A rapidly aging population poses serious challenges for many countries around the world, particularly in Asia, home to the most populous countries. China and India account for nearly 36% of the world’s population, and are expected to face social and economic complications from demographic change in the next decades.

A special issue of the Journal of the Economics of Ageing explores these trends in a comparative perspective, “The Economic Implications of Population Ageing in China and India” (December 2014), co-edited by David Bloom, a professor at Harvard University’s School of Public Health, and Karen Eggleston, a Center Fellow at the Shorenstein Asia-Pacific Research Center.

“Population ageing represents uncharted waters for China and India,” Bloom and Eggleston write in their coauthored introduction.

The special issue is a collection of 10 articles that examine the economic benefits and potential dilemmas arising from decreased fertility and increased life expectancy, two trends that will impact the development and future trajectories of China and India at the micro- and macroeconomic levels.

Dropping or continued low birth rates imply fewer young people to refresh the labor market. But will this cause the workforce to shrink to an unsustainable level? Demand will increase for health care, long term care, and other social services that support the elderly. What must the government do to ensure adequate access to care?

Empirical data and commentary presented in the special issue seek to inform stakeholders about emerging patterns, and to provide insight on how to best address related policy challenges going forward.

“By adopting responsive behaviors and consultative institutions that address the challenges of population ageing in ways that are appropriate to their unique circumstances, China and India could reap the full economic and social benefits of longer, healthier lives,” they write.

The special issue includes an introduction by Bloom and Eggleston, a feature interview with Richard Suzman, and additional analysis by noted global health experts following each article. The titles and authors of the 10 original research articles are listed below:

• Intergenerational co-residence and schooling (Anjini Kochar)
• Regional disparities in adult height, educational attainment, and late-life cognition: Findings from the Longitudinal Aging Study in India (LASI) (Jinkook Lee, James P. Smith)
• Healthy aging in China (James P. Smith, John Strauss, Yaohui Zhao)
• Gender differences in cognition in China and reasons for change over time: Evidence from CHARLS (Xiaoyan Lei, James P. Smith, Xiaoting Sun, Yaohui Zhao)
• Reprint of: Health outcomes and socio-economic status among the mid-aged and elderly in China: Evidence from the CHARLS national baseline data (Xiaoyan Lei, Xiaoting Sun, John Strauss, Yaohui Zhao, Gonghuan Yang, Perry Hu, Yisong Hu, Xiangjun Yin)
• Should China introduce a social pension? (Bei Lu, Wenjiong He, John Piggott)
• China’s age of abundance: When might it run out? (Yong Cai, Feng Wang, Ding Li, Xiwei Wu, Ke Shen)
• The macroeconomic impact of non-communicable diseases in China and India: Estimates, projections, and comparisons (David E. Bloom, Elizabeth T. Cafiero-Fonseca, Mark E. McGovern, Klaus Prettner, Anderson Stanciole, Jonathan Weiss, Samuel Bakkila, Larry Rosenberg)
• Economic development and gender inequality in cognition: A comparison of China and India, and of SAGE and the HRS sister studies (David Weir, Margaret Lay, Kenneth Langa)
• Comparing the relationship between stature and later life health in six low and middle income countries (Mark E. McGovern)

The special issue of the Journal of the Economics of Ageing, vol. 4, pages 1-154 (December 2014) is available through Elsevier’s online platform ScienceDirect.

When Siyan Yi was a medical student in Cambodia 12 years ago, he volunteered with a collaborative government-NGO project to provide young women at high risk for HIV/AIDS—the victims of sexual exploitation—with housing, vocational training, medical care, and psychological support. Cambodia at that time had one of Asia’s highest HIV-infection rates.

That rate has dropped by half, thanks to government policy measures, international NGO support, and the efforts of medical professionals like Yi. Cambodia’s government must now find ways to curb HIV infection in new segments of the population, says Yi, who is the Shorenstein Asia-Pacific Research Center’s inaugural Developing Asia Health Policy Fellow. Sustaining funding for the long-term care of HIV-infected individuals also poses a future challenge, he explains, and new health issues associated with development are beginning to crop up.

Cambodia’s first HIV case was detected in 1991 in a blood donor, and the rate of HIV/AIDS increased dramatically throughout the decade. HIV/AIDS hit Thailand slightly earlier, and was spread through the commercial sex trade. The epidemic reached an even greater scale there than it ever did in Cambodia.

