Society

FSI researchers work to understand continuity and change in societies as they confront their problems and opportunities. This includes the implications of migration and human trafficking. What happens to a society when young girls exit the sex trade? How do groups moving between locations impact societies, economies, self-identity and citizenship? What are the ethnic challenges faced by an increasingly diverse European Union? From a policy perspective, scholars also work to investigate the consequences of security-related measures for society and its values.

The Europe Center reflects much of FSI’s agenda of investigating societies, serving as a forum for experts to research the cultures, religions and people of Europe. The Center sponsors several seminars and lectures, as well as visiting scholars.

Societal research also addresses issues of demography and aging, such as the social and economic challenges of providing health care for an aging population. How do older adults make decisions, and what societal tools need to be in place to ensure the resulting decisions are well-informed? FSI regularly brings in international scholars to look at these issues. They discuss how adults care for their older parents in rural China as well as the economic aspects of aging populations in China and India.

-

Life expectancy at aged 65 is remarkably similar in the three Chinese cities of Hong Kong, Shanghai, and Taipei, even though the cities differ in levels of socioeconomic development, health systems, and other factors. Edward Jow-Ching Tu will discuss research that aims to understand this phenomenon. Despite unprecedented increases in life expectancy and attainment of similar current levels of life expectancy, the cities differ in the contributions of changes in major causes of death to the improvements in life expectancy among the elderly. Tu and colleagues have explored several possible determinants of these different patterns and trends in the three cities, including socioeconomic development, health service delivery systems, cause-of-death classification systems, and competing risks from cardiovascular disease and other diseases. Their analysis suggests that the effect of equity of health service delivery has become more important over time.

Edward Jow-Ching Tu is a senior lecturer of demography in the Division of Social Science at Hong Kong University of Science and Technology. His work is focused on the impact of fertility, mortality, and migration on socio-economic changes in East Asia countries with special emphasis on nations experiencing a transition from planned economy to market economy; on causes and impacts of mortality changes and health transition on aging societies; and on the causes of lowest-low fertility in many East Asia countries. He has several active research projects ongoing in China, Japan, Taiwan, Hong Kong, and Singapore. He holds graduate degress from West Virginia University, the University of Pennsylvania, and the University of Tennessee (Knoxville). Tu has worked extensively in Asia, and has served as an adjunct professor and taught in many universities in China, including Peking University, Peoples University, Nankai Univerity, and Fudan University. He had served as a senior research scientist at the New York State Health Department and as a research fellow (full professor) at the Institute for Social Sciences and Philosophy at Academia Sinica. Tu has also taught at the State University of New York in Albany.

Philippines Conference Room

Edward Jow-Ching Tu Senior Lecturer of Demography at the Division of Social Science Speaker Hong Kong University of Science and Technology
Seminars
-

The physiological factors underlying links between health and socioeconomic position in the Russian population are important to investigate. This population continues to face political and economic challenges, has experienced poor general health and high mortality for decades, and has exhibited widening health disparities. Dr. Dana A. Glei and colleagues used data from a population-based survey of Moscow residents 55 and older to investigate whether physiological dysregulation mediates the link between socioeconomic status and health. She will discuss the the results of their study, which revealed large educational disparities in health outcomes and physiological dysregulation, especially in men.

Dana A. Glei is a senior research investigator at Georgetown University and has worked on the Social Environment and Biomarkers of Aging Study (Taiwan) since 2001. From 2002 to 2009, she also served as project coordinator for the Human Mortality Database, a collaborative project involving research teams at the University of California, Berkeley and the Max Planck Institute for Demographic Research. Over the past 18 years, she has published articles on a variety of topics related to health, mortality, marriage and the family, and poverty. Her current research focuses on sex differences in health and mortality, the impact of stressors on subsequent health, and how bioindicators mediate the links between psychosocial factors and health outcomes. She has an MA from the University of Virginia and a PhD from Princeton University.

