The July/August issue of Health Affairs, the leading U.S.-based health policy journal, focuses on China and India. The special issue includes an article on China’s pharmaceutical policy by five contributors to Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, a book forthcoming in 2009 from the Shorenstein Asia-Pacific Research Center series with Brookings Institution Press. Chapters on Korea and Japan by Soonman Kwon (Seoul National University) and Toshiaki Iizuka (Aoyama Gakuin University) also appear in Chinese translation in the journal Bijiao (Comparative Studies), along with an overview paper (“Pharmaceutical policy reforms to separate prescribing from dispensing in Japan and South Korea: Possible implications for China”) by Karen Eggleston, Asian Health Policy Program Director.

As Eggleston writes in the introduction to Prescribing Cultures, pharmaceuticals and their regulation play an increasingly important and often contentious role in the health care systems of the Asia Pacific.  For example, some economies such as China have extraordinarily high drug spending as a percentage of total health spending; India and a few others host thriving domestic pharmaceutical industries of global importance, while controversy surrounds patents, trade-related aspects of intellectual property (TRIPS), and pharmaceutical pricing within bilateral trade agreements (Australia-US, Republic of Korea-US); nations throughout the region struggle with appropriate regulation of drugs, from patents to evidence-based purchasing (e.g., Australia’s Pharmaceuticals Benefit Scheme) and direct-to-consumer advertising; deeply-rooted traditions of indigenous medicine are modernizing and integrating into broader health care systems; and policies to separate prescribing and dispensing re-write the professional roles of physicians and pharmacists, with modifications to accommodate cultural norms and strong economic interests. Effective prescribing and pharmaceutical use will be central to controlling infectious diseases, both old and emerging; protecting the global public good of antimicrobial effectiveness; and treating the growing burden of chronic disease in the Asia Pacific.

The forthcoming book will explore these issues in detail, through a multi-disciplinary lens. The first section of the book features chapters on pharmaceutical policy within seven selected health care systems of the Asia Pacific: South Korea, Japan, Thailand, Taiwan, Australia, India, and China. The second section focuses on the cross-cutting themes of prescribing cultures and access versus innovation. Taken as a whole, the contributions aim to provide an evidence base for policy while acknowledging the historical and cultural context that makes policies distinctive.

Clear evidence suggests the importance of health service provider payment incentives for achieving efficiency, equal access, and quality, including attention to primary, secondary, and tertiary prevention. “Pay for performance” may be on the cusp of significant expansion in Asia, and reform away from fee-for-service has been underway for several years in several economies. Yet despite the policy relevance, the evidence base for evaluating payment reforms in Asia is still very limited.

China in particular has been undertaking significant reforms to its health care system in both rural and urban areas. With the expansion of insurance coverage and need to resolve incentive problems like “supporting medical care through drug sales,” there is an urgent need for evaluating alternative ways of paying health service providers. Evidence from policy reforms in specific regions of China, as well as other economies of the Asia-Pacific, can provide valuable evidence to help inform policy decisions about how to align provider incentives with policy goals of quality care at reasonable cost.

To illuminate these questions, the Asia Health Policy Program and several collaborating institutions are planning to convene a conference on health care provider payment incentives on November 7-8, 2008 in Beijing. The conference will highlight and seek to distill “best-practice” lessons from rigorous and policy-relevant evaluations of recent reforms in China and elsewhere in the Asia Pacific.

The organizing committee – including health economists from Shorenstein APARC, Peking University, Tsinghua University, and Seoul National University – reviewed submissions in June 2008 and accepted sixteen. The conference papers cover payment issues in Korea, Japan, China, Taiwan, Thailand, Tajikistan, the Philippines, and the US, and the disciplines of economics, health services research/health policy, public health, medicine, and ethics. Topics include institutionalized informal payments; the impact of global budget policies on high-cost patients; public-private partnerships; public-sector physicians owning private pharmacies; evidence-informed case payment rates; payment and hospital quality; bonuses and physician satisfaction; physician prescription choice between brand-name and generic drugs; and differences in pharmaceutical utilization across insurance plans that pay providers differently (fee-for-service versus capitation).

Policymakers from China’s National Development and Reform Commission and Ministry of Health will also speak at the conference. Selected research papers will be published through the Shorenstein Asia-Pacific Research Center either in a special volume or in a special issue of an English-language health policy journal.

“Should the United States promote democracy around the world?” Stanford alumna Kathleen Brown, a former FSI advisory board member, former Treasurer of the State of California, and current head of public finance (Western region) Goldman Sachs

How are democracy, development, and the rule of law in transitioning societies related? How can they be promoted in the world’s most troubled regions? These were among the provocative issues addressed by faculty from the Freeman Spogli Institute’s Center on Democracy, Development, and the Rule of Law, as part of Stanford Day in Los Angeles on January 21, 2006. Panelists included Michael A. McFaul, CDDRL director, associate professor of political science, and senior fellow, the Hoover Institution; Kathryn Stoner, associate director for research and senior research associate at CDDRL; and Larry Diamond, coordinator of CDDRL’s Democracy Program, a Hoover Institution senior fellow, and founding co-editor of the Journal of Democracy.

The capstone of a day devoted to “Addressing Global Issues and Sharing Ideas,” the CDDRL panel was attended by more than 850 alumni, Stanford trustees, and supporters as part of the nationwide “Stanford Matters” series. Moderated by Stanford alumna Kathleen Brown, a former FSI Advisory Board member, former treasurer of the State of California, and current head of public finance (western region) Goldman Sachs, the panel looked at some of the toughest trouble spots in the world, including Iraq, Russia, and other parts of the former Soviet Union.

“Should the United States promote democracy around the world?” Brown began by asking Center Director Michael McFaul. “The President of the United States has said that the United States should put the promotion of liberty and freedom around the world as a fundamental policy proposition,” McFaul responded, noting “it is the central policy question in Washington, D.C., today.” It is not a debate between Democrats and Republicans, he continued, but rather between traditional realists, who look at the balance of power, and Wilsonian liberals, who argue that a country’s conduct of global affairs is profoundly affected by whether or not it is a democracy. The American people, McFaul noted, are divided on the issue. In opinion polls, 55 percent of Republicans say we should promote democracy, while 33 percent say no. Among Democrats, only 13 percent answer unequivocally that the United States should promote democracy.

“The President of the United States has said that the United States should put the promotion of liberty and freedom around the world as a fundamental policy proposition, and it is the central policy question in Washington, D.C., today.” CDDRL Director Michael McFaulAsserting that the United States should promote democracy, McFaul offered three major arguments. First is the moral issue—democracies are demonstrably better at constraining the power of the state and providing better lives for their people. Democracies do not commit genocide, nor do they starve their people. Moreover, most people want democracy, opinion polls show. Second are the economic considerations—we benefit from open societies and an open, liberal world trade system, which allows the free flow of goods and capital. Third is the security dimension. Every country that has attacked the United States has been an autocracy; conversely, no democracy has ever attacked us. The transformation of autocracies, including Japan, Germany, Italy, and the Soviet Union, has made us safer.

