Rural areas of China have made remarkable progress in reducing adult mortality within the past 15 years yet broadened health insurance was not a casual factor in that decline, according to a new study by an international research team that includes Asia Health Policy Program Director Karen Eggleston.

The New Cooperative Medical Scheme (NCMS), a government-subsidized insurance program that began in 2002-03, expanded to cover all of rural China within a decade. Examining NCMS and cause-specific mortality data for a sample of 72 counties between 2004 and 2012, the researchers found that there were no significant effects of health insurance expansion on increased life expectancy.

The study, published in the September issue of Health Affairs, showed results consistent with previous studies that also did not find a correlation between insurance and survival, although much research confirms NCMS increased access to healthcare, including preventive services, and shielded families from high health expenditures.

Commenting on the study, Eggleston said population health policies remain central to China’s efforts to increase life expectancy and to bridge the gap between rural and urban areas.

Eggleston also noted that multiple factors beyond the availability of health care determine how long people live, and anticipates the research team will continue to explore the impacts of NCMS by extending the study to look at infants and youth.

Read the study (may require subscription) and view a related article on the Stanford Scope blog.

The Asia Health Policy Program, established in 2007, promotes a comparative understanding of health and health policy in the Asia-Pacific region through research and collaboration with regional scholars, a colloquium series on health and demographic change, and conferences and publications on comparative health policy topics. The program is committed to supporting young researchers through its Asia Health Policy Postdoctoral Fellowship. Every year, the program director, Karen Eggleston, mentors recent doctoral graduates invited to come to Stanford to undertake original research on contemporary health policy of relevance to the Asia-Pacific region. The Program recently organized the Workshop of Young Leaders in Asia Health Policy in Beijing to celebrate its 10th anniversary.

Asia Health Policy Program alumni have been expanding around the globe. Young Kyung Do, from South Korea, was the first Asia Health Policy Postdoctoral Fellow in 2008-09. He earned his doctorate in health policy and management from the University of North Carolina at Chapel Hill, and is currently an associate professor in the Department of Health Policy and Management at Seoul National University in South Korea. His research interests include aging and long-term care, the interplay of health, education and labor, health behavior, sleep and time use, risk literacy and risk communication, value of medical interventions, and quality assessment from the patient's perspective. Working papers: 

The Effect of Informal Caregiving on Labor Market Outcomes in South Korea

The Effect of Coresidence with an Adult Child on Depressive Symptoms among Older Widowed Women in South Korea: An Instrumental Variable Estimation

The Effect of Sleep Duration on Body Weight in Adolescents: Evidence from a Natural Experiment

Brian K. Chen, from the United States, was the 2009-10 Asia Health Policy Postdoctoral Fellow. He earned his doctorate in business administration from the Haas Business School at the University of California, Berkeley. He is currently an associate professor in the Department of Health Services Policy and Management at the Arnold School of Public Health, University of South Carolina in the United States.  He is also the associate director of Taiwan Doctoral Program housed in the Department of Health Services Policy and Management.  He has a unique combination of legal and economic expertise. He received a Juris Doctor from Stanford Law School in 1997. His research focuses on health policy, particularly with respect to health disparities, the burden of chronic illnesses and aging as well as the impact of incentives in health care organizations on provider and patient behavior.  Working papers: 

Strict Liability for Medical Injuries? The Impact of Increasing Malpractice Liability on Obstetrician Behavior: Evidence from Taiwan

Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from China’s Essential Medications List Policy

Qiulin Chen, from China, was the 2010-11 Asia Health Policy Postdoctoral Fellow. He earned his doctorate in economics from Peking University. He is currently an associate professor and director of the Social Security Research Division of the Institute of Population and Labor Economics, and deputy director of the Research Center of Health Industry Development at the Chinese Academy of Social Sciences in Beijing. His research interests are health economics and health policy, aging and social security, and public finance.

There were two Asia Health Policy Postdoctoral Fellows from 2011until 2012. Ang Sun, from China, earned her doctorate in economics from Brown University in the United States. She is currently an associate professor at Central University of Finance and Economics in Beijing, China. Her research focuses on household and marriage, development, demography and health. The second fellow, Siyan Yi from Cambodia, was the first recipient of the Developing Asia Health Policy Fellowship for citizens of low-income countries in Asia. Dr. Yi earned his doctorate in international health sciences from the University of Tokyo. He is currently a director of KHANA Center for Population Health Research in Cambodia and adjunct associate professor at Center for Global Health Research of Touro University California in the United States. His research projects are in population health, including clinical epidemiology, social and behavioral determinants of health, health promotion, health system strengthening, and health policy in both developed and developing countries.

