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.

Paragraphs

The intention to pay for human papillomavirus (HPV) vaccination among women of childbearing age in Vietnam, where cervical cancer remains a significant public health concern, has been mostly lacking. To examine this issue, we conducted a cross-sectional study of 807 pregnant women in an urban and a rural district (Dong Da and Ba Vi) of Hanoi, Vietnam. The vast percentage of our respondents expressed a firm intention to vaccinate, especially women in rural areas (over 90.0%). However, on being informed of the current price of the HPV vaccine, their intention to vaccinate dropped to about one-fifth of overall respondents, i.e., only 4.4% of women in rural areas. It was also observed that the initial intention to get the HPV vaccination among women in the rural district was
about ten times higher than that of women living in the metropolitan district. Those participants who had greater knowledge of cervical cancer andHPV vaccinations also had a significantly higher intention to vaccinate. Our findings underscore the need to develop a well-designed vaccination program in Vietnam and other countries in a similar situation to increase the adoption of HPV vaccination.

Keywords: HPV vaccination; cervical cancer; intention; women; Vietnam

Published: Intention to Pay for HPV Vaccination among Women of Childbearing Age in Vietnam

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
Asia Health Policy Program working paper # 57
Authors
Paragraphs
Cover of Healthy Aging in Asia that shows an elderly woman in a Chinese village.
Life expectancy in Japan, South Korea, and much of urban China has now outpaced that of the United States and other high-income countries. With this triumph of longevity, however, comes a rise in the burden of noncommunicable diseases (NCDs) like diabetes and hypertension, reducing healthy life years for individuals in these aging populations, as well as challenging the healthcare systems they rely on for appropriate care.  
 
The challenges and disparities are even more pressing in low- and middle-income economies, such as rural China and India. Moreover, the COVID-19 pandemic has underscored the vulnerability to newly emerging pathogens of older adults suffering from NCDs, and the importance of building long-term, resilient health systems. 
 
What strategies have been tried to prevent NCDs—the primary cause of morbidity and mortality — as well as to screen for early detection, raise the quality of care, improve medication adherence, reduce unnecessary hospitalizations and increase “value for money” in health spending? 
 
Fourteen concise chapters cover multiple aspects of policy initiatives for healthy aging and economic research on chronic disease control in diverse health systems — from cities such as Singapore and Hong Kong to large economies such as Japan, India, and China. 
 

Desk, examination, or review copies can be requested through Stanford University Press.

All Publications button
1
Publication Type
Books
Publication Date
Authors
Karen Eggleston
Book Publisher
Shorenstein APARC
-

This event is via Zoom Webinar. Please register in advance for the webinar by using the link below.

REGISTRATION LINKhttps://bit.ly/2Kpjiww

A Discussion between Matthew Kohrman and Gan Quan, co-editors of Poisonous Pandas: Chinese Cigarette Manufacturing in Critical Historical Perspectives (Stanford University Press, 2018).

Image
gan quan

 

 

 

Gan Quan (PhD, Berkeley) is the director of Tobacco Control of the International Union Against Tuberculosis and Lung Disease. His research tackles various topics pertaining to tobacco control in China.

 

 

 

 

 

Image
mathew kohrman

 

 

 

Matthew Kohrman (PhD, Harvard) is an associate professor in Stanford’s Department of Anthropology and senior fellow by courtesy at APARC/FSI. His research brings anthropological methods to bear on the ways health, culture, and politics are interrelated.

 

 

 

 

 

 

 

 

Via Zoom Webinar.

Register at https://bit.ly/2Kpjiww

Gan Quan Director of Tobacco Control of the International Union Against Tuberculosis and Lung Disease
Matthew Kohrman Associate Professor of Anthropology, Stanford University
Panel Discussions
News Type
News
Date
Paragraphs

To support Stanford students working in the area of contemporary Asia, the Shorenstein Asia-Pacific Research Center is offering up to ten research assistant internships for summer 2020 and up to three predoctoral fellowships for the 2020-21 academic year. The Center will review applications starting April 15 and expects to fill the positions by April 30, 2020. 

