Elections

As democracy has spread over the past three decades to a majority of the world's states, analytic attention has turned increasingly from explaining regime transitions to evaluating and explaining the character of democratic regimes. Much of the democracy literature of the 1990s was concerned with the consolidation of democratic regimes. In recent years, social scientists as well as democracy practitioners and aid agencies have sought to develop means of framing and assessing the quality of democracy.

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Olena Nikolayenko
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Over the past decade, thousands of young people in the post-communist region applied nonviolent methods of resistance to protest against large-scale electoral fraud. In 2000, the social movement Otpor (Resistance) played a vital role in removing Slobodan Milosevic from power. Inspired by Otpor, a number of youth movements emerged in Azerbaijan, Belarus, Georgia, and Ukraine. In my post-doctoral project at the Center on Democracy, Development, and the Rule of Law, I examine why some youth movements were more successful than others in mobilizing the population against the repressive political regime. My research suggests that political learning of autocratic incumbents has contributed to the diminishing power of similar youth movements.

In the wake of the 1998 draconic laws on universities and the mass media, a group of students from the University of Belgrade formed the youth movement Otpor and chose the clenched fist as its symbol. In the course of two-year nonviolent struggle against Milosevic, Otpor spread across Serbia and attracted more than 70,000 supporters. The youth movement launched a campaign with the provocative title “He Is Finished” and shifted the blame for all the country’s problems on the incumbent president. In addition, Otpor collaborated with other civil society actors to stage a get-out-to-vote campaign “It’s Time!” aimed at bringing first-time voters to the polling stations. In the 2000 election, almost 86 percent of 18-29 year old Serbs cast their ballot; most of them voted against Milosevic.

Given state pressures on the mainstream media, the Serbian movement delivered its messages by occupying the public space. Movement participants plastered Otpor stickers, spray-painted graffiti, staged street performances, and organized street concerts. “It is amazing how people notice branding in their everyday life, but underestimate it in nonviolent struggle,” a former Otpor activist noted. Without doubt, Otpor succeeded in creating and popularizing a model of nonviolent resistance.

Notwithstanding slight modifications of Otpor’s model, Belarus’ Zubr (Bison) in 2001, Georgia’s Kmara (Enough) in 2003, Ukraine’s Pora (It’s Time) in 2004, and an assortment of Azerbaijani youth groups in 2005 largely took a similar course of action. The youth movements were formed around the time of a national election and called for free and fair elections. Emulating Otpor, youth activists planned a negative campaign targeted at the incumbent president and a positive campaign aimed at boosting youth voter turnout. Likewise, youth movements employed a similar toolkit of protest strategies, including stickers, graffiti, street performances, and rock concerts.

At the same time, autocratic incumbents in the post-Soviet region began to scrutinize Otpor’s model of nonviolent resistance to prevent the repeat of the Serbia scenario. In light of electoral revolutions in Serbia, Georgia, and Ukraine, the governments in Azerbaijan and Belarus deployed coercive measures against youth movements before they could develop into powerful agents of political change. In addition, the incumbent presidents have invested considerable resources into the creation of state-sponsored youth organizations. In 2005 and 2008, the Azerbaijani youth movement Ireli (Forward) called upon young voters to support President Ilham Aliyev. Similarly, the Komsomol-like Belarusian Republican Union of Youth has become a tool for youth co-optation under President Alyaksandr Lukashenka. Like in the Soviet times, membership in the state-sponsored youth organization is now a pre-requisite for university admission and career growth in Belarus.

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Donald K. Emmerson
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The 2008-09 academic year was a busy time for the Southeast Asia Forum (SEAF).  A dozen on-campus lectures by Southeast Asianists from Australia, Germany, Malaysia, Thailand, and the United States ranged from country-specific topics such as labor resistance in Vietnam, political opposition in Malaysia, and the 2009 elections in Indonesia, to broader-brush treatments of Southeast Asian identities and modernities, regional repercussions of the global economic slowdown, and the wellsprings of “late democratization” across East Asia.

