Maarten G. Lansberg
Neuroscience Clinic
300 Pasteur Dr Rm A301
Boswell MC 5325
Stanford, CA 94304
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.
Neuroscience Clinic
300 Pasteur Dr Rm A301
Boswell MC 5325
Stanford, CA 94304
The event will be a dialogue with Justice Sachs about contemporary human rights challenges in South Sfrica and the role South Africa plays in the region. It will be moderated by David Palumbo- Liu, professor of Comparative Literature at Stanford University and Tim Stanton, director of the Overses Studies Program at Stanford University will be a discussant.
Sachs will also be offering guest lectures in Professor Helen Stacy’s course, INTNLREL 144: New Global Human Rights, and ANTHRO 125S: International Criminal Courts and the Question of Global Justice with Professor Ron Jennings. Sachs is further available – and eager – to speak with interested students and faculty throughout his visit. Interested parties should contact Jessica Matthews at jess.matthews@stanford.edu.
Albert Sachs’s career in human rights activism started when he was 17 years old, continuing through college and into his law practice in Cape Town. In defending people charged under the state’s racist statutes, he attracted the displeasure of authorities and was initially subjected to “banning laws” restricting his activities, then arrested, and finally put into solitary confinement. Upon release from prison, he went into voluntary exile but never discontinued his human rights work. In 1988 in Mozambique, Sachs lost his arm and the sight of one eye when a bomb placed under his car by South African security agents exploded, but emerged from the ordeal with renewed idealism for his cause and what he describes as simple joy at being alive.
In 1990, Sachs returned to South Africa, where he worked to draft the constitution for the newly democratic country. In 1994, he was appointed by Nelson Mandela to the Constitutional Court, where he served as judge until 2009, writing decisions that changed the face of human rights in South Africa, including a decision against the death penalty in 1995, a decision in favor of same-sex marriage in 2005, and several significant decisions about health care, access to clean water, housing and infrastructure.
He is the author of Soft Vengence of a Freedom Fighter, wich chronicles his response tothe 1988 car bombing, and five other books including The Jail Diary of Albie Sachs, which was dramatized for the Royal Shakespeare Company and broadcast by the BBC.
CISAC Conference Room
Justice Sachs will deliver the keynote address for Summer Session's Human Rights Intensive in CEMEX Auditorium on Wednesday, June 26 at 7:30 p.m. A courageous anti-apartheid campaigner in South Africa, Justice Sachs's talk is entitled: HEALTH AND HUMAN RIGHTS IN SOUTH AFRICA TODAY.
Albert Sachs’s career in human rights activism started when he was 17 years old, continuing through college and into his law practice in Cape Town. In defending people charged under the state’s racist statutes, he attracted the displeasure of authorities and was initially subjected to “banning laws” restricting his activities, then arrested, and finally put into solitary confinement. Upon release from prison, he went into voluntary exile but never discontinued his human rights work. In 1988 in Mozambique, Sachs lost his arm and the sight of one eye when a bomb placed under his car by South African security agents exploded, but emerged from the ordeal with renewed idealism for his cause and what he describes as simple joy at being alive.
In 1990, Sachs returned to South Africa, where he worked to draft the constitution for the newly democratic country. In 1994, he was appointed by Nelson Mandela to the Constitutional Court, where he served as judge until 2009, writing decisions that changed the face of human rights in South Africa, including a decision against the death penalty in 1995, a decision in favor of same-sex marriage in 2005, and several significant decisions about health care, access to clean water, housing and infrastructure.
He is the author of Soft Vengence of a Freedom Fighter, wich chronicles his response tothe 1988 car bombing, and five other books including The Jail Diary of Albie Sachs, which was dramatized for the Royal Shakespeare Company and broadcast by the BBC.
This event is free and open to the public
CEMEX Auditorium
Knight Management Center
Abstract: Dr. Wang will be discussing some of the formal governmental and non-governmental collaborative mechanisms between Taiwan, China, Hong Kong, and other countries (including the US) on survaillance and reporting for flu. He will also discuss lessons learned from SARS, including the development of specific policies, protocols, or procedures, and new technologies deployed for public health preparedness.
