Critical Industry Studies in Cigarette Production Before, During, and After “Liberation”
Over the last hundred years, the cigarette has become a pillar of consumer life in China and many parts of the world. In 2010, the Chinese tobacco industry produced over two trillion cigarettes, generating over U.S. $90 billion in taxes and profits. Over 300 million Chinese citizens now use cigarettes every day, and tobacco kills 90 times more people each year than HIV/AIDS in China.
How has the cigarette become so integrated into the fabric of everyday life across the People’s Republic of China?
The importance of answering this question is unmistakable, but very little historical research and writing has examined China’s cigarette industry from the mid-20th century to the present. To get to the heart of this question, historians, health policy specialists, sociologists, anthropologists, business scholars, and other experts will meet Mar. 26 and 27 at the new Stanford Center at Peking University for a conference organized by the Asia Health Policy Program. They will examine connections intricately woven over the past 60 years between marketing and cigarette gifting, production and consumer demand, government policy and economic profit, and many other dimensions of China’s cigarette culture.
Stanford Center at Peking University
Battle Against HIV/AIDS in Cambodia: Successes and Challenges
More than two decades have passed since the first case of HIV infection was detected in Cambodia in 1991. Cambodia is among the countries with the highest HIV prevalence in Asia and has been experiencing the most serious HIV/AIDS epidemic in the region. The epidemic is spread primarily through heterosexual transmission and revolves largely around the sex trade.
Since the beginning of the epidemic, the Royal Government of Cambodia has made a strong political commitment to the need for prevention of HIV transmission and care for people living with HIV/AIDS. It has received some technical and financial support from national and international agencies. Several prevention and intervention programs have been successfully implemented, and the WHO/UNAIDS recognized that the Cambodia’s HIV/AIDS epidemic appeared to have stabilized in 2002.
The estimated HIV prevalence in the general adult population declined to 0.5% in 2009, down from 1.2% in 2001. Among women visiting antenatal care clinics, the prevalence also declined from 2.1% in 1999 to 1.1% in 2006. There was also a gradual increase in the percentage of HIV-infected pregnant women who received antiretroviral therapy to reduce the risk of mother-to-child transmission, from 1.2% in 2003 to 11.2% in 2007, and finally to 32.3% in 2009.
Despite the decline of HIV prevalence in the general population, the prevalence remains high among high-risk groups such as commercial sex workers, men who have sex with men, and injection drug users. Furthermore, the so-called prevention-successful-country is also seeing the growing need for HIV/AIDS treatment and care.
This seminar will highlight the past and current features of Cambodia’s HIV/AIDS epidemic, lessons learned from prevention and care policies, and future challenges that Cambodia may face in the battles against HIV/AIDS.
Dr. Siyan Yi joins the Walter H. Shorenstein Asia-Pacific Research Center during the 2011–12 academic year from the National Center of Global Health and Medicine and the University of Tokyo, Japan, where he jointly served as a research fellow and lecturer. He has also served as an adjunct faculty member at Cambodia’s School of Public Health, the National Institute of Public Health, and the School of International Studies at the Royal University of Phnom Penh.
Daniel and Nancy Okimoto Conference Room
Siyan Yi
Dr. Siyan Yi joined the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) as a 2011-12 Developing Asia Health Policy Postdoctoral Fellow from the National Center of Global Health and Medicine and the University of Tokyo, Japan, where he jointly served as a research fellow and lecturer. He also served as an adjunct faculty member at Cambodia’s School of Public Health, the National Institute of Public Health, and the School of International Studies at the Royal University of Phnom Penh. He is currently an Associate Professor and UHS-SPH Integrated Research Programme Leader at NUS Saw Swee Hock School of Public Health (profile page here).
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 risky behaviors among tuberculosis patients. Currently, he is involved in hospital- and community-based research projects in several developing countries as well as in Japan. He has published several papers in these research areas in international journals. His selected publications include:
- Siyan Yi, Akiko Nanri, Kalpana Poudel, Daisuke Nonaka, Hori Ai, Tetsuya Mizoue. “Association between serum ferritin and depressive symptoms in Japanese municipal employees.” Psychiatry Research, 2011. 189: 368-372.
- Siyan Yi, Daisuke Nonaka, Marino Nomoto, Jun Kobayashi, and Tetsuya Mizoue. “Predictors of the uptake of A (H1N1) influenza vaccine: Findings from a population-based longitudinal study in Tokyo.” PLoS One, 2011. 6: e18893.
- Siyan Yi, Krishna C. Poudel, Junko Yasuoka, Paula H. Palmer, Songky Yi, and Masamine Jimba. “Risk vs. protective factors for substance use among adolescent students in Cambodia.” Journal of Substance Use, 2011. 16:14-26.
- Siyan Yi, Krishna C. Poudel, Junko Yasuoka, Paula H. Palmer, Songky Yi, and Masamine Jimba. “Role of risk and protective factors for risky sexual behaviors among high school students in Cambodia.” BMC Public Health, 2010. 10: 477.