It is plausible to believe that the benefits of transformation in the Middle East will make us more secure, McFaul argued. “It would decrease the threats these states pose for each other, their need for weapons, and the need for U.S. intervention in the region,” he stated. Democratic transformation would also address a root cause of terrorism, as the vast majority of terrorists come from autocratic societies. There are, however, short-term problems, McFaul pointed out. Free elections could lead to radical regimes less friendly to the United States, as they have in Egypt, Iran, Iraq, and now in Palestine. U.S. efforts to promote democracy, he noted, can actually produce resistance.

Having advanced a positive case, McFaul asked FSI colleague Stoner-Weiss, “So, how do we promote democracy?” Stoner-Weiss, also an expert on Russia, said it is instructive to see how Russia has fallen off the path to democracy. In 1991, when the Soviet Union collapsed, it seemed to be an exciting time, rife with opportunity. “Here was an enemy, a major nuclear superpower, turning to democracy,” she stated. Despite initial U.S. enthusiasm, the outcome has not been a consolidated democracy. Russia, under Vladimir Putin, is becoming a more authoritarian state, a cause for concern because it is a nuclear state and a broken state—with rising rates of HIV and unable to secure its borders or control the flow of illegal drugs.

“So can we promote democracy?” Stoner-Weiss asked. The answer is a qualified yes, from Serbia to Georgia, and the Ukraine to Kyrgyzstan. But Russia has 89 divisions, 130 ethnicities, 11 time zones, and is the largest landmass in the world, she noted. Moving from a totalitarian state to a democracy and an open economy is enormously complicated. As Boris Yeltsin said in retiring as president on December 31, 1999, “What we thought would be easy turned out to be very difficult.”

Where is Russia today? It ranks below Cuba on the human development index; it is moving backward on corruption; and its economic development is poor, with 30 percent of the public living on subsistence income. Under Putin’s regime, private media have come under pressure, television is totally stated controlled, elections for regional leaders have been canceled, troops have remained in Chechnya, and Putin has supported controversial new legislation to curb civil liberties and NGO’s operating in Russia.

“How did Russia come to this?” she asked. In retrospect, the power of the president has been too strong. Initial “irrational exuberance” in the United States and Europe about what we could do has given way to apathy. Under Yeltsin, rule was oligarchical and democracy disorganized. Putin came to office promising a “dictatorship of law” to rid the country of corruption. Yet Russia under Putin, who rose through the KGB and never held elective office, has become far less democratic. He has severely curtailed civil liberties. The economy, dependent on oil and natural gas, is not on a path of sustainable growth.

“What can the United States do?” Stoner-Weiss asked. We have emphasized security over democracy, she pointed out, and invested in personal relations with Russia’s leaders, as opposed to investing in political process and institutions. We do have important opportunities, she noted. Russia chairs the G-8 group of major industrial nations this year, providing major opportunities for consultation, and wants to join the World Trade Organization. The United States should advance an institutional framework to help put Russia back on a path to democracy, a rule of law, and more sustainable growth, she argued.

Diamond, an expert on democratic development and regime change, examined U.S. involvement in the Middle East, noting that it is difficult to be optimistic at present. “Democracy is absolutely vital in the battle against terrorism,” he stated. The United States has to drain the swamp of rotten governments, lack of opportunity for participation and the pervasive indignity of human life. “The dilemma we face,” he pointed out, “is getting from here to there in the intractable Middle East.” There is not a single democracy in the Arab Middle East. This is not because of Islam, but rather the authoritarian nature of regimes in the region and the problem of oil.

“Can we promote democracy under these conditions?” Diamond asked. We need to get smart about it, he urged, noting that success depends on the particular context of each country. “If we want to promote democracy, the first rule is to know the country, its language, culture, history, and divisions,” he stated. We need to know, he continued, “who stands to benefit from a democratic transformation and, conversely, who stands to lose?” Rulers of these countries need to allow the space for freedom, for civic and intellectual pluralism, for open societies and meaningful participation. The danger is that there could be one person, one vote, one time. A second rule is that “academic knowledge and political practice must not be compartmentalized.” “To succeed,” Diamond stated, “we need to marry academic theories with concrete knowledge of these countries’ traditions, cultures, practices, and proclivities.”

In the lively question-and-answer session, panelists were asked, “Under what conditions is it appropriate to use force to promote democracy?” McFaul answered that we cannot invade in the name of democracy—we rebuilt Japan in that name but we did not invade that nation. We invaded Iraq in the name of national security. We know how to invade militarily, but still must learn how to build democracy. Effectiveness in the promotion of democracy, Diamond pointed out, requires the exercise of “soft” power—engagement with other societies, linkages with their schools and associations, and offering aid to democratic organizations around the world. Stoner-Weiss concurred, noting that we have used soft power effectively in some parts of the former Soviet Union, notably the Ukraine. People-to-people exchanges definitely help, she added.

To combat Osama bin Laden and the threat of future attacks in the United States, Diamond stated, we must halt the proliferation of nuclear weapons. North Korea and Iran are two of the most important issues on the global agenda. And we have got to improve governance in the Middle East in order to reduce the chances that the states of the region will breed and harbor stateless terrorists. A democratic Iran is in our interest, McFaul emphasized. Saudi Arabia must change as well—the only issue is whether change occurs with evolution or revolution. Democracy, economic development, and the rule of law, McFaul concluded, are inextricably intertwined.

Asked by alumnus and former Stanford trustee Brad Freeman what needs to happen to re-democratize Russia, McFaul pointed out that inequality has been a major issue in Russia—a small portion of the population controls its wealth and resources and, therefore, the political agenda and the use of law. Russia has been ruled by men and needs the rule of institutions, said Stoner-Weiss. We should insist that Putin allow free and fair elections, freedom of the press, and freedom of political expression, and re-focus efforts on developing the institutions of civil society, she stated.

Reform is a generational issue, McFaul emphasized. We need to educate and motivate the young so they can change their country from within. The Stanford Summer Fellows Program, which brought emerging leaders from 28 transitioning countries to Stanford in the program’s inaugural year of 2005, provides an important venue for upcoming generations to meet experienced U.S. leaders and others fighting to build democracies in their own countries. Such exchanges help secure recognition that building support for democracy, sustainable development, and the rule of law is a transnational issue.

This past autumn, the Freeman Spogli Institute ( FSI ) in conjunction with the Woods Institute for the Environment launched a program on Food Security and the Environment (FSE) to address the deficit in academia and, on a larger scale, the global dialogue surrounding the critical issues of food security, poverty, and environmental degradation.