Amid the fallout of the COVID-19 pandemic, students are facing summer internship cancelations and hiring freezes. They are left wondering about the long-term implications of the current crisis for their academic careers and their access to future jobs and valuable work experience.

At Shorenstein APARC, we want to do all we can to support Stanford students. That’s why we are announcing new internship and fellowship opportunities for current students working in the area of contemporary Asia: research assistant internships for the summer quarter of 2020 and predoctoral fellowships for the 2020-21 academic year.

The summer internships are all remote: research assistants will work as telecommuters. Regarding the predoctoral fellowships, we hope we can all have a normal 2020-21 academic year, in which case we expect the fellows to be in residence, but we will reassess the evolving COVID-19 situation closer to the appointment start dates and shift to flexible, online options as needed.

APARC will review applications for both opportunities on a rolling basis starting April 15, 2020. The Center will select up to ten research assistants and up to three predoctoral fellows by April 30, 2020.

Read on to learn more about these offerings and the application requirements, and follow the guidelines below to submit your candidacy.

Summer 2020 APARC Research Assistant Internships

Shorenstein APARC is seeking highly motivated and dedicated undergraduate and graduate students to join our team as paid research assistant interns for the summer quarter of 2020. Research assistants will work with assigned APARC faculty members on projects focused on contemporary Asia, studying varied issues related to the politics, economies, populations, security, foreign policies, and international relations of the countries of the Asia-Pacific region.

All positions will be for eight weeks starting late June or early July 2020. The hourly pay rate is $17 for undergraduate students, $25 for graduate students.

Research assistant positions are open to current Stanford students only. Undergraduate- and graduate-level students are eligible to apply.

Apply Now

  • Complete the application form and submit it along with these two (2) required attachments:
    • CV;
    • A cover letter (up to 1 page).
  • Arrange for a letter of recommendation from a faculty to be sent directly to APARC. Please note: the faculty members should email their letters directly to Kristen Lee at kllee@stanford.edu.

We will consider only complete applications that include all the abovementioned supporting documents.  

2020-21 Shorenstein APARC Predoctoral Fellowships

APARC is inviting applications from current Stanford students for the 2020-21 Shorenstein APARC Predoctoral Fellowship. The fellowship supports predoctoral students working within a broad range of topics related to contemporary Asia. 

Up to three fellowships are available to Ph.D. candidates who have completed all fieldwork and are nearing the completion of their dissertation. The Center will give priority to candidates who are prepared to finish their degree by the end of the 2020-21 academic year.

Shorenstein APARC offers a stipend of $36,075 for the 2020-21 academic year, plus Stanford's Terminal Graduate Registration (TGR) fee for three quarters. We expect fellows to remain in residence at the Center throughout the year and to participate in Center activities.

Apply Now

  • Complete the application form and submit it along with these three (3) required attachments:
    • CV;
    • A cover letter including a brief description of your dissertation (up to 5 double-spaced pages);
    • A copy of your transcripts. Transcripts should cover all graduate work and include evidence of recently-completed work.
  • Arrange for two (2) letters of recommendation from members of your dissertation committee to be sent directly to Shorenstein APARC. Please note: the faculty/advisors should email their letters directly to Kristen Lee at kllee@stanford.edu.

We will consider only complete applications that include all the abovementioned supporting documents. 

Hero Image
Architectural detail on Stanford colonnade with palm trees in the background L.A. Cicero
All News button
1
-

This event is via Zoom Webinar. Please register in advance for the webinar by using the link below.

REGISTRATION LINKhttps://bit.ly/2VUQmTJ

The prevalence of obesity for adults aged 19 and over in Korea has risen from 25.8% in 1998 to 35.5% 2016, while it is still low compared with other developed countries. Body mass index (BMI), focusing on weight for a given height, has traditionally been used to define obesity despite of its shortcomings of not distinguishing between muscle and fat, being inaccurate in predicting the percentage of body fat (PBF), and being not a good measure for the risk of heart attack, stroke, or death. Another measure of abdominal obesity, the z-score of the log-transformed A Body Shape Index (LBSIZ), has been recently introduced to focus on waist circumference for a given both weight and height. We examine their respective association with the risk of diabetes using a cohort data from the Korean Genome and Epidemiology Study.

