Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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This paper considers household decision making on living arrangements and maternal labor supply in an extended family with young children. In such a context, the decision making is driven by the concern that the companionship of children is a household public good and that family members share childcare and related domestic duties. The incentive to share children’s companionship is affected by son preference, whereas the economic motive of labor division hinges on the potential wage rate of the mother. Both channels play important roles in households with mothers whose wage rates are high,  while sharing the companionship of (grand)sons is the main driving force in households with mothers whose wage rates are low. Using China Health and Nutrition Survey (CHNS) data, we find that among less-educated mothers, the incidence of a family co-residing with the paternal grandmother is at least 8.6 percentage points higher if the firstborn is a boy. At the same time, maternal labor supply increases by 2.9 days per month. By contrast, for educated mothers, the propensity for co-residence is higher, and the working hours are longer than for less-educated mothers, and the impact of the child’s sex is not significant. This paper not only provides a better understanding of the demographic and economic factors determining co-residence and intra-household time allocations, but also lends empirical support to policies aiming to increase female labor supply and improve the well-being of girls.

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Asia Health Policy Program working paper # 44
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In this public colloquium, a leading expert on public health in India discusses strategies and tactics to address the chronic disease burden in India. Drawing from the cutting edge research of the Centre for Chronic Disease Control, D. Prabhakaran will discuss the prevention and management of chronic diseases in India and the developing world, including initiatives to create solutions for cardiovascular disease through translational research and human resource development.

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Professor D. Prabhakaran is a cardiologist and epidemiologist by training. He is an internationally renowned researcher and is currently the Vice President- Research & Policy, Public Health Foundation of India, Executive Director of Centre for Chronic Disease Control, New Delhi, India and Professor (Epidemiology) London School of Hygiene and Tropical Medicine, UK. He heads the Centre for Control of Chronic Conditions at PHFI which is a joint initiative of four leading institutions (Public Health Foundation of India, London School of Hygiene and Tropical Medicine, All India Institute of Medical Sciences, New Delhi and Emory University). His work spans from mechanistic research to understand the causes for increased propensity of cardiovascular diseases (CVD) among Indians, to developing solutions for CVD. Prof. Prabhakaran is a Fellow of the Royal College of Physicians, UK, Fellow of the National Academy of Sciences, India, and an Adjunct Professor at the Emory University. He is member of Executive Council of the International Society of Hypertension (ISH) and Chair of the International Society of CVD Epidemiology and Prevention (ISCEP). He has received funding from NHLBI, Wellcome Trust, European Commission and several other international and national funding bodies.  He has mentored over 40 post-doctoral and doctoral students so far. He has authored several chapters and over 375 scholarly papers with an H index of 59. He is the lead editor of the Cardiovascular Disease Volume of the latest Disease Control Priorities Project.

About the Colloquia:

In 2016, the Walter H. Shorenstein Asia-Pacific Research Center, in collaboration with the Stanford Center for South Asia, launched a series of public lectures to broaden our understanding and discussion of contemporary India — its enormous domestic potential and problems, its place in the region and the world, and the ambitious agenda of the new Modi administration. Building on the strong engagement of those issues from across the university community and beyond, we are continuing the series, with generous support from the U.S. India Business Council, in the 2017-2018 academic year. We will  draw business, political, diplomatic and academic experts from the U.S. and India to explore topics including India’s innovation economy, India-China relations, India’s pivotal role in global health, and U.S.-India relations. 

 

This Colloquia is co-sponsored with the U.S.-India Business Council 

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  and the Stanford Center for South Asia

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Encina Hall, 3rd floor, Central

D. Prabhakaran Vice President (Research & Policy), Public Health Foundation of India, Executive Director of Centre for Chronic Disease Control, New Delhi, India
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Co-sponsored by the Center for East Asian Studies and the Asia Health Policy Program

With rapid economic development, changes in lifestyle, epidemiologic transition and the ageing of the population, China’s primary health challenge has become Non-Communicable Diseases (NCDs). Zhejiang province—one of the wealthiest and longest-lived—illustrates how China is responding to this challenge. In Zhejiang, NCDs account for 85% of deaths; the prevalence of hypertension and diabetes are 26.7 % and 7.4%, respectively; and the age of onset of diabetes is getting progressively younger. This seminar will focus on two inter-related strategies: strengthening primary care management of chronic disease, and leveraging newly created regional “big data” platforms to improve policy. Drawing on collaborative research with Stanford’s Asia Health Policy Program, Dr. Zhong will discuss management of hypertension and diabetes patients in community health centers, as well as how Ningbo City of Zhejiang exemplifies the experience of many local governments (municipalities or counties) in building their own regional health information platforms. By gradually collecting all administrative data and other health-related information for their residents from birth to death, including medical claims, vaccination records, lifestyle behaviors, environmental and meteorological factors, and so on, more and more local policymakers seek to analyze big data to explore potential risk factors, pilot targeted interventions, and support evidence-based health policies.

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Zhong, Jieming graduated from the school of public health of Zhejiang University and received his master's degree in public health (MPH) from the Chinese Center for Disease Control and Prevention. He is the director of the Department of Non-communicable Disease (NCD) Control and Prevention in the Zhejiang CDC. He served as deputy director of the Department of Tuberculosis Control and Prevention in Zhejiang CDC during 2008-2014. He is a member of the Zhejiang Preventive Medicine Association and has engaged in and chaired several international cooperation and local research projects. He has in-depth research on NCDs and TB control and prevention, and has published over 30 scientific papers in related fields.

Zhong Jieming Director of the Department of NCD Control and Prevention, Zhejiang CDC, China.
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The Shorenstein Asia-Pacific Research Center (APARC) at Stanford is now accepting applications for the Shorenstein Postdoctoral Fellowship in Contemporary Asia, an opportunity made available to two junior scholars for research and writing on Asia.

Fellows conduct research on contemporary political, economic or social change in the Asia-Pacific region, and contribute to Shorenstein APARC’s publications, conferences and related activities. To read about this year’s fellows, please click here.

The fellowship is a 10-mo. appointment during the 2018-19 academic year, and carries a salary rate of $52,000 plus $2,000 for research expenses.

For further information and to apply, please click here. The application deadline is Dec. 20, 2017.

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616 Serra StreetEncina Hall E301Stanford, CA94305-6055
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Natt Hongdilokkul joins the Walter H. Shorenstein Asia-Pacific Research Center (APARC) during the 2017-2018 academic year as a postdoctoral scholar in Developing Asia Health policy. His research interests concern the effect of universal health care on household outcomes and welfare using micro-level panel data in Thailand. He received a PhD and an MA in Economics from Simon Fraser University, Canada, and another MA and a BA in Economics from Thammasat University, Thailand.

Developing Asia Health Policy Postdoctoral Fellow, 2017-18
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Health insurance holds the promise of improving population health and survival and protecting people from catastrophic health spending. Yet evidence from lower- and middle-income countries on the impact of health insurance is limited. We investigated whether insurance expansion reduced adult mortality in rural China, taking advantage of differences across Chinese counties in the timing of the introduction of the New Cooperative Medical Scheme (NCMS). We assembled and analyzed newly collected data on NCMS implementation, linked to data from the Chinese Center for Disease Control and Prevention on cause-specific, age-standardized death rates and variables specific to county-year combinations for seventy-two counties in the period 2004–12. While mortality rates declined among rural residents during this period, we found little evidence that the expansion of health insurance through the NCMS contributed to this decline. However, our relatively large standard errors leave open the possibility that the NCMS had effects on mortality that we could not detect. Moreover, mortality benefits might arise only after many years of accumulated coverage.

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Health Affairs
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Karen Eggleston
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Rural areas of China have made remarkable progress in reducing adult mortality within the past 15 years yet broadened health insurance was not a casual factor in that decline, according to a new study by an international research team that includes Asia Health Policy Program Director Karen Eggleston.

The New Cooperative Medical Scheme (NCMS), a government-subsidized insurance program that began in 2002-03, expanded to cover all of rural China within a decade. Examining NCMS and cause-specific mortality data for a sample of 72 counties between 2004 and 2012, the researchers found that there were no significant effects of health insurance expansion on increased life expectancy.

The study, published in the September issue of Health Affairs, showed results consistent with previous studies that also did not find a correlation between insurance and survival, although much research confirms NCMS increased access to healthcare, including preventive services, and shielded families from high health expenditures.

Commenting on the study, Eggleston said population health policies remain central to China’s efforts to increase life expectancy and to bridge the gap between rural and urban areas.

Eggleston also noted that multiple factors beyond the availability of health care determine how long people live, and anticipates the research team will continue to explore the impacts of NCMS by extending the study to look at infants and youth.

Read the study (may require subscription) and view a related article on the Stanford Scope blog.

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Farmers dry star anise seeds in a country yard in Tanbin Township, China, Nov. 26, 2005.
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Lisa Lee
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The Asia Health Policy Program, established in 2007, promotes a comparative understanding of health and health policy in the Asia-Pacific region through research and collaboration with regional scholars, a colloquium series on health and demographic change, and conferences and publications on comparative health policy topics. The program is committed to supporting young researchers through its Asia Health Policy Postdoctoral Fellowship. Every year, the program director, Karen Eggleston, mentors recent doctoral graduates invited to come to Stanford to undertake original research on contemporary health policy of relevance to the Asia-Pacific region. The Program recently organized the Workshop of Young Leaders in Asia Health Policy in Beijing to celebrate its 10th anniversary.

Asia Health Policy Program alumni have been expanding around the globe. Young Kyung Do, from South Korea, was the first Asia Health Policy Postdoctoral Fellow in 2008-09. He earned his doctorate in health policy and management from the University of North Carolina at Chapel Hill, and is currently an associate professor in the Department of Health Policy and Management at Seoul National University in South Korea. His research interests include aging and long-term care, the interplay of health, education and labor, health behavior, sleep and time use, risk literacy and risk communication, value of medical interventions, and quality assessment from the patient's perspective. Working papers: 

The Effect of Informal Caregiving on Labor Market Outcomes in South Korea

The Effect of Coresidence with an Adult Child on Depressive Symptoms among Older Widowed Women in South Korea: An Instrumental Variable Estimation

The Effect of Sleep Duration on Body Weight in Adolescents: Evidence from a Natural Experiment

Brian K. Chen, from the United States, was the 2009-10 Asia Health Policy Postdoctoral Fellow. He earned his doctorate in business administration from the Haas Business School at the University of California, Berkeley. He is currently an associate professor in the Department of Health Services Policy and Management at the Arnold School of Public Health, University of South Carolina in the United States.  He is also the associate director of Taiwan Doctoral Program housed in the Department of Health Services Policy and Management.  He has a unique combination of legal and economic expertise. He received a Juris Doctor from Stanford Law School in 1997. His research focuses on health policy, particularly with respect to health disparities, the burden of chronic illnesses and aging as well as the impact of incentives in health care organizations on provider and patient behavior.  Working papers: 

Strict Liability for Medical Injuries? The Impact of Increasing Malpractice Liability on Obstetrician Behavior: Evidence from Taiwan

Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from China’s Essential Medications List Policy

Qiulin Chen, from China, was the 2010-11 Asia Health Policy Postdoctoral Fellow. He earned his doctorate in economics from Peking University. He is currently an associate professor and director of the Social Security Research Division of the Institute of Population and Labor Economics, and deputy director of the Research Center of Health Industry Development at the Chinese Academy of Social Sciences in Beijing. His research interests are health economics and health policy, aging and social security, and public finance.

There were two Asia Health Policy Postdoctoral Fellows from 2011until 2012. Ang Sun, from China, earned her doctorate in economics from Brown University in the United States. She is currently an associate professor at Central University of Finance and Economics in Beijing, China. Her research focuses on household and marriage, development, demography and health. The second fellow, Siyan Yi from Cambodia, was the first recipient of the Developing Asia Health Policy Fellowship for citizens of low-income countries in Asia. Dr. Yi earned his doctorate in international health sciences from the University of Tokyo. He is currently a director of KHANA Center for Population Health Research in Cambodia and adjunct associate professor at Center for Global Health Research of Touro University California in the United States. His research projects are in population health, including clinical epidemiology, social and behavioral determinants of health, health promotion, health system strengthening, and health policy in both developed and developing countries.

Marjorie Pajaron, from the Philippines, was the 2012-13 Asia Health Policy Postdoctoral Fellow. She earned her doctorate in economics from the University of Hawaii at Manoa. She is currently an assistant professor at the School of Economics, University of the Philippines. Her research lies at the intersection of applied microeconomics and health policy, with a focus on gender, health, development and labor economics.  Working papers: 

Remittances, Informal Loans, and Assets as Risk-Coping Mechanisms: Evidence from Agricultural Households in Rural Philippines

The Roles of Gender and Education on the Intrahousehold Allocations of Remittances of Filipino Migrant Workers

Margaret Triyana, from Indonesia, was the 2013-14 Asia Health Policy Postdoctoral Fellow. She earned her doctorate in public policy from the Harris School of Public Policy at the University of Chicago. She is currently a visiting assistant professor at the Keough School of Global Affairs at the University of Notre dame, in the United States. Prior to joining the Asia Health Policy Program, she was an Indonesia research fellow at the Harvard Kennedy School. She is particularly interested in how social policies affect health outcomes for the poor, early health investments, and health-seeking behavior in limited-resource settings.

Gendendarjaa Baigalimaa, from Mongolia, was the 2013-14 Visiting Scholar for Developing Asia Health Policy. A medical doctor by training, she studied cancer prevention and the impact of the National Cervical Cancer Program in Mongolia. Upon completion of her fellowship with the Asia Health Policy Program, she became a gynecological oncologist at Mungun Guur Hospital in Mongolia.

There were two Asia Health Policy postdoctoral fellows from 2014 until 2015. Pham Ngoc Minh, from Vietnam, who earned his doctorate in medical science from Kyushu University in Japan, is currently a visiting research fellow at Curtin University in Australia. His main research interests include the epidemiology and prevention of metabolic diseases, particularly diabetes, and depression in Asian adults. He also works on systematic reviews and meta-analyses of observational and clinical studies to inform health policy. The second postdoctoral fellow was Phyu Phyu Thin Zaw, from Myanmar, who completed her doctorate in epidemiology from the Prince of Songkla University in Thailand. She is a research scientist at the Department of Medical Research in the Pyin Oo Lwin branch of the Ministry of Health and Sport in Myanmar. Currently, she is on leave to attend a master of public policy at Oxford University, in the United Kingdom.  Her current research work involves equitable allocation of healthcare resources, the current health system transformations, and the democratization process in Myanmar.

Darika Saingam, from Thailand, was the 2015-16 Asia Health Policy Postdoctoral Fellow. She earned her doctorate in epidemiology from the Prince of Songkla University in Thailand. Her research interests are public health, substance abuse and drug policy. She seeks to identify potentially effective policy directions suitable for Thailand. Before she joined the Asia Health Policy Program, she served as a researcher at Songkla University’s Epidemiology Unit. She has since continued her work on substance abuse research.

Kim Ngan Do, from Vietnam, was the 2016-17 Asia Health Policy Postdoctoral Fellow. She earned her doctorate in health policy and management from the College of Medicine at Seoul National University, South Korea. She has a strong interest in health system-related issues, especially health financing, human resources for health, and health care service delivery. She implemented comparative studies at the regional level and completed fieldwork in Cambodia, Laos, Philippines, South Korea and Vietnam.

Since its inception, the Asia Health Policy Program has supported numerous fellows to develop their expertise. They continue to pursue their academic and research interests, and have become experts in their fields. Alumni hold various academic, research and professional positions around the world, and are part of a vital community that promotes deeper understanding of comparative health policy through education, training and implementation of best healthcare practice.

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ahpp young leaders Courtesy of Asia Health Policy Program
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In the face of population aging, policymakers throughout the Asia-Pacific are seeking ways to improve health service provision for older individuals. The InterRAI (International Resident Assessment Instrument) is a comprehensive assessment tool for older people, and is used as a de facto assessment tool for the care needs of older people in many countries, including New Zealand (see http://www.interrai.org). Part of the full InterRAI assessment is a home care assessment, which provides the data we use in this study, including three main outcome measures: (1) CHESS (Changes in Health, End-stage Disease, Signs, and Symptoms); (2) MAPLe (Method of Assigning Priority Levels); and (3) the ADL (Activities of Daily Living) hierarchy. Specifically, we use data on over 8000 assessments in the Waikato region of New Zealand over the period 2013-2016.

In this seminar, Professor Cameron discusses the relationship between the three outcome measures and a range of clinical and operational outcomes within 90 days of the assessment, including hospital admissions; dementia admissions; number of bed days; and mortality. The CHESS outcome measure offers the greatest predictive validity of the three measures, with a one unit increase in CHESS score (interpreted as a higher risk of serious decline in health status) associated with 26 percent higher odds of hospital admission within 90 days of assessment, 18 percent more bed days, and 30 percent higher odds of mortality. Finally, Cameron discusses how these results are being used by the Waikato District Health Board to improve the services provided to older people in the region.

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Dr. Michael Cameron is an associate professor in economics at the University of Waikato (New Zealand). He is also a research fellow in the National Institute of Demographic and Economic Analysis (NIDEA). He was a PGDA Visiting Fellow at the Harvard T.H. Chan School of Public Health at Harvard University from 2015-16.

Dr. Cameron gained his PhD from University of Waikato in 2007, with a thesis titled "The Relationship between Poverty and HIV/AIDS in Rural Thailand". His current research interests include population, health and development issues (including the social impacts of liquor outlet density, the economics of communicable diseases especially HIV/AIDS, health applications of non-market valuation, and health and development project monitoring and evaluation), population modelling and stochastic modelling, financial literacy and economics education.

He also blogs regularly at Sex, Drugs and Economics (http://sex-drugs-economics.blogspot.com/).

 

Michael P. Cameron National Institute of Demographic and Economic Analysis (NIDEA), University of Waikato, New Zealand
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The Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center, in conjunction with The Next World Program, is soliciting papers for a workshop, “Inequality & Aging,” held at the University of Hohenheim from May 4-5, 2018. The workshop will result in a special issue of the Journal of the Economics of Ageing, and aims to address topics such as:

  • Population dynamics and income distribution
  • The evolution of inequality over time and with respect to age
  • Health inequality in old age
  • The effects of social security systems and pension schemes on inequality
  • Policies to cope with demographic challenges and the challenges posed by inequality
  • Family backgrounds and equality of opportunities
  • Demographically induced poverty traps
  • Effects of automation and the digital economy in ageing societies
  • Flexible working time and careers, and their long-term implications
  • The dynamics of inheritances, etc.

Researchers who seek to attend the workshop are invited to submit a full paper or at least a 1-page extended abstract directly to Klaus Prettner and Alfonso Sousa-Poza by Sept. 30, 2017.

Authors of accepted papers will be notified by the end of October and completed draft papers will be expected by Jan. 31, 2018. Economy airfare and accommodation will be provided to one author associated with each accepted paper. A selection of the presented papers will be published in the special issue; the best paper by an author below the age of 35 will receive an award and be made available online as a working paper.

Researchers who do not seek to attend the workshop are also invited to submit papers for the special issue. Those papers can be submitted directly online under “SI Inequality & Ageing” by May 31, 2018.

For complete details, please click on the link below to view the PDF.

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