In conversation with Shorenstein APARC, Karen Eggleston, center fellow and director of the Asia Health Policy Program, reflects on her initial draw to Asian studies and eventual focus on comparative Asia health policy. She also shares perspectives on health reform in China and demographic change across East Asia, and talks about related upcoming activities.
How did you begin in Asia health policy?
I have long been interested in Asia in general. My initial appeal to the region came from my family’s roots (my grandfather taught Korean history at Berkeley) and early international travel. Only much later in graduate school did I come to the area of economics as a discipline and health policy as my specialty; however, I had been attracted to economic development and social policy in Asia earlier on. I started with an undergraduate degree in Asian studies, which followed with a Masters degree in Asian studies specifically focused on China and Korea. During graduate school, my father-in-law introduced me to unique perspectives, as he was a physician in China. When he visited the United States to present his work, I helped translate his findings. As my career developed, I had the privilege of working with many inspiring health economists, and economists interested in health policy, some of whom acted as my mentors at Harvard and here at Stanford - János Kornai, Victor Fuchs, Joseph Newhouse, Richard Zeckhauser, and Jay Bhattacharya, to name a few. These experiences helped to further narrow my focus and interests.
What led you to Stanford?
It was extremely exciting when the opportunity arose to come to Stanford. The university is a world-class learning environment and is unique in having a health policy program focused on Asia. I was recruited to the Shorenstein Asia-Pacific Research Center at the founding of the Asia Health Policy Program. The Program is distinctive given its comparative approach focusing on the Asia-Pacific region, which differs from most other institutions. The west coast is also geographically closer to Asia, so you get a ‘flavor’ and infusion of Asian studies here more so than on the east coast. Not to mention, it was a delight to come back to my home state of California after many long years of New England winters.
To be a successful scholar of global health policy, what tools or perspectives should one be informed about?
Global health policy is a very complex field, and can be approached many ways. This, of course, makes it both exciting and challenging. My own approach is through the lens of economics. If you are looking at research and evidence-based policy, it can be beneficial to have either a social science background or a medical-clinical discipline (or both), perhaps combined with a specific geographic focus. Knowing about the history, culture, and institutions are very important for understanding health policy challenges. It also helps to build capacity within that region of focus. Partnering with practitioners and scholars in the country or region allows you to know what is really happening on-the-ground, and feed the research back into local policy decisions. I also think it is important to emphasize evidence over ideology – for example, to keep clear in your mind whether you are more of a policy advocate or academic. A scholar can play varying roles at different times in their careers, but it isn’t easy to do both fully at once.
As China’s population and social inequalities continue to grow, are its current governance structures sustainable?
Even though political economy is not my expertise, institutions and how they adapt to a society’s needs is pertinent to anyone looking at health reform. For example, in China, there has been a lot of debate since the leadership transition and its implications for national health administration. Should health policy be led solely by the Ministry of Health, now the Health and Family Planning Commission? The Ministry runs the hospitals but is not in charge of the urban insurance system – this falls to Labor and Human Resources. Other branches of government administer regulation, pricing and other aspects of health policy. And of course the Ministry of Finance, and National Development and Reform Commission, play key roles. Like many countries, China has over 14 different ministries and agencies that are involved in the organization of its health system. Thus a relevant question is: who is in charge of taking the next step and coordinating between those entities? A health reform office was established directly under the State Council. Population aging is another issue that spans multiple sectors and policymaking entities. The Chinese government will be impelled to adapt its policies to face new challenges.
What are the connections between health policy and demographic change? Can you tell us about your upcoming work?
One important connection between health policy and demographic change is that the burden of disease changes as the population changes. A country with a large young population (like India) will have a different burden of disease than a country with a large older population (like Japan). If fertility and mortality rates decline, the burden of disease shifts toward chronic, non-communicable disease incidence. Partly, this trend reflects a ‘triumph’ from control of infectious disease and the demographic transition (with longer lives and lower fertility), but then it presents a new set of challenges for society to deal with problems of that older population. Some of my work compares China and India, which have similarities in size and socio-economic diversity. This May, I am helping to organize a conference at the Stanford Center at Peking University in Beijing with my Stanford colleagues Jean Oi, Scott Rozelle and Xueguang Zhou, and our collaborators at the PRC National Development and Reform Commission. The conference will compare urbanization and demographic trends in China and India. It is envisioned that the conference will lead to two separate book projects – one on urbanization in China in comparative perspective and another on demographic change in China and India. We will also present findings that were an outcome of a three-year research project, with initial findings published in The Journal of Asian Studies.
Tell us something we don’t know about you.
In my youth, I was very much into equestrian vaulting and played the violin. As one of my mentors said to all his students, ‘you might not be the world’s best at any one category, but if you look at the overlap between different categories, you could be distinctive.’ So I might very well be one of the world’s only horse-vaulting, violin-playing health economists, for what it’s worth.
The Faculty Spotlight Q&A series highlights a different faculty member at Shorenstein APARC each month giving a personal look at his or her scholarly approaches and outlook on related topics and upcoming activities.