Philippines Conference Room

Dana A. Glei Senior Research Investigator Speaker Georgetown University
Seminars
Authors
News Type
News
Date
Paragraphs

Newly printed “no smoking” signs went up across China when the government rolled out a nationwide public indoor smoking ban in May 2011. A sticky gray layer of smoke residue now coats many signs, representing the challenges China’s growing tobacco-control movement faces against a multibillion-dollar government-run industry and deeply embedded social practices.

How has the cigarette become so integrated into the fabric of everyday life across the People’s Republic of China (PRC)?

To get to the heart of this question, historians, health policy specialists, sociologists, anthropologists, business scholars, and other experts met Mar. 26 and 27 in Beijing for a conference organized by Stanford’s Asia Health Policy Program. They examined connections intricately woven over the past 60 years between marketing and cigarette gifting, production and consumer demand, government policy and economic profit, and many other dimensions of China’s cigarette culture.

Anthropologist Matthew Kohrman, a specialist on tobacco in China, led the conference, which was held at the new Stanford Center at Peking University. In an interview, he spoke about the history of China’s cigarette industry, cigarettes and society, and the tobacco-control movement.

The early years

Tobacco first entered China through missionary contact in the 1600s, says Kohrman, but it was not until the early 20th century when cigarettes began gaining popularity. The first cigarette advertising was a “confused tapestry” of messages as marketers figured out what spoke to the public. “There were just as many images of neo-Confucian filial piety as there were of cosmopolitan ‘modern women,’” says Kohrman.

Through improved marketing and aggressive factory building, British American Tobacco and Nanyang Brothers, China’s two largest pre-war firms, helped increase the demand for cigarettes. The Sino-Japanese War (1937–1945) disrupted the cigarette supply, but their popularity had taken hold. Some cigarette firms shifted during the war to the relative safety of southwest China, where tobacco production has remained concentrated ever since.

Post-1949

After the founding of the PRC in 1949, the tobacco industry was nationalized and strong relationships between the central government and cigarette manufacturers in the provinces were formed. Cigarettes also began to be viewed as a part of everyday life. “Ration coupons for cigarettes were issued alongside grain, sugar, and bicycle coupons,” says Kohman. “The Maoist regime legitimized cigarettes as the right of every citizen."

During the Deng Xiaoping era (1978–1997), China’s cigarette industry really took off as manufacturers competed with one another for foreign currency to purchase cutting-edge European equipment and newer varieties of tobacco seed stock. Increased production and the return of full-scale advertising fueled greater consumer demand, and manufacturers began producing more and more varieties of cigarette. Vendors displayed glass cases filled with a colorful patchwork of cigarette packs bearing names like Panda, Double Happiness, and Red Pagoda.

The tobacco industry remained under government control as other industries privatized in the 1980s and 1990s. Party-state management of the cigarette became even more centralized in the early 1980s with the creation of the China Tobacco Monopoly Administration and its parallel external counterpart, the China Tobacco Corporation.

Since 1949, provincial protectionism has marked the cigarette market. It is now possible to purchase Beijing cigarettes in Kunming, Chengdu brands in Shanghai, and so on, but to distribute cigarettes in another province, a manufacturer must cut a deal with provincial government officials. Provincial administrations are loath to cut such deals because central government policy dictates that the portion of cigarette sales tax which does not go to the central government always is channeled to the finance bureau of the province of original production. China’s 2001 entry into the World Trade Organization opened the market ever so slightly to international brands like Marlboro and Kent, but domestic brands continue to dominate because of fierce protectionism.

...If it chooses to do so, China is in a position to lead and change the landscape in a very profound way.
-Matthew Kohrman, Professor of Anthropology, Stanford

A new era

In 2003, the World Health Organization established the first global health treaty, the Framework Convention on Tobacco Control (FCTC). Although the United States still has not yet ratified the FCTC, China signed the treaty in 2003 and ratified it in 2005. Kohrman says China’s tobacco industry giants fear competition from international cigarette brands more than they worry about tobacco-control measures related to the FCTC.

