Recalibration of the Framingham Equations in the Thai Population
We derived equations for predicting cardiovascular disease (CVD) risks for Thai men and women, separately, over a specific time period using associations between risk factors and CVD events from the Framingham cohort study. The equations were recalibrated against the cumulative risks estimated for Thailand. Equations were developed separately for predicting risks of ischemic heart disease (IHD) and stroke. Recalibration of the Framingham equations reduced the CVD risks predicted for Thai men by 97% and for Thai women by 10%. The correction was largest at younger ages. In older women, recalibration increased the predicted risk. When compared with an existing equation for Thai men our recalibrated Framingham equation produced similar predictions for CVD risks over 8 years. However, the recalibrated Framingham equations are more flexible because they can be used for predicting risks over any time span and for women and men.
New Asia Health Policy Postdoctoral Fellows
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."
AHPP welcomes inaugural Developing Asia Health Policy Fellow
The breadth of [Shorenstein] APARC's work is truly impressive... I look forward to making full use of the resources and opportunities afforded me through the visiting fellowship.
-Dr. Siyan Yi
How can Stanford University contribute to improved health policy in the low-income countries of Asia? In addition to our formal degree-granting and research programs, mentorship of young scholars can play a role in strengthening the evidence base and analytic skills undergirding health policy for the millions of Asians who live on only a few dollars a day.
The Asia Health Policy Program (AHPP) is delighted to announce the inauguration of a fellowship program for young health policy experts from developing countries in Asia. The first Developing Asia Health Policy Fellow will be Dr. Siyan Yi from Cambodia. He holds a medical doctor degree from the University of Health Sciences in Cambodia as well as a doctoral degree in international health sciences from the Graduate School of Medicine at the University of Tokyo. Dr. Karen Eggleston, director of AHPP, will be his primary sponsoring faculty member.
Dr. Yi's research has centered largely on epidemiological methods. This has included, for example, work on surveys in Cambodia on adolescent risky sexual behaviors, substance abuse, and depression; a health promotion project in primary schools; sexual behaviors among people living with HIV/AIDS; and HIV risk behaviors among tuberculosis patients. Currently, he is involved in hospital- and community-based research projects in several developing countries as well as in Japan.
Cambodia has recently created a School of Public Health and is facing an increasing burden of chronic disease, while the burden from infectious diseases such as tuberculosis remains significant. Since Dr. Yi's research interests lie in health promotion and risky behaviors, he could someday be instrumental in helping to set policies to address the public health challenges Cambodia will face.
Dr. Yi will join the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) in autumn 2011 for a nine-month fellowship to immerse in the academic environment and to develop additional skills to contribute to improved health policy in Cambodia. He notes that "the breadth of [Shorenstein] APARC's work is truly impressive... I look forward to making full use of the resources and opportunities afforded me through the visiting fellowship."
The Performance and Driving Force of Government Health Expenditure in China: Evidence from Provincial Panel Data, 1991-2007
The new health reform started in 2009 has shown the determination of the Chinese government, especially the central government, to increase its responsibility in the health sector. The most obvious manifestation of this commitment would be to increase government health expenditure (GHE). But there is still a hot debate about whether the government should allocate more public finds to health or just deepen the marketization of the health sector. Moreover, commitments at the central and local levels are not the same: local government responsibility for GHE is high, and commitments by the central government to increase GHE have not translated into increases in local government GHE as much as proposed in the national health reform.
Our research seeks to answer two questions: What was the actual pattern of GHE? And why did China’s local governments respond as they did? We first discuss the necessity of public financing for health care, and then analyze how intergovernmental economic competition affects local governments’ behavior under “Chinese-style decentralization” (known as fiscal decentralization with political centralization). Empirically, we apply a dynamic panel data model to provincial panel data from 1991 to 2007 to identify the effect of GHE on health performance in each province over time, using infant mortality and some morbidity metrics as health performance variables. We also examine differences across regions, as well as before and after the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003.
Our analysis provides evidence that Chinese-style decentralization negatively impacted GHE. The main findings are as follows:
- Increasing GHE did improve health performance, and this improvement was mainly
driven by the GHE through the health department directly, not
through spending by other governmental departments that also impact health.
However, pursuit of economic performance lowered local governments’ GHE, mainly
by decreasing GHE through local health departments.