Marjorie Pajaron, from the Philippines, was the 2012-13 Asia Health Policy Postdoctoral Fellow. She earned her doctorate in economics from the University of Hawaii at Manoa. She is currently an assistant professor at the School of Economics, University of the Philippines. Her research lies at the intersection of applied microeconomics and health policy, with a focus on gender, health, development and labor economics.  Working papers: 

Remittances, Informal Loans, and Assets as Risk-Coping Mechanisms: Evidence from Agricultural Households in Rural Philippines

The Roles of Gender and Education on the Intrahousehold Allocations of Remittances of Filipino Migrant Workers

Margaret Triyana, from Indonesia, was the 2013-14 Asia Health Policy Postdoctoral Fellow. She earned her doctorate in public policy from the Harris School of Public Policy at the University of Chicago. She is currently a visiting assistant professor at the Keough School of Global Affairs at the University of Notre dame, in the United States. Prior to joining the Asia Health Policy Program, she was an Indonesia research fellow at the Harvard Kennedy School. She is particularly interested in how social policies affect health outcomes for the poor, early health investments, and health-seeking behavior in limited-resource settings.

Gendendarjaa Baigalimaa, from Mongolia, was the 2013-14 Visiting Scholar for Developing Asia Health Policy. A medical doctor by training, she studied cancer prevention and the impact of the National Cervical Cancer Program in Mongolia. Upon completion of her fellowship with the Asia Health Policy Program, she became a gynecological oncologist at Mungun Guur Hospital in Mongolia.

There were two Asia Health Policy postdoctoral fellows from 2014 until 2015. Pham Ngoc Minh, from Vietnam, who earned his doctorate in medical science from Kyushu University in Japan, is currently a visiting research fellow at Curtin University in Australia. His main research interests include the epidemiology and prevention of metabolic diseases, particularly diabetes, and depression in Asian adults. He also works on systematic reviews and meta-analyses of observational and clinical studies to inform health policy. The second postdoctoral fellow was Phyu Phyu Thin Zaw, from Myanmar, who completed her doctorate in epidemiology from the Prince of Songkla University in Thailand. She is a research scientist at the Department of Medical Research in the Pyin Oo Lwin branch of the Ministry of Health and Sport in Myanmar. Currently, she is on leave to attend a master of public policy at Oxford University, in the United Kingdom.  Her current research work involves equitable allocation of healthcare resources, the current health system transformations, and the democratization process in Myanmar.

Darika Saingam, from Thailand, was the 2015-16 Asia Health Policy Postdoctoral Fellow. She earned her doctorate in epidemiology from the Prince of Songkla University in Thailand. Her research interests are public health, substance abuse and drug policy. She seeks to identify potentially effective policy directions suitable for Thailand. Before she joined the Asia Health Policy Program, she served as a researcher at Songkla University’s Epidemiology Unit. She has since continued her work on substance abuse research.

Kim Ngan Do, from Vietnam, was the 2016-17 Asia Health Policy Postdoctoral Fellow. She earned her doctorate in health policy and management from the College of Medicine at Seoul National University, South Korea. She has a strong interest in health system-related issues, especially health financing, human resources for health, and health care service delivery. She implemented comparative studies at the regional level and completed fieldwork in Cambodia, Laos, Philippines, South Korea and Vietnam.

Since its inception, the Asia Health Policy Program has supported numerous fellows to develop their expertise. They continue to pursue their academic and research interests, and have become experts in their fields. Alumni hold various academic, research and professional positions around the world, and are part of a vital community that promotes deeper understanding of comparative health policy through education, training and implementation of best healthcare practice.

A new biosecurity initiative at the Freeman Spogli Institute for International Studies (FSI) aims to identify and mitigate biological risks, both natural and man-made, and safeguard the future of the life sciences and associated technologies.

The initiative will be led by David A. Relman, a senior fellow at the Center for International Security and Cooperation and FSI. Relman, the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and Microbiology & Immunology, has served as the science co-director at CISAC for the past four years. He will leave this position on Aug. 31 to lead the new initiative.

Michael McFaul, director and senior fellow at FSI, said, “With exceptional leadership skills, valuable experience and abundant energy, David Relman is ideally positioned to work with scholars from across campus who offer critical expertise in biosecurity. This is an exciting, challenging and important new initiative for FSI that is designed to protect public health from the many new risks now accelerating.”

