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.

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The United Nations has thus far fulfilled its charter to prevent a third world war, but with 60 million refugees, continued bloodshed with unresolved civil conflicts and terrorism spreading like cancer, the world's leading peacekeeping organization must spearhead global action, U.N. Secretary-General Ban Ki-moon said Friday at Stanford on the 70th anniversary of the international organization.

Ban, the U.N.'s eighth secretary-general, did not rest on any laurels during his speech at a public event sponsored by the Walter H. Shorenstein Asia-Pacific Research Center (APARC). "I humbly accept criticism that the U.N. is not doing enough," he said. 

However, the situation could have been worse if not for the United Nations, he continued. "Without peacekeepers, or without the U.N.'s continued humanitarian assistance and advocacy of human rights, I'm afraid to tell you that this world would have been poorer, more dangerous and even bloodier without the United Nations."

Ban's visit to Stanford – his second to the university in less than three years – was part of a trip to the Bay Area to commemorate the signing of the U.N. charter. In 1945, representatives from 50 nations gathered in San Francisco to create the United Nations – an international organization aimed at saving future generations from the "scourge of war."

Today, the United Nations has grown to 193 member nations. Its challenges – from climate change and poverty to civil wars and terrorism – have never been greater, Ban said.

"This is a critical year; 2015 is a year of global action," he said. "The U.N. cannot do it alone. We need strong solidarity among government, business communities and civil societies, from each and every citizen."

The fact that so many young people around the globe are drawn to violent narratives is worrisome, Ban said. "Violent terrorism is spreading like cancer around the world."

The rise in terrorist activities stems from "a failure of leadership," he said. That's why the United Nations needs to develop a comprehensive plan of action to address extremism, he maintained.

The U.N.'s 70th anniversary coincidentally fell on a momentous day of tragedy and celebration around the world. Dozens were killed when terrorists launched horrific attacks across three continents – in France, Tunisia and Kuwait – fueling anger, sadness and fear of more violence.

But in the United States, celebrations rang out in response to a landmark U.S. Supreme Court ruling that legalizes same-sex marriages nationwide.

Ban, who has long advocated for equality and last year pushed the United Nations to recognize same-sex marriages of its staff, drew a round of applause when he heralded the court ruling as "a great step forward for human rights."

The June 26 event was co-sponsored by Shorenstein APARC and the Freeman Spogli Institute for International Studies at Stanford University, with promotional co-sponsors Asia Society, Asia Foundation and the World Affairs Council of Northern California. 

May Wong is a freelance writer for the Stanford News Service.

Coverage and related multimedia links:

Remarks at Stanford University by Ban Ki-moon (U.N. News Centre, 6/26/15)

Photos of Ban Ki-moon at Stanford University (U.N. Photo, 6/26/15)

At Stanford University, Ban says U.N. ready to build a better future for all (U.N. News Centre, 6/27/2015)

U.N. Secretary-General Ban Ki-moon welcomes growing engagement of India, China (NDTV, 6/27/2015)

U.N. Secretary-General Ban Ki-moon speaks at Stanford, celebrates U.N.'s 70th anniversary (Stanford Daily, 6/29/15)

Hoover archival photographs featured at lecture delivered by U.N. Secretary-General Ban Ki-moon (Hoover Institution, 6/29/2015)

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Ban Ki-moon, the eighth secretary-general of the United Nations, urged the audience to see 2015 as a year of global action. | UN/Mark Garten
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Bad weather in sub-Saharan Africa increases the spread of HIV, according to a study published in the June 2015 issue of the Economic Journal, co-authored by Stanford professor and FSE fellow Marshall Burke.

When the rains fail, farmers in rural areas often see their incomes fall dramatically and will try to make up for it however they can, including through sex work. Analysing data on more than 200,000 individuals across 19 African countries, the research team finds that by changing sexual behaviour, a year of very low rainfall can increase local infection rates by more than 10%.