Thailand’s government struck back with a 100-percent condom use promotion program, which Cambodia successfully adopted in the late 1990s. Brothels are illegal in Cambodia, but the government worked cooperatively with owners to provide basic HIV/AIDS education to sex workers. These efforts significantly reduced the transmission of HIV.

Since then, a more indirect form of prostitution has sprung up in places such as karaoke halls, massage parlors, restaurants, and even in factories. HIV prevalence remains high among some sentinel groups such as female sex workers, beer promoters, men who have sex with men (MSM), injected-drug users, and migrant workers.

Yi advocates that the government expand the scope of its HIV/AIDS prevention programs to encompass these new at-risk populations. He even suggests that the government consider creating a system of licensed brothels such as previously existed in Hong Kong and Taiwan. “It would provide the government with an easier means of controlling prostitution, and allow it to work with brothel owners to control HIV-infection rates,” states Yi.

HIV increases the risk of contracting or developing symptoms of tuberculosis; a large proportion of Cambodia’s population carries the disease but shows no signs of it. Tuberculosis went largely undetected during the decades of the Khmer Rouge regime, but with the advent of HIV/AIDS it has become more prevalent. Yi has been involved in government-NGO projects to provide tuberculosis screening for HIV patients, including a tuberculosis control project with the Japan International Cooperation Agency.

Tuberculosis screening and HIV treatment advances may greatly prolong the life—and even improve the health—of patients. But heartening as Cambodia’s success against HIV/AIDS has proven in the past decade, the government largely bears the responsibility for funding the expensive treatment and care for the low-income individuals most affected by it. A critical portion of government funding for its HIV/AIDS prevention programs comes from external organizations. 

“I think that the main issue for the government of Cambodia in the battle against HIV and AIDS is financial sustainability,” says Yi, who worries that donor agencies will withdraw support as the HIV-infection rate continues to improve. Prevention is less expensive, he explains, but long-term care is costly to a developing country such as Cambodia.

Yi, however, feels less concerned now about the HIV/AIDS epidemic and speaks hopefully of working to help the government find ways to measure and treat non-communicable diseases associated with economic development, such as diabetes and hypertension. While he is at Stanford, he will collaborate with Asia Health Policy Program researchers to move his work toward solving Cambodia’s new health challenges.

The results of my research [on HIV/AIDS intervention programs in China] have led to improvements in the…programs that were studied, and potentially will lead to broader change as I write up my research for publication. My research experience showed me the rewarding impact of public policy analysis on the quality and scope of health services. As a result, I decided to pursue a master’s in public policy at Stanford.

-Crystal Zheng, MA student, Public Policy Program

As an undergraduate student majoring in East Asian studies, Crystal Zheng spent two summers conducting extensive HIV/AIDS-related field research in China’s Yunnan province and Shenzhen special economic zone. Zheng worked closely with primary thesis advisor Karen Eggleston, director of the Asia Health Policy Program (AHPP) at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC). In the end, the project shaped the direction of her future academic and professional interests as well as contributed to potentially far-reaching program improvements for a key health policy challenge in China.

In the short time since its 2007 founding, AHPP has empowered the research of numerous Stanford University students like Zheng—emerging scholars, researchers, and thought leaders—through its teaching and mentoring activities. The program promotes the comparative study of health and health policy across the Asia-Pacific region, and its work with students closely accords with Shorenstein APARC’s commitment to training the next generation of scholars. In keeping with the interdisciplinary nature of scholarship at Shorenstein APARC, students who tap into AHPP’s resources come from a wide variety of academic backgrounds.

The six undergraduate and graduate students profiled here have conducted or are in the process of carrying out timely, innovative research focusing on various aspects of healthcare and health policy in China. Depending on the context of their research, many students—such as Zheng, who received a Chappell Lougee Scholarship and a Major Grant through the Vice Provost for Undergraduate Education (VPUE)—have found Stanford-based funding in the form of research assistantships, grants, and scholarships. Several have also conducted substantial field research in China—even without prior Chinese-language training. In many cases, the research has proved life changing—one student was so inspired that she entirely switched the focus of her graduate studies.

It has been a true privilege to work with these students—their enthusiasm, quick learning, and productive research on their chosen topics make them a pleasure to mentor.”