The lecture on “late democratization” was delivered to a capacity audience by the 2008-09 National University of Singapore-Stanford University Lee Kong Chian (LKC) Distinguished Fellow, Mark Thompson.  Mark is a political science professor in Germany at the University of Erlangen-Nuremberg.  He and another 08-09 SEAF speaker, Australian National University Prof. Ed Aspinall, jointly with State University of New York-Albany Prof. Meredith Weiss, will lead a 28-30 August 2009 workshop in Singapore under the auspices of the NUS-Stanford Initiative (NSI).  The workshop will review and analyze the record and prospects of student movements in Asia.  Attendees will include authors of chapters of a book-in-progress stemming from the research and writing on democratization done by Thompson during his fellowship at Stanford.

A second NSI awardee this past academic year was the 2008 NUS-Stanford LKC Distinguished Lecturer Joel Kahn, professor of anthropology emeritus at La Trobe University, Melbourne, who gave three talks at SEAF this year: 

His insightful interpretations of identity and modernity in Southeast Asia may be heard via the relevant audio icons at the links above.

Off-campus lectures involving SEAF included three panel discussions convened to launch Hard Choices: Security, Democracy, and Regionalism in Southeast Asia (introductory chapter and information on ordering the title are available), published by Stanford’s Shorenstein APARC and the Institute of Southeast Asian Studies (ISEAS), Singapore, in 2008-09.  The book was edited by SEAF Director Donald K. Emmerson.  

Hosting these launches in their respective cities were ISEAS in Singapore, the Asia Society in New York, and Johns Hopkins University’s School of Advanced International Studies in Washington, D.C.  Panelists at these events included Ellen Frost (Peterson Institute for International Economics), Mike Green (Georgetown University School of Foreign Service), Alan Chong Chia Siong (NUS), and Joern Dosch (Leeds University).  

Another panelist was John Ciorciari, a Shorenstein Fellow at Shorenstein APARC in 2007-08 and a National Fellow at the Hoover Institution in 2008-09.  In 2009, despite the U.S. recession and a correspondingly competitive academic marketplace, he published several Southeast Asia-related pieces, completed and submitted to a university press the manuscript he had worked on at APARC, and won a tenure-track assistant professorship at the University of Michigan’s School of Public Policy starting in September 2009.  Congratulations, John! 

Apart from speaking at the launches of Hard Choices, Don Emmerson gave papers on Indonesian foreign policies and Asia Pacific regionalism in Jakarta and Manila, and discussed these and other topics at events in Chicago and Los Angeles among other venues.  At two conferences in Washington,D.C. on a proposed U.S.-Indonesian “comprehensive partnership,” he addressed what such a relationship could and should entail.  In Spring 2009 at Stanford, he served as faculty sponsor and lecturer in a student-initiated course on Thailand.  His interviewers during the year included the BBC, Radio Australia, The New York Times, and various Indonesian media.

SEAF organized its final on-campus event of the 2008-09 academic year in June 2009 — an invitation-only roundtable co-sponsored with the U.S.-ASEAN Business Council.  Nine scholars met with three current American ambassadors to Southeast Asian countries for off-the-record conversations on seven topics of mutual interest regarding the region and its relations with the United States.

None of the above could have happened without the talent, friendliness, and all-round indispensability of SEAF’s administrative associate, Lisa Lee.  Thank you, Lisa!