“Hunger is the silent killer and moral outrage of our time; however, there are few university programs in the United States designed to study and solve the problem of global food insecurity,” states program director Rosamond L. Naylor. “FSE’s dual affiliation with FSI and Stanford’s new Woods Institute for the Environment position it well to make significant steps in this area.”

Through a focused research portfolio and an interdisciplinary team of scholars led by Naylor and Center for Environmental Science and Policy (CESP) co-director Walter P. Falcon, FSE aims to design new approaches to solve these persistent problems, expand higher education on food security and the environment at Stanford, and provide direct policy outreach.

Productive food systems and their environmental consequences form the core of the program. Fundamentally, the FSE program seeks to understand the food security issues that are of paramount interest to poor countries, the food diversification challenges that are a focus of middle-income nations, and the food safety and subsidy concerns prominent in richer nations.

CHRONIC HUNGER IN A TIME OF PROSPERITY

Although the world’s supply of basic foods has doubled over the past century, roughly 850 million people (12 percent of the world’s population) suffer from chronic hunger. Food insecurity deaths during the past 20 years outnumber war deaths by a factor of at least 5 to 1. Food insecurity is particularly widespread in agricultural regions where resource scarcity and environmental degradation constrain productivity and income growth.

FSE is currently assessing the impacts of climate variability on food security in Asian rice economies. This ongoing project combines the expertise of atmospheric scientists, agricultural economists, and policy analysts to understand and mitigate the adverse effects of El Niño-related climate variability on rice production and food security. As a consequence of Falcon and Naylor’s long-standing roles as policy advisors in Indonesia, models developed through this project have already been embedded into analytical units within Indonesia’s Ministries of Agriculture, Planning, and Finance. “With such forecasts in hand, the relevant government agencies are much better equipped to mitigate the negative consequences of El Niño events on incomes and food security in the Indonesian countryside,” explain Falcon and Naylor.

FOOD DIVERSIFICATION AND INTENSIFICATION

With rapid income growth, urbanization, and population growth in developing economies, priorities shift from food security to the diversification of agricultural production and consumption. “Meat production is projected to double by 2020,” states Harold Mooney, CESP senior fellow and an author of the Millennium Ecosystem Assessment. As a result, land once used to provide grains for humans now provides feed for hogs and poultry.

These trends will have major consequences for the global environment—affecting the quality of the atmosphere, water, and soil due to nutrient overloads; impacting marine fisheries both locally and globally through fish meal use; and threatening human health, as, for example, through excessive use of antibiotics.

An FSE project is analyzing the impact of intensive livestock production and assessing the environmental effects to gain a better understanding of the true costs of this resource-intensive system. A product of this work recently appeared as a Policy Forum piece in the December 9, 2005, issue of Science titled "Losing the Links Between Livestock and Land."

Factors contributing to the global growth of livestock systems, lead author Naylor notes, are declining feed-grain prices, relatively inexpensive transportation costs, and trade liberalization. “But many of the true costs remain largely unaccounted for,” she says, including destruction of forests and grasslands to provide farmland for feed crops destined not for humans but for livestock; utilization of large quantities of freshwater; and nitrogen losses from croplands and animal manure.

Naylor and her research team are seeking better ways to track all costs of livestock production, especially hidden costs of ecosystem degradation and destruction. “What is needed is a re-coupling of crop and livestock systems,” Naylor says, “if not physically, then through pricing and other policy mechanisms that reflect social costs of resource use and ecological abuse.” Such policies “should not significantly compromise the improving diets of developing countries, nor should they prohibit trade,” Naylor adds. Instead, they should “focus on regulatory and incentive-based tools to encourage livestock and feed producers to internalize pollution costs, minimize nutrient run-off, and pay the true price of water.”

LOOKING AHEAD

The future of the program on Food Security and the Environment looks bright and expansive. Building on existing research at Stanford, researchers are identifying avenues in the world’s least developed countries to enhance orphan crop production— crops with little international trade and investment, but high local value for food and nutrition security. This work seeks to identify advanced genetic and genomic strategies, and natural resource management initiatives, to improve orphan crop yields, enhance crop diversity, and increase rural incomes through orphan crop production.

Another priority research area is development of biofuels. As countries seek energy self-reliance and look for alternatives to food and feed subsidies under World Trade Organization (WTO) rules, the conversion of corn, sugar, and soybeans to ethanol and other energy sources becomes more attractive. New extraction methods are making the technology more efficient, and high crude oil prices are fundamentally changing the economics of biomass energy conversion. A large switch by key export food and feed suppliers, such as the United States and Brazil, to biofuels could fundamentally alter export prices, and hence the world food and feed situation. A team of FSE researchers will assess the true costs of these conversions.

The FSE program recently received a grant through the Presidential Fund for Innovation in International Studies to initiate new research activities. One project links ongoing research at Stanford on the environmental and resource costs of industrial livestock production and trade to assess the extent of Brazil’s rainforest destruction for soybean production. “Tens of millions of hectares of native grassland and rainforest are currently being cleared for soybean production to supply the global industrial livestock sector,” says Naylor. An interdisciplinary team will examine strategies to achieve an appropriate balance between agricultural commodity trade, production practices, and conservation in Brazil’s rainforest states.

“I’m extremely pleased to see the rapid growth of FSE and am encouraged by the recent support provided through the new Presidential Fund,” states Naylor. “It enables the program to engage faculty members from economics, political science, biology, civil and environmental engineering, earth sciences, and medicine—as well as graduate students throughout the university—in a set of collaborative research activities that could significantly improve human well-being and the quality of the environment.”

The Office of the President and the Stanford International Initiative announced on February 1, 2006, the award of eight new grants totaling $1.05 million to multidisciplinary Stanford faculty teams. The grants are the first to be awarded from Stanford’s new Presidential Fund for Innovation in International Studies (PFIIS) created in 2005.

“The world does not come to us as neat disciplinary problems, but as complex interdisciplinary challenges. The collaborative proposals we have selected for this first round of funding offer great potential to help shed light on some of the most persistent and pressing political issues on the global agenda today—issues acutely important to our common future.” john hennessy, stanford president

The fund supports interdisciplinary research and teaching on three overarching global challenges: pursuing peace and security, improving governance at all levels of society, and advancing human well-being. Priority was given to teams of faculty who did not typically work together, representing multiple fields, and choosing to address issues falling broadly within the three primary research areas of the Initiative. Projects were to be based on collaborative research or teaching, involving faculty from two or more disciplines, and, where possible, from two or more of the University’s seven schools.

“The International Initiative’s Executive Committee was encouraged to receive more than 35 proposals of an impressive caliber and, after careful review, to award the first project and planning grants, totaling $1.05 million, to eight deserving faculty teams.” Coit D. Blacker, director of the Freeman Spogli Institute and chair of the Executive Committee“The International Initiative’s Executive Committee was encouraged to receive more than 35 proposals of an impressive caliber and, after careful review, to award the first project and planning grants, totaling $1.05 million, to eight deserving faculty teams,” stated Coit D. Blacker, director of the Freeman Spogli Institute and chair of the Executive Committee.