- Compared with in the
eastern and western regions, this health improvement was not significant in China’s
middle regions, where the intergovernmental economic competition leads to much
less GHE through health departments.
- The outburst of SARS in 2003 further
increased the positive effect from GHE through local health departments, while
the effect from GHE through other departments was not equally significant.
All these results suggest that adjusting the structure of public health financing, reforming the fiscal system, and improving the performance evaluation system for local governments are critical for the success of China’s on-going health reform.
Philippines Conference Room
Qiulin Chen
Shorenstein APARC
Stanford University
Encina Hall, Room C335
Stanford, CA 94305-6055
Qiulin Chen is a postdoctoral fellow of Shorenstein APARC and a member of the center's Asia Health Policy Program. His main interest of research is health economics and public finance, focusing on policy and outcome comparison of health care systems and Chinese health reform. His dissertation focused on performance comparison between public (or governmental) and private health care financing, between local and central government responsibility on health care, between contracted and integrated health care system. In particular, his dissertation examined under Chinese-style decentralization, known as fiscal decentralization with political centralization, how economic competition affect local government's behaviour on health investment, and why public contracted system obstructs health performance and provides one channel of such effects in terms of preventive care and public health. He is currently involved in a comparative research project on demographic change in East Asia based on the National Transfer Accounts data and analysis.
Chen's recent publication is "The changing pattern of China's public services" (with Ling Li and Yu Jiang) in Population Aging and the Generational Economy: A Global Perspective (Ronald Lee and Andrew Mason, editors), forthcoming 2011. Before studying in Stanford, he has published more than 10 papers in academic journals in Chinese, such as Jing Ji Yan Jiu (Economic Research) and Zhong Guo Wei Sheng Jing Ji (Chinese Health Economics), and 5 book chapters. He has participated in about 20 research projects, such as A Design of Framework for Healthcare Reform in China which is commissioned by the State Council Working Party on Health Reform, Strategy Planning Study of "Healthy China 2020" which is commissioned by the Minister of Health, and Health Challenge in the Aging Society and It's Policy Implication funded by Chinese National Natural Science Foundation.
Chen earned his Ph.D. in Economics from Peking University in 2010, and earned a B.A. in Business Administration from Nanjing University in 2001. From 2004 through 2008, he was Executive Assistant of the Director of the China Centre for Economic Research at Peking University (CCER). He is also a postdoctoral fellow of National School of Development at Peking University (Its predecessor is CCER).
Pradnya Palande discusses Reliance Life Sciences and Stanford cancer research
Pradnya Palande's passion for improving human health through scientific research began during her graduate studies, and has continued to the present day through her work with Reliance Life Sciences (RLS) of India. Palande, a 2010-2011 Corporate Affiliates Fellow, holds a master's degree in zoology, with a specialization in animal physiology and a minor in biotechnology. "I used to dream of getting a job in the biotechnology industry," she says. Within just a few short months of graduating, Palande began working for RLS, and she has enjoyed serving the company for the past nine years.
RLS belongs to the Reliance Group, one of India's
largest corporate entities. It conducts research in a wide variety of areas,
such as stem cell therapy, molecular medicine, and industrial biotechnology,
and it offers products ranging from therapeutic proteins to tissue-cultured plants.
"RLS is a life sciences company in the truest sense," Palande states. In her
role as a team leader for the company's biopharmaceuticals division, which is
headed by Dr. Venkata Ramana, she conducts literature searches and strategic
planning for new research projects, and also supports regulatory audits. In
addition to her primary duties, Palande is dedicated to her role as secretary
of the safety observation committee. "RLS believes in safety and a safe working
culture," Palande emphasizes. "It is a perfect place for me to work."
During her year at the Walter H. Shorenstein Asia-Pacific Research Center
(Shorenstein APARC), Palande is conducting cancer-related research in a
laboratory under the direction of Cliff L. Wang of the Department of Chemical
Engineering. Her Shorenstein APARC advisors are Rafiq Dossani, a senior
research scholar, and Karen Eggleston, the director of the Asia Health Policy
Program. Palande and her fellow researchers in Wang's lab are studying the population
dynamics of cancer cells. In the process of cancer development, Palande
explains, it is thought that cells often develop high mutational activity
before accumulating mutations that lead to cancer. Mutations—changes in the
genome sequence—can be advantageous, benign, or harmful to cells. Palande is examining
whether a high mutation rate provides a survival advantage to cancer cells. For
this, she is studying the activation-induced cytidine deaminase (AID) enzyme,
which plays a key role in the development of immune response in the human body.