Prospect:  2009-2010

As of June 2009, SEAF anticipated hosting, directly or indirectly, these scholars of Southeast Asia during academic year 2008-09:

  • Sudarno Sumarto is the director of the SMERU Research Institute, Jakarta.  He will be at Stanford for the full academic year as the 2009-10 Shorenstein APARC-Asia Foundation Visiting Fellow. While on campus, Sudarno will do research and write on the political economy of development in Indonesia.  He is likely to focus within that field on the economic consequences of violent conflict, policy lessons to be drawn from the record of cash-transfer welfare programs, and whether and how such aid has affected its recipients’ voting behavior. 
  • James Hoesterey will spend academic year 2009-10 at APARC as the year’s Shorenstein Fellow.  He will revise for publication his University of Wisconsin-Madison doctoral dissertation in anthropology on “Sufis and Self-help Gurus:  Postcolonial Psychology, Religious Authority, and Muslim Subjectivity in Indonesia.” Jim researched this topic in Indonesia over two years of fieldwork focused on the outlook and activities of a popular, charismatic, media-savvy Muslim preacher, Abdullah Gymnastiar.  Jim’s aim is to understand and interpret how a new generation of Muslim preachers and trainers in Indonesia has found a marketable niche and acquired personal and religious authority by combining piety with practical advice. 
  • Thitinan Pongsudhirak is an associate professor in international relations at Chulalongkorn University, Bangkok, where he also heads the Institute of Security and International Studies.  He will be at Stanford in Spring 2010, one of four visiting experts from overseas in a new joint effort by the Stanford Humanities Center and the Freeman Spogli Institute for International Studies to bring “high-profile international scholars into the intellectual life of Stanford.” 

Together with SEAF, the Center for East Asian Studies and the Center for Democracy, Development, and the Rule of Law will co-host Thitinan during his stay.  While at Stanford he will lecture and write on Thai politics and foreign policy, among other possible topics.  His op ed in the 18 April 2009 New York Times, “Why Thais Are Angry,” may be accessed at the New York Times.

Christian von Luebke, a 2008-09 Shorenstein Fellow, will remain at Stanford in 2009-2010 as a visiting scholar on a German Science Foundation fellowship.

He will enlarge, for publication, the focus of his doctoral dissertation, on the political economy of subnational policy reform in Indonesia, to encompass the Philippines and China as well.  To that end, he did preparatory fieldwork in Manila in Summer 2009.

SEAF is happy to congratulate all four of these 2009-2010 scholars for winning these intensely competitive awards!  

In addition to sponsoring the lectures these scholars are expected to give, SEAF will host a full roster of occasional speakers from the United States and other countries in AY 2009-2010.  These speakers will analyze and assess, for example, the (in)efficacy of ex-Prime Minister Thaksin Shinawatra’s welfare programs in Thailand, the role of intra-military tensions in propelling Asian transitions from authoritarian to democratic rule, and aspects of Japan’s occupation of Southeast Asia during World War II that need reconsideration.

As for the 2009-10 iteration of the NUS-Stanford Initiative and its fellowship and lectureship awards, as of June 2009 this prospect was on hold pending clarification of NSI’s financial base, which has been affected by the global economic downturn.  Whatever the status of NSI in 2009-10, SEAF’s speakers, whether resident on campus or invited for one-time talks, should make up in quality for the modest shortfall in quantity—not filling one slot for a visitor—that the possible absence of an NSI-funded scholar would imply.

Controversy:  “Islamism” and Its Discontents

SEAF expects to learn in 2009-10 of the publication of one or more books written wholly or partly at Stanford under its auspices.  One of these titles is Islamism: Contested Perspectives on Political Islam.  It is set to appear by November 2009 and can be ordered now from Stanford University Press at http://www.sup.org/book.cgi?id=11926.  

In this volume, SEAF’s director debates a friend and colleague, Middle Eastern and Islamic studies expert and Hofstra University anthropologist Dan Varisco.  They disagree over the meaning of the term “Islamism” and the (un)desirability of its use in discourse about Muslims and their faith.  Of particular sensitivity in this context is the (mis)use of “Islamism” to describe or interpret instances of violence that have been or may be committed by Muslims in the name of Islam.  A dozen other experts on Islam, mostly Muslims, contribute shorter comments on “Islamism” and on the positions taken by Emmerson and Varisco.  If one early reviewer turns out to be right, “this lively work will be a great help for anyone concerned with current debates between Islamic nations and the West.” 