Image
picturewankyo cropped 4x4
Wankyo Chung is a Professor in the Department of Public Health Science, Graduate School of Public Health at Seoul National University, Seoul Korea. His research interests include economic evaluation of health care programs, equity in health, health policy, and prevention. He has been active as a board member of the Korea Expert Committee on Immunization Practices at Korea CDC, the Information Disclosing Council at Korea HIRA, and an editorial board member of the Korean Journal of Health Economics and Policy and the KDI Journal of Economic Policy. His work has been published regularly in leading international journals. He is currently studying risk prediction models for diabetes at the CEAS, Stanford.

Last few years, China have implemented several national initiatives, for example, the National Healthcare Improvement Initiative (NHII) launched in 2015, to improve patient experiences in healthcare, harmonize the relationship between patients and healthcare workers (i.e., doctors and nurses), and decrease medical disputes in public hospitals. However, reports of medical disputes and violence (verbal abuse or physical violence) against healthcare workers in tertiary public hospitals are still making headlines in China. To help understand and tackle these problems, based on a three-year longitudinal study (2017-2019) conducted in six leading tertiary public hospitals in Shaanxi, a west province of China, we try to depict these problems’ changes, identify the healthcare workers who are at a high risk of medical dispute and violence from patients or their families, and explore the potential causes. These findings could help governments and hospitals protect healthcare workers with more pertinence and build a better medical environment in China.

Image
jinlin liu hr 4x4
Jinlin Liu joins the Walter H. Shorenstein Asia-Pacific Research Center as visiting scholar during the 2019-2020 academic year from Xi'an Jiaotong University, where he serves as a researcher for the Research Center for the Belt and Road Health Policy and Health Technology Assessment. His research lies in the areas of health system and health policy in China, with emphasis on the public hospital governance and development of human resources for health. He obtains a Ph.D. in Public Administration from Xi'an Jiaotong University in 2018.

Via Zoom Webinar.

Register at https://bit.ly/2VUQmTJ

 

Wankyo Chung Professor in the Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul Korea
2019-2020 Walter H. Shorenstein Asia-Pacific Research Center Visiting Scholar
Panel Discussions
-

More than 80% of cardiovascular diseases (CVD) and diabetes mellitus (DM) burden now lies in low and middle-income countries. Thus, there is an urgent need to identify and implement the most cost-effective interventions, particularly in the resource-constraint South Asian settings. A 2018 systematic review evaluated the cost-effectiveness of individual-level, group-level and population-level interventions to control CVD and DM in South Asia. Of the 2949 identified studies through a search of 14 electronic databases up to 2016, 42 met full inclusion criteria. Critical appraisal of studies revealed 15 excellent, 18 good and 9 poor quality studies. Most studies were from India (n=37), followed by Bangladesh (n=3), Pakistan (n=2) and Bhutan (n=1). The economic evaluations were based on observational studies (n=9), randomised trials (n=12) and decision models (n=21). Together, these studies evaluated 301 policy or clinical interventions or combination of both. We found a large number of interventions were cost-effective aimed at primordial prevention (tobacco taxation, salt reduction legislation, food labelling and food advertising regulation), and primary and secondary prevention (multidrug therapy for CVD in high-risk group, lifestyle modification and metformin treatment for diabetes prevention, and screening for diabetes complications every 2–5 years). Significant heterogeneity in analytical framework and outcome measures used in these studies restricted meta-analysis and direct ranking of the interventions by their degree of cost-effectiveness. The cost-effectiveness evidence for CVD and DM interventions in South Asia is growing, but most evidence is from India and limited to decision modelled outcomes. There is an urgent need for formal health technology assessment and policy evaluations in South Asia and other low- and middle- income countries using local research data.

Image
kavita
I am Dr. Kavita Singh, interested in global cardiometabolic disease epidemiology and economic evaluations of interventions for prevention and control of chronic diseases in low- and middle- income countries. I am an Epidemiologist by training, and work as a research scientist at the Public Health Foundation of India. My research work has primarily focused on evaluating the long-term effectiveness and cost-effectiveness of a multicomponent quality improvement intervention (consisting of decision-support electronic health records to enhance physician’s responsiveness and care coordinators to improve patient’s adherence to therapy) in 1,146 patients with type 2 diabetes attending 10 tertiary care clinics in India and Pakistan as part of the National Heart Lung Blood Institute funded CARRS Trial. Recently, I have been awarded the Emerging Global Leader Award (K43 grant, 2019-2024), funded by the National Institutes of Health, Fogarty International Centre to conduct a research project that aims to develop and test the feasibility of a multicomponent cardiovascular quality improvement strategy for patients with established cardiovascular diseases (CVD) in India.

Kavita Singh 2019-2020 Walter H. Shorenstein Asia-Pacific Research Center Visiting Scholar
Seminars
-

Given the significant health risks faced by households in developing countries, publicly provided health insurance may confer important benefits. Yet, demand for formal insurance is often found to be low. Since health insurance may be relatively unfamiliar to many households, understanding the factors that shape households’ demand for, and ability to utilize, insurance is important for research and policy. It is also important to understand the health and financial impacts of health insurance. We shed light on these questions using a two-stage randomized control trial in Karnataka, India. Many households are willing to pay for insurance. Households’ ability to successfully utilize the insurance is limited, however, especially when only a small fraction of the community has access to insurance. When a higher share of the community has access, households are more able to benefit, suggesting that harnessing community learning is important in designing the rollout of health insurance.

Image
kinnan photo 4x4
Cynthia Kinnan is an assistant professor of economics at Tufts University and a Research Associate of the NBER. She holds a Ph.D. in economics from MIT. Her research lies in the areas of economic development and social networks, with emphasis on understanding linkages between formal finance (including insurance and microcredit) and informal networks. She has been a recipient of research grants from the International Growth Centre, the Tata Centre for Development, and others. Her work has been featured in outlets including the Economist and the NBER Digest and been published in journals including the American Economic Review and the American Economic Journal – Applied Economics.

Advisory on Novel Coronavirus (COVID-19)

In accordance with university guidelines, if you (or a spouse/housemate) have returned from travel to mainland China in the last 14 days, we ask that you DO NOT come to campus until 14 days have passed since your return date and you remain symptom-free. For more information and updates, please refer to the Stanford Environmental Health & Safety website: https://ehs.stanford.edu/news/novel-coronavirus-covid-19

Cynthia Kinnan Assistant Professor of Economics, Tufts University and Research Associate of the NBER.
Seminars
Authors
News Type
News
Date
Paragraphs

Southeast Asia, home to over 640 million people across 10 countries, is one of the world’s most dynamic and fastest growing regions. APARC just concluded the year 2019 with a Center delegation visit to two Southeast Asian capital cities, Hanoi and Bangkok, where we spent an engaging week with stakeholders in the academic, policy, business, and Stanford alumni communities.

Led by APARC Director Gi-Wook Shin, the delegation included APARC Deputy Director and Asia Health Policy Program Director Karen Eggleston, Southeast Asia Program Director Donald Emmerson, and APARC Associate Director for Communications and External Relations Noa Ronkin. Visiting Scholar Andrew Kim joined the delegation in Bangkok.

With a focus on health policy, our first day in Hanoi included a visit to Thai Nguyen University, a meeting with government representatives at the Vietnam Ministry of Health, and a seminar on healthy aging and innovation jointly with Hanoi Medical University.

Image
Collage of four images showing participants at a roundtable held at Hanoi Medical University with APARC delegation members

Karen Eggleston and participants at the roundtable held at Hanoi Medical University, December 9, 2019.

Throughout the day, Eggleston presented some of her collaborative research that is part of two projects involving international research teams: one that assesses public-private roles and institutional innovation for healthy aging and another that examines the economics of caring for patients with chronic diseases across diverse health systems in Asia and other parts of the world. We appreciated learning from our counterparts about the health care system and health care delivery in Vietnam.

Shifting focus to international relations and regional security, day 2 in Hanoi opened with a roundtable, “The Rise of the Indo-Pacific and Vietnam-U.S. Relations,” held jointly with the East Sea Institute (ESI) of the Diplomatic Academy of Vietnam (DAV). Following a welcome by ESI Director General Nguyen Hung Son, the program continued with remarks by Shin, Emmerson, ESI Deputy Director General To Anh Tuan, and Assistant Director General Do Thanh Hai.

Image
Participants at a roundtable held at the Diplomatic Academy of Vietnam with APARC delegation members

Roundtable at the Diplomatic Academy of Vietnam, December 10, 2019.

The long-ranging conversation with DAV members included issues such as the future of the international order in Asia; the U.S. withdrawal from multilateralism; the concern about a lack of U.S. engagement in Southeast Asia, sparked by President Trump’s absence from the November 2019 summit of the Association of Southeast Asian Nations (ASEAN) at a time when China is bolstering its influence in the region and when ASEAN hopes to set a code of conduct with China regarding disputed waters in the South China Sea; the priorities for Vietnam as it assumes the role of ASEAN chair in 2020; and the challenges for the Vietnam-U.S. bilateral relationship amid the changing strategic environment in Southeast Asia.

In the afternoon we were joined by members of the American Chamber of Commerce in Hanoi at an AmCham-hosted Lunch ‘n’ Learn session on Vietnam's challenges and opportunities amid the U.S.-China rivalry. The event featured Emmerson in conversation with AmCham Hanoi Executive Director Adam Sitkoff.

Image
Two men in conversation seated on stage and a man speaking at a podium

(Left) Donald Emmerson in conversation with Adam Sitkoff; (right) Gi-Wook Shin welcomes AmCham Hanoi members; December 10, 2019. 

Moving to Bangkok, delegation members Shin, Eggleston, Emmerson, and Kim spoke on a panel for executives of the Charoen Pokphand Group (C.P. Group), one of Thailand’s largest private conglomerates, addressing some of the core issues that lie ahead for Southeast Asia in 2020 and beyond in the areas of geopolitics, innovation, and health.

Image
Participants at a panel discussion with APARC delegation hosted by the C.P. Group, Thailand

Top, from left to right: Gi-Wook Shin, Karen Eggleston, Andrew Kim; bottom: C.P. Group executive listening to the panel, December 12, 2019.

We also enjoyed a tour at True Digital Park, Thailand’s first startup and tech entrepreneur’s campus. Developed by the C.P. Group, True Digital Park aspires to be an open startup ecosystem that powers Thailand to become a global hub for digital innovation.

The following day, Shin and Emmerson participated in a public forum hosted by Chulalongkorn University’s Institute of Security and International Studies (ISIS Thailand), "Where Northeast Asia Meets Southeast Asia: The Great Powers, Global Disorder and Asia’s Future.” They were joined by ISIS Thailand Director Thitinan Pongsudhirak and Chulalongkorn University Faculty of Political Science Associate Dean for International Affairs and Graduate Studies Kasira Cheeppensook. The panel was moderated by Ms. Gwen Robinson, ISIS Thailand senior fellow and editor-at-large of the Nikkei Asian Review.

Image
Panelists and participants at a public forum held at Chulalongkorn University

ISIS Thailand forum participants and panelists, from left: Pngsukdhirak, Shin, Robinson, Emmerson, Cheeppensook; December 13, 2019.

As part of that discussion, Emmerson speculated that – driven by deepening Chinese economic and migrational involvement in Southeast Asia’s northern tier – Cambodia and Laos, less conceivably Myanmar, and still less conceivably Thailand could become incorporated de facto into an economically integrated “greater China” that could eventually reduce ASEAN to a more-or-less maritime membership in the region’s southern tier. Emmerson’s speculation was made in the context of his critique of ASEAN’s emphasis on its own “centrality” to the neglect of its lack of the proactivity that would serve as evidence of centrality and of a desire not to be rendered peripheral by the growing centrality-cum-proactivity of China. The event was covered by the Bangkok Post (although that report’s headline and quote of Emmerson are inaccurate, as neither the panel nor Emmerson predicted the “break-up of ASEAN.”)