The goal of the project is to provide insight into the nature of cancer
development, and also to give direction for the prevention of chemotherapy
resistance due to AID activity.
"Before I leave for India, I would like to complete my project successfully in
a way that will instigate future research in cancer biology," Palande says.
Upon returning to RLS, she intends to apply some of the concepts that she has
gained while conducting research at Stanford. She also hopes to build upon the
Stanford management classes that she has been auditing, studying the subject in
more detail with the intention of utilizing it in her work at RLS.
"It has been a great privilege for me to work at Stanford, and it has been an
amazing experience," she states. "Interacting with people from various
backgrounds has been enlightening. Also, I am quite impressed by the
professionalism of people [in the United States], their helping nature, and
their free way of life. I love it." She adds that through her Stanford research
and classes, her horizons have been broadened.
As passionate about the natural world as she is about scientific research,
Palande looks forward to traveling more before returning to India. "I love
traveling to be close to nature," she says. Also something of an adventurer,
she has taken a rock-climbing course and has tried skydiving. Inspired by the
range of activities in the United States, she plans to take an activity class,
such as dance, after returning to India. "I want to keep myself as active and
healthy as possible," she says with a smile.
Health, Gender, and Migrant Workers in China
This colloquium will feature presentations by two visiting scholars from China. First, Dr. Huijun Liu will present research on health risks associated with gender imbalance in China. The problems of abnormal sex ratio at birth and high female infant mortality have plagued many Asian countries with a strong male preference and gender inequality. In China, these problems having lasted for more than twenty years and contributed to a serious gender imbalance in the population. As a direct consequence, “surplus men” or “forced bachelors,” are expected to increase to more than 30 million. Dr. Liu will discuss the potential health risks and other social problems likely to be exacerbated by this large-scale gender imbalance in China.
Second, Dr. Dahai Zhao will present “How Is Health Insurance Coverage Utilized among Migrant Workers in Shanghai, China?” According to the regulations of the Chinese national and Shanghai municipal governments, migrant workers employed in Shanghai should all be entitled to the Shanghai Migrant Worker Hospitalization Insurance (SMWHI) without premium and the vast majority should also have coverage through the New Rural Cooperative Medical System (NRCMS). Dr. Zhao will present results from research, conducted jointly with Dr. Wei Yu and Dr. Alan M. Garber, examining the status of the coverage and utilization of health insurance among migrant workers employed in Shanghai. Through their study, they found that a significant minority of migrant workers in Shanghai still had no health insurance, and that health insurance utilization among migrant workers was strongly limited by hospital location.
Huijun Liu is an associate professor in the Public Policy and Administration School at Xi'an Jiaotong University, China. She received her PhD in management science and engineering from the Management School of Xi'an Jiaotong University. Her main areas of research focus on gender imbalance, reproductive health, vulnerability, and social support. Her current research focuses on how gender imbalance and migration amplify the risk of HIV transmission in China. Liu has published over twenty papers in Chinese academic journals, including China Soft Science, Population and Economics, Psychological Science Advance, Collection of Women's Studies, and Modern Preventive Medicine.
Dr. Zhao is an assistant professor with the School of Public Economics and Administration at Shanghai University of Finance and Economics (SUFE), and a fellow with the Center for Health Policy at SUFE. He earned a master's degree in medicine in 2005 and a PhD in 2008, both from Fudan University, China.
Daniel and Nancy Okimoto Conference Room
Huijun Liu
Shorenstein APARC
Stanford University
Encina Hall, Room E301
Stanford, CA 94305-6055
Huijun Liu is an associate professor in the Public Policy and Administration School, Xi'an Jiaotong University, China. She received her PhD in management science and engineering from Management School of Xi'an Jiaotong University. Her main areas of research focuses on gender imbalance, reproductive health, vulnerability and social support. Her current research focuses on how gender imbalance and migration amplify the risk of HIV transmission in Chinese transformation society.
Liu has published over twenty papers in Chinese academic journals, which was featured in China Soft Science, Population & Economics, Psychological Science Advance, Collection of Women's Studies and Modern Preventive Medicine.