new law on the sex ratio should have diminishing returns to divorce cost reduction for women. All the predictions are supported by the empirical evidence. Most importantly, she finds that most of the decline occurred in historically high divorce-cost regions, which is consistent with the predictions of the model and helps rule out concomitant changes in household income and relative returns to male and female children.

Ang Sun received her PhD from Brown University’s Department of Economics. Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families.

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Ang Sun

Walter H. Shorenstein
Asia-Pacific Research Center
616 Serra St C335
Stanford University
Stanford, CA 94305-6055

(650) 724-5668 (650) 723-6530
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2011-12 Asia Health Policy Fellow
SunAng_Profile.jpg MA, PhD

Ang Sun joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) from Brown University’s department of economics where she recently received her PhD.

Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families. During her time at Shorenstein APARC, Sun will participate in an interdisciplinary study of the impact of the aging process in Asia on economic growth.

Sun holds a PhD and an MA in economics from Brown University, and an MA from the China Center of Economic Research. She also received a BA in economics and a BS in information and computer science from Beijing University.

Ang Sun 2011-12 Asia Health Policy Fellow Speaker Stanford University
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The Insider Threat: Preserving the Good of Powerful Science in a Dangerous World

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Recent events in the U.S. have raised concerns about the safety and security of research with hazardous microbial agents, particularly with regard to the insider threat. The anthrax letters of 2001 and several technical surprises in legitimate infectious disease research, led to a series of high-level committee recommendations on safety and security of the ongoing work. When a scientist from a U.S. military high-containment laboratory was implicated in the anthrax letters case, the president and congress called for more regulation. Subsequently, a series of steps to reduce the risk have been proposed: from armed guards, pathogen accountability and medical and psychological exams for scientists to training, ethical frameworks, codes of conduct and standards of quality research. Franz will discuss the implications of these events on both security and productive research in support of public health and the life-sciences enterprise, and the important role of leadership and culture in enhancing both safety and security.

About the speaker: Dave Franz is a Vice President and Chief Biological Scientist at MRIGlobal. He served in the U.S. Army Medical Research and Materiel Command for 23 of 27 years on active duty and retired as Colonel. He served as Commander of the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) and as Deputy Commander of the Medical Research and Materiel Command. Prior to joining the Command, he served as Group Veterinarian for the 10th Special Forces Group (Airborne). Dr. Franz was Technical Editor for the Textbook of Military Medicine on Medical Aspects of Chemical and Biological Warfare released in 1997. He serves on numerous national committees and boards. Dr. Franz holds an adjunct appointment as Professor for the Department of Diagnostic Medicine and Pathobiology at the College of Veterinary Medicine, Kansas State University. The current focus of his activities relates to the role of international engagement in the life sciences as a component of national security policy.

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Dave Franz Vice President and Chief Biological Scientist Speaker MRIGlobal
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The Commitment to Public Services in India

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Abstract:

There is a wide diversity in the provision of public services in India. In some states one can go for miles without seeing a functional school or public health centre, where roads are poorly maintained, and electricity has not yet been introduced. In other places, governments tend to function remarkably in extending basic public services to all, with tremendous consequences to human lives. In this talk, Vivek Srinivasen will explore why some parts of India have developed an impressive social commitment to such services unlike others. In this context, he will also discuss the remarkable changes in Bihar and other parts of North India in the recent years.

 Speaker Bio: 

Vivek Srinivasen joined the Liberation Technology Program as the manager in February 2011 after completing his Ph.D. in Social Sciences from the Maxwell School of Syracuse University. Prior to this, Srinivasen worked with campaigns on various socio-economic rights in India, including the right to food, education and the right to information. Based on these experiences he has written (and co-authored) extensively on issues surrounding the right to food, including Notes from the right to food campaign: people's movement for the right to food (2003), Rights based approach and human development: An introduction (2008), Gender and the right to food: A critical re-examination (2006), Food Policy and Social Movements: Reflections on the Right to Food Campaign in India (2007).

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Vivek Srinivasen Program Manager Speaker Program on Liberation Technology, Stanford University
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d.school uses mobile technology for social issues in Kenya

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The November 17 Liberation Technology Seminar was co-hosted by the Stanford Institute for Economic Policy Research (SIEPR), a nonpartisan economic policy research organization that unites remarkable economic talent from all parts of Stanford University. This seminar featured four student-led design projects that were created in the Designing Liberation Technologies course taught each spring at Stanford's Hasso Plattner Institute of Design (d.school) by professors' Josh Cohen and Terry Winograd. The class works in partnership with the University of Nairobi's School of Computing and Informatics to develop user-based designs that address outstanding challenges in the slums of Nairobi, Kenya. 

Josh Cohen described the three main elements of the design school class:

(1) There is a focus on user/human-centered design. Projects are designed based on a close engagement with end users: the people who will be using the solutions. (2) Courses are inter-disciplinary. The idea is to take people who are deeply embedded in a certain discipline and put them together with people from other disciplines. In order to come up with a solution to a real problem, team collaboration is necessary and (3) The approach to problem solving is about practice, not about theory. It is necessary to fail early and fail often in the process of creating workable solutions.

The panelists consisted of students who were working with partners in Kenya on how mobile technology could be used to address various social issues. A multidisciplinary team of students work in close collaboration with partners in Kenya, and some of these ideas are now being tested on the ground.

The first project that was described was M-maji (mmaji.wordpress.com). Sangick Jeon described how water in Kibera is scarce, costly and contaminated. Their aim is to use the nearly ubiquitous mobile technology to improve access to water. Vendors are able to advertise their water and then buyers can ask questions and provide feedback. This saves the time and resources that it takes to find clean water.

Nishuari, the second project, addresses the problem of inaccurate advice and rumors which lead to risky sexual behavior and often HIV and AIDS. They provide a mobile counseling service whereby individuals can submit health questions and receive responses from trained counselors using text messages. This helps to break down logistical and social barriers.

The third, Makmende considered the issue of serious crime in Kibera. Their aim is to look at how individuals can get safely from Point A to Point B. They set up walking groups so that people would not have to walk alone. Over 90% of people had a mobile phone and this was seen to be an effective way of building timely communication, so that groups of people can coordinate to walk more safely to reach their destinations.

The final project was Take Taka, which was the one project that was not focused on using computer technology. The team took up sanitation as the project and decided early on that the use of mobile phones adds no value to the issue. The focused instead of designing a special sanitary bucket that could be used instead of a toilet inside the home, and on developing a system of transmitting the deposits to a biogas unit. This project however has not been carried forward.

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