International Relations

FSI researchers strive to understand how countries relate to one another, and what policies are needed to achieve global stability and prosperity. International relations experts focus on the challenging U.S.-Russian relationship, the alliance between the U.S. and Japan and the limitations of America’s counterinsurgency strategy in Afghanistan.

Foreign aid is also examined by scholars trying to understand whether money earmarked for health improvements reaches those who need it most. And FSI’s Walter H. Shorenstein Asia-Pacific Research Center has published on the need for strong South Korean leadership in dealing with its northern neighbor.

FSI researchers also look at the citizens who drive international relations, studying the effects of migration and how borders shape people’s lives. Meanwhile FSI students are very much involved in this area, working with the United Nations in Ethiopia to rethink refugee communities.

Trade is also a key component of international relations, with FSI approaching the topic from a slew of angles and states. The economy of trade is rife for study, with an APARC event on the implications of more open trade policies in Japan, and FSI researchers making sense of who would benefit from a free trade zone between the European Union and the United States.

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Demographic changes are profoundly shaping the political, economic, and social landscape of the Asia-Pacific region. How have individuals, families, communities, and policymakers responded? How should they? For example, how will national and social identities transform as population ageing strains traditions of filial piety and immigration disrupts ethnic homogeneity? Will the economies of East Asia languish, or will a "second demographic dividend" spur renewed economic growth? Demographic change can have important psychological and political effects. For example, can one seriously imagine a resurgent, militaristic Japan with a declining and aging population? The responses to demographic change in Japan, South Korea, China, and their neighbors will have great potential long-term effects in the Asia-Pacific region.

This panel discussion, the opening and public portion of a 1-1/2 day workshop that will define a research agenda for the next three years, will bring together selected outside experts and faculty within the Shorenstein Asia-Pacific Research Center for an interdisciplinary and comparative discussion of the policy responses to rapid demographic change in East Asia.

  • 3:00p.m. – 3:10p.m.
    Gi-Wook Shin, Director, Shorenstein Asia-Pacific Research Center, Stanford University: Introduction and welcome
  • 3:10p.m. – 3:25p.m.
    Brian Nichiporuk, RAND Corporation: The Security Implications of Demographic Trends in East Asia
  • 3:25p.m. – 3:40p.m.
    Michael Sutton, East-West Center, Washington, DC: Political & Security Implications of Population Aging in Japan
  • 3:40p.m. – 3:55p.m.
    John Skrentny, Director, Center for Comparative Immigration Studies, Professor of Sociology, University of California, San Diego: An East Asian Model to Managing Immigration? Durability & Change in the 2000s.
  • 3:55p.m. – 4:10p.m.
    Chong-En Bai, Chair, Department of Economics, Freeman Chair Professor of Economics, Tsinghua University: Policy Responses to Demographic Change in China
  • 4:10p.m. – 4:25p.m.
    David Bloom, Clarence James Gamble Professor of Economics and Demography Chair, Department of Global Health and Population, Harvard University: Demographic Change in East Asia: Challenges, Options and Evidence
  • 4:25p.m. – 4:40p.m.
    Naohiro Ogawa, Director, Population Research Institute, Nihon University: Population Aging & Changing Human Capital in Japan & other East Asian Countries
  • 4:40p.m. – 4:55p.m.
    Andrew Mason, Professor of Economics, University of Hawaii, Manoa & Senior Fellow, East-West Center, Hawaii: Population Aging and the Generational Economy: Key Findings
  • 4:55p.m. – 5:10p.m.
    James Raymo, Professor of Sociology, University of Wisconsin, Madison The “Second Demographic Transition” and family change in Japan
  • 5:10p.m. – 5:30p.m.
    Discussion/Conclusion

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Gi-Wook Shin Director Speaker Shorenstein Asia-Pacific Research Center, Stanford University
Andrew Mason Professor of Economics, University of Hawaii, Manoa & Senior Fellow Panelist East-West Center, Hawaii
Naohiro Ogawa Director, Population Research Institute Panelist Nihon University
David Bloom Clarence James Gamble Professor of Economics and Demography, Chair, Department of Global Health and Population Panelist Harvard University
Chong-En Bai Chair, Department of Economics, Freeman Chair Professor of Economics Panelist Tsinghua University
John Skrentny Director, Center for Comparative Immigration Studies, Professor of Sociology Panelist University of California, San Diego
Michael Sutton Panelist East-West Center, Washington, DC
Brian Nichiporuk Panelist RAND Corporation
James Raymo Professor of Sociology Panelist University of Wisconsin, Madison
Panel Discussions
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Professor Ogawa will present recent work on declining fertility and the rising cost of children in East Asian countries, using measures of investment per child from the National Transfer Accounts analysis of public and private investments in children's education and health. He and his co-authors also study whether the amount of resources allocated to children has been crowded out by the increasing amount of resources needed for support of the elderly in Japan and other aging societies.

Naohiro Ogawa is professor of population economics at the Nihon University College of Economics and Advanced Research Institute for Sciences and Humanities (ARISH), Tokyo. He is also Director of the Nihon University Population Research Institute (NUPRI). Over the past thirty years he has written extensively on population and development in Japan and other Asian countries. More specifically, his research has focused on issues such as socioeconomic impacts of low fertility and rapid aging, modeling demographics and social security-related variables, as well as policies related to fertility, employment, marriage, child care, retirement and care for the elderly. His recent work includes measuring intergenerational transfers. He has published numerous academic papers in internationally recognized journals. In collaboration with other scholars he has also edited several journals and books among which the most recent one is Population Aging, Intergenerational Transfers and the Macroeconomy (2007). Naohiro Ogawa has served on a number of councils, committees and advisory boards set up by the Japanese government and international organizations such as the Asian Population Association, the IUSSP and the WHO. He is currently an associate member of the Science Council of Japan.

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Naohiro Ogawa Professor of Population Economics Speaker the Nihon University
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Over the past year, the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) has engaged in leading-edge research on demographic change in East Asia. Karen Eggleston, director of the Asia Health Policy Program at Shorenstein APARC, discusses the recent book Aging Asia: The Economic and Social Implications of Rapid Demographic Change in China, Japan, and South Korea, and the workshop on the economic, social, and political/security implications of demographic change in East Asia, held January 20-21 at Shorenstein APARC.

Across Northeast Asia, countries are facing the issue of an aging population, which causes socio-economic challenges that have policy implications. You explore this phenomenon in your forthcoming book Aging Asia: The Economic and Social Implications of Rapid Demographic Change in China, Japan, and South Korea. When did aging begin to become an issue and what are some of the greatest factors that you address in the book?

Aging started at different times in the countries of East Asia. The country with the oldest life expectancy in the world and the oldest age structure of its population is Japan. It had a very short baby boom after the war and has had a steep decline in fertility. Mortality has also been falling around the world, and so this creates a change in the population. Japan is already at the fourth stage of demographic transition. South Korea is rapidly moving towards that and already has one of the lowest fertility rates in the world. Of course, neither of them have policies to reduce fertility; in fact, they are trying to encourage it. China, on the other hand, has long been trying to control fertility and is not as extreme in terms of the population age structure, but it is rapidly changing. China will be older in median age than the United States soon—this is not a trivial factor when you think in terms of the absolute size of the Chinese population.

One of the things that we wanted to study in this project is the premise that the demographic transition is a "problem." It is true that you need to think about and have policy responses to it. But it can also be seen as a sign of success, and as an opportunity. We wanted to reframe the issue and think about evidence on both sides. There is some research highlighted in the book, for example, that looks at the impact of population aging on economic growth, which is one of the first things that comes to many people's minds. For example, if you have a lot of elderly people, they are not in the work force and they need to be supported. It is true that this can be bad for economic growth, but there also are policy and individual responses that may moderate the effects. Our research is trying to highlight several different aspects of aging, including the question of opportunity. For example, there is more investment in individual children now and elderly persons' savings have actually contributed to economic growth. In some aspects, this has been a sign of resiliency for Japan where there are a lot of transfers to the working-age population.