The projects qualifying for first-round funding of approximately $1.025 million are the following:

• Governance Under Authoritarian Rule. Stephen Haber and Beatriz Magaloni, political science; Ian Morris, classics, history; and Jennifer Trimble, classics. Will examine the political economy of authoritarian systems and, by drawing on methods from history, archaeology, political science, and economics, determine why some authoritarian governments are able to transition to democracy, stable economic growth, and functioning political institutions, while others prove predatory and unstable.
• Addressing Institutional and Interest Conflicts: Project Governance Structures for Global Infrastructure Development. Raymond Levitt, civil and environmental engineering, and Doug McAdam and Richard Scott, sociology. Will examine the challenges of creating effective and efficient public/ private institutions for the provision of low-cost, distributed, and durable infrastructure services to underserved populations in emerging economies, drawing on engineering cost management, organizational and institutional theory, political science, political sociology, and transaction cost analysis.
• Combating HIV/AIDS in Southern Africa: The Treatment Revolution and Its Impact on Health, Well-Being, and Governance. David Katzenstein, infectious diseases, and Jeremy Weinstein, political science. Based on the 2005 commitment by the Group of 8 donors to put 10 million people infected with HIV/AIDS on treatment within five years, will research the impact of this treatment revolution on health, wellbeing, and governance in Sub-Saharan Africa, with an emphasis on South Africa and Zimbabwe. Seeks to develop a systematic protocol for the collection and analysis of biomedical and social science data.
• Evaluating Institutional Responses to Market Liberalization: Why Latin America Was Left Behind. Judith Goldstein, political science; Avner Greif, economics; Stephen Haber, political science; Herb Klein, history; Grant Miller, medicine; and Barry Weingast, political science. Will research the dynamic interaction between inequality and Latin American institutions, formal and informal, in explaining the poor performance of Latin American countries over the past two decades, seeking in particular to explain why liberal institutional reforms, such as trade liberalization, have failed to yield expected economic benefits.
• Feeding the World in the 21st Century: Exploring the Connections Between Food Production, Health, Environmental Resources, and International Security. Rosamond Naylor, FSI/economics; Stephen Stedman, FSI/political science; Peter Vitousek, biological sciences; and Gary Schoolnik, medicine, microbiology and immunology. Launches new research and teaching program at Stanford on Food Security and the Environment (FSE), with an initial priority on two research areas: 1) Food Security, Health, and International Security; 2) Globalization, Agricultural Trade, and the Environment. Seeks to address the problems of global food insecurity and hunger, the “silent killer” of our time, affecting more than 1 billion people globally. Research and teaching will focus on the interconnections between food security, agricultural production, infectious diseases, environmental degradation, and national and international security, with the aim of advancing human well-being by identifying linkages, policy interventions, and new forms of political cooperation.
• Political Economy of Cultural Diversity. James Fearon, political science, and Romain Wacziarg, Graduate School of Business. Will research the effect of cultural diversity on economic and political performance, examining specifically the role of ethnic, linguistic, and religious diversity on economic growth, the free flow of trade and capital across borders, governance, development of democratic institutions, and political stability. Will develop novel measures of ethnic, linguistic, and religious differences within countries and use these to assess their causal impact on important political and economic outcomes.

Two planning grants were also awarded, as follows:

• Global Health by Design. Geoffrey Gurtner, plastic and reconstructive surgery; David Kelley, mechanical engineering; Thomas Krummel, surgery; Julie Parsonnet, medicine, health research and policy; and Paul Yock, medicine, bioengineering. Will design a project to examine how new technology can be used to develop effective, affordable, and sustainable methods and devices to prevent disease in the world’s poorest countries.
• Ecological Sanitation in Rural Haiti: An Interdisciplinary Approach to Sanitation and Soil Fertility. Ralph Greco, surgery, and Rodolfo Dirzo, biological sciences. Will develop a plan to test the efficacy of ecological sanitation in decreasing disease and enhancing soil fertility in rural Haiti.

“It is abundantly clear that addressing some of the most significant problems on the global agenda will require imaginative thinking, bold approaches, and interdisciplinary collaboration,” Blacker said. The projects will produce new field research and protocols, conferences, research papers, books, symposia, and courses. Additional annual project awards totaling roughly $1 million each will be made in the fall of 2006 and in 2007.

Epidemic infectious diseases have shaped many aspects of ancient and modern history. In an interdependent world, well-known pathogens and new, emerging infectious diseases continue to pose a global threat. At the same time, the biomedical and social sciences have been making incredible progress in the diagnosis, prevention, and treatment of communicable diseases.

Recent events highlight the importance of emerging infectious agents, including HIV/AIDS in the early 1980s, the introduction of West-Nile Virus in the western hemisphere in the late 1990s, and SARS (Severe Acute Respiratory Syndrome) in 2003, and draw attention to the role of increased travel and global connections in facilitating the rapid spread of infectious diseases.

HIV/AIDS is now the world’s greatest pandemic. It has claimed more lives than the Black Plague of the 14th century. With an estimated 16,000 new infections daily, more than 40 million people worldwide are infected with Human Immunodeficiency Virus (HIV). More than seven out of 10 of the world’s HIV-infected people live in sub-Saharan Africa. The impact of HIV/AIDS on local economies, its potential to contribute to regional instability due to loss of human life, and the moral imperative to address the pandemic has brought prevention and treatment of HIV/AIDS to the forefront. Increasingly, it is clear that a multidisciplinary team approach including social scientists, behavioral specialists, clinicians, researchers, and policymakers is essential to address this global pandemic.

Advances in epidemiology, molecular diagnostics, bio-informatics, and genomics have enriched our understanding of ancient and emerging pathogens and offer new avenues for addressing infectious diseases. Vaccines, pharmaceuticals, and new paradigms of public health have increased our ability to control and even eradicate infectious agents. The control of many formerly common childhood diseases has been effectively achieved through the development of vaccines. Smallpox and measles provide examples of diseases that have been eradicated by the culmination of modern innovative public health approaches and widespread vaccination. In the news today, the potential for a viral antigenic shift resulting in a more transmissible form of the deadly H5N1 influenza virus has led to extensive media coverage and disaster planning at local, state, and federal levels of government, as well as international public health bodies.

Teachers and students need a strong foundation in the biologic and social sciences to place these events and responses in context and to allow transfer of vital information and understanding to the community at large. There have been few initiatives to provide high school teachers with accurate, up-to-date knowledge on infectious diseases. U.S. high school students continue to be exposed to global infectious diseases through sensationalized media coverage including popular films and television.