Nonetheless, the FCTC ushered in a new era of public health research about tobacco and has helped increase public awareness about the dangers of smoking. New restrictions have been imposed on print and television advertising for cigarettes, and international organizations, such as the Bloomberg Family Foundation, have begun funding anti-tobacco work in China.

A big challenge to tobacco-control campaigns, says Kohrman, is the sheer amount of money that tobacco companies have available for marketing. “In 2010, China’s tobacco industry posted profits in excess of U.S. $90 billion—that’s huge. Tobacco control research and advocacy now annually receive a few million dollars, and much of that is coming through outside funders, which have very specific projects in mind.”

China’s tobacco advertisers have adapted to the new restrictions that prevent them from openly promoting cigarettes in the media. They have instead moved to point-of-sale and soft-marketing tactics, including misinformation campaigns about the “dangers” of quitting smoking. “The actual expenditure on marketing probably hasn’t dropped very much,” says Kohrman.

Cigarettes and society

Strong marketing and the legitimization of cigarettes as a part of everyday life have led to the deep integration of cigarettes into Chinese society. While only 3 to 4 percent of women in China smoke, cigarettes are an important part of male identity and social mobility. The wide range of cigarette brands has led to the growth of high-end varieties favored by businessmen and politicians, with some brands costing as much as $50 a pack. The custom of cigarette gifting has existed in China for decades, and it is difficult for a young man to turn down a package of cigarettes from a senior colleague or supervisor.

There is also the fact that nicotine is highly addictive, and quitting is difficult in an environment where smoking cigarettes is socially sanctioned. Kohrman says, “When you take an incredibly addictive substance like nicotine and throw it into the mix of all of these norms and customs, it creates a pretty toxic brew.”

The future?

Tobacco control presents a formidable challenge in China, one that requires understanding the historical context and complex dimensions of the cigarette industry. “Cigarettes have been insinuated into so many aspects of daily life across China, and the market for this product has now become so closely enmeshed with matters of government finance and operations,” says Kohrman.

What happens in China could have implications for the entire world. “There’s a tobacco-induced human annihilation unfolding right now in almost every country and questions about how society and Big Tobacco are enmeshed, and how cigarette culture and government finance have become mutually supportive are pivotal,” says Kohrman. “Every country except Bhutan has legalized cigarette sales and is subject to many of the same general issues as China—only in China they’re on a much larger scale. But if it chooses to do so, China is in a position to lead and change the landscape in a very profound way.”   

Hero Image
PandaCigarettes NEWSFEED
Premium Chinese cigarette brand Panda for sale in a duty-free shop at Dubai's airport.
Flickr/Bernard Oh
All News button
1
Paragraphs

Emerging infectious diseases (EIDs) pose international security threats because of their potential to inflict harm upon humans, crops, livestock, health infrastructure, and economies. The following questions stimulated the research described in this paper: What infrastructure is necessary to enable EID surveillance in developing countries? What cultural, political, and economic challenges stand in the way of setting up such infrastructure? And are there general principles that might guide engagement with developing countries and support EID surveillance infrastructure?

Using the U.S. Naval Area Medical Research Unit No. 2 as a common denominator, this paper compares barriers to EID surveillance in Cambodia and Indonesia and presents key factors—uncovered through extensive interviews—that constrain disease surveillance systems. In Cambodia, the key factors that emerged were low salaries; poor staff and human resources management; the effect of patronage networks; a culture of donor dependence; contrasting priorities between the government and international donors; and a lack of compensation for animal culling. The Cambodian military has also played a part. The government ceased a merit-based salary supplement scheme for civil servants after the military is alleged to have demanded similar pay incentives that donors had no interest in funding.

In Indonesia the key issues emerging as barriers to effective surveillance include poor host-donor relationships, including differing host-donor priorities and a misunderstanding of NAMRU-2 by Indonesian authorities; low salaries; a decline in the qualifications of personnel in the Ministry of Health; poor compensation for animal culling; and difficulties incentivizing local-level reporting in an era of decentralization.