-Karen Eggleston, Director, AHPP

Amy Chen, a human biology major and a 2011 Newman Civic Fellow Award recipient, will spend the summer surveying and conducting interviews with medical staff and students at Shandong Provincial Hospital to understand hospital worker attitudes about organ donation and transplantation in China. She received a Chappell Lougee Scholarship and a supplementary grant from the Center for East Asian Studies (CEAS) in support of her research activities. Eggleston, who is serving as Chen’s advisor for the project, helped connect Chen with colleagues at Shandong University who will work with her throughout the summer. “I came to her [Eggleston] with a passion and a genuine interest in learning more about organ transplantation,” says Chen, “but through her guidance I was really able to narrow down my interests...” Chen hopes to one day establish a workplace-based organ donation education program in China and has already started developing a future action plan for it. 

Overcoming a potentially challenging language barrier, human biology major Monica Jeong successfully conducted diabetes-related research at Shandong Provincial Hospital. A recipient of a Major Grant, Jeong worked closely with her advisor Eggleston. She credits her honors research project with enriching her current work as a clinical research coordinator with the Department of Psychiatry and Behavioral Sciences. “I feel a lot more at ease interviewing patients,” she notes. “Furthermore, understanding the barriers that patients might face in seeking healthcare has made me a better-informed and more sensitive person when encountering patients at the Stanford Cancer Center.”

While studying the link between improved education enrollment and decreased mortality in Mao-era China as an AHPP research assistant, Jing Li, a former School of Education graduate student, developed a strong interest in health economics and policy analysis. “I am intrigued by the intuitiveness in quantifying relationships in health studies, as well as the crucial role of government in shaping health development using policy tools,” she says. This fall, Li will begin a doctoral program in health services and policy analysis at the University of California, Berkeley, where she plans to focus on health insurance policy, finance mechanisms, and payment systems in China. Li is particularly concerned with issues of inefficiency and inequality in healthcare policy.

Kelvin Bryan Tan, a doctoral student in the Department of Management Science and Engineering, gained a significant understanding of China’s healthcare system through the course “Healthcare in East Asia” taught by Eggleston. It led him to conduct a study to discover the optimal mix of different types of financing in medical savings-based healthcare financing systems, with a focus on Singapore and China. Eggleston worked closely with Tan, providing him with additional theoretical and background information. “This research project is likely to form a substantial part of my dissertation,” states Tan.

Anthony Vasquez, an East Asian studies master’s student, was inspired in a class taught by Eggleston to write a research paper about blindness prevention care in China, especially the role international non-governmental organizations (NGOs) play in providing this type of care in rural areas. In his research, Vasquez utilized a combination of academic literature and a study of NGOs currently operating in China. “By conducting this research,” he says, “I became more informed about the challenges that China faces in providing universal healthcare coverage, which is the government’s goal.” Although his MA thesis will focus on a different topic, Vasquez plans to stay closely connected to developments in China’s healthcare system.

Through her thesis research, Rachel Zimet Strick, a joint East Asian studies-business administration master’s student, examined the conditions for producing high-quality pharmaceuticals within China’s current market-based socialist economy. Eggleston served as her primary advisor, providing valuable guidance on her source materials and methodology, which combined economic modeling and theory, challenging field research, and primary and secondary source materials. Zimet, who now works for Abbott Laboratories as a member of its Management Development Program, credits her research with providing her with key skills that she utilizes in her work today. “[It] allowed me to demonstrate to Abbott…my ability to think deeply about the Chinese market…and to identify key market and non-market forces that would affect our business in any international environment,” she states.

AHPP welcomes inquiries from current and prospective students with an interest in issues surrounding healthcare and health policy in the Asia-Pacific region, and looks forward to continuing to help guide and inspire students for many years to come.

“Stanford attracts a diverse group of intellectually engaged students with a passion for research that can inform policy and improve lives,” says Eggleston. “AHPP strives to support those students interested in health and medical care across the Asia-Pacific, from freshmen to advanced grad students across a broad range of disciplines, to create a community of like-minded scholars and push boundaries. Our own research and policy outreach benefit tremendously from the synergies that result.”

More information about undergraduate and graduate research funding opportunities at Stanford is available at the AHPP, VPUE, CEAS, and Global Gateway websites.