At Stanford in February 2009, Don Emmerson conveyed his and Dan Varisco’s views to a standing-room-only lecture and discussion hosted by the Abbasi Program in Islamic Studies entitled “Debating Islamism: Pro, Semi-pro, Con, and Why Bother?” (audio recording available).  One listener later commented anonymously on the talk.  Also relevant, in the context of larger questions regarding how best to convey Muslims’ lives and religion to non-Muslims, is Jonathan Gelbart's article "Who Speaks For Islam? Not John Esposito".

Don does not know the authors of these posts; ran across their comments by chance while cyber-surfing; and does not necessarily endorse their views, let alone views to be found in the sources to which these comments may be electronically linked.  But the blog and the article do contribute to a debate whose importance was illustrated at the very end of Stanford’s 2008-09 academic year by Barack Obama’s own treatment of Islam and Muslims in the unprecedented speech that he gave at Cairo University on 4 June 2009.  After he spoke, in conversation with an Indonesian journalist, Obama promised to visit—actually, to revisit—Jakarta on his next trip to Asia.  That stop is most likely to take place before or after he attends the Asia Pacific Economic Cooperation forum in nearby Singapore in November 2009.  Viewers interested in a commentary can also read Don's Obama's Trifecta: So Far, So Good.

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Over the past decade, the rise of youth movements applying nonviolent methods of resistance against autocratic incumbents occurred in the post-Soviet region. This protest cycle was set in motion by the spectacular mobilization of Serbia's social movement Otpor against Slobodan Milosevic in 2000. Similarly, Ukraine's Pora in 2004 and, to a lesser extent, Georgia's Kmara in 2003 mobilized large numbers of young people to demand political change in the aftermath of fraudulent elections. In contrast, Belarus' Zubr in 2001/2006 and an assortment of Azerbaijan's youth groups in 2005 were less effective in staging nonviolent struggle against autocratic incumbents. This paper provides an explanation for divergent social movement outcomes in non-democracies by investigating the dynamics of tactical interaction between challenger organizations and the ruling elite. The paper argues that both civic activists and autocratic incumbents engaged in processes of political learning. Hence, tactical innovation was vital to the success of youth movements, especially late risers in the protest cycle.

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Olena Nikolayenko
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As pressure builds on the White House and Congress to deliver on their promise of health care reform, the idea of a government health insurance company to compete with for-profit and not-for-profit private companies is gaining political momentum. Advocates claim that this new company would be more efficient, honest, and successful in forcing lower reimbursement rates on physicians and hospitals. However, a close look at how the present health care system functions, what its major problems are, and what reforms are needed to solve them suggests that this new idea is not the answer. The three major problems of the current U.S. system are that 45 million to 50 million people have no health insurance, the cost of care is high and rapidly increasing, and there are gross lapses in the quality of care. There is no reason to think that a government insurance company would make a significant dent in any one of these problems, let alone all three. To do that would require real reform in the financing, organization, and delivery of care.

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Sarah Catanzaro is a senior undergraduate student at Stanford University majoring in international relations and minoring in Art History. Her interest in international security studies was provoked by the September 11, 2001 terrorist attack on the Twin Towers. Living on Long Island in a community that was impacted by this tragedy, she experienced firsthand the acute anxiety and sense of vulnerability induced by terrorism and sought to understand this phenomenon through academic research. As a result, she, like Ms. Esberg worked as a research assistant for Jacob Shapiro, a former postgraduate fellow at CISAC, examining the inefficiencies and vulnerabilities of terrorist groups. Since her junior year, she has served as a research assistant for Professor Martha Crenshaw. Moreover, Sarah interned at the Center on Law and Security at New York University School of Law, where she created a database of released Guantanamo Bay detainees that now serves as a crucial research tool for the executive director of the Center, Karen Greenberg. She is also active in the Stanford community as the President of the Public Health Initiative and former Events Director of Stanford Women in Business. She looks forward to expand her knowledge and professional experiences in the field of international security in the near future.