C. Jason Wang, M.D., Ph.D. is an Associate Professor of Pediatrics at the Center for Policy, Outcomes, and Prevention at Stanford University. He received his B.S. from MIT, M.D. from Harvard, and Ph.D. in policy analysis from RAND. After completing his pediatric residency training at UCSF, he worked in Greater China with McKinsey and Company, during which time he performed multiple studies in the Asian healthcare market. In 2000, he was recruited to serve as the project manager for the Taskforce on Reforming Taiwan's National Health Insurance System. His fellowship training in health services research included the Robert Wood Johnson Clinical Scholars Program and the National Research Service Award Fellowship at UCLA. Prior to coming to Stanford in 2011, he was an Assistant Professor of Pediatrics and Public Health (2006-2010) and Associate Professor (2010-2011) at Boston University and Boston Medical Center.
Among his accomplishments, he was selected as the student speaker for Harvard Medical School Commencement (1996). He received the Overseas Chinese Outstanding Achievement Medal (1996), the Robert Wood Johnson Physician Faculty Scholars Career Development Award (2007), the CIMIT Young Clinician Research Award for Transformative Innovation in Healthcare Research (2010), and the NIH Director’s New Innovator Award (2011). He was recently named a “Viewpoints” editor and a regular contributor for theJournal of the American Medical Association (JAMA). He served as an external reviewer for the 2011 IOM Report “Child and Adolescent Health and Health Care Quality: Measuring What Matters” and as a reviewer for AHRQ study sections.
Dr. Wang has written two bestselling Chinese books published in Taiwan and co-authored an English book “Analysis of Healthcare Interventions that Change Patient Trajectories”. His essay, "Time is Ripe for Increased U.S.-China Cooperation in Health," was selected as the first-place American essay in the 2003 A. Doak Barnett Memorial Essay Contest sponsored by the National Committee on United States-China Relations.
Currently he is the principal investigator on a number of quality improvement and quality assessment projects funded by the Robert Wood Johnson Foundation, the National Institutes of Health (USA), Health Resources and Services Administration (HRSA), and the Andrew T. Huang Medical Education Promotion Fund (Taiwan).
Dr. Wang’s research interests include: 1) developing tools for assessing and improving the quality of healthcare; 2) facilitating the use of innovative consumer technology in improving quality of care and health outcomes; 3) studying competency-based medical education curriculum, and 4) improving health systems performance.
CISAC Conference Room
Encina Commons Room 180,
615 Crothers Way,
Stanford, CA 94305-6006
C. Jason Wang, M.D., Ph.D. is a Professor of Pediatrics and Health Policy and director of the Center for Policy, Outcomes, and Prevention at Stanford University. He received his B.S. from MIT, M.D. from Harvard, and Ph.D. in policy analysis from RAND. After completing his pediatric residency training at UCSF, he worked in Greater China with McKinsey and Company, during which time he performed multiple studies in the Asian healthcare market. In 2000, he was recruited to serve as the project manager for the Taskforce on Reforming Taiwan's National Health Insurance System. His fellowship training in health services research included the Robert Wood Johnson Clinical Scholars Program and the National Research Service Award Fellowship at UCLA. Prior to coming to Stanford in 2011, he was an Assistant Professor of Pediatrics and Public Health (2006-2010) and Associate Professor (2010-2011) at Boston University and Boston Medical Center.
Among his accomplishments, he was selected as the student speaker for Harvard Medical School Commencement (1996). He received the Overseas Chinese Outstanding Achievement Medal (1996), the Robert Wood Johnson Physician Faculty Scholars Career Development Award (2007), the CIMIT Young Clinician Research Award for Transformative Innovation in Healthcare Research (2010), and the NIH Director’s New Innovator Award (2011). He was recently named a “Viewpoints” editor and a regular contributor for the Journal of the American Medical Association (JAMA). He served as an external reviewer for the 2011 IOM Report “Child and Adolescent Health and Health Care Quality: Measuring What Matters” and as a reviewer for AHRQ study sections.
Dr. Wang has written two bestselling Chinese books published in Taiwan and co-authored an English book “Analysis of Healthcare Interventions that Change Patient Trajectories”. His essay, "Time is Ripe for Increased U.S.-China Cooperation in Health," was selected as the first-place American essay in the 2003 A. Doak Barnett Memorial Essay Contest sponsored by the National Committee on United States-China Relations.
Currently he is the principal investigator on a number of quality improvement and quality assessment projects funded by the Robert Wood Johnson Foundation, the National Institutes of Health (USA), Health Resources and Services Administration (HRSA), and the Andrew T. Huang Medical Education Promotion Fund (Taiwan).