- Siyan Yi, Krishna C. Poudel, Junko Yasuoka, Masao Ichikawa, Vutha Tan, and Masamine Jimba. “Influencing factors for seeking HIV voluntary counseling and testing among tuberculosis patients in Cambodia.” AIDS Care, 2009. 21: 529-534.
Yi holds an MHSc (2007) and a PhD (2010) in international health sciences from the School of International Health at the University of Tokyo’s Graduate School of Medicine. He also earned an MD in general medicine from the University of Health Sciences, Cambodia (2001). Yi has won research awards, including: the Young Investigator Award from the Asia Pacific Academic Consortium for Public Health (2008), the Montreux Prize from the Swiss Association for Adolescent Health and the International Association for Adolescent Health (2009), and the Scientific Research Award from the University of Tokyo (2009).
Getting to the roots of the tobacco industry
Three graduates with FSI ties earn Rhodes, Mitchell scholarships
Two Stanford graduates with close ties to FSI’s centers have been named 2012 Rhodes Scholars. A third was selected as a Mitchell Scholar.
Anand Habib was a graduate of the 2011 CISAC honors program in international security studies and a 2010 Dachs undergraduate intern. Habib and Katherine Niehaus – who is now a research assistant for a CHP/PCOR project evaluating whether HIV medication increases the risk of cardiovascular disease – will study at the University of Oxford in England under the Rhodes program.
Philippe de Koning, who will study in Ireland as a Mitchell fellow, wrote a manuscript about Japan’s defense and financial crisis with Shorenstein APARC faculty member Phillip Lipscy. Lipscy, a political scientist, was de Koning’s advisor through his undergraduate career and also advised him on his senior thesis. De Koning was also a 2010 CISAC honors student.
More about the scholars:
Habib is working on community health programs at St. Joseph's Clinic in Thomassique, Haiti, under a one-year global health fellowship awarded by Medical Missionaries. The nonprofit organization is a volunteer group of more than 200 doctors, nurses, dentists, and others who work to improve the health of the poor in the United States and throughout the world.
In 2011, he won a Deans' Award for Academic Accomplishment, which honors extraordinary undergraduate students for "exceptional, tangible" intellectual achievements. One of the professors who nominated him for the award described him as a "superb critical thinker" whose work is characterized by "creative genius" and "mature insights," adding that he "exemplifies exactly the kind of deeply informed, pragmatic and caring leadership that the world needs and Stanford enables."
As a Stanford student, Habib worked on behalf of politically and medically disenfranchised people in India, Mexico and Guatemala. His field research internship in Guatemala’s indigenous region during summer 2010 was carried out under the supervision of Paul Wise, professor of pediatrics and FSI senior fellow, as part of FSI’s Dachs mentored undergraduate research program. On campus, he turned the Stanford tradition of the annual Dance Marathon into a vehicle dedicated to addressing the HIV/AIDS pandemic by engaging not only Stanford students but also local communities and corporations, raising more than $100,000. His exceptional work was recognized by his participation in the Clinton Global Initiative University Conference in April, 2011.
She plans to pursue a doctorate of philosophy in systems approaches to biomedical science at Oxford.
At Stanford, Niehaus captained Stanford's varsity track and cross country teams, won the Pac-10 5,000 meters, and won Academic-All American status. She also served as a mentor and tutor for students in low-income families.
Working with faculty in the Center for Health Policy, Kate led a project to evaluate how well newer HIV antiretroviral drugs work compared with older drugs. Her work was among the first to evaluate comprehensively all of the trials of new drugs in treatment of experienced patients, and showed that these drugs have substantial benefits.
He is a Herbert Scoville Jr. Peace Fellow at the Nuclear Threat Initiative in Washington, D.C. The nongovernmental organization works to prevent nuclear, chemical, and biological threats from materializing. De Koning is researching nuclear materials security and the U.S.-China dialogue on nuclear issues.
De Koning, who earlier was awarded a Fulbright Scholarship, spent the 2010-2011 academic year at Hiroshima University in Japan. He examined various components of Japanese security policy, with emphasis on current evolution of Japanese Self-Defense Forces, policies on nuclear issues and approaches toward peacekeeping.
In 2009, he was a member of the Stanford delegation to the United Nations Climate Change Conference in Copenhagen.
Cambodia's successful battle against HIV/AIDS
When Siyan Yi was a medical student in Cambodia 12 years ago, he volunteered with a collaborative government-NGO project to provide young women at high risk for HIV/AIDS—the victims of sexual exploitation—with housing, vocational training, medical care, and psychological support. Cambodia at that time had one of Asia’s highest HIV-infection rates.