Jane Esberg is a CISAC Undergraduate Honors Student graduating this June with a B.A. in International Relations. She currently works as a research assistant for acting co-director of CISAC, Professor Lynn Eden, investigating US nuclear war planning. Previously, she has researched for Professor Kenneth A. Schultz, CISAC Homeland Security Fellow Jacob Shapiro, and PhD Candidate Luke Condra. In Summer 2008 Jane received a Stanford in Government Fellowship to work with the International Institute for Strategic Studies (IISS) in London, in the Transnational Threats and Political Risks division. She studied abroad at Oxford University, where she completed a tutorial on "the Politics of Terrorism," and in Santiago, Chile, where she was awarded a Stanford Quarterly Research Grant to conduct independent research for use in her thesis. After graduation, she will be traveling as a Haas Center Fellow to the Tambopata region of the Peruvian Amazon to conduct a research and service project on the impact of national policy, urbanization, and immigration on agricultural sustainability.

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Sarah Catanzaro CISAC Honors Student and winner of the William J. Perry Prize Speaker
Jane Esberg CISAC Honors Student and winner of the Firestone Medal Speaker
Michael M. May CISAC Co-Director Moderator
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Background

Although the Accreditation Council for Graduate Medical Education (ACGME) limits the work hours of residents, concerns about fatigue persist. A new Institute of Medicine (IOM) report recommends, among other changes, improved adherence to the 2003 ACGME limits, naps during extended shifts, a 16-hour limit for shifts without naps, and reduced workloads.

Methods

We used published data to estimate labor costs associated with transferring excess work from residents to substitute providers, and we examined the effects of our assumptions in sensitivity analyses. Next, using a probability model to represent labor costs as well as mortality and costs associated with preventable adverse events, we determined the net costs to major teaching hospitals and cost-effectiveness across a range of hypothetical changes in the rate of preventable adverse events.

Results

Annual labor costs from implementing the IOM recommendations were estimated to be $1.6 billion (in 2006 U.S. dollars) across all ACGME-accredited programs ($1.1 billion to $2.5 billion in sensitivity analyses). From a 10% decrease to a 10% increase in preventable adverse events, net costs per admission ranged from $99 to $183 for major teaching hospitals and from $17 to $266 for society. With 2.5% to 11.3% decreases in preventable adverse events, costs to society per averted death ranged from $3.4 million to $0.

Conclusions

Implementing the four IOM recommendations would be costly, and their effectiveness is unknown. If highly effective, they could prevent patient harm at reduced or no cost from the societal perspective. However, net costs to teaching hospitals would remain high.

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Shadi Hamid
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President Bush's vision of a democratic Middle East was premised in part on the region's popular Islamist groups reconciling themselves to the give-and-take nature of democracy.

It might make sense then, that the Bush administration would do what it could to support a party that has made such a transformation in Turkey. But it's not.

Turkey's Justice and Development Party (AKP), which fashioned itself as the Muslim equivalent of Europe's Christian Democrats, has stood out by passing a series of unprecedented political reforms as the country's ruling party.

Yet the Turkish Constitutional Court - bastion of the hard-line secularist old guard - is now threatening to close down the AKP and ban its leading figures, including Prime Minister Recep Tayyip Erdogan and President Abdullah Gul, from party politics for five years. And the Bush administration, in the face of this impending judicial coup, has chosen to remain indifferent. The consequences could reach beyond a setback to democracy in Turkey and affect the Middle East.

The Constitutional Court will rule as soon as next week on an indictment accusing the AKP of being a "focal point of antisecular activities."

Turkey's Constitution establishes secularism as an unalterable principle and allows the court to ban parties it deems antisecular. But disbanding a democratically-elected party on such dubious grounds as attempting to lift a controversial ban on wearing head scarves in universities - the crux of the case against the AKP - is not how mature democracies handle divisive issues. Judges should not decide parties' fates; voters should.