Dr. Wang’s research interests include: 1) developing tools for assessing and improving the quality of healthcare; 2) facilitating the use of innovative consumer technology in improving quality of care and health outcomes; 3) studying competency-based medical education curriculum, and 4) improving health systems performance.
Symposium description:
A unique, two-day symposium at which an international panel of leading medical and biological scientists, nuclear engineers, and policy experts will make presentations on and discuss the bio-medical and ecological consequences of the Fukushima disaster, will be held at The New York Academy of Medicine on March 11-12, 2013, the second anniversary of the accident.
A project of The Helen Caldicott Foundation, the symposium is being co-sponsored by Physicians for Social Responsibility.
View the video online at The Helen Caldicott Foundation.
President Barack Obama’s 2014 budget proposal promises significant food aid reform that will enable the United States to feed about 4 million more people without a significant increase of the current $1.8 billion spent on feeding the world's most hungry. Since the food aid program's inception in 1954, the U.S. has helped feed more than 1 billion people in more than 150 countries, and remains the largest provider of international food aid.
The intention of the reform is to make food aid more efficient, cost effective, and flexible. It aims to use local and regional markets to lower the cost of food and speed its delivery, and calls for the use of cash transfers and electronic food vouchers.
The proposed reforms would also end monetization—the sale of U.S. food abroad to be sold by local NGOs for cash. This practice has been criticized for hurting vulnerable communities by depriving local farmers of the incentives and opportunities to develop their own livelihoods. Several studies, including one by the Government Accountability Office, found monetization to be costly and inefficient—an average of 25 cents per taxpayer dollar spent on food aid is lost.
Barry Riley, a food aid expert and visiting fellow at the Center on Food Security and the Environment, discusses his perspective on the importance of these new reforms, their chances of passage, and the country's current role in international food aid.
Why is local procurement such an important addition to food aid reform?
An increase of funding for local and regional procurement is the most important programmatic element of the proposed reforms. It would help managers working in food security-related development programs to determine for each emergency what commodities are most appropriate and where they can be procured most quickly and inexpensively. Some studies have shown local and regional procurement of food and other cash-based programs can get food to people in critical need 11 to 15 weeks faster at a savings of 25-50 percent. Equally important, local procurement is less likely to disrupt local economic conditions, but rather promote self-sufficiency by increasing demand (often for preferred local staples) and incomes of local producers. The move to 45 percent local (and 55 percent tied) procurement is a BIG step, and one to face strong opposition from American commodity interests and U.S.-flag shippers.
How difficult is it to ensure vouchers and electronic cash transfers are getting into the hands of people that really need the aid?
Vouchers (and similar urban coupon shops) have been used many times over the past decades as a food transfer mechanism (also sometimes used in food for work programs) enabling the recipient to trade the voucher(s) for foodstuffs when it is most convenient or when they are most needed. Electronic vouchers are new, and how well they work depends on local situations. In places like urban Latin America, Africa and India, it probably could be made to work quite well; the technology is evolving quickly that would enable this sort of transfer mechanism.
Rural Ethiopia, Burkina Faso, Central African Republic, Malawi – probably not so well. I’m admittedly skeptical that electronic transfers of purchasing power to remote areas would be sufficient in most cases to motivate traders to move food to these hungry areas. Their risks are extremely high and, in my experience in Africa, traders will only deliver food to remote rural areas (inevitably over very bad roads) if they can command prices considerably higher than costs plus a high risk premium.
Why aren’t international food aid organizations more in favor of direct dollar support for local operating costs?
There is (and has long been) opposition among many of the NGOs to the President’s proposal to replace “monetization” with a promise of on-going direct dollar support for the local operating costs of NGO food security-related projects. They believe it will continue to be easier to get Congress to approve money to buy American food commodities to ship overseas than to get approval for dollars to ship overseas, particularly in light of tightening budgets. These NGOs have tended, over the years, to receive a sympathetic ear from Congress.
The proposal shifts oversight of the food aid program from the Agriculture Committees within the U.S. Department of Agriculture (USDA) to the Foreign Affairs/Relations Committees of the State Department’s U.S. Agency for International Development (USAID). What is the likelihood of Congress approving this transfer?
The chance of that happening, in this of all Congresses, is about the same as winning the Power Ball Lottery. Crusty committee chair-people are extremely sensitive to reductions in their empires and the agriculture committees – especially in the Senate – are powerful committees. On top of that, there are so many elements in the overall 2014 federal budget creating heartburn on the Hill that food aid considerations are far, far, far down the line. The best the President is likely to get in the present divided Congress are hearings and a continuing resolution of some sort.
