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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Sex differences in mortality (SDIM) vary over time and place as a function of social, health, and medical circumstances. The magnitude of these variations, and their response to large socioeconomic changes, suggest that biological differences cannot fully account for sex differences in survival. We develop a set of empiric observations about SDIM with which any theory will have to contend. We draw on a wide swath of mortality data, including probability of survival to age 70 by county in the United States, the Human Mortality Database data for 18 high-income countries since 1900, and mortality data within and across developing countries over time periods for which reasonably reliable data are available. We show that as societies develop, M/F survival first declines and then increases, a “SDIM transition” embedded within the well-described demographic and epidemiologic transition. After the onset of this transition, cross-sectional variation in SDIM exhibits a consistent pattern of female resilience to mortality under adversity, which strengthens over time.

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Asia Health Policy Program working paper # 41
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Karen Eggleston
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A long line of research has shown that women live longer than men, yet according to Karen Eggleston, director of the Asia Health Policy Program, and four other Stanford health researchers, mortality rate differences between men and women are much more variable than previously thought, following predictable patterns. Life expectancy differs depending on time, location and socioeconomic circumstance, not on biological factors alone, according to their newly published findings.

The researchers found that women have greater resilience when faced with socioeconomic adversity in a developing country—living nearly 10 years longer than men on average—but this pattern changes as the country evolves. Developed countries typically have smaller gaps in mortality rates between men and women than developing countries do.

Japan and South Korea are outliers, however, with higher mortality rate differences between men and women than is average for developed countries. In addition to the prevalence of male smoking, one possible explanation they draw is the lack of career-related opportunities for women in Japan and South Korea, two countries that have low gender wage equity among Organisation of Economic Co-operation and Development members.

Eggleston, who is part of the core faculty at the Shorenstein Asia-Pacific Research Center, et al. suggested the idea that reducing gender inequality may help narrow the mortality gap: men increase years lived when fewer barriers for women exist, but concluded that their findings supporting this conclusion merit further inquiry.

Their findings were published in the August edition of SSM – Population Health and highlighted in an earlier column on Voxeu.

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A woman walking in Tokyo, Japan. | Getty Images/Kiyoshi Ota
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Exploiting the variation in the amount of subsidy for child health care by municipality, age and time in Japan, this paper examines the effect of patient cost-sharing on child health care utilization. Using longitudinal claims data and triple difference-in-difference framework, we find that reduced cost-sharing significantly increases utilization of outpatient care among children. We further investigate whether these increase in outpatient visits solely reflects moral hazard or increases in beneficial care.

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hitoshi shigeoka
Hitoshi
Shigeoka
received a B.A. (2001) and an MA (2003) in chemical engineering from University of Tokyo, and master of international affairs (2006) and PhD in economics (2012) from Columbia University. Hitoshi’s research interests include health, labor, public economics, and experimental economics. His current research involves estimating the demand elasticity of health care utilization, examining the degree of supplier-induced demand by physicians and hospitals, examining the effects of competition and peer-to-peer teaching on learning, and investigating how the long-term incentives of mothers affect the timing of births.
Hitoshi Shigeoka Simon Fraser University
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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 2017-18 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. 16, 2016.

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The Asia Health Policy Program at Stanford’s Shorenstein Asia-Pacific Research Center, in collaboration with scholars from Stanford Health Policy's Center on Demography and Economics of Health and Aging, the Stanford Institute for Economic Policy Research, and the Next World Program, is soliciting papers for the third annual workshop on the economics of ageing titled Financing Longevity: The Economics of Pensions, Health Insurance, Long-term Care and Disability Insurance held at Stanford from April 24-25, 2017, and for a related special issue of the Journal of the Economics of Ageing.

The triumph of longevity can pose a challenge to the fiscal integrity of public and private pension systems and other social support programs disproportionately used by older adults. High-income countries offer lessons – frequently cautionary tales – for low- and middle-income countries about how to design social protection programs to be sustainable in the face of population ageing. Technological change and income inequality interact with population ageing to threaten the sustainability and perceived fairness of conventional financing for many social programs. Promoting longer working lives and savings for retirement are obvious policy priorities; but in many cases the fiscal challenges are even more acute for other social programs, such as insurance systems for medical care, long-term care, and disability. Reform of entitlement programs is also often politically difficult, further highlighting how important it is for developing countries putting in place comprehensive social security systems to take account of the macroeconomic implications of population ageing.

The objective of the workshop is to explore the economics of ageing from the perspective of sustainable financing for longer lives. The workshop will bring together researchers to present recent empirical and theoretical research on the economics of ageing with special (yet not exclusive) foci on the following topics:

  • Public and private roles in savings and retirement security
  • Living and working in an Age of Longevity: Lessons for Finance
  • Defined benefit, defined contribution, and innovations in design of pension programs
  • Intergenerational and equity implications of different financing mechanisms for pensions and social insurance
  • The impact of population aging on health insurance financing
  • Economic incentives of long-term care insurance and disability insurance systems
  • Precautionary savings and social protection system generosity
  • Elderly cognitive function and financial planning
  • Evaluation of policies aimed at increasing health and productivity of older adults
  • Population ageing and financing economic growth
  • Tax policies’ implications for capital deepening and investment in human capital
  • The relationship between population age structure and capital market returns
  • Evidence on policies designed to address disparities – gender, ethnic/racial, inter-regional, urban/rural – in old-age support
  • The political economy of reforming pension systems as well as health, long-term care and disability insurance programs

 

Submission for the workshop

Interested authors are invited to submit a 1-page abstract by Sept. 30, 2016, to Karen Eggleston at karene@stanford.edu. The authors of accepted abstracts will be notified by Oct. 15, 2016, and completed draft papers will be expected by April 1, 2017.

Economy-class travel and accommodation costs for one author of each accepted paper will be covered by the organizers.

Invited authors are expected to submit their paper to the Journal of the Economics of Ageing. A selection of these papers will (assuming successful completion of the review process) be published in a special issue.

 

Submission to the special issue

Authors (also those interested who are not attending the workshop) are invited to submit papers for the special issue in the Journal of the Economics of Ageing by Aug. 1, 2017. Submissions should be made online. Please select article type “SI Financing Longevity.”

 

About the Next World Program

The Next World Program is a joint initiative of Harvard University’s Program on the Global Demography of Aging, the WDA Forum, Stanford’s Asia Health Policy Program, and Fudan University’s Working Group on Comparative Ageing Societies. These institutions organize an annual workshop and a special issue in the Journal of the Economics of Ageing on an important economic theme related to ageing societies.

 

More information can be found in the PDF below.


 

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Flickr/Vinoth Chandar
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Abstract cover image for book Policy Challenges from Demographic Change in China and India

The world’s two most populous countries face numerous policy challenges from rapid demographic change. Drawing on social science expertise from China, India, and the United States, the contributors examine the social and economic challenges for policies across a range of domains, from China’s changed family planning policies and India’s efforts to address gender imbalance, to both countries’ policies regarding old-age support, human capital investment, poverty alleviation, and broader issues of governance.

Sections focus on:

  • Policy Challenges and Economic Impact
  • Fertility and Sex Imbalance
  • Human Capital and Urbanization
  • Population Aging

Desk or examination copies can be ordered from Stanford University Press.

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This forum will focus on the importance of community health services and primary health care reform in China and discuss the deepening efforts to establish a two-way referral system to help boost access and equality of high-quality medical resources and basic public health services.  At this year’s annual forum, distinguished experts will present research examining China’s emerging hierarchical medical system (including insurance payments, referral arrangements, and chronic and acute disease treatment initiatives). Policymakers, providers, and researchers will introduce China's overall policies towards this new system as well as describe the practice and challenges of primary care delivery and innovative approaches of internet-based and integrated medical care systems.

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Xiaofang Han Former Director of Beijing Municipal Development and Reform Commission
Xinbo Liao Inspector of The Health and Family Planning Commission of Guangdong Province
Jifu Zhan Deputy Mayor of Sanming, Fujian province
Su Xu Deputy Director General of Shanghai Health and Family Planning Commission, Director of Shanghai health care reform office
"and other speakers; please see agenda"
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