We have been developing a high school curriculum unit with Stanford students Robin Lee, Michelle Silver, Piya Sorcar, and Jessica Zhang and Gary Mukai of SPICE to allow teachers and students to place news concerning infectious diseases in perspective; appreciate diverse social and economic responses to infectious diseases; and understand infectious diseases in the context of a global, interdependent world. The curriculum will also encourage students to consider issues related to epidemic and pandemic infectious diseases and their own personal risk.

The proposed five-module unit is as follows, with the first module having been completed this summer:

I: Introduction to Virology and Infectious Diseases

II: The Epidemiology of HIV/AIDS in the United States and around the World

III: Science, Economics, and Business in Infectious Diseases

IV: Local and International Politics and Policy in Infectious Diseases

V: Community and Personal Health

On November 16, 2006, FSI convened its annual international conference, A World at Risk, devoted to systemic and human risk confronting the global community. Remarks by Stanford Provost John Etchemendy, FSI Director Coit D. Blacker, former Secretary of State Warren Christopher, former Secretary of Defense William J. Perry, and former Secretary of State George Shultz set the stage for stimulating discussions. Interactive panel sessions encouraged in-depth exploration of major issues with Stanford faculty, outside experts, and policymakers.

“When I was a child, the world was a simpler place,” stated Stanford Provost John Etchemendy. “What has changed is not the risk, but the number and complexity of problems that face the world today.” The complex challenges of the 21st century require that universities change, as well. The International Initiative, led by FSI, was launched “to identify key challenges of global importance and to contribute to their solutions by leveraging the university’s academic strength and international reach.”

Invoking Jane and Leland Stanford’s desire to educate students to become useful, contributing citizens, Etchemendy said, “We can best serve that mission today by producing graduates well-versed in the complex problems of a world at risk and willing to make the difficult choices that might lead to their solution.”

“It has been acutely apparent to us at FSI that we must actively engage a world at risk,” stated FSI director Coit D. “Chip” Blacker, “risk posed by the growing number of nuclear issues on the international agenda; the insurgency in Iraq; global poverty, hunger, and environmental degradation; the tensions of nationalism versus regionalism in Asia; infectious diseases; terrorism; and the geopolitical, financial, and ecological risks of the West’s current energy policies, especially its voracious appetite for oil.”

Introducing three Stanford luminaries, Blacker said, “One of the remarkable things about Stanford is the privilege of working with some of the outstanding intellects and statesmen of our time. Warren Christopher, William Perry, and George Shultz tower among them.”

“As Stanford University’s primary forum for the consideration of the major international issues of our time, we at FSI are dedicated to interdisciplinary research and teaching on some of the most pressing and complex problems facing the global community today.” – Coit D. “Chip” Blacker, Director, Freeman Spogli Institute“The Middle East has descended into hate, violence, and chaos,” said Warren Christopher, the nation’s 63rd secretary of state. “It really is a dangerous mess.” Discussing the Israeli incursion into Lebanon, the war in Iraq, and Iran’s regional and nuclear ambitions, he said the U.S. has aggravated these threats by “action and inaction.” Nonetheless, the U.S. remains the most influential foreign power in the region. “We must not give up on the Middle East,” he said. “We have to return to old-fashioned diplomacy with all its frustrations and delays.”

“We live in dangerous times,” stated William J. Perry, the nation’s 19th secretary of defense and an FSI senior fellow. “Last month about 1,000 of our service personnel in Iraq were killed, maimed, or wounded; the Taliban is resurging in Afghanistan; North Korea just tested a nuclear bomb; and Iran is not far behind. China’s power is rising and Russia’s democracy is falling.” As Elie Wiesel wrote, he said, “Peace is not God’s gift to its children. Peace is our gift to each other.” Comparing major security issues of 1994 to today, Perry assessed the nuclear arms race, North Korea, Iran, and Iraq. He noted that the Clinton administration had eliminated more than 10,000 nuclear weapons and urged that the work continue, because “the danger of terrorists getting a nuclear bomb is very real.”

Citing North Korea’s 2006 missile and nuclear tests, Perry said he was concerned that a robust North Korean nuclear program will stimulate a “dangerous arms race in the Pacific” and increase “the danger of a terrorist group getting a nuclear bomb.” “Iran is moving inexorably toward becoming a nuclear power,” Perry said. “We are facing new dangers,” he concluded, “and we must adjust our thinking accordingly.”

“The world has never been at a more promising moment than it is today,” said George Shultz, the nation’s 60th secretary of state. “All across the world, economic expansion is taking place. The U.S. is giving fantastic leadership to the global economy.” For Shultz, the imperative is to prevent the security challenges “from aborting all these fantastic opportunities.”

“The Middle East has descended into hate, violence, and chaos. The U.S. remains the most influential foreign power in the region. We have to return to old-fashioned diplomacy with all its frustrations and delays.” – Former Secretary of State Warren ChristopherU.S. leadership should inspire the world, Shultz said, advocating four initiatives. We should aspire to have a world with no nuclear weapons. We should take a different approach to global warning, based on the Montreal Protocols. “This is a gigantic problem we need to do something about and can do something about,” he said. We should build greater understanding of the world of Islam. We must combat rising protectionism. The postwar system reduced tariffs and quotas, promoting trade and growth. “The best defense is a good offense,” Shultz stated. “We need a lot of leadership in that arena.”

Plenary I, chaired by Chip Blacker, examined systemic risk. Elisabeth Paté-Cornell, Burton and Deedee McMurtry Professor and Chair of Management Science and Engineering, discussed how scientists measure risk, asking what can happen, what are the chances it will, and what are the consequences? “The good news is that the worst is not always the most certain,” she noted. Citing challenges of intelligence analysis, she said, “Certainty is rare; signals are imperfect; there is a tendency to focus on one possibility (groupthink) and underestimate others; and it is difficult to assess and communicate uncertainties.” “Success is not guessing in the face of uncertainties,” she said. “It is describing accurately what is known, what is unknown, and what has changed.”

Scott D. Sagan, professor of political science and director of CISAC, examined “Iran and the Collapse of the Global Non-proliferation Regime?” The crux of the issue, Sagan noted, is the emergence of two dangerous beliefs, “deterrence optimism” and “proliferation fatalism.” In Sagan’s view, too little attention has been given to why Iran seeks a nuclear weapon. Arguing that U.N. sanctions are unlikely to work and military options are problematic, Sagan said a negotiated settlement is still possible if the U.S. offers security guarantees to Iran, contingent on Tehran’s agreement to constraints on future nuclear development. As Sagan concluded, “Instead of accepting what appears inevitable, we should work to prevent the unacceptable.”

Siegfried S. Hecker, CISAC co-director, tackled the challenge of “Keeping Fissile Materials out of Terrorist Hands.” Although nuclear terrorism is an old problem, today there is easier access to nuclear materials, greater technological sophistication, and a greater proclivity toward violence. The greatest risk, he said, “is an improvised nuclear device built from stolen or diverted fissile materials.” “Given a few tens of kilograms of fissile material, essentially a grapefruit-sized chunk of plutonium,” he stated, “terrorists will be able to build and detonate an inefficient, but devastating Hiroshima- or Nagasaki-like bomb.” The most likely threat is a so-called “dirty bomb,” he said, which would be a “weapon of mass disruption, not destruction,” but still able to cause panic, contamination, and economic disruption, making risk analysis imperative to mitigate its consequences.