What did you wish to see in the food aid reform proposal that was not addressed in this budget?
Change, if it ever comes, will likely be incremental and halting. I’ll be happy to see any step, however small, in the right direction. The total end of tied procurement would be at the top of my wish list. Even more important, perhaps, iron-clad, multi-year commitments of funding to food security programs intended to overcome long-term institutional impediments to achieving enduring food security in low income food deficit situations…and sticking with such commitments for 15 years.
What role does food aid play in advancing American foreign policy goals?
Most importantly, by being the single largest source of food commodities to the World Food Program in confronting disaster and emergency situations. Food support to American NGOs has been under-evaluated over the past 40 years. I’ll be talking about this later in the book I am writing, but these small projects were all that kept agricultural development (and early food security efforts) going in many small countries during the “dark decades” when international finance institutions and bilateral donors were not financing agricultural development. There are valuable on-the-ground lessons in that NGO food-assisted experience still waiting to be assessed.
Let me add, given what we know about the onset of serious climate change in the decades to come, the need to supply large amounts of food to populations suffering severe food deprivation will probably grow in the future. Where will the food come from and who will pay for those future transfers?
While the U.S. remains the largest provider of food aid, what can the EU and Canada teach the U.S. about food aid policy?
Donors hate to think that other donors have something to teach them. But, of course, they always do. The Canadian and European experience with food aid is best summed up in the way their objective has come to be restated over the past 15 or so years: not “food aid” but “aid for food.” The purpose of assistance intended to improve food security is to improve either, or both, availability and access over the long term (leave nutrition aside for a moment).
European and Canadian assistance can be much more flexible in choosing the instruments – food, cash, technical assistance, training, institutional strengthening, public policy, public-private cooperation, etc. – required to achieve a realistic food security goal which I would describe as pretty good assurance that most people can get their hands on the food they need most of the time. Commodity food aid, in some form – or the promise of its ready availability when needed – will probably need to be part of the total array of inputs required for the several years needed in particular food insecure countries to achieve that “pretty good assurance.” Europe and Canada are closer to understanding this and have become appropriately flexible in concerting resources to get it done. That’s the lesson.
Encina Hall, Room C338-H1
616 Serra Street
Stanford, CA 94305-6019
Neesha Joseph is the Senior Program Lead for the Stanford Healthcare Innovation, Policy, and Engagement (HIPE) Lab at Stanford Health Policy. Since joining Stanford Health Policy, she has managed three NIH-funded research centers focused on areas including diabetes translational research and the demography and economics of healthy aging. During the COVID-19 pandemic, she served as Program Manager for the Stanford-CIDE Coronavirus Simulation Model (SC-Cosmo) Consortium, which collaborated with government decision-makers engaged in pandemic response planning. Most recently, her work has centered on research related to diabetes and cancer. She also spearheads HIPE Lab initiatives to advance innovation through the design of AI-enabled tools to support research planning, development, and operational efficiency.
China’s commitment to agricultural development over the last thirty years has dramatically transformed the country’s economy. Rural income per capita has risen an astounding 20 times after 30 prior years of stagnation. Its poverty rate (US$1.25/day) has dropped from 40 percent to less than five, and 350 million rural people between the ages of 18-65 are now working in the industrial or service sector, enjoying rising wages and new economic opportunities.
This rapid transformation is largely the result of three key agricultural policy decisions: putting land in the hands of farmers, market deregulation, and major public investment in the agricultural sector. Although China must now contend with extreme inequality, high levels of pollution, and an aging farming sector there are still lessons to draw from China’s experience that could hasten the transformation of other developing countries.
China expert and agricultural economist Scott Rozelle broke these lessons down at FSE’s fourteenth Global Food Policy and Food Security Symposium Series last week, opening with an underlying theme of the series.
“Growth and development starts with agriculture,” said Rozelle. “Agriculture provides the basis for sound, sustained economic growth needed to build housing, invest in education for kids, start self-employed enterprises, and finance moves off the farm.”
To prove this point he referenced China’s ‘lost decades’ (1950s-1970s) when 80 percent of the population lived in the rural sector and relied on communal, subsistence agriculture. Poor land rights, weak incentives, incomplete markets and inappropriate investments left the average rural farmer poorer at the end of 70s than they were in the 50s with almost no off-farm employment growth.
So what changed? Incentives, market deregulation and strategic investments by the state were key.