Relman said the biosecurity initiative will seek to advance the beneficial applications of the life sciences while reducing the risks of misuse by promoting research, education and policy outreach in biological security. His CISAC leadership gives him the know-how to lead such a wide-ranging effort across diverse disciplines and communities.

Relman said, “The opportunity to serve as co-director at CISAC has been a wonderful experience, one that has afforded me the chance to get to know outstanding faculty and staff, their scholarship, and critical policy-relevant work, all of which I had not fully appreciated sitting across campus. This experience has made clear the unusual qualities of Stanford University, and the great people that work here. I am now greatly looking forward to this new opportunity at FSI.”

Biosecurity collaborations

During Relman’s term as CISAC’s science co-director from 2013-2017, he led an expansion of the transdisciplinary work in science and security to include biology, biological and other areas of engineering, medicine, and earth and environmental sciences.

The foundations for work in biological science, technology and security were established at CISAC, especially in the hiring of Megan Palmer, a senior research scholar at CISAC and FSI. Both Relman and Palmer worked together on engagements and discussions with a growing network of more than 20 faculty involved in biosecurity across Stanford.

Palmer said, “Stanford has an opportunity and imperative to advance security strategies for biological science and technology in a global age. Our faculty bring together expertise in areas including technology, policy, and ethics, and are deeply engaged in shaping future of biotechnology policy and practices.”

New insights, new risks

In his new post, Relman said he intends to build on this foundation by creating an initiative that consolidates and focuses activity in biosecurity, develops research and educational programs, attracts new resources, and looks outward at opportunities for policy impact and changing practices across the globe.

Relman said that “new capabilities and insights are reshaping important aspects of the life sciences and associated technologies, and are accompanied by a host of new risks.” If misused, whether by malice or accident, “they pose the potential for large-scale harm,” he noted.

Relman added that the initiative will bring together interest and expertise across the centers and programs of FSI in partnership with Schools and Departments across the university.

At FSI, CISAC will co-sponsor the biological security initiative, which will leverage Stanford expertise in the life sciences, engineering, law and policy.  Key partners will include Tim Stearns (biology), Drew Endy (bioengineering), Mildred Cho (bioethics), and Hank Greely (law), according to Relman. The biosecurity group will also partner with another new program at FSI in global health and conflict, which is led by Paul Wise, Frank Fukuyama, Steve Stedman, Steve Krasner, and others, he added.

Stanford’s School of Medicine and Department of Medicine will also co-sponsor the initiative, thanks to leadership from Lloyd Minor, Michele Barry and Robert Harrington. Relman looks forward to establishing similar relationships with other schools and departments, he said.

 “These partnerships are critical. I’m excited to work with a growing community both within and beyond Stanford towards the goal of a peaceful and prosperous world in the century of biology,” he said.

MEDIA CONTACTS:

David Relman, Center for International Security and Cooperation: relman@stanford.edu

Megan Palmer, Center for International Security and Cooperation:  mjpalmer@stanford.edu

Clifton B. Parker, Center for International Security and Cooperation: (650) 725-6488, cbparker@stanford.edu

Stanford welcomes Cousin, a global hunger expert, to the Center on Food Security and the Environment.

The Freeman Spogli Institute for International Studies (FSI) at Stanford University is pleased to announce that former U.S. Ambassador and World Food Programme (WFP) Director Ertharin Cousin will serve as this year’s Frank E. and Arthur W. Payne Distinguished Lecturer and Visiting Fellow at the Center on Food Security and the Environment (FSE).  

Cousin brings over 25 years of experience addressing hunger and food security strategies on both a national and international scale. As U.S. Ambassador to the United Nations Agencies for Food and Agriculture, she focused on advocating for longer-term solutions to food insecurity and hunger, and at WFP she addressed the challenges of food insecurity in conflict situations.

“Dr. Cousin’s outstanding leadership at the WFP and extensive experience in public service exemplifies the attributes we seek for Payne Lecturers,” says FSI Director Michael McFaul. The Payne Distinguished Lectureship is awarded to scholars with international reputations as leaders, with an emphasis on visionary thinking, practical problem solving, and the capacity to clearly articulate an important perspective on the global political and social situation. Past Payne Lecturers include Bill Gates, Nobel Laureate Mohamed El Baradei, UNAIDS Executive Director Peter Piot, and novelist Ian McEwan.