Our delegation visit in Bangkok concluded with a buffet dinner reception and panel discussion jointly with the Stanford Club of Thailand.

Image
alumni event

Stanford and IvyPlus alumni listening to the panel, December 13, 2019.

Moderated by Mr. Suthichai Yoon, a veteran journalist and founder of digital media outlet Kafedam Group, the conversation focused on the changing geopolitics of Southeast Asia, innovation and health in the region, and the opportunities and challenges facing Thailand-U.S. relations. It was a pleasure to meet many new and old friends from the Stanford and IvyPlus alumni communities.

APARC would like to thank our partners and hosts in Hanoi and Bangkok for their hospitality, collaboration, and the stimulating discussions throughout our visit. We look forward to keeping in touch!

Hero Image
APARC delegation speaking to Stanford and IvyPlus alumni, Bangkok
All News button
1
-

The extraordinary achievement of Chinese poverty reduction practice has been well acknowledged. Meanwhile, in similar practices throughout the world, microfinance, as the most widely adopted policy tool, has recently been documented to generate almost nil impacts, a frustrating puzzle for both the academia and policy practitioners. By employing the micro-level data of Chinese households from 2005 to 2010, we investigate the effects of poverty fund injection on incomes and expenditures. The empirical results show that the increased income observed afterwards mainly comes from the fund itself, rather than any increases in households’ business and/or labor income. Next, in order to rule out the possibility that the weak impacts on income comes from the decreased prices as a result of increased supply of agricultural markets, we study the treatment effects on the quantities of 122 agricultural products that households produce and their selling prices, and find that those quantities and prices barely change after the poverty fund injects.

Image
zhang jing 111519
Jing Zhang, Associate Professor, graduated from Peking University (BA, MA) in 2005 and received her PhD in economics from University of Maryland in 2011. After that, she has been working in School of Finance at Renmin University of China. The focus of her research lies in health economics and public finance. Her research has been published in the leading international and Chinese academic journals, including Journal of Development Economics, Journal of Health Economics, China Economic Review, The Journal of World Economy (in Chinese) etc. She was invited to present at many prestigious universities and research institutes, such as Stanford University, the World Bank, the Asian Development Bank, Peking University. She also worked as a consultant at the World Bank (Washington, D.C.) from 2010 to 2011 and in 2015.

Jing Zhang Associate Professor, School of Finance, Renmin University of China
Seminars
-

Diabetes is a significant problem worldwide and especially for developing countries including Thailand, where the disease has increased in prevalence rapidly, resulting in high healthcare expenditure and loss of productivity due to illness and premature death. Thailand has adopted multiple policies to control diabetes, such as screening through annual health checkups for people aged 35 and over, increasing healthcare access in rural communities, and developing diabetes clinical practice guidelines to improve the quality of care. However, multiple national health surveys still showed a rising pattern of diabetes in the country. To help understand and tackle the problem, we created a 10-year cohort using data from the national health exam survey (NHES) as a starting point and followed the population by linking to healthcare utilization and expenditure data from the universal health coverage scheme, the main health insurance program in Thailand. With this cohort, we study 3 topics. The first is to understand the burden of diabetes in the Thai health service system by calculating incidence of diabetes and its complications. Furthermore, we will identify factors which affect diabetes incidence and therefore can be used to create evidence-based control policies. Second, we seek to identify the bottleneck between each step in the “cascade of care” (screening, starting and adhering to treatment, and controlling disease). Finally, we will compare healthcare utilization patterns, expenditure, and outcomes related to diabetes between the overall population and vulnerable subgroups to identify factors that prevent vulnerable populations from obtaining better health outcomes.

Image
laohavinij 4x4
Wasin Laohavinij is a physician at King Chulalongkorn Memorial Hospital and a research assistant at Department of Preventive Medicine, Faculty of Medicine, Chulalongkorn University. His research focus on non-communicable disease prevention policies and economic evaluation of health promotion and prevention. Wasin Laohavinij completed his MD at Chulalongkorn University.

Wasin Laohavinij 2019-2020 Walter H. Shorenstein Asia-Pacific Research Center Visiting Scholar
Seminars
Subscribe to Health and Medicine