Creating the right incentives
In 1978 the Chinese government broke the communes down into small “family farms” such that every rural resident was allocated a small parcel of land. A family of five farmed an area the size of a football field. While they did not own nor could sell the land, they had the right to choose what crops and inputs they used and the right to the income generated from their land.
“Incentives are important, and can be enough in the short run,” said Rozelle. “Hard work led to money in the pockets of farmers and China was off.”
“Every two and half years China added another California in term of agriculture,” said Rozelle.
Between 1979 and 1985 productivity for wheat, maize, and rice went up 50 percent using the same amount of labor, land and inputs. Agriculture across the spectrum has grown at an astounding rate of 5 percent since 1988 (about four times the population growth rate). Livestock and fisheries have grown even faster – accounting for most of the output of the agricultural sector by 2005.
Income growth from farming enabled family members to begin to seek work off the farm. Between 1980 and 2011, off-farm work increased 71 percent with more than 90 percent of households reporting that at least one family member worked off the farm.
Increasing efficiency through liberalization and investment
Another key policy decision was China’s commitment to market liberalization and investment in public goods.
“Markets can be an effective, pro-poor tool of development,” said Rozelle. “A remarkable partnership is formed when you let farmers do production and government do infrastructure…let markets guide decisions.”
The government dismantled state-owned grain trading companies and deregulated trading rules. Prices were set once a week the same day across China to better integrate markets, and eventually prices for major crops closely mirrored those of world prices. Villages began specializing in crops and livestock and incomes of the poor increased. By not providing government input subsidies (e.g, pesticides, fertilizers), traders were incentivized to participate in the market.
“Giving land to farmers and letting the private sector emerge is an easy thing for governments, even without a lot of money, to do,” said Rozelle.
The government provided more indirect market support by publicly investing in better roads, communications, and surface water irrigation. Groundwater was left to the private sector. There were no water or pumping fees nor subsidies for electricity, keeping it completely deregulated. As a result, 50 percent of cultivated land in China is irrigated, compared to 10 percent in the US and only four percent in sub-Saharan Africa.
Finally, China has invested heavily in agricultural research and development (R&D). One percent of China’s agricultural GDP is now invested in agricultural R&D while US investment has fallen over time. US$2 billion alone goes to investments in Chinese biotechnology.
Despite major investment, China only has one major success story to show for so far. The introduction of Bt cotton led to a significant drop in pesticide use (with important health benefits for farmers), and drop in labor and seed price; resulting in a huge 30 percent increase in net income.
“GM technology benefits exist but big policy decisions still need to be made in the face of much resistance both in China and elsewhere in the world on its application,” said Rozelle.
Status of China’s economy
China has largely solved the country’s macro-nutrient food security problem at the household level (>3000 Kcal/day/person) and millions have been lifted out of poverty. Practically all 16-25 years old are now working off the farm.
“This is a real transformation, and one that could not have happened without a major investment in agriculture,” said Rozelle.
While China’s agricultural accomplishments have been major, Rozelle recognizes the system is far from perfect. For starters, there are serious food safety concerns due to lack of traceability. An astounding 98 percent of Beijing consumers think their food is tainted, said Rozelle.
Water is being pumped like crazy and farmers are aging. The younger generation is neither willing nor interested in following in their parents’ farming footsteps. To make up for a labor deficit farmers are applying huge amounts of fertilizer on their land with serious environmental consequences. As a result of changing demographics and an increasing demand for meat, fish, fruits and vegetables, China is likely to be a net importer of food in the long run.
China also faces major urban and rural inequality issues. Even though wages have risen, inequality has not fallen, largely a result of China’s decision not to privatize rural land.
“Rural people have no assets on which to build wealth while urban people were given assets in the form of housing,” said Rozelle. “Housing prices in major cities in China now rival those in the Bay Area!”
The Chinese government fears losing control of the land, but this comes at a price of less individual incentive to invest and inability to build larger farmers. As agricultural growth slows, Rozelle worries high levels of inequality could lead to instability.
Adding fuel to the fire, investment in rural health, nutrition, and education remains far from sufficient. Only 40 percent of the rural poor go to high school resulting in 200 million people who can barely read or write.
“What’s going to happen in 20 years when low skill manufacturing jobs move to other countries?” asked Rozelle. “The rural, uneducated poor are going to become unemployable.”
China’s record leaves room for improvement, but presents a strong case for supporting smallholder agriculture. For those countries emerging out of their own lost decades, smallholder agriculture should remain a primary focus of investment and development.