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The Program on Arab Reform and Democracy (ARD) at Stanford’s Center on Democracy, Development, and the Rule of Law (CDDRL) is pleased to welcome Egyptian economist Samer Atallah as a visiting scholar for the 2015-16 academic year. Atallah has taught economics at the American University in Cairo (AUC) since 2011, and his work focuses on development economics and political economy of democratization. He is a leading contributor to debates on economic public policy in Egypt, and previously served as an advisor to the 2012 presidential campaign of Abdel-Moneim Abul-Fettouh. He holds a PhD in Economics from McGill University and a Masters Degree in Engineering from University of California, Berkeley. His research on the Arab world has received the support of the Arab Council for Social Sciences and the Economic Research Fund, and spans a wide range of areas, including; education, electoral behavior, public opinion, trade policies, and political institutions in resource dependent economies.

During his residency at CDDRL, Atallah will work on a series of publications examining salient questions in the political economy of the Arab World, including the impact of trade and capital flows on governance in Egypt and Tunisia, and the relationship between education and wealth inequality in Egypt. Atallah’s fellowship is generously funded by a grant from the Carnegie Corporation to support scholars from the Arab world. In the following interview, Atallah discusses his current research projects and their relevance to important public policy debates.

 

What are your research goals and priorities during your residency at CDDRL?

First of all, I would like to say that I am extremely delighted to be here and excited at this valuable opportunity to collaborate with distinguished scholars at CDDRL and Stanford University, which promises to be a nourishing environment for my research. 

My research agenda during my residency here at CDDRL includes working on two projects, both of which are related to broader questions of democratization and development. This first one is a comprehensive theoretical and empirical study investigating how political and economic institutions evolve as economies become integrated in the global economy. I am interested in understanding how trade and capital flows impact institutions - in the economic sense of the term - and the implications of that impact on political change. For instance, the experiences of economic liberalization in countries like Egypt and Tunisia had unquestionable consequences on the distribution of wealth within their respective societies. Economic liberalization policies had equally important effects on the performance and evolution of their legal, economic governance and political institutions. My own research seeks to investigate how these institutional changes have evolved and the impact of these processes on political change.  The second project is an empirical study examining the relationship between wealth inequality and educational inequality in Egypt.

 

In what ways do your projects speak to contemporary debates on the origins and trajectories of the Arab uprisings?

I would argue that the divergence in outcomes across the various uprisings in Arab region cannot be understood without seriously thinking about the different historical evolution of political and economic institutions in these countries. These institutions impact the functioning of the economy, its growth, and the social inclusiveness of that growth—factors that were very pertinent to the popular mobilization that advanced the post-2010 uprisings. Certainly these institutions are in part the product of how the economy is managed in a given country in the short-run. At the same time, they are the result of long-term external and internal factors that we need to investigate and understand.

A case in point is the bureaucratic apparatus in Egypt. That sizable bureaucracy is the outcome of a long-standing policy of guaranteed employment, which the government had adopted in the 1960s to secure political support. Whereas economic liberalization policies adopted by President Anwar al-Sadat in the 1970s shrunk the economic role of the state, the size of the bureaucracy, nevertheless, increased significantly. Thus, the question we confront as researchers is why have these institutions remained stagnant and shielded from change despite the fact the nature and priorities of the economy have shifted. This is a major concern in my own research.

 

What lessons, if any, does your work offer policy-makers involved in the areas of economic and human development?

My second project on inequality and education speaks to one of the central factors that have animated the post-2010 uprisings in the Arab world, namely economic inclusion. In the context of Egypt, educational inequality has contributed greatly to the huge disparities in income and wealth in the country. Exacerbating and reinforcing these disparities is an intergenerational dependency in educational attainment—that is, children of uneducated parents are highly likely to remain uneducated, and by implication, economically underprivileged. This is an area that leaves a lot of room for policy interventions.

