Stanford University

International Development

Air Pollution and Short-Term Mortality in Beijing

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Little empirical evidence exists on the health costs of air pollution in China, one of the most polluted countries in the world. Unsurprisingly, the lack of reliable data on pollution levels and health outcomes impede research. Because the pollution-health relationship is likely non-linear, it is difficult to extrapolate from existing high quality studies in developed countries to ascertain health costs. We address this deficiency by obtaining new data on Beijing’s daily mortality April 2008-April 2013 from the Chinese Center for Disease Control and Prevention. We combine these data with daily pollution measures from the US Embassy in Beijing, which records particulate matter of 2.5 microns or less in width (PM 2.5). We find that after controlling for weather conditions, year, month, and day of week fixed effects, daily PM2.5 indeed predicts daily mortality, particularly deaths from cardiovaslular disease. A 100 μg/m3 increase in daily PM2.5 is associated with 7 deaths daily, among them 4 cardiovascular deaths, and 0.8 respiratory deaths. Furthermore, deaths among less-educated and outdoor workers show a stronger relationship to PM2.5 levels. Notably, the relationship is robust to controlling for the official measure of Beijing’s air pollution, the average daily air pollution index (API), despite the fact that PM2.5 is measured by 1 monitor at the US embassy whereas API (and mortality) combine data from across the Beijing metropolitan area. Indeed, Beijing’s API does not have a significant relationship to mortality once AQI at the Embassy is accounted for. Our finding supports previous research arguing for measuring PM 2.5 and reporting it promptly to the public. 
 
Shuang Zhang is an assistant professor in the Department of Economics at University of Colorado Boulder. She works on various topics in development, including health, education, environment, political economy, etc,. with a focus on China. She holds a PhD in Economics from Cornell University and was a postdoctoral fellow in SIEPR of Stanford University in 2012-13.

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Shuang Zhang assistant professor in the Department of Economics Speaker University of Colorado Boulder
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Testimony on China's healthcare sector

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On April 3, 2014, Karen Eggleston provided testimony before the U.S-China Economic and Security Review Commission at the "Hearing on China’s Healthcare Sector, Drug Safety, and the U.S.-China Trade in Medical Products."

Some of the questions addressed included:

  • How has the nature of disease in China changed in recent decades? What kind of burden might it place on China's future development?
  • If providers are "inducing" demand by overprescribing drugs, it this a public health crisis in the making?
  • Can you outline the pros and cons of market reform in China's healthcare sector? What might be the proper role of the state of improving healthcare delivery?
  • Kan bing nan, kan bing gui (inaccessible and unaffordable healthcare) is one of the top concerns of ordinary Chinese. Which groups are most affected? Is this a global problem, what lessons can we learn from China?
  • The pharmaceuticals industry features in China's Medium and Long-term Plan for Science and Technology (2006-2020), as well as in more recent measures to promote indigenous innovation and industrial upgrading. Is it fair to say that the Chinese government is prioritizing domestic pharmaceutical companies, which foster economic growth, over the welfare of patients?
  • What were major successes and failures of the 2009 healthcare reforms [in China]? How have those reforms been supplemented by more recent measures (e.g. last November's Third Plenum)?
  • What aspects of China's healthcare reform should the U.S. government and U.S. companies pay most attention to?
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Karen Eggleston
Karen Eggleston

Overcoming Health Challenges Facing Mongolia: Medical and Entrepreneurial Perspectives

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Average life expectancy in Mongolia is 65 years, much shorter than that of other East Asian countries such as South Korea (78.5 years) and China (72.5 years). Furthermore, healthy life expectancy in Mongolia is even shorter, rendering the situation even more tragic. The World Health Organization estimates that the healthy life expectancy is 53 years for males and 58 years for females.

This colloquium will provide an overview of health in Mongolia and its healthcare system, with expertise from two speakers. First, Dr. Gendengarjaa Baigalimaa, Developing Asia Health Policy Fellow at Shorenstein APARC, will discuss her comparative study of how knowledge of cervical cancer risk factors has influenced behavior changes in Mongolia before and after the introduction of the National Cervical Cancer Program.

Second, Dr. Dashdorj will present on overview of the healthcare initiatives of the Onom Foundation, designed to mitigate excess and premature mortality of Mongolians via knowledge transfer and entrepreneurship. He will report on a March national health policy meeting in Mongolia’s capital and recent strides in health improvement made with the support of the Onom Foundation.

Gendengarjaa Baigalimaa joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) during the 2013-2014 academic year as the Developing Asia Health Policy Fellow. She joins APARC from the Mongolian National Cancer Center, where she serves as a Gynecological Oncologist.

During her appointment as Health Policy Fellow, she is completing her comparative study of how knowledge of cervical cancer risk factors has influenced behavior changes in Mongolia before and after the introduction of the National Cervical Cancer Program.

Baigalimaa is the Executive Director of Mongolian Society of Gynecological Oncologists and is also a member of the International Gynecological Cancer Society (IGCS) in Mongolia, Russia, and France.

Baigalimaa holds a MD from Minsk Belarussia Medical University. She also received a Masters in Health Science from Mongolian Medical University. She is fluent in both Russian and English.

Dr. Dashdorj hails from very humble beginnings. He was born and raised in the southwestern outskirts of Mongolia known as Gobi-Altay province, where the Altay Mountains border with the bare rock covered desert basins of the Gobi. Because of the unique upbringing, Dr. Dashdorj has a profound commitment for making a tangible difference in lives of fellow Mongols. At the same time, he strongly believes that entrepreneurship is the best vehicle for making a difference.

He obtained a Ph.D. in physics from Purdue University in 2005 and was a postdoctoral fellow at the US National Institutes of Health. His research using ultrafast optical spectroscopy and time-resolved x-ray imaging techniques is published in 17 original manuscripts in prominent, peer-reviewed scientific journals, such as the Proceedings of the National Academy of Sciences. In 2010, Dr. Dashdorj became a faculty member at the Argonne National Laboratory. Despite his successes in scientific research, he gave up his academic career in 2013 to pursue his entrepreneurial dreams, since he truly believed that he can make a tangible difference via entrepreneurship, experimenting with a model of subsidizing philanthropic actions by a certain percentage of equity and profits of a for-profit company.

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Gendengarjaa Baigalimaa

Shorenstein APARC
Encina Hall E332
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5710 (510) 705-2049 (650) 723-6530
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Developing Asia Health Policy Fellow
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MD

Gendengarjaa Baigalimaa joins the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) during the 2013-2014 acedemic year as the Asia Health Policy Program Fellow. She joins APARC from the Mongolian National Cancer Center, where she serves as a Gynecological Oncologist.

During her appointment as Health Policy Fellow, she will conduct a comparative study of how knowledge of cervical cancer risk factors has influenced behavior changes in Mongolia before and after the introduction of the National Cervical Cancer Program.

Baigalimaa is the Executive Director of Mongolian Society of Gynecological Oncologists and is also a member of the International Gynecological Cancer Society (IGCS) in Mongolia, Russia, and France.

Baigalimaa holds a MD from Minsk Belarussia Medical University. She also received a Masters in Health Science from Mongolian Medical University. She is fluent in both Russian and English.

Gendengarjaa Baigalimaa Developing Asia Health Policy Fellow Speaker Stanford University
Naranbaatar Dashdorj Founder and Chairman of Onom Foundation and a 2014 Sloan Fellow at the Stanford Graduate School of Business Speaker
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The Effects of Indonesia's Conditional Cash Transfer Program

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This study analyzes the effects of Indonesia's conditional cash transfer program on the local health care market in terms of price, utilization, and quality of care. The CCT program is associated with increased delivery fees and increased utilization of prenatal care and trained attendants for delivery assistance. Consequently, program participants experience improvements in prenatal care quality. 

Margaret Triyana is the Asia Health Policy Post-doctoral fellow. Her main interests are inequality and human capital investments, particularly early health investments in developing countries.

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Encina Hall 3rd Floor Central
616 Serra Street,
Stanford University

Margaret Triyana

Shorenstein APARC
Encina Hall C331
616 Serra Street
Stanford, CA 94305-6055

(650) 724-5656 (650) 723-6530
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2013-2014 Asia Health Policy Postdoctoral Fellow
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PhD

Margaret (Maggie) Triyana’s main research interests are inequality and human capital investments in developing countries. In particular, she is interested in the effects social policy changes on children’s health outcomes. As a Postdoctoral Fellow, she will analyze the effects of rural-urban migration in Indonesia and China, as well as the impact of health insurance expansion in Indonesia and Vietnam.

Triyana received a PhD in Public Policy from the University of Chicago in 2013.

 

Working Papers

“Do Health Care Providers Respond to Demand-Side Incentives? Evidence from Indonesia“

“The Effects of Community and Household Interventions on Birth Outcomes: Evidence from Indonesia”

“The Longer Term Effects of the ‘Midwife in the Village’ Program in Indonesia”

“The Sources of Wage Growth in a Developing Country” (with Ioana Marinescu)

Margaret Triyana Postdoctoral Fellow in Asia Health Policy Speaker Stanford University
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The Effect of Sleep Duration on Body Weight in Adolescents: Evidence from a Natural Experiment

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June 2020 Update:
Dr. Do wins the 2020 Rothman Epidemiology Prize for this article that has been selected as the best paper published in the journal Epidemiology in 2019.
View the announcement of the editors and editorial board of Epidemiology and our news post.

November 2019 Update: 
Paper published: Do, Young Kyung. "Causal Effect of Sleep Duration on Body Weight in Adolescents: A Population-based Study Using a Natural Experiment." Epidemiology 30, no. 6 (2019): 876-884.

 

Despite a large number of observational studies consistently reporting the association between shorter sleep duration and higher body weight, causality has yet to be established at a population level. This study aims to estimate the population-level causal effect of sleep duration on adolescent body weight, using an instrumental variable (IV) approach that exploits a unique natural experiment in the context of South Korea’s highly competitive secondary education. In March 2011, amid growing concerns over the negative consequences of late-night tuition at private tutoring institutes (hagwon), authorities in 3 of the 16 administrative regions in South Korea decreed adjusting the closing hours of hagwon to 10 p.m. This policy change caused a substantial and plausibly exogenous variation in the sleep duration of the “marginal student,” whose sleep duration is most likely to be affected by the policy. The IV estimation results on a sample of general high school 10th- and 11th-graders in the 2009−2012 Korea Youth Risk Behavior Web-based Survey show that a 1-hour increase in sleep duration led to a 0.56 kg/m2 reduction in body mass index, or a 4.3 percentage-point decrease in overweight/obesity. Short sleep duration among adolescents may be an important contributor to increased body weight at the population level.

 
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Asia Health Policy Program working paper # 38
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Young Kyung Do
Young Kyung Do

Information, Development, and Life-course Smoking Pattern in Mainland China and Taiwan over 50 Years

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We use retrospectively reported data on smoking behavior of residents of Mainland China and Taiwan to compare and contrast patterns in smoking behavior over the life-course of individuals in these two regions. Because we construct the life-history of smoking for all survey respondents, our data cover an exceptionally long period of time – up to fifty years in both samples. During this period, both societies experienced substantial social and economic changes. The two regions developed at much different rates and the political systems of the two areas evolved in very different ways. More importantly, governments in the two areas set policies that caused the flow of information about the health risks of smoking to differ across the regions and over time. We exploit these differences, using counts of articles in newspapers from 1951 to present, to explore whether and how the arrival of information affected life-course smoking decisions of residents in the two areas. We also present evidence that suggests how prices/taxes and key historical events might have affected decisions to smoke.

Dean Lillard received his PhD in economics from the University of Chicago in 1991. From 1991 to 2012, he was a faculty member and senior research associate in the Department of Policy Analysis and Management at Cornell University. In August 2012 he joined the Department Human Sciences at Ohio State University as an Associate Professor. He is Director and Project Manager of the Cross-National Equivalent File study that produces cross-national data. He is a member of the American Economics Association, the Population Association of America, the International Association for Research on Income and Wealth, the International Health Economics Association, the American Society for Health Economics, a Research Associate at the German Institute for Economic Research in Berlin, Germany, and a Research Associate of the National Bureau of Economic Research. He serves on the advisory board of the Danish National Institute for Social Research in Copenhagen, Denmark and the Cross-National Studies: Interdisciplinary Research and Training Program – a collaborative program run by the Polish Academy of Sciences (PAN), and together with the Mershon Centre at OSU.

Dean Lillard's current research focuses on health economics, the economics of schooling, and international comparisons of economic behavior. His research in health economics is primarily focused on the economics of the marketing and consumption of cigarettes and alcohol. His research on the economics of schooling includes studies of direct effects of policy on educational outcomes and on the role that education plays in other economic behaviors such as smoking, production of health, and earnings. His cross-national research ranges widely from comparisons of the role that obesity plays in determining labor market outcomes to comparisons of smoking behavior cross-nationally.

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Dean R. Lillard Associate Professor, Department Human Sciences Speaker Ohio State University
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Why Do Parents Abort Girls? Patrilocality and Its Historical Origin

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Co-sponsored by the Stanford Center for International Development

Recent scholarship has documented an alarming increase in the sex ratio at birth in parts of East Asia, South Asia and the Caucuses. In this paper, I argue that parents in these regions engage in sex selection because of patrilocal norms that dictate elderly coresidence between parents and sons. Sex ratios and coresidence rates are positively correlated when looking across countries, within countries across districts, and within districts across ethnic groups. The paper then examines the roots of patrilocality and biased sex ratios using the Ethnographic Atlas (Murdock 1965). I find that ethnic groups in areas with land conducive to intensive agriculture have stronger patrilocal norms, higher modern coresidence rates, and higher sex ratios at birth. The paper concludes with an examination of the expansion to old age support in South Korea. Consistent with the paper’s argument, I find that the program was associated with a normalization in the sex ratio at birth.

Avi Ebenstein received his Ph.D. in economics from the University of California, Berkeley in 2007 is a Lecturer at the Hebrew University of Jerusalem in the Department of Economics. His fields of interest include environmental economics, economic demography, and international trade. Avi's past research has focused primarily on issues related to  China, including the health impacts of air and water pollution, causes and consequences for the country’s high sex ratio at birth, internal migration, and the impact of China’s entry into the global economy on wage patterns domestically and in the United States. He is currently a Visiting Research Scholar at the Center for Health and Wellbeing at Princeton University.

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Avraham Ebenstein Lecturer Speaker The Hebrew University of Jerusalem in the Department of Economics
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