“We are facing new dangers and we must adjust our thinking accordingly. As President Lincoln said, ‘The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew, and act anew.’” – Former Secretary of Defense William J. PerryTurning to human risk, Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, addressed “Pandemic Influenza: Harbinger of Things to Come?” “The risk is one that a pandemic is going to happen,” he told a riveted audience. Comparing the great influenza of 1918 with the pandemics of 1957 and 1968, he noted that pandemics have differed in season of onset, mortality rates, and number of cases. Avian influenza has a 65 percent mortality rate and could affect 30–60 percent of the world’s 6.5 billion people, producing 1.6 billion deaths worldwide and 1.9 million deaths in the U.S. Inevitably, mutation will reduce its lethality.

“It is not a matter of if, just when and where” the pandemic will strike, said Osterholm. Noting that vaccines will not be available in numbers needed, he argued for measures to safeguard families, communities, and essential infrastructure, such as police, firefighters, and health-care workers. Just-in-time inventory practices, he said, have increased vulnerability to disruptions in food supply, transportation, equipment, and communications, making it vital to plan in earnest, now.

Plenary II, chaired by FSI deputy director Michael A. McFaul, assessed risks to humans from “Natural, National, and International Disasters.” Stephen E. Flynn, Jeane J. Kirkpatrick Senior Fellow at the Council on Foreign Relations and a trade and transportation security expert, decried the “artificial firewalls between homeland and national security.” The Hart-Rudman Commission of 1998 warned of a catastrophic attack on U.S. soil, yet we did not rethink national security even after 9/11. We must approach security as a transnational issue, with no clear “domestic” and “international” lines, he urged. More than 65 percent of critical infrastructure is privately owned and has been given inadequate attention by federal authorities. Hurricane Katrina exposed the vulnerabilities. “We face more threats from acts of God than acts of man,” Flynn stated. We need to move from a concept of “security” to one of “resiliency,” he said, greatly improving our ability to withstand a man-made or natural disaster.

David G. Victor, FSI senior fellow and professor of law, addressed three faces of energy security: oil, natural gas, and climate change. Oil prices are volatile, future fields are in places difficult to do business, and the global supply infrastructure is vulnerable, posing the risk of a one- to six-month supply disruption. For Victor, who directs FSI’s Program on Energy and Sustainable Development, the big threat is less supply than a potential demand-side shock, driven by the U.S. and China. Europe relies on an unreliable Russia for 25–30 percent of its natural gas needs, making it imperative to switch to cheaper, more reliable LNG from North Africa and the Middle East. Oil and gas price volatility has driven further dependence on coal-fired plants, with dire consequences for carbon emissions. New coal plant lifetime emissions, Victor said, are equal to all historic coal emissions, making it critical to invest in advanced technology to protect the environment.

“The world has never been at a more promising moment than it is today. All across the world economic expansion is taking place. Poverty is being reduced dramatically as China and India expand, along with Brazil.” – Former Secretary of State George ShultzPeter Bergen, CNN terrorism analyst and producer of Osama bin Laden’s first television interview, offered the dinner keynote, “Successes and Failures of the War on Terrorism Since 9/11.” Assessing negatives, Bergen noted that al Qaeda continues to carry on attacks from its base in Pakistan; Afghanistan is beset by instability; more than 20 million Muslims in Europe remain dangerously un-integrated; bin Laden has not been apprehended and continues to inspire followers through terrorist attacks; Iraq is an unstable breeding ground for jihad; and anti-Americanism is on the rise. Enumerating positives, there has been no follow-on attack on the U.S.; the government has made the country safer; many Muslims have rejected jihad; plots have been foiled and suspects apprehended across the globe. Weighing whether fighting the terrorists abroad has made the U.S. safer here, Bergen was equivocal: The U.S. can identify and eliminate only so many people and cannot stay in Bagdad forever. A network of educated, dedicated terrorists remains, he warned, capable of bringing down commercial aircraft or deploying a radiological bomb.

On May 1, 2003, President Bush publicly declared an end to combat in Iraq. Four years later, the conflict had only intensified, fueled by a violent insurgency, sectarian strife, and a resurgent al-Qaeda in Iraq. More than 3,000 American servicemen and servicewomen had been killed and 790,000 Iraqi civilians were dead. What had gone so disastrously wrong? Charles Ferguson, an MIT-trained political scientist, determined to find out.

Drawing on shockingly frank interviews with U.S. government officials, military personnel, diplomats, journalists and Iraqi leaders and citizens, his first film, No End in Sight: The American Occupation of Iraq, examines comprehensively how the Bush administration constructed the Iraq war and subsequent occupation. The film won the Special Jury Prize, documentary competition, at the 2007 Sundance Film Festival, as a “timely work that clearly illuminates the misguided policy decisions that have led to the catastrophic quagmire of the U.S. invasion and occupation of Iraq.”

“Overnight rendered unemployed and infuriated are 500,000 armed men,” one of many ill-advised moves that ignited resentment, desperation, and a still-raging insurgency.On May 23, the Freeman Spogli Institute hosted a special screening of the film, followed by a distinguished panel of experts. Among the film’s central themes was the failure to commit sufficient troops to maintain order, secure the borders, or protect government ministries, historic sites, or ammunition depots. The destruction of national treasures, depicted vividly, was heartbreaking.

Soon after one watershed—the toppling of Saddam Hussein and the defeat of the military—there was another watershed, characterized by widespread looting, lawlessness, and a growing feeling among Iraqis that Americans could not protect them. The film chronicles three especially fateful decisions: to halt the formation of an Iraqi interim government (as Iraqi opposition leaders felt they had been promised) and impose an American occupation instead; a wide-ranging campaign of de-Baathification—the purging of higher-level Baath Party officials who ran the civil service and even staffed many schools and hospitals; and the hasty decision to disband the Iraqi military and intelligence services.

Said Col. Paul Hughes (Ret.), “We could have used Iraqi units to clean up, build roads, and rebuild their country.” Instead, the military were told they were going to be out of work, leaving millions of Iraqis suddenly without support. The film recounts, “Overnight rendered unemployed and infuriated are 500,000 armed men,” one of many ill-advised moves that ignited resentment, desperation, and a still-raging insurgency. Ambassador Barbara Bodine recalled, “When we were first starting the reconstruction, we used to joke that there were 500 ways to do it wrong and two to three ways to do it right. What we didn’t understand is that we were going to go through all 500.”