Ronald Lee at the University of California, Berkeley and Andrew Mason at the East-West Center at the University of Hawai'i, who is participating in the January workshop, have been working on the concept of a "second demographic dividend." They find that as countries have an older age structure, there are more people that are saving. In the widely accepted "first demographic dividend," there are more people in the working-age part of the population—more people employed and more people contributing to the GDP. You get a boom contributing to growth. We know that this contributed to Japan and South Korea's earlier growth, and to China's in the 80s and part of the 90s, but only one or two percent of GDP. The question then is whether it is a problem that with aging you are losing that first demographic dividend. A second demographic dividend might arise because people who are preparing for a longer retirement life are saving more, and those savings are then invested in the economy and the investment drives economic growth.

Is there any correlation to demographic issues faced by the United States?

Interestingly, the aging issue is more pronounced in East Asia than in the United States for several reasons. We have a higher fertility rate than in Japan and South Korea, and many other countries in Europe as well. We also historically are much more open to immigration than most other countries, and this has led to a certain vitality in the population mix that has slowed the impact of demographic change. That said, of course, there are issues with having a lot of baby boomers. Sometimes, depending on the specific question or the specific area of policy, you find other factors that are much more important than aging. For example, the growth of healthcare spending has been in the news a lot lately. Although obviously there is an impact from having more elderly people, there are much bigger issues, such as what we are spending per person per age group and the growth of that spending. Just aging per se is not as big of an issue as people might think.

In late January, you will be holding the workshop Comparative Policy Responses to Demographic Change in East Asia: Defining a Research Agenda. What are the major issues you will explore in the conference? Who will be involved? Finally, what is the publication or research project that you will launch from this?

We had an Aging Asia conference in February 2009, co-sponsored with the Global Aging Program at the Stanford Center on Longevity. The outcome of this is the forthcoming volume, co-edited with Shripad Tuljapurkar of the Department of Biology at Stanford University. We started with a basic survey of the region and thought about the basic trends-demographic, social, and economic-and built upon that to figure out where the gaps are in the literature and where the interesting research questions are. That is where the January 2011 workshop comes in as the next step. We are bringing in some of the same and some different people to focus on three specific themes: economics, society, and politics/security. The upcoming event again focuses on East Asia and there will be a public component, but it is a smaller event and its main goal is to dig deeper into these themes to figure out an interesting research agenda on the policy responses to demographic transition.

We decided to focus again on East Asia, which is the research focus of a lot of our Shorenstein APARC faculty. Masahiko Aoki and Michael Armacost are going to chair sessions, and Gi-Wook Shin is going to kick it all off and talk about the social aspects of demographic change. Andrew Walder will be participating in that session as well. Thomas Fingar will be covering the political and security implications. All Shorenstein APARC faculty have been invited to participate and think about how this issue of demographic change—and particularly policy responses—might be related to their own areas of research. 

An illustration that I like to give when people ask about how demographic change is related to other things is from Andrew Walder when he was talking about China's transition in the 1980s. He received a question about whether or not there had been an impact from the One Child policy. He said that obviously there are many different impacts, but the one thing that he noted was that students in China now, especially if they are only children, are under a lot of career pressure. This has changed the space or the freedom for self-exploration. Why does this have broader implications? Young people see access to political power as one key for their careers and this changes their views about joining the Communist Party, which has big implications for China's political future. This is just one illustration of how we are trying to explore the broader implications of demographic change.

Finally, what is the outcome that you would most hope to achieve through Aging Asia and the upcoming demographic change workshop?

I think that the biggest hope would be to develop a much better understanding of what is going on with demographic change: what are the processes and how is society changing? What are the individual challenges that families are facing and what are they are doing about it? What is the broader social or even global perspective on how this is going to shape our future world? For me, I think about the world that my children are going to grow up in.

Through our research, I hope that we will impact not only the understanding of what has driven past developments, but create policy recommendations for each of the societies that were are examining—including our own—on the opportunities and the challenges related to changes in population. That hopefully will be useful as these different societies think about how to respond.

Our research on the economic, the social, and political/security aspects of demographic change is intended to be tangible for individuals and families as well as for broader national policy.

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Objective: To show the pattern of patient satisfaction with top-level delivery organizations (Level 2 and Level 3 hospitals), and using neo-institutionalism approach to explain the relatively low satisfaction and to explore the limitations with top providers, focusing on how to improve the competence of Level 2 and Level 3 hospitals at both the individual hospital level and the whole delivery system level.

Data Sources/Study Setting: The household survey by the National Bureau of Statistics in China in 2008; China Health Statistics Yearbooks.

Data Collection/Extraction Methods: The analysis uses a 2008 sample medical experiences of 5,036 residents from 17 provinces collected in a household survey by the National Bureau of Statistics in China. The linear regression model, the structural difference regression model, and the ordered probit model are used in our framework.

Principal Findings: The imbalance between the needs of patients and the limited competence of top-level providers, and the conflict between the business expansion and the limited competence of those providers are deeply and widely influenced by patterns of patient needs, the top providers’ expansion, and the institutional environment.

Conclusions: In order to effectively respond to patient needs, top and lower level providers need to set their own individual priorities. The government needs to improve institutional arrangements to respond to patient needs with the development of a fair and appropriate reimbursement and compensation pricing mechanism, and with further evaluation of top level providers’ advanced and limited health services.

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Asia Health Policy Program working paper #19
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Qunhong Shen
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How will population aging impact the economies and social protection systems of Japan, South Korea, China, and India? This colloquium showcases research addressing that question by contributors to a new Shorenstein APARC book, Aging Asia, co-edited by Karen Eggleston and Shripad Tuljapurkar. Dr. Bloom discusses how aging of the baby boom generation, declines in fertility rates, and an increase in life expectancy imply several changes for the economies of the region. Notwithstanding the potential challenges, Bloom argues that population aging may have less of a negative effect on economic growth than some have predicted. Bloom will also discuss the longitudinal aging study in India.

David Bloom is Clarence James Gamble Professor of Economics and Demography at Harvard University, Chair of the Department of Global Health and Population at the Harvard School of Public Health, and Director of Harvard University’s Program on the Global Demography of Aging (funded by the National Institute of Aging). He is Research Associate at the National Bureau of Economic Research, where he serves as a member of three research programs: Labor Studies, Aging, and Health Economics. He co-chairs the Public Policy Committee of the American Foundation for AIDS Research. Bloom received a B.S. in Industrial and Labor Relations from Cornell University in 1976, an M.A. in Economics from Princeton University in 1978, and a Ph.D. in Economics and Demography from Princeton University in 1981.

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David Bloom Clarence James Gamble Professor of Economics and Demography Speaker Harvard University
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Many researchers have concluded that longer life expectancies prompt increased investment in education, as a prolonged labor supply raises the rate of return on education. Besides explaining the empirical evidence behind this conclusion (at an absolute level), there is another issue to be discussed: does time spent in studying and working increase proportionally with higher longevity? Building on an extended life-cycle model with an assumption on a more realistic distribution of life cycle mortality rates, this article considers dynamic effects of prolonging longevity on economic development by directly introducing changes in longevity into the economy, which is more preferable than comparative static analysis that relies on changes in relevant parameters. It shows that prolonged life expectancy will cause individuals to increase their time in education but may not warrant rises in labor input. Later we show that higher improvement rate of longevity will also promote economic growth, even if we exclude the mechanism of human capital formation and only consider the growth effects of the higher improvement rate of life expectancy from physical capital investment.

Forthcoming in The Chinese Journal of Population, Resources and the Environment

Published: Qiong, Zhang. "Longevity, Capital Formation and Economic Development." Chinese Journal of Population Resources and Environment 10.1 (2012): 53-63.

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Asia Health Policy Program working paper #16
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The extent and existence of "defensive medicine" -- excessive medical care to defend a physician against malpractice claims -- is a perennial subject of both policy and academic debate.  For example, malpractice liability and associated defensive medicine are among the most-cited reasons for escalating health-care spending in the United States.

In this colloquium, Dr. Brian Chen will present results from his research investigating the extent of defensive medicine in Taiwan. He studies the impact of a series of court rulings in Taiwan that increased physicians’ liability risks, and a subsequent amendment to the law that reversed the courts’ rulings, on physicians’ test-ordering behavior and propensity to perform Caesarean sections.  He finds that physicians faced with higher malpractice pressure increased laboratory tests as expected, but unexpectedly reduced Caesarean sections.  (The reduction in Caesarean deliveries may be due to the fact that liability risks were more closely aligned with physicians’ standard of care after the court rulings.) After the law was amended to negate the court decisions, physicians reversed their previous behavior by reducing laboratory tests and increasing Caesarean deliveries.

This pattern of behavior is highly suggestive of the existence of defensive medicine among physicians in Taiwan. In other words, by studying physicians' response to legal changes in Taiwan, we find that greater malpractice liability may, under certain circumstances, prompt physicians to perform more services without necessarily improving patient health.

Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.

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Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055

(650) 736-0771 (650) 723-6530
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2011 AHPP/CEAS Visiting Scholar
IMG_5703.JPG JD, PhD

Dr. Brian Chen is currently a visiting scholar with the Asia Health Policy Program and Center for East Asian Studies at Stanford University. He was recently Shorenstein Asia-Pacific Research Center's 2009-2010 postdoctoral fellow in Comparative Health Policy. As a visiting scholar, Dr. Chen will conduct collaborative research about health of the elderly and chronic disease in China.

As an applied economist, Chen’s research focuses on the impact of incentives in health care organizations on provider and patient behavior. For his dissertation, Chen empirically examined how vertical integration and prohibition against self-referrals affected physician prescribing behavior. His job market paper was selected for presentation at the American Law and Economics Association’s Annual Meeting, the Academy of Management, the Canadian Law and Economics Association, the Conference on Empirical Legal Studies, and the First Annual Conference on Empirical Health Law and Policy at Georgetown Law Center in 2009.  The paper was also nominated for best paper based on a dissertation at the Academy of Management.

Chen comes to the Shorenstein Asia-Pacific Research Center not only with a multidisciplinary law and economics background, but also with an international perspective from having lived and worked in Taiwan, Japan, and France. He has a particularly intimate knowledge of the Taiwanese health care system from his experience as an assistant to the hospital administrator at a medical college in Taiwan.

During his past residence as a postdoctoral fellow with the Asia Health Policy Program, Chen conducted empirical research on cost containment policies in Taiwan and Japan and how those policies impacted provider behavior. His work also contributed to the program’s research activities on comparative health systems and health service delivery in the Asia-Pacific, a theme that encompasses the historical evolution of health policies; the role of the private sector and public-private partnerships; payment incentives and their impact on patients and providers; organizational innovation, contracting, and soft budget constraints; and chronic disease management and service coordination for aging populations.

Dr. Brian Chen recently completed his Ph.D. in Business Administration in the Business and Public Policy Group at the Haas School of Business, University of California at Berkeley. He received a Juris Doctor from Stanford Law School in 1997, and graduated summa cum laude from Harvard College in 1992.

Brian Chen Shorenstein-Spogli Fellow in Comparative Health Policy Speaker
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