As a visiting fellow with FSE, Cousin will be working to further her research focus on global food security and humanitarian efforts. In November 2015, FSE welcomed Cousin as the featured speaker in their Food and Nutrition Symposium series, where she presented her paper “Achieving food security and nutrition for the furthest behind in an era of conflict and climate change.” FSE Director, Roz Naylor, sees Cousin’s appointment as a pivotal opportunity for FSE and FSI to advance a global agenda on food security and human rights. “Ertharin Cousin is one of the most inspirational leaders we could ever hope to attract to Stanford as a year-long visitor,” Naylor says.

“This is a truly humbling, yet exciting prospect,” says Cousin. “This position provides an opportunity for scholarly work and dialogue with distinguished academics across Stanford's schools and policy institutes.  I also look forward to the opportunity to convene thought leaders from a broad variety of backgrounds, who can help us explore some of the intractable issues plaguing humanitarian and development practitioners today.”

Following the completion of her term with the WFP, Cousin accepted an appointment as a Distinguished Fellow with The Chicago Council on Global Affairs, which conducts research on food and agriculture, global cities, economics, energy, immigration, security, public opinion, and water. Cousin hopes her appointments can provide a unique collaborative opportunity to expand her work on food security and nutrition issues.

“In my career I have never before been given the opportunity of pursuing intellectual inspiration. Just thinking about the ‘what’s possible’ gives me genuine pleasure,” Cousin said.

About FSE

The Center on Food Security and the Environment (FSE) is a research center at Stanford University, jointly funded by the Freeman Spogli Institute for International Studies and the Stanford Woods Institute for the Environment.

Rod Ewing will serve as co-director of the sciences for Stanford’s Center for International Security and Cooperation.

Ewing, a mineralogist and materials scientist, is the Frank Stanton Professor in Nuclear Security at CISAC and senior fellow at the Freeman Spogli Institute for International Studies. He begins his new position on Sept. 1, following David Relman, the previous co-director for the sciences. Amy Zegart is the CISAC co-director for the social sciences.

Ewing, whose research is focused on the properties of nuclear materials, leads the Reset Nuclear Waste Policy program at CISAC. He describes the center as a unique organization that “explicitly acknowledges” the role of science and the social sciences in formulating policy. 

“CISAC is a rare opportunity for political and social scientists, historians and scientists and engineers to work together on solving pressing problems. The fact that we have two co-directors reflects a serious intent to integrate knowledge from the widest range of perspectives in order to find policy solutions to important problems,” he said.

Scholarship, research

Ewing is the author or co-author of more than 750 research publications and the editor or co-editor of 18 monographs, proceedings volumes or special issues of journals. He has published widely in mineralogy, geochemistry, materials science, nuclear materials, physics and chemistry in more than 100 different journals. Ewing was granted a patent for the development of a highly durable material for the immobilization of excess weapons plutonium. He is also a founding editor of the magazine, Elements. In 2015, he won the Roebling Medal, the highest award of the Mineralogical Society of America for scientific eminence.

“My work on nuclear waste started out with a focus on technical issues, but over several decades, I realized that technical solutions were not enough.  I now focus on trying to understand why institutions – universities, national laboratories and federal agencies – fail to arrive at the technical solutions. I have been surprised to learn how little science has been applied to the nuclear waste problem – and how social issues have dominated the outcome,” Ewing said.

Expertise, policy

In particular, Ewing seeks to understand why so little information from experts rise through an organization and change accepted ‘truths.’

“I first saw this when I was a soldier in Vietnam and continue to see the same problem in many other areas, that a disconnect exists between the on-the-ground reality and policy,” said Ewing who served in the U.S. Army as an interpreter of Vietnamese attached to the 25th Infantry Division from 1969 to 1970.

“At the very highest levels, policies seem to be based on a hunch or a bias rather than an analysis of the problem. I have always wondered why this is so common – as it often leads a country or organization down a wrong and often dangerous path,” he added.

Born in Abilene, Texas, Ewing attended Texas Christian University (B.S., 1968, summa cum laude) and graduate school at Stanford University (M.S., 1972; Ph.D., 1974). He began his academic career as an assistant professor at the University of New Mexico (1974) rising to the rank of Regents’ Professor of Earth & Planetary Sciences in 1993.

From 1997 to 2013, Ewing was a professor at the University of Michigan, and in 2014, he joined Stanford.

MEDIA CONTACTS:

Rod Ewing, Center for International Security and Cooperation: (650) 725-8641, rewing1@stanford.edu

Clifton B. Parker, Center for International Security and Cooperation: (650) 725-6488, cbparker@stanford.edu