But such interventions must be grounded in a better understanding of the causes of this dependency and why it persists. Toward that end, my research seeks to investigate how the type and range of assets in a given household affect schooling and education decisions. Other key determinants of these decisions include access to credit, spatial distribution of educational facilities, and volatility of household income. With a sufficiently nuanced understanding of the problem at hand, all of these factors present potential areas for policy interventions to alter the incentives for school enrolment and quality of education delivery. Such interventions could potentially lead to a better distribution of education and income in the long run.

 

What are the potentially important research questions that address Arab reform and democracy?

I believe the recent upheavals in the Arab world have pushed us to re-evaluate our understanding of the underlying reasons and implications of political and economic change. This has opened up a multitude of lines of inquiry related to the economic incentives and costs of political change. One such endeavor entails an ambitious effort to compare the evolution of social movements, economic policies, and political structures in the Arab world with other regions of the world. For instance, I think we could draw multiple parallels between the Arab experience and that of many Latin American countries, especially with respect to the role of military institutions, the impact of economic liberalization, social inequality, and civil society movements. Having said that, there is also a lot of work that needs be done in understanding and analyzing the divergent outcomes of the Arab uprisings.

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As part of a talk titled "Tunisia's Pathway to Democracy," former Tunisian Ministry of Industry, Energy, and Mines Kamel Ben Naceur spoke at the Program on Arab Reform and Democracy on March 2, 2016 about his experience in the 2014 technocratic government, which was tasked with helping bring the country's democratic transition back on track after a period of political turbulence. Mr. Ben Naceur, who is currently the Director for Sustainability, Technology, and Outlooks at the International Energy Agency, discussed how the technocratic government managed the challenges of organizing the country’s first fully democratic presidential and legislative elections, re-establishing security, and restoring economic fundamentals. He also examined the prospects for democratic and economic development in Tunisia one year after the appointment of the government that resulted from the 2014 elections.


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In a recent op-ed piece in The Washington Post, FSI Senior Fellow Larry Diamond and Peter Ackerman, chairman of Level the Playing Field, highlight  the need to ease restrictions that disincentivize third party candidates from running in US presidential elections: "It would be great if Bloomberg decided to run and give the American voter a nonpartisan choice for president in 2016. But what about 2020 and beyond? We think serious and compelling independent candidates would be willing to run for president if they could count on a fair fight between them and the major party nominees."

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One of the key objectives of introducing a compulsory health insurance is to provide citizens, regardless of socioeconomic status, with financial risk protection against unexpected catastrophic expenditures in the face of illness.  South Korea and Taiwan achieved universal health coverage (UHC) through mandatory social insurance schemes in 1989 and 1995, respectively.  Despite both countries' efforts to achieve the goal of financial risk protection for more than two decades, past research has demonstrated that household out-of-pocket (OOP) payment still accounts for more than one-third of total health expenditures in both countries.  When OOP payment represents a significant share of financial sources for health care, one should be particularly concerned about the distribution of such payments, in particular, catastrophic health expenditures, across households of differing economic levels.  This talk sets out to examine the change in the incidence and distribution of catastrophic health expenditures before and after the introduction of the National Health Insurance programs in South Korea and Taiwan.

 

Given similarity in the health and National Health Insurance (NHI) system characteristics observed in South Korea and Taiwan, substantial variation in the distribution of catastrophic payment among households was noted. The rich are more likely to incur catastrophic payment in South Korea, but the opposite trend is noted in Taiwan.  Further assessment on the impact of universal health coverage (UHC) on reducing catastrophic headcount (defined as the proportion of households incurring catastrophic health payment) is observed in Taiwan, but not in South Korea.  We found that when South Korea introduced the NHI program with a limited benefit package and high copayment, it produced little effect (if not none) in reducing financial burden in terms of proportion of catastrophic headcount. On the contrary, the impact of universal health coverage on catastrophic headcount ranged from -1.82% to -4.08% for Taiwan, due to the provision of a rather comprehensive benefit package with modest copayment. While UHC is a well-lauded policy goal and may be a magic word for many countries striving for the achievement, it is definitely not a panacea to resolve the incidence of catastrophic payment and potential medical impoverishment.  To provide sufficient financial protection against unexpected medical expenses, the design of the benefit coverage and risk sharing mechanism is key to the success of effectively achieving UHC. 

 

Bio

Jui-fen Rachel Lu, Sc.D., is the Fulbright Visiting Scholar at Center for East Asian Studies, Stanford University, and a Professor at Chang Gung University (CGU) in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of College of Management (2010-2013).  She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005).  Prof. Lu is currently the President of Taiwan Society of Health Economics (TaiSHE) and an Honorary Professor at Hong Kong University (2007-2017).  Dr. Lu was also the recipient of IBM Faculty Award in 2009.   

 

Her research focuses on 1) the equity issues of the health care system; 2) impact of the NHI program on health care market and household consumption patterns; 3) comparative health systems in Asia-Pacific region.  She is a long-time and active member of Equitap (Equity in Asia-Pacific Health Systems) research network and was the coordinator for the catastrophic payment component of Equitap II research project which involved 21 country teams and was jointly funded by IDRC, AusAID, and ADB.  Professor Lu has also been appointed to serve as a member on various government committees dealing with health care issues in Taiwan.  

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Rachel Jui-fen Lu Visiting Scholar, Center for East Asian Studies Stanford University
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As part of the Program on Arab Reform and Democracy's speaker series, George Mason University scholar Bassam Haddad explained the roots and dynamics of the tragic Syrian uprising, with particular attention to its background and to the recent Russian intervention, in a talk dated January 22, 2016. After nearly five years since the start of the uprising, Syria finds itself divided and embattled, with no end in sight. More significantly, more than half of the Syrian population is displaced and the death toll surpassed 300,000 by all counts. The Syrian tragedy persists and, more than any other case of mass uprising in the region, continues to be shrouded in political power-plays and contradictions at the local, regional, and international levels, Haddad explained.


 

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After having witnessed the beginning of the Arab Spring in December 2010, and the ouster of former President Zine El Abidine Ben Ali in January 2011, Tunisia went through a period of intense political turbulence, including a rapid succession of governments and a paralyzing political gridlock in the summer of 2013. The Tunisian national dialogue quartet, which represented the major stakeholders in civil society and is the recipient of the 2015 Nobel Peace Prize, paved the way for a technocratic government that helped bring the country’s democratic transition back on track. After discussing the conditions that led to these developments, this presentation will focus on how the technocratic government managed the challenges of organizing the country’s first fully democratic presidential and legislative elections, re-establishing security, and restoring economic fundamentals. Finally, the presentation will discuss the prospects for democratic and economic development in Tunisia, one year after the appointment of the government that resulted from the 2014 elections.

 

Speaker Bio

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Kamel Ben Naceur is the Director for Sustainability, Technology, and Outlooks at the International Energy Agency and previously served as Minister of Industry, Energy and Mines of Tunisia in a government that was tasked in 2014 with leading the country’s first fully democratic elections and resorting its economic fundamentals. He has more than thirty-four years of experience and knowledge in the energy and industry sectors around the world in both public and private service. Mr. Ben Naceur served in various leading positions at the energy multinational Schlumberger, including Chief Economist in Paris, President of the Schlumberger technology organization in Rio de Janeiro, and Senior Advisor and Vice President for technology. He has served on several boards of international businesses and organizations, and is the co-author of thirteen books and more than 120 articles. A French-Tunisian dual national, Mr. Ben Naceur is a graduate of Ecole Polytechnique and Ecole Normale Supérieure of France, with an Agrégation de Mathématiques.

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Kamel Ben Naceur Director for Sustainability, Technology, and Outlooks International Energy Agency
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