As the interviews with in-country practitioners revealed, low levels of development in general are the main impediments to building EID surveillance infrastructure and are perhaps beyond the scope of health and scientific agencies at this point. Nevertheless, promoting greater understanding of these issues is a critical first step in mitigating negative outcomes.

Published: Ear, Sophal. "Emerging Infectious Disease Surveillance in Southeast Asia: Cambodia, Indonesia, and the US Naval Area Medical Research Unit 2." Asian Security 8.2 (2012): 164-187.

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
Asia Health Policy Program working paper #27
Authors
Paragraphs

What kind of a health care system do China’s 1.3 billion turn to when ill, injured, or in need of care? This article provides a brief overview of how China’s health system has transformed alongside China’s society and economy since the Mao era, including how the current system is financed, organized, regulated, and being reformed. It first provides a brief description of the Mao-era health system and China’s demographic and epidemiologic transitions. Then it gives an overview of China’s contemporary health care system, including the dramatic expansion of health insurance over the last eight years and the progress of national health system reforms initiated in 2009.

A condensed and revised version of this paper is published in The Milken Institute Review 2012 second quarter: 16-27. 

Published: Eggleston, Karen. "Health care for 1.3 billion: An overview of China’s health system." (2012).

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
Asia Health Policy Program working paper # 28
Authors
Karen Eggleston
Authors
News Type
News
Date
Paragraphs
Tobacco now kills 90 times more people each year than HIV/AIDS in China. China's tobacco industry is closely tied to the global industry, and the Asia Health Policy Program is working to establish a new field of research on its history, beginning with a Mar. 2012 conference at the new Stanford Center at Peking University. Robert Proctor, a Stanford historian and author of a groundbreaking new book on the global tobacco industry, will take part.
Hero Image
BeautyCigarettesNEWSFEED
Beauty and smoking are paired in this vintage-style cigarette poster in China, Nov. 2005.
Flickr/Yeap Ku
All News button
1
-

This seminar explores whether and to what extent the relative circumstances of men and women following marital dissolution affect sex selection behavior within marriages. China's new divorce law, which was enacted in 2001, reduced divorce costs, especially for women, by granting the right to divorce and claim damages in the case of domestic violence and extra-marital relationships and by securing women's property rights upon divorce. Ang Sun has modeled the legal change as a decrease in women's divorce costs in a household in which all the marital surplus accrues to the husband. Sun shows: (1) that the new divorce law predicts an increase in divorce rates after the birth of a daughter; (2) that the new law results in fewer sex-selective abortions for the second birth if the first birth produced a daughter; and (3) that the effect of the new law on the sex ratio should have diminishing returns to divorce cost reduction for women. All the predictions are supported by the empirical evidence. Most importantly, she finds that most of the decline occurred in historically high divorce-cost regions, which is consistent with the predictions of the model and helps rule out concomitant changes in household income and relative returns to male and female children.

Ang Sun received her PhD from Brown University’s Department of Economics. Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families.

Philippines Conference Room

Walter H. Shorenstein
Asia-Pacific Research Center
616 Serra St C335
Stanford University
Stanford, CA 94305-6055

(650) 724-5668 (650) 723-6530
0
2011-12 Asia Health Policy Fellow
SunAng_Profile.jpg MA, PhD

Ang Sun joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) from Brown University’s department of economics where she recently received her PhD.

Sun’s research interests encompass development economics, labor and demographic economics, and health economics. She focuses on intra-household allocations, gender differences, and household formation. In particular, she studies how a combination of different forces in China—including traditional values, rapid growth, and the population structure—is affecting Chinese families. During her time at Shorenstein APARC, Sun will participate in an interdisciplinary study of the impact of the aging process in Asia on economic growth.

Sun holds a PhD and an MA in economics from Brown University, and an MA from the China Center of Economic Research. She also received a BA in economics and a BS in information and computer science from Beijing University.

Ang Sun 2011-12 Asia Health Policy Fellow Speaker Stanford University
Seminars
Subscribe to Society