The riveting documentary was followed by a lively panel discussion among Stanford political scientists, historians, and experts on the war in Iraq. Moderating the panel was Larry Diamond, Hoover Institution senior fellow and coordinator of the Democracy Program at FSI’s Center on Democracy, Development, and the Rule of Law, who called the war “one of the greatest policy tragedies in American history.” Diamond served as an advisor to the Coalition Provisional Authority and wrote a book about the experience, titled %publication1%.

Writer and director Charles Ferguson noted that the shooting to inclusion ratio was 100:1 and said he will release more than 100 hours of film and 3,000 pages of transcripts as a public archive for the historical record. Col. Christopher Gibson, a 2006–07 National Security Affairs fellow at the Hoover Institution, who served in both the Gulf and Iraq wars, observed in his opening remarks, “For this to work in a republic, soldiers have to be there to take the tough questions.” Drawing on his experience during two tours of duty supervising national elections, he underscored the Iraqi people’s desire for freedom and “their deep and sincere desire for democracy.”

David Kennedy, Stanford’s Donald J. McLachlan Professor of History and a 2000 Pulitzer-Prize winner, commended the film for making an important contribution to the historical record. Future historians will have to consider a number of major questions, Kennedy said, including these two: “What was the deep strategic rationale for this war and how was that rationale related to the declared reasons for going to war,” namely the now discredited claims that the regime possessed weapons of mass destruction and had verifiable links to al-Qaeda.

In a lively discussion among panelists, it was agreed that the calculus was complex and many factors converged—an Iraq believed both to be a menace and weakened by many years of sanctions under a brutal leader; a son wishing to redress the policy of the father and avenge a near assassination attempt. But the ideological factor was significant—the belief that we had the ability to effect political change in a country that would transform the character of an entire region.

The debate addressed other critical issues—could the outcome have been better had policy been better informed and more skillfully implemented? Could anything change the outcome now? Said Diamond, the only thing that could materially change the outcome now “would be to combine a military surge with a diplomatic surge,” involving the United Nations, the European Union, the United States, and a cooperative Iraqi leadership. The United States should let Iraq know we’ll leave, he stated, if Iraqi leaders fail to undertake the requisite political reconciliation and compromise. As the lively debate and discussion with more than 300 audience members ended, there was little doubt that all these questions would be debated for some time to come.

“Preparing the next generation of leaders and creating more informed elementary and secondary students means changing and improving curricula, setting higher standards, and ensuring that content is based on current research relevant to the world’s critical problems and urgent issues.” Coit “Chip” Blacker, FSI Director and Co-Chair, International Initiative

SPICE was established more than 30 years ago and serves as a bridge between FSI and elementary and secondary schools in the United States and independent schools abroad. SPICE’s original mission in 1976 was to help students understand that we live in an increasingly interdependent world that faces problems on a global scale. For 30 years, SPICE has continued to address this original mission and currently focuses its efforts primarily in three areas:

1. curriculum development for elementary and secondary schools;
2. teacher professional development; and
3. distance-learning education.

SPICE hopes to continue to educate new generations of leaders by addressing five key initiatives of The Stanford Challenge, announced by President Hennessy last fall.

Initiative on Human Health / 1

SPICE is working with the School of Medicine and the Center for Health Policy on a high school curriculum unit that focuses on HIV/AIDS. SPICE is collaborating with Drs. Seble Kassaye, David Katzenstein, and Lucy Thairu of the School of Medicine’s Division of Infectious Diseases & Geographic Medicine. Using an epidemiological framework, students will be encouraged to consider the many issues involved in the pandemic, including but not limited to poverty, gender inequality, and biomedical research and development. Two Stanford undergraduates, Jessica Zhang and Chenxing Han, are working with the physicians on this unit.

Initiative on the Environment and Sustainability / 2

SPICE recently completed a curriculum unit called 10,000 Shovels: China's Urbanization and Economic Development. 10,000 Shovels examines China’s breakneck growth through a short documentary that integrates statistics, video footage, and satellite images. The documentary, developed by Professor Karen Seto of the Center for Environmental Science and Policy, focuses on China’s Pearl River Delta region while the accompanying teacher’s guide takes a broader perspective, exploring many current environmental issues facing China. Stanford’s School of Earth Sciences is helping to promote this unit and documentary.

The International Initiative / 3

All of SPICE’s curriculum units focus on international topics. Two of SPICE’s most popular units are Inside the Kremlin: Soviet and Russian Leaders from Lenin to Putin and Democracy-Building in Afghanistan. Inside the Kremlin introduces students to key elements of Soviet and Russian history through the philosophies and legacies of six of its leaders—Lenin, Stalin, Khrushchev, Gorbachev, Yeltsin, and Putin. The unit includes (on DVD) six lectures by six FSI faculty members, including FSI director Coit D. Blacker; professors David Holloway and Gail W. Lapidus, CISAC; professor and deputy FSI director Michael A. McFaul; history professor Norman M. Naimark; and history professor Amir Eshel, Forum on Contemporary Europe.

Democracy-Building in Afghanistan is a teacher’s guide for a film called Hell of a Nation. The film’s lead advisor and SPICE’s key advisor was former CDDRL fellow J. Alexander Thier. Hell of a Nation documents the lives of two Afghans participating in the political process to develop a new constitution for Afghanistan—illustrating the “human face” of democracy-building and elucidating the complexities and difficulties of democratic construction in a divided and historically conflict-ridden nation.

Arts and Creativity Initiative / 4

Following 9/11, SPICE decided to develop a unit called Islamic Civilization and the Arts, which introduces students to various elements of Islamic civilization through a humanities approach. Lessons on art, the mosque, Arabic language and calligraphy, poetry, and music provide students with experience analyzing myriad primary source materials, such as images, audio clips, sayings of Muhammad, and excerpts from the Quran. In each lesson, students learn about the history, principles, and culture of Islam as they pertain to particular forms of art.

SPICE recently completed a new unit called Along the Silk Road, which explores the vast ancient network of cultural, economic, and technological exchange that connected East Asia to the Mediterranean. Students learn how goods, belief systems, art, music, and people traveled across such vast distances to create interdependence among disparate cultures. This was a collaboration with the Silk Road Project, the Art Institute of Chicago, Stanford’s Cantor Arts Center and Center for East Asian Studies, and the Shorenstein Asia-Pacific Research Center.

The K-12 Initiative / 5

SPICE develops curriculum based on FSI scholarship, conducts teacher professional development seminars locally, nationally, and internationally, and also offers a distance-learning course called the Reischauer Scholars Program to U.S. high school students. At seminars at Stanford, FSI faculty members offer lectures to the teachers and SPICE curriculum writers give curriculum demonstrations that draw upon the content presented in the lectures. Last summer, Stanford professor Al Dien (Asian Languages) and the SPICE staff gave a workshop for 80 teachers in the Chicago Public Schools. World-renowned cellist Yo-Yo Ma performed at the workshop.