That rate has dropped by half, thanks to government policy measures, international NGO support, and the efforts of medical professionals like Yi. Cambodia’s government must now find ways to curb HIV infection in new segments of the population, says Yi, who is the Shorenstein Asia-Pacific Research Center’s inaugural Developing Asia Health Policy Fellow. Sustaining funding for the long-term care of HIV-infected individuals also poses a future challenge, he explains, and new health issues associated with development are beginning to crop up.
Cambodia’s first HIV case was detected in 1991 in a blood donor, and the rate of HIV/AIDS increased dramatically throughout the decade. HIV/AIDS hit Thailand slightly earlier, and was spread through the commercial sex trade. The epidemic reached an even greater scale there than it ever did in Cambodia.
Thailand’s government struck back with a 100-percent condom use promotion program, which Cambodia successfully adopted in the late 1990s. Brothels are illegal in Cambodia, but the government worked cooperatively with owners to provide basic HIV/AIDS education to sex workers. These efforts significantly reduced the transmission of HIV.
Since then, a more indirect form of prostitution has sprung up in places such as karaoke halls, massage parlors, restaurants, and even in factories. HIV prevalence remains high among some sentinel groups such as female sex workers, beer promoters, men who have sex with men (MSM), injected-drug users, and migrant workers.
Yi advocates that the government expand the scope of its HIV/AIDS prevention programs to encompass these new at-risk populations. He even suggests that the government consider creating a system of licensed brothels such as previously existed in Hong Kong and Taiwan. “It would provide the government with an easier means of controlling prostitution, and allow it to work with brothel owners to control HIV-infection rates,” states Yi.
HIV increases the risk of contracting or developing symptoms of tuberculosis; a large proportion of Cambodia’s population carries the disease but shows no signs of it. Tuberculosis went largely undetected during the decades of the Khmer Rouge regime, but with the advent of HIV/AIDS it has become more prevalent. Yi has been involved in government-NGO projects to provide tuberculosis screening for HIV patients, including a tuberculosis control project with the Japan International Cooperation Agency.
Tuberculosis screening and HIV treatment advances may greatly prolong the life—and even improve the health—of patients. But heartening as Cambodia’s success against HIV/AIDS has proven in the past decade, the government largely bears the responsibility for funding the expensive treatment and care for the low-income individuals most affected by it. A critical portion of government funding for its HIV/AIDS prevention programs comes from external organizations.
“I think that the main issue for the government of Cambodia in the battle against HIV and AIDS is financial sustainability,” says Yi, who worries that donor agencies will withdraw support as the HIV-infection rate continues to improve. Prevention is less expensive, he explains, but long-term care is costly to a developing country such as Cambodia.
Yi, however, feels less concerned now about the HIV/AIDS epidemic and speaks hopefully of working to help the government find ways to measure and treat non-communicable diseases associated with economic development, such as diabetes and hypertension. While he is at Stanford, he will collaborate with Asia Health Policy Program researchers to move his work toward solving Cambodia’s new health challenges.
Inaugurated in 2011, the Siyan Yi is designed to bring leading health policy experts from low-income Asian countries to Stanford for three to 12 months. Fellows will work on conceptualizing and launching collaborative research on a topic of importance for health policy in their country. Details about the 2011–12 application will become available during Winter Quarter 2012.
Siyan Yi
Dr. Siyan Yi joined the Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) as a 2011-12 Developing Asia Health Policy Postdoctoral Fellow from the National Center of Global Health and Medicine and the University of Tokyo, Japan, where he jointly served as a research fellow and lecturer. He also served as an adjunct faculty member at Cambodia’s School of Public Health, the National Institute of Public Health, and the School of International Studies at the Royal University of Phnom Penh. He is currently an Associate Professor and UHS-SPH Integrated Research Programme Leader at NUS Saw Swee Hock School of Public Health (profile page here).
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 risky behaviors among tuberculosis patients. Currently, he is involved in hospital- and community-based research projects in several developing countries as well as in Japan. He has published several papers in these research areas in international journals. His selected publications include:
- Siyan Yi, Akiko Nanri, Kalpana Poudel, Daisuke Nonaka, Hori Ai, Tetsuya Mizoue. “Association between serum ferritin and depressive symptoms in Japanese municipal employees.” Psychiatry Research, 2011. 189: 368-372.
- Siyan Yi, Daisuke Nonaka, Marino Nomoto, Jun Kobayashi, and Tetsuya Mizoue. “Predictors of the uptake of A (H1N1) influenza vaccine: Findings from a population-based longitudinal study in Tokyo.” PLoS One, 2011. 6: e18893.
- Siyan Yi, Krishna C. Poudel, Junko Yasuoka, Paula H. Palmer, Songky Yi, and Masamine Jimba. “Risk vs. protective factors for substance use among adolescent students in Cambodia.” Journal of Substance Use, 2011. 16:14-26.
- Siyan Yi, Krishna C. Poudel, Junko Yasuoka, Paula H. Palmer, Songky Yi, and Masamine Jