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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The economic reforms of the past two decades have initiated a major social transition in China, characterized by unprecedented social mobility and stratification.  Meanwhile, the privatization of health care has increased costs to the consumer and further changed familial and social norms. While such changes would logically affect individuals’ psychological well-being, little attention has been paid to their impact in this regard. Using data from the Chinese General Social Survey (CGSS 2005), this paper looks at the relationships between social change, social support and the psychological well-being of individuals in both urban and rural areas, as well as the role of marital status in Chinese society. We find that an increasing health care burden is significantly reducing individuals’ psychological well-being. Perceptions of social status, especially as it changes over time and when compared against peers, also have an effect. Social support has protective function for psychological well-being, and also compensates for the negative effect of increasing health-care burden and relative deprivation during social change on psychological well-being. Marital status is also significantly correlated with psychological well-being, and moderates the relationships between social change, other social support and psychological health, especially in rural cases.

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Asia Health Policy Program working paper #23
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Huijun Liu
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The Asia Pacific Observatory (APO) on Health Systems and Policies was established in June 2011. It is a collaborative partnership of interested governments, international agencies, foundations, civil society, and the research community. Modeled on the European Observatory of the same name, the APO has as its main function the collection and analysis of information and research evidence on health care systems, policies, and reforms, with the aim of making this knowledge widely available and easily accessible throughout the Asia Pacific Region; it will also draw cross-country lessons and disseminate these in formats that can be directly used for policymaking.

This presentation will trace the history underlying the creation of the Observatory and indicate its objectives, organizational structure, and proposed modes of operation. It will describe the challenges of attempting to bring a wide range of stakeholders together in support of a regional collaborative research effort. It will also touch on ways that research entities located outside the Asia Pacific region might interact with the APO.

L. Richard Meyers was employed by the World Bank for two decades managing teams that carried out World Bank health sector projects and analytical work in a number of countries in East Asia. He directed a team that produced the first comprehensive health sector review for Vietnam, as well as the first Vietnam National Health Survey.  He also led a team that produced the most comprehensive and empirically-based external analysis to date of the rural health sector in China. More recently he has worked with the European Health Observatory, the Asian Development Bank, the World Bank, the WHO Western Pacific and South Asia regional offices, and other stakeholders to facilitate the creation of the Asia Pacific Observatory.

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L. Richard Meyers Consultant Speaker World Bank
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What influence might graphic warning labels have on cigarette sales? Matthew Kohrman is studying that question with experimental methods in Southwest China. Kohrman’s research is generating much-needed data in support of the expansion of China’s warning label system. Among the countries increasingly adopting graphic labels, the United States will require visual warnings on all cigarette packages by next fall.

Stanford Cancer Center News: Smoking cessation in a land of two trillion cigarettes
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Packages of cigarettes for sale in China.
Ryan Pikkel
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Objective To investigate educational disparities in the care process and health outcomes among patients with diabetes in the context of South Korea's universal health insurance system.

Design Bivariate and multiple regression analyses of data from a cross-sectional health survey.

Setting A nationally representative and population-based survey, the 2005 Korea National Health and Nutrition Examination Survey.

Participants Respondents aged 40 or older who self-reported prior diagnosis with diabetes (n= 1418).

Main Outcome Measures Seven measures of the care process and health outcomes, namely (i) receiving medical treatment for diabetes, (ii) ever received diabetes education, (iii) received dilated eye examination in the past year, (iv) received microalbuminuria test in the past year, (v) having activity limitation due to diabetes, (vi) poor self-rated health and (vii) self-rated health on a visual analog scale.

Results Except for receiving medical care for diabetes, overall process quality was low, with only 25% having ever received diabetes education, 39% having received a dilated eye examination in the past year and 51% having received a microalbuminuria test in the past year. Lower education level was associated with both poorer care processes and poorer health outcomes, whereas lower income level was only associated with poorer health outcomes.