The Reischauer Scholars Program is a distance-learning course sponsored by SPICE. Named in honor of former ambassador to Japan Edwin O. Reischauer, a leading educator and noted scholar on Japanese history and culture, the RSP annually selects 25 exceptional high school juniors and seniors from throughout the United States to engage in an intensive study of Japan. This course provides students with a broad overview of Japanese history, literature, religion, art, politics, and economics, with a special focus on the U.S.-Japan relationship. Top scholars affiliated with the Shorenstein Asia-Pacific Research Center (including Ambassador Michael H. Armacost, Professor Daniel I. Okimoto, and Professor Gi-Wook Shin), leading diplomats, and young professionals provide web-based lectures as well as engage students in online dialogue. These lectures and discussions are woven into an overall curriculum that provides students with reading materials and assignments.

SPICE has for many years focused on the initiatives that have been identified by President Hennessy to be at the core of The Stanford Challenge. By continuing to focus on these initiatives, the SPICE staff hopes to continue to make FSI scholarship accessible to a national and international audience of educators and students, with the ultimate goal of empowering a new generation of leaders with the tools needed to deal with complex problems on a global scale.

The Bill & Melinda Gates Foundation’s Agricultural Development Program has awarded Stanford University’s Program on Food Security and the Environment (FSE) and a team of collaborators $3.8 million over three years to conduct a quantitative assessment of the effect of biofuels expansion on food security in the developing world. This work will determine how different scenarios of expanded biofuels production in rich and poor countries will affect global and regional food prices, farmer incomes, and food consumption of the poor. In three case-study countries (India, Mozambique, Senegal), it will make a more detailed assessment of the opportunities and pitfalls associated with an array of possible biofuels development scenarios (e.g., using different crops for biofuels production, using marginal land versus highly productive land, etc.). We expect the work will represent the first systematic, detailed effort to address the effects of biofuels expansion on welfare in poor countries and the first available analytic tool for assessing possible biofuels investments in individual developing countries. Project collaborators include FSE, the International Food Policy Research Institute, the Center on Chinese Agricultural Policy, and the University of Nebraska.

Through this grant, the Bill & Melinda Gates Foundation aims to assess how biofuels may affect smallholder farmers in the developing world. This includes assessing both the risks, such as increasing food prices, and the potential opportunities for smallholder farmers to leverage biofuels to boost their productivity, increase their incomes, and build better lives for themselves and their families. The foundation and Stanford University will disseminate the findings widely to inform a broad audience, including policymakers.

FSE is also very pleased to announce a private gift from Lawrence Kemp for further work in the biofuels area. The Kemp gift will be devoted to building a team of faculty and students on campus who will analyze the transmission of global price effects to local markets, provide policy advice and communication on biofuels, and expand the field-level coverage of Stanford’s biofuels work.

In the November 2007 issue of Environment, project collaborators Rosamond L. Naylor (FSE), Adam Liska, Marshall Burke (FSE), Walter P. Falcon (FSE), Joanne Gaskell, Scott Rozelle (FSE), and Kenneth Cassman demonstrate how high energy prices and biofuelspromoting agricultural policy result in higher food prices generally and then examine in detail the potential global effects of biofuels expansion in four countries for four crops—corn in the United States, cassava in China, sugarcane and soy in Brazil, and palm oil in Indonesia. They argue that in each case, the threats to global food security from biofuels expansion likely outweigh the benefits, especially in the short run. This is because in many poor countries these crops play an important role in the diets of the poor and because the poorest in the world typically spend more money on food than they earn in income through farming. They also note that “second generation” technologies such as cellulosic biofuels will likely not play a significant role in biofuels production over the next decade or longer—and thus in the near-term are very unlikely to be the win-win that their proponents suggest. “The ripple effect: biofuels, food security, and the environment” excerpted from Environment, November 2007

The integration of the agricultural and energy sectors caused by rapid growth in the biofuels market signals a new era in food policy and sustainable development. For the first time in decades, agricultural commodity markets could experience a sustained increase in prices, breaking the long-term price decline that has benefited food consumers worldwide. Whether this transition occurs—and how it will affect global hunger and poverty—remain to be seen. Will food markets begin to track the volatile energy market in terms of price and availability? Will changes in agricultural commodity markets benefit net food producers and raise farm income in poor countries? How will biofuels-induced changes in agricultural commodity markets affect net consumers of food? At risk are more than 800 million food-insecure people—mostly in rural areas and dependent to some extent on agriculture for incomes— who live on less than $1 per day and spend the majority of their incomes on food. An additional 2–2.5 billion people living on $1 to $2 per day are also at risk, as rising commodity prices could pull them swiftly into a food-insecure state.

The potential impact of a large global expansion of biofuels production capacity on net food producers and consumers in low-income countries presents challenges for food policy planners and raises the question of whether sustainable development targets at a more general level can be reached. Achieving the 2015 Millennium Development Goals adopted by the United Nations General Assembly in 2000, which include halving the world’s undernourished and impoverished, lies at the core of global initiatives to improve human well-being and equity, yet today virtually no progress has been made toward achieving the dual goals of alleviating global hunger and poverty. The record varies on a regional basis: Gains have been made in many Asia-Pacific and Latin American-Caribbean countries, but progress has been mixed in South Asia and setbacks have occurred in numerous sub-Saharan African countries. Whether the biofuels boom will move extremely poor countries closer to or further from the Millennium Development Goals remains uncertain.

Biofuels growth also will influence efforts to meet two sets of longer-run development targets. The first encompasses the goals of a “sustainability transition,” articulated by the Board on Sustainable Development of the U.S. National Academy of Sciences, which seeks to provide energy, materials, and information to meet the needs of a global population of 8–10 billion by 2050, while reducing hunger and poverty and preserving the planet’s environmental life-support systems. The second is the Great Transition of the Global Scenario Group, convened by the Stockholm Environment Institute, which focuses specifically on reductions in hunger and greenhouse gas (GHG) emissions beyond 2050. As additional demands are placed on the agricultural resource base for fuel production, will ecosystem services (such as hydrologic balances, biodiversity, and soil quality) that support agricultural activities be eroded? Will biofuels development require a large expansion of crop area, which would involve conversion of marginal land, rainforest, and wetlands to arable land? And what will be the net effect of biofuels expansion on global climate change?

Although the questions outnumber the answers at this stage, two trends seem clear: Total energy use will continue to escalate as incomes rise in both industrial and developing countries, and biofuels will remain a critical energy development target in many parts of the world if petroleum prices exceed $55–$60 per barrel. Even if petroleum prices dip, policy support for biofuels as a means of boosting rural incomes in several key countries will likely generate continued expansion of biofuels production capacity. These trends will have widespread ripple effects on food security—defined here as the ability of all people at all times to have access to affordable food and nutrition for a healthy lifestyle—and on the environment at local, regional, and global scales. The ripple effects will be either positive or negative depending on the country in question and the policies in play.