Indeed, voters have flocked to the AKP since its founding by break away reformists within the Islamic movement. The party was elected in 2002 on pledges to preserve secularism and vigorously pursue Turkey's efforts to join the European Union. It also explicitly disavowed the Islamist label.

The AKP-led government then passed a series of democratic reforms that led Brussels to begin formal accession negotiations with Turkey. Those reforms, together with a booming economy, spurred 47 percent of Turks to vote for the AKP in its landslide 2007 reelection.

To be sure, the AKP's democratic credentials are hardly perfect. It has been overly cautious in repealing certain restrictions on freedom of speech, and it abruptly lifted the head scarf ban without first initiating a national dialogue.

Yet despite its flaws, the AKP is the most democratically inclined - and somewhat ironically, the most pro-Western - political party on the Turkish scene today. Closing it down would be a mistake.

A ban on a party that nearly half of the country supports could spark violence - which Turkey's secularist generals might then use as a pretext for a direct military intervention. Regardless, senior EU figures have criticized the closure case and warned that banning the AKP could gravely damage Turkey's candidacy.

Even more troubling is the message it would send to the rest of the Muslim world - no matter how much Islamists moderate, they won't be accepted as legitimate participants in the democratic process.

In recent years, mainstream Islamist groups throughout the region - including in Egypt, Jordan, and Morocco - have embraced many of the foundational components of democratic life. Yet their moderation has been met with harsh government repression, or more subtle designs to restrict their political participation.

More is at stake than may initially appear. If the AKP - the most moderate, pro-democratic "Islamist" party in the region today - is disbanded, it will strengthen those Islamists who see violence and confrontation as a surer means to influence political power.

During the past year, a number of Islamist leaders we've spoken to in Egypt and Jordan have warned that rank-and-file activists are losing faith in the democratic process, and may soon become attracted to more radical approaches. A ban on the AKP would only make it that much harder for moderates to continue making the case that participating in elections is worthwhile.

Though US Secretary of State Condoleezza Rice praises the AKP's democratization agenda, last month she said, "Obviously, we are not going to get involved in ... the current controversy in Turkey about the court case." Yet moments later she opined, "Sometimes when I'm asked what might democracy look like in the Middle East, I think it might look like Turkey." It's difficult to tell if she's referring to the new, democratizing Turkey of the past five years - or the reactionary Turkey where judges and generals flagrantly overrule the people's will.

President Bush has one last opportunity to reinvigorate the cause of Middle East democracy. By publicly denouncing the closure case, the administration would signal that the US not only supports Turkish democracy against a dangerous internal assault, but that it is also committed to defending all actors willing to abide by democratic principles in a region that desperately needs more of them.

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Shadi Hamid
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The fortunes of the Jordanian Muslim Brotherhood may be shifting after three difficult years that saw the group's worst electoral result in history, reports of diminished influence, and sustained government repression. After hitting an unprecedented low, the relationship between the Jordanian regime and the Muslim Brotherhood, the country's largest opposition grouping, has improved recently. This is the opposite of what many observers, including this author, expected. Hammam Sa'id, known as a hardliner, was elected General Guide of the organization in May 2008, leading many to predict heightened confrontation between regime and opposition. Analysts Matthew Levitt and David Schenker wrote, for instance, that the leadership change suggested the Brotherhood "can no longer be considered ‘loyal' to the kingdom." During Sa'id's tenure, however, events have moved in an unexpected direction. Since being elected, he has toned down his abrasive rhetoric, emphasized domestic priorities, and made an effort to reach understandings with the government of Prime Minister Nader al-Dahabi on key issues of contention.

The question of the Palestinian Resistance Movement (Hamas) is one area where Islamists and the regime have moved closer to each other. After nine years of severed ties, Jordan has opened a dialogue with Hamas, recognizing the group's growing influence and its strong position in Gaza. With its close ties to Hamas leaders, the Jordanian Muslim Brotherhood and its political arm, the Islamic Action Front (IAF), played a critical role in facilitating the resumption of contacts.  

Moreover, Jordan's King Abdullah-known as one of the region's most pro-Western rulers-has attempted to strengthen ties to other U.S. adversaries, including Iran and Russia. He has met with Russian President Dmitri Medvedev three times in the last eight months, and their discussions have increasingly revolved around military assistance and cooperation, including joint production of multi-caliber grenade launchers. Such moves have given Islamists hope that Jordan is beginning to shake off Washington's tight embrace.  

For their part, Islamists are drawing a degree of optimism from their improved relations with the regime. Even IAF Secretary-General Zaki Bani Irsheid, one of the government's fiercest detractors, said in a private conversation in August that Jordan may be entering a "new political phase." Coinciding with the improved ties between Islamists and the regime, relations between internal Brotherhood/IAF factions have also improved after nine months of crippling internal divisions that had threatened to tear the movement apart. In early August, so-called hawks and doves reached an agreement that left both sides content, at least temporarily. The agreement reflects what had been a difficult and sustained round of internal negotiations over a variety of contentious issues, including Bani Irsheid's pending trial by an internal IAF court for allegedly sabotaging his own party's prospects in the 2007 parliamentary elections. This agreement might have postponed further infighting, however, rather than ended it; there are still factions within the Brotherhood that hold substantially different visions on how to proceed in what remains a challenging economic and political environment.  

It is unclear what the Jordanian regime's efforts at strategic repositioning-taking into account a perceived decline in U.S. influence in the region-bode for further political opening and reform. Over the last three years, the Jordanian government interpreted U.S. silence on reform as a green light to clamp down aggressively on Islamists. However, if it continues to see a need to reach out to Hamas, the regime will    need to expand political space for the Islamist opposition and maintain a mutually beneficial working relationship with it.  

Of course, there have been bouts of optimism before, and they have been misplaced. Each time the regime has reached out to the Brotherhood, as it did in advance of the November 2007 elections, it has quickly reversed course and resumed anti-Islamist policies. Islamists are unlikely to be fooled again. Despite the optimism expressed by Bani Irsheid and others, most Islamists see this as yet another round of tactical maneuvering. The Jordanian regime is not necessarily acting in good faith; it is acting in its own self-interest. So too is the Islamist opposition.

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As part of health reforms announced in April 2009, China plans to expand and strengthen primary care (i.e., provision of first contact, person-focused, ongoing care over time, and coordinating care when people receive services from other providers). Other nations of Asia continue to grapple with how to promote population health and constrain healthcare spending. What is the evidence about the effectiveness of primary care in improving population health and making healthcare accessible and affordable?

In this talk, Dr. Starfield will speak about the robust evidence of the association between primary care and better health outcomes at lower cost; ways of measuring the effectiveness of primary care; how selected Asian countries compare in such rankings; and the broader implications of primary care research for health policy in Asia.

Dr. Starfield, a physician and health services researcher, is internationally known for her work in primary care; her books, Primary Care:  Concept, Evaluation, and Policy and Primary Care: Balancing Health Needs, Services, and Technology, are widely recognized as the seminal works in the field.  She has been instrumental in leading projects to develop important methodological tools, including the Primary Care Assessment Tool, the CHIP tools (to assess adolescent and child health status), and the Johns Hopkins Adjusted Clinical Groups (ACGs) for assessment of diagnosed morbidity burdens reflecting degrees of  co-morbidity.   She was the co-founder and first president of the International Society for Equity in Health, a scientific organization devoted to furthering knowledge about the determinants of inequity in health and ways to eliminate them.  Her work thus focuses on quality of care, health status assessment, primary care evaluation, and equity in health. She is a member of the Institute of Medicine and has been on its governing council, and has been a member ofthe National Committee on Vital and Health Statistics and many other government and professional committees and groups. She has a BA from Swarthmore College, an MD from the State University of New York, Downstate Medical Center, and an MPH from Johns Hopkins University School of Public Health.

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Barbara Starfield University distinguished professor and professor of health policy and pediatrics Speaker Johns Hopkins University
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