India is facing a mounting burden of noncommunicable diseases (NCDs) such as diabetes, cancers, and cardiovascular diseases. NCDs affect more than 20 percent of the Indian population and their prevalence is projected to expand substantially as the population aged 60 and over increases. Left unchecked, the costs of managing chronically ill and aging sectors of the population grow exponentially.

To control costs and address the growing chronic disease burden, India’s public programs must integrate curative hospital services with the most cost-effective preventive and primary interventions, argue Karen Eggleston, APARC’s deputy director and the director of the Asia Health Policy Program (AHPP), and Radhika Jain, a postdoctoral research fellow with AHPP. India must also urgently expand and improve the evidence base on economic evaluations of both preventive and curative health interventions in the country.

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In a correspondence piece published by BMC Medicine, Eggleston and Jain examine the features and limitations of a study that takes an important first step in that direction: a cost-effectiveness study of the Kerala Diabetes Prevention program (K-DPP) that adds such evidence on how to prevent diabetes cost-effectively in India and other low- and middle-income countries.

The study’s authors present a cost-effectiveness analysis of 1007 participants in the K-DPP, and their estimates indicate that K-DPP was cost-effective. Indeed, Eggleston and Jain determine that the analysis shows potential cost-effectiveness in “nudging” the participants towards a healthier lifestyle through suggestive reductions in tobacco and alcohol use and waist circumference. The results of the cost-effectiveness analysis of the K-DPP “highlight the importance of continued research on community-based promotion of healthy lifestyles,” say Eggleston and Jain.

Evidence-based approaches to chronic noncommunicable disease intervention are essential for providing cost-effective care and creating models for future programs like the K-DPP. Eggleston and Jain conclude that future studies advancing evidence-based approaches to chronic noncommunicable disease intervention — ones that cover larger and more representative populations over longer time periods — remain important for more generalizable assessments to inform policy decisions.

As the COVID-19 pandemic continues to take massive tolls on lives and livelihoods at home and abroad, students have been thrown into turmoil and are facing uncertainties about funding, graduation, research opportunities, and career choices. At Shorenstein APARC, we are committed to supporting Stanford students as best we can. We are therefore announcing today new quarter-long research assistantships for current undergraduate and graduate students working in the area of contemporary Asia. These opportunities are in addition to our recent internship and fellowship offerings.

Guidelines

Shorenstein APARC is seeking to hire motivated and dedicated undergraduate and graduate students as paid research assistants who will work with assigned APARC faculty members on projects focused on contemporary Asia, studying varied issues related to the politics, economies, populations, security, foreign policies, and international relations of the countries of the Asia-Pacific region.

2020-21 research assistant positions will be offered in the fall, winter, spring, and summer quarters. We expect to hire up to 10 research assistants per quarter.

Application Cycles
Students should submit their applications by the following deadlines:

• Applications for fall 2020 by September 1, 2020;
• Applications for winter 2020 by December 1, 2020;
• Applications for spring 2021 by March 1, 2021.
   

The positions are open to current Stanford students only. Undergraduate- and graduate-level students are eligible to apply.

All positions will be up to 15 hours per week for undergraduate students and up to 20 hours per week for graduate students (minimum of 10 hours per week). The hourly pay rate is $17 for undergraduate students, $25 for graduate students.

Hiring is contingent upon verification of employment eligibility documentation.

The fall-quarter employment start date is September 16, 2020.

Successful candidates may request appointment renewal for a consecutive quarter.

Apply Now

• Complete the application form and submit it along with these 3 required attachments:
  • CV
  • A cover letter (up to 1 page)
  • Completed Student Information Sheet
• Arrange for a letter of recommendation from a faculty to be sent directly to APARC. Please note: the faculty members should email their letters directly to Kristen Lee at kllee@stanford.edu.
   

We will consider only applications that include all supporting documents.

We are delighted to share that Young Kyung Do, APARC’s inaugural postdoctoral fellow in Asia health policy (2008-9), has won the 2020 Rothman Epidemiology Prize. The prize is awarded annually for the best paper published in the journal Epidemiology in the preceding year. Dr. Do is a professor in the Department of Health Policy and Management and director of the Institute of Health Policy and Management at the Seoul National University College of Medicine.

Dr. Do’s winning paper, titled “Causal Effect of Sleep Duration on Body Weight in Adolescents: A Population-based Study Using a Natural Experiment,” appeared in the November 2019 issue of Epidemiology. It provides new, population-level, causal evidence that corroborates consistent findings in the epidemiologic literature on the relationship between reduced sleep and increased body weight, particularly in children and adolescents.

Dr. Do’s study uses a unique natural experiment that arguably increased the sleep duration of adolescents in South Korea, where authorities in three of the 16 administrative regions required private tutoring institutes to close at 10 PM instead of later at night. This policy change was associated with sleep gain and body weight reduction in a subset of high school students whose sleep duration would otherwise have not increased. The natural experiment made it possible to study a population-wide sleep gain, thus providing evidence for a potential effective public health intervention.

An earlier version of this winning paper first appeared in our Asia Health Policy Program’s working paper series. The series is open to scholars and health policy experts from around the world and disseminates their papers to a broad international audience through the Program’s website and scholar network and in collaboration with the Social Science Research Network. The Asia Health Policy Program sponsors and manages the Asia health policy postdoctoral fellowship at APARC. Each year, it offers a fellowship position to a recent doctoral graduate.

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This is the third installment in our series, “Stories in a Time of Pandemic,” in which APARC alumni across Asia share their perspectives on the responses to and implications of COVID-19 in their communities. In part 1 and part 2 of the series, we feature observations from our alumni in China, Mongolia, Myanmar, and Singapore.

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The first case of COVID-19 in the Philippines was reported on January 30, 2020, and local transmission was confirmed on March 7, 2020. As of May 21, the number of cases of COVID-19 has risen to 13,434 and the number of deaths attributed to the virus increased to 846, according to the Philippine Department of Health COVID-19 Case Tracker. It is quite alarming that among the ASEAN countries, the Philippines had the second-highest mortality due to COVID-19, next to Indonesia (as per May 5 date by the WHO COVID-19 Dashboard). This could be attributed to several factors, including whether the country’s health system can handle the overwhelming demand for health care due to the COVID-19 crisis and how effective the government’s response is in stemming the spread of this new pathogen. Inherent in the death statistics is the capacity of a country to conduct COVID-19 tests, which means that there should be a sufficient number of test kits available and that the health workers are properly trained to conduct the tests, trace the contacts, and isolate identified individuals.

The President of the Philippines imposed a total lockdown called enhanced community quarantine (ECQ) for the entire island of Luzon, which encompasses eight administrative regions, including the national capital region, from March 15 to April 30. Other parts of the country have also been under some degree of quarantine at different periods since the appearance of local transmission. Executive Order 112, signed on April 30, 2020, was issued to further extend the ECQ in identified high-risk areas and a general community quarantine (GCQ) in the rest of the country. The inter-agency task force for the management of emerging infectious diseases defines ECQ as the implementation of temporary restrictions on the mobility of people, strict regulations of industries, and a heightened presence of uniformed personnel. GCQ is, in a nutshell, a less strict version of ECQ.

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Image captured from the Center for Strategic and International Studies, Southeast Asia COVID-19 Tracker, May 21, 2020.

The Philippines has faced a lot of challenges during this crisis. First, the health system lacks adequate surge capacity to safely handle a nationwide outbreak of COVID-19 due to shortages of personal protective equipment (PPE), mechanical ventilators, and hospitals with ICUs and isolation beds (see this World Bank report and this Rappler article). More importantly, the insufficient number of health workers, especially in areas outside the metropolitan, is a major concern. Nonetheless, the Department of Health has worked hard to meet the surge in demand due to COVID-19, including partnering with the private sector to repurpose structures and providing data to the public to ensure transparency and accountability. As in other countries, the health workers and those with frontline responsibilities have truly been the new heroes or “bayani” with their tireless efforts and sacrifices. 

Another challenge pertains to the adverse economic impact of COVID-19. The Philippines has a relatively large informal sector and the income of many families depends on daily transactions with no formal job or social security. This has prompted the government to extend cash or in-kind support to vulnerable populations – a response that has posed several challenges, particularly related to the who/what/how framework. First, the Philippine government had to properly identify those in need (who). Second, it had to ensure that sufficient resources can be allocated to the identified groups (what). And third, it had to distribute aid in an efficient, timely, and equitable way (how). The government's social welfare efforts to provide for the vulnerable groups have mixed results: at times, the distribution of aid is organized and efficient, at other times insufficient and disorderly (see these CNN Philippines reports of April 7 and April 30).

COVID-19 in the Philippines – How Filipinos Have Coped

There has been a strong spirit of “bayanihan” or collectivism in the country amidst the COVID-19 crisis. People are volunteering, distributing goods to vulnerable groups, or donating PPE to those with frontline duties. Some enterprises also rose to the occasion by repurposing their businesses to meet the local demand for medical products and PPE.

Different individuals have coped differently: some have welcomed the work hiatus that the quarantine has afforded them, some connected more with friends and family, others become more productive working from home. Staying healthy and being mindful are also factors that contribute to remaining calm and rational in this time of national distress.

Despite the challenges, we will continue to face, especially once the quarantine has eased and the new normal is in effect, we can say that Filipinos have also learned some valuable lessons amid this crisis. For one, Filipinos have become more mindful of the importance of good sanitation and non-pharmaceutical public health measures in mitigating the transmission of the virus. Most Filipinos have also become more proactive in their approach, keeping social distance, wearing masks, and practicing proper handwashing, among others. Furthermore, this crisis has redefined and created new heroes who rose to the challenge – from those staying at home to avoid the further spread of the virus to those on the frontline who have dedicated their time and effort to combat the pandemic, to government and business leaders who have served the country sincerely during this crisis.

Perhaps there really is a silver lining in every cloud.

What are the Chinese government’s objectives for the development of its healthcare system? How do these ambitions affect its interaction with U.S. and other foreign healthcare markets? And what policy recommendations should lawmakers consider regarding the development of China's healthcare system and its implications for U.S. national interests? These are some of the questions that APARC Deputy Director and Asia Health Policy Program Director Karen Eggleston discussed in her testimony before the U.S.-China Economic and Security Review Commission on May 7, 2020.

Watch Eggleston’s testimony (start time 23:25]