The results have important policy implications for fighting the spread of the epidemic, as co-author Erick Gong of Middlebury College notes:

‘Existing approaches to stopping the spread of HIV – such as promoting condom use and the use of anti-retrovirals – remain critically important. But our results suggest that other policy approaches could be very useful too – in particular, approaches that provide safety nets to rural households when the weather turns bad.’

Policies and investments seemingly unrelated to HIV – such as the promotion of rural insurance or household savings schemes, or the development of drought-tolerant crops – might have surprising benefits in slowing the HIV epidemic. Co-author Kelly Jones of the International Food Policy Research Institute says:

‘The HIV/AIDS epidemic remains one of the world’s greatest health challenges, with over a million new infections per year in Africa alone. Our results expand the menu of options for addressing the epidemic, and highlight some surprising options that are not at the forefront of people’s minds.’

The research sheds valuable light on why HIV continues to spread in Africa. Previous studies have documented in limited settings that poor women often alter their sexual behaviour in response to an income shortfall. But until now, there has been little evidence that this response is big enough to affect the trajectory of the HIV epidemic.

To fill this gap, the researchers combined data on the HIV status of thousands of people across sub-Saharan Africa with data on the recent rainfall history in each individual’s location.

Because years of low rainfall can lead to much lower incomes in these locations, particularly in rural areas where people depend more heavily on agriculture for their livelihoods, variation in rainfall provides a way to study how changes in local economic conditions affect infection rates. Co-author Marshall Burke comments:

‘We were surprised by how strong the relationship is between recent rainfall fluctuations and local infection rates. As expected, the relationship is much stronger in rural areas, and particularly for women who report working in agriculture. These are the people who really suffer when the rains fail, and who are forced to turn to more desperate measures to make ends meet.’

Notes for editors: ‘Income Shocks and HIV in Africa’ by Marshall Burke, Erick Gong and Kelly Jones is published in the June 2015 issue of the Economic Journal.

Marshall Burke is an assistant professor of Earth System Science at Stanford University. Erick Gong is an assistant professor of economics at Middlebury College. Kelly Jones is a research fellow at the International Food Policy Research Institute (IFPRI).

For further information: contact Marshall Burke on +1-650-736-8571 (email: mburke@stanford.edu); Erick Gong on +1-802-443-5553 (email: egong@middlebury.edu); Kelly Jones on +1-202-862-4641 (email: k.jones@cgiar.org); or Romesh Vaitilingam on +44-7768-661095 (email: romesh@vaitilingam.com; Twitter: @econromesh).

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This workshop will focus on the importance of community health services and primary health care reform in China and discuss what clinicians and policymakers are doing to improve health outcomes. With researchers and clinicians from China and the US, we will discuss the policy challenges to improving China’s health care system at the community and grassroots level. Key themes include China’s local experiences, showcasing innovations in Hangzhou, as well as the question of how the private sector might play a role in strengthening community health in China. The Asia Health Policy Program thanks ACON Biotechnology for sponsoring this event.

http://aparc.fsi.stanford.edu/research/innovations-primary-care

 

Stanford Center at Peking University

Beijing, China

Jean Oi Stanford University
Liang Wannian China Health and Family Planning Commission
Feng Lin Chairman, ACON Biotechnology

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
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Senior Fellow at the Freeman Spogli Institute for International Studies
Professor, by courtesy, Health Policy
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
karen-0320_cropprd.jpg PhD

Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director, Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
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Stanford University
Jiangnan Cai Director of Health Management and Policy Research, CEIBS
Jiaji Wang Guangzhou School of Public Health
Hai Fang Peking University School of Public Health
Min Yu Deputy - Director, Zhejiang CDC
Zhiling Zhou Deputy - Director, Hangzhou Health and Family Planning Commission
Yan Ma Deputy - Director, Shangcheng District Government
Randall Stafford Program Director, Program on Prevention Outcomes and Practices, Stanford University
Hengjin Dong Zhejiang University
Shuling Chen Zhejiang University
Zhihong Hu Director, Xiao Ying Xiang Community Health Service Center
Fang Qian Director, Si Ji Qing Community Health Service Center
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This project adapts the Future Elderly Model (FEM), a demographic and economic Markov microsimulation model that projects the health conditions and functional status of an elderly population, to the Japanese population. The model starts with a “snap-shot” of the middle-aged and elderly Japanese population in 2010 and then projects risk of developing 19 chronic conditions, health care utilization, annual medical expenditures, and mortality.

This study aims to assess the extent to which wealth accurately proxies health status in low- and middle-income countries. Specifically it is testing the hypothesis that absolute wealth is much more important for health than wealth inequalities or relative wealth. The researchers have collected 150+ DHS surveys with suitable information on wealth and health outcomes, and have finalized and validated a harmonized wealth index that allows for measuring absolute and relative wealth gradients.

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Bioengineering researchers have recently constructed the final steps required to engineer yeast to manufacture opiates, including morphine and other medical drugs, from glucose, drawing significant interest, and concern, from the media and academics in the science and policy fields, including at the Center for International Security and Cooperation (CISAC).  

“Researchers are getting better at building biology based platforms to create a wide variety of compounds that are difficult, inefficient, or sometimes impossible to create by other means,” Dr. Megan J. Palmer told National Public Radio in the weekly Science Friday segment.

She highlighted how these platforms can enable production of potentially safer, cheaper and more effective drugs. “But one significant concern is if we create the full pathway to go from glucose to this intermediate and then all the way to things like morphine, this could feed into illicit markets and bolster new illicit markets.”

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Palmer is a William J. Perry Fellow in International Security at CISAC whose work focuses on developing best practices and policies for responsibly advancing biotechnology.

The media this week has focused on comments by researchers who pointed out that the modified yeast could be used to manufacture heroin, a synthesized version of morphine. The prospect of “home-brewed heroin” has been prominently featured in news coverage.

There are significant concerns, says Palmer, but she cautioned that focusing solely on that possibility could lead to bad policy outcomes.

“There is a big opportunity for researchers, policy makers, and industry to work together to figure out what controls they can put in,” she said in a separate interview. “We have time to get ahead of this problem. We now have choices in how we build and regulate the technology. The challenge for regulatory and technical communities will be to avoid reactive quick fixes. It’s encouraging to see researchers engaging in these issues early on.”

The challenge will be to find ways for researchers, law enforcers, and policy experts to work together to build safeguards into the biology itself as well as into organizations and institutions. 

“We really need to think about security as a design principle,” Palmer said. She hopes to foster thoughtful and rigorous analysis of how the design of biotechnology impacts future governance options.

“This issue highlights beautifully the nexus between public policy and science and technology, which is where CISAC has already, and will continue to make important contributions,” said CISAC Co-Director David Relman. Dr. Relman is also the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University. 

CISAC recently hosted a seminar led by Stanford’s Dr. Christina Smolke that discussed technology advances that are resulting in alternative supply chains for drugs, with particular attention to opiates.

Dr. Smolke is also troubled by the over-emphasis of the risks associated with the potential technology. “I believe it’s inflammatory, biased, and not grounded in an accurate representation of the technology. However, the commentary focuses on the risks of the supply chain and proposes regulations/governance for such a technology, without implementing a process to engage various parties in discussions to thoughtfully assess risks, opportunities, and regulatory needs in this context.”

“I think we need to frame this issue in the context of the larger systemic challenges involving the rearrangements of supply chains enabled through bio-manufacturing and how we spread responsible norms and practices,” Palmer said. “We need to think about governance options in terms of human capacities and technical capacities. What safeguards can we engineer into our technologies, and in turn what safeguards can we build into our organizations and institutions?”

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