Conclusion While South Korea's universal health insurance system may have succeeded in substantially reducing financial barriers related to diabetes care, the quality of diabetes care is low overall and varies by education level. System-level quality improvement efforts are required to address the weaknesses of the health system, thereby mitigating educational disparities in diabetes care quality.

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International Journal for Quality in Health Care
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Young Kyung Do
Karen Eggleston
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Karen Eggleston
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Can social, economic, and policy changes turn a period of growing old-age dependency into one of positive opportunity and growth in China? Qiong Zhang and Asia Health Policy Program director Karen Eggleston explore this challenging question in a recent China Brief article. They look back into several decades of China's history and also consider the current demographic picture of one-child families, gender imbalance, declining fertility rates, and a healthy and prosperous aging population.

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China is now predominantly a country with one-child families.
Stefan Lins
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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.

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An AIDS awareness poster in China
Tricia Wang
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Tobacco is the single greatest cause of preventable death in the world today, including in China where cigarette smoking is a popular pastime. "The [tobacco] industry in China is run by the Tobacco Monopoly Administration, a central government administrative body created in the 1980s, also known as China Tobacco Corp.," said Matthew Kohrman in a February 2011 interview with NPR's Morning Edition. China nonetheless issued a nationwide indoor smoking ban on May 1. Speaking with Al Jazeera English on the first day of the ban, Kohrman predicted that Chinese citizens will increasingly comply with the ban even if in fits and starts initially. "It all has to do with implementation," he suggested. "It all has to do with changing the culture of smoking and people’s thinking about it—that takes time."



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Oriol Salvador
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The Asia Health Policy Program (AHPP) of the Walter H. Shorenstein Asia-Pacific Research Center, in conjunction with the Stanford Center for Population Research (SCPR), announces the availability of 2011–2012 pre-doctoral research assistantships in contemporary Asian demography. The research assistantships support pre-doctoral students working within a broad range of topics related to demographic change in Asia while they provide research assistance to Karen Eggleston, faculty director of AHPP, and Shripad Tuljapurkar, faculty director of SCPR.

DESCRIPTION

Research assistantships are available to Stanford University PhD candidates who have completed three quarters of graduate studies at Stanford and have made progress toward defining original research related to population aging, gender imbalance, inter-generational support, migration and health, or other topics related to demographic change in one or more countries of Asia. A minimum of three quarters of residence and participation in AHPP activities is required. AHPP and SCPR invite applications from a broad range of disciplines, including anthropology, biology, economics, demography, history, law, political science, and sociology.

Students on research assistantships (RAs) receive salary and tuition allowance for up to 10 units (depending on the time commitment) in autumn, winter and spring quarters of the 2011–12 academic year. In the summer, tuition allowance for an RA is usually for three units. The RA may choose to work between 10 hours (25% time) and 20 hours (50% time) per week during the quarters in which they are employed. The research assistance will be an extension of research related to the book co-edited by Eggleston and Tuljapurkar: Aging Asia: The Economic and Social Implications of Rapid Demographic Change in China, Japan, and South Korea. Each RA also receives cubicle space at SCPR.

APPLICATION PROCESS

Applicants should send the following materials to the research assistantship coordinator, Lisa Lee:

  • CV
  • Description of research interests or a detailed dissertation prospectus. The description should be clear and concise, especially to readers outside your discipline, and should not exceed five double-spaced or three single-spaced typewritten pages.
  • Description of previous RA experience and relevant skills, including in quantitative and qualitative analysis. This description should be no longer than one page.
  • Copy of transcripts. Transcripts should cover all graduate work, including evidence of work recently completed.
  • Two letters of recommendation from faculty or advisors, sent directly to AHPP.

Only those applications that contain the complete materials listed above will be considered.

Deadline for receipt of all materials is May 20, 2011.

Please address all materials to:

Lisa Lee, Administrative Associate for AHPP and SEAF
Shorenstein APARC
Stanford University
Encina Hall, Room E301
Stanford, CA 94305-6055

llee888@stanford.edu
(650) 725-2429 (voice)
(650) 723-6530 (fax)

 

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