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.

After completing the postdoc program, I landed a dream academic job, where I can continue to research health policy with a focus on the Asia-Pacific region. Despite its relatively short period, my postdoc experience also helped expand the scope of my research and the breadth of professional network.

-Dr. Young Kyung Do 
Former Asia Health Policy Postdoctoral Fellow (2008–09)

The Asia Health Policy Program (AHPP) at the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) is pleased to announce that Ang Sun has been awarded the 2011–12 Asia Health Policy Postdoctoral Fellowship. Sun is currently completing her PhD in development economics at Brown University. She earned bachelor degrees in computer science and economics from Peking University in 2002. Sun's research focuses on resource allocation within households, especially in developing Asia. In her dissertation, she provides empirical evidence that the 2001 divorce law in China empowered women and decreased sex-selective abortion. She has also studied multi-generational living arrangements and household decisions about fertility and labor-force participation.

We also are delighted to announce that Yuki Takagi, currently completing her PhD in government at Harvard University, will be the 2012-13 Asia Health Policy Postdoctoral Fellow. Takagi is completing her dissertation on the political economy of insurance provision and intergenerational family transfers, such as nursing and childcare, focusing on East Asia. She has earned bachelor of economics and master of law degrees from the University of Tokyo. Takagi will join Shorenstein APARC after completing a postdoctoral fellowship in the Department of Politics at Princeton University in 2011–12.

The research of these two postdoctoral fellows will complement the Shorenstein APARC research initiative on demographic change in East Asia.

The Asia Health Policy Postdoctoral Fellowship is designed to strengthen research in the field of Asian comparative health policy and demographic change, drawing from junior scholars in a variety of disciplines, including: demography, sociology, political science, economics, law, anthropology, public policy, health services research, and related fields. Fellows participate in AHPP events and collaborative research while completing their own projects on health policy or the social and economic implications of population aging in Asia.

Previous postdoctoral fellows in the program have accepted faculty positions in Asia and the United States. Dr. Young Kyung Do (2008–09), who earned his PhD from the University of North Carolina at Chapel Hill, is now an assistant professor at the Duke-National University of Singapore Graduate Medical School. Dr. Brian Chen (2009–10), who earned his PhD in 2009 from the University of California, Berkeley, has accepted a faculty position at the Arnold School of Public Health at the University of South Carolina. The current postdoctoral fellow, Dr. Qiulin Chen, earned his PhD from Peking University. He studies the political economy of China's health reforms as well as how China compares to other countries in terms of public and private intergenerational transfers (the China component of the National Transfer Accounts project).

Thoughts from the postdoctoral fellows

Dr. Do notes that "given that the primary goal of most postdoc programs is to help fresh PhD graduates prepare a successful academic career, my postdoc experience at Stanford['s Shorenstein] APARC has proved to be effective in my professional career thus far. After completing the postdoc program, I landed a dream academic job, where I can continue to research health policy with a focus on the Asia-Pacific region. Despite its relatively short period, my postdoc experience also helped expand the scope of my research and the breadth of professional network."

Dr. Chen adds that "the postdoctoral position opened many more doors than I had coming directly out of my Ph.D. program... The support I received was phenomenal... The wider Stanford community affords the postdoctoral fellow the opportunity to meet and interact with leading scholars of virtually any field in the arts and sciences."

The new postdoctoral fellows anticipate similarly stimulating experiences at Stanford:  Takagi says she is "delighted and excited" to accept the fellowship, and Sun emphasizes that she appreciates "the opportunity to spend one year at such a prestigious place as the Shorenstein Asia-Pacific Research Center at Stanford, which will be a very nice start of my research career."