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.

The breadth of [Shorenstein] APARC's work is truly impressive... I look forward to making full use of the resources and opportunities afforded me through the visiting fellowship.

-Dr. Siyan Yi

How can Stanford University contribute to improved health policy in the low-income countries of Asia? In addition to our formal degree-granting and research programs, mentorship of young scholars can play a role in strengthening the evidence base and analytic skills undergirding health policy for the millions of Asians who live on only a few dollars a day.

The Asia Health Policy Program (AHPP) is delighted to announce the inauguration of a fellowship program for young health policy experts from developing countries in Asia. The first Developing Asia Health Policy Fellow will be Dr. Siyan Yi from Cambodia. He holds a medical doctor degree from the University of Health Sciences in Cambodia as well as a doctoral degree in international health sciences from the Graduate School of Medicine at the University of Tokyo. Dr. Karen Eggleston, director of AHPP, will be his primary sponsoring faculty member.

Dr. Yi's research has centered largely on epidemiological methods. This has included, for example, work on surveys in Cambodia on adolescent risky sexual behaviors, substance abuse, and depression; a health promotion project in primary schools; sexual behaviors among people living with HIV/AIDS; and HIV risk behaviors among tuberculosis patients. Currently, he is involved in hospital- and community-based research projects in several developing countries as well as in Japan.

Cambodia has recently created a School of Public Health and is facing an increasing burden of chronic disease, while the burden from infectious diseases such as tuberculosis remains significant. Since Dr. Yi's research interests lie in health promotion and risky behaviors, he could someday be instrumental in helping to set policies to address the public health challenges Cambodia will face.  

Dr. Yi will join the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) in autumn 2011 for a nine-month fellowship to immerse in the academic environment and to develop additional skills to contribute to improved health policy in Cambodia. He notes that "the breadth of [Shorenstein] APARC's work is truly impressive... I look forward to making full use of the resources and opportunities afforded me through the visiting fellowship."

East Asia's demographic landscape is rapidly changing and comparative academic research is crucial to help guide well-informed decisions in the many policy areas that are affected, such as security, economics, and immigration. From January 20 to 21, the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) gathered subject experts from numerous fields for two days of lively and productive presentations and dialogue to help identify key research issues and questions for its new, three-year research initiative on this significant subject.

Shorenstein APARC held a public panel discussion on January 20, featuring eight scholars from across the United States and Asia. The issue of aging featured prominently in their presentations, as did fertility rates and immigration. A full audio recording of the panel discussion is available on the Shorenstein APARC website and summaries of the presentations follow below. A closed-session workshop took place the next day, the discussions from which will serve as the foundation for future programs and publications related to the research initiative.

January 20 Panel Discussion Presentations

The link between demography and security is more tenuous in East Asia than in other parts of the world, suggested Brian Nichiporuk, a political scientist with the RAND Corporation. Nichiporuk discussed possible policy responses to demographic change in Japan, North and South Korea, the Russian Federation, and China. He suggested, for example, that Japan's new maritime security focus is related to perceived economic and political competition from China, which is magnified by its domestic demographic concerns.

Michael Sutton, a visiting fellow with the East-West Center in Washington, DC, stated that Japan's aging population would remain a major policy issue for the next 20–30 years. He emphasized that the policy challenges posed by this phenomena are complicated by the role that the United States plays in the regional security structure, and also by the growing dominance of China and the history that it shares with Japan. Nonetheless, maintained Sutton, despite the obvious challenges, it is possible for Japan and the other countries facing this demographic issue to successfully adapt.

Social attitudes and policy in East Asia do not favor immigration, as they do in European countries such as Spain and Italy, suggested John Skrentny, director of the Center for Comparative Immigration Studies at the University of California, San Diego. Skrentny focused his talk on low-skill immigrant workers in South Korea and Japan, noting that these two countries, which began receiving workers in the 1970s and 1980s, commonly associate immigrants with social disruption. According to Skrentny, immigration policy is often tied to economics and tends to favor co-ethnic workers.

Chong-En Bai, chair of the Department of Economics at Tsinghua University, discussed numerous economic policy implications and responses related to demographic change in China. He noted areas where successful policies have been adopted but challenges still remain, including savings and investment, labor and urbanization, pension, healthcare, and long-term care. Bai described, for example, how the children of rural migrants now have access to urban schools, but that they still face the logistical challenge of having to travel back to their home provinces to take college entrance examinations.

Examining demographic change and health improvements is essential to understanding the significant economic growth in East Asia over the past several decades, emphasized David Bloom, chair of the Department of Global Health and Population at Harvard University. He noted the success of East Asian countries in lowering their infant mortality rates through investment in public health improvements, such as sanitation and vaccination. Bloom suggested that these and other past successful policy mechanisms have run their course, and that it is now imperative to find ways to address the region's key demographic issue of aging.

Naohiro Ogawa, director of the Population Research Institute at Nihon University, described findings from the National Transfer Accounts (NTA) project, an international effort to gauge economic flows across age groups. He discussed the pressure placed on Japan's working-age population by the increasing cost of caring for children and the elderly, as well as the challenges and possibilities related to having a large, healthy, aging population. Ogawa noted that institutional responses to demographic change, such as increasing the retirement age and adopting more open immigration policy, have moved slowly in Japan.

Andrew Mason, a professor of economics at the University of Hawai'i, Manoa, also utilized NTA data to make predictions about East Asia's economic future. He proposed that the amount of human capital, such as the money that parents spend on the education of their children, is likely to grow quite rapidly. He also suggested that financial wealth in East Asia is likely to increase significantly as the populations of its countries age. Finally, he suggested that the current trend of regional economic growth would continue, although at a somewhat steadier rate. Mason qualified his predictions with questions, such as whether the return on investment in education would be commensurate with what is spent.

James Raymo, a professor of sociology at the University of Wisconsin-Madison, described a wide array of findings about changes in fertility and family structure in Japan and their connections, as well as possible policy implications. Raymo discussed trends in marriage, childbearing, divorce, non-marital cohabitation, and the participation of women in the labor force. He pointed to gaps in current research, and suggested possible linkages to research on other demographic trends, such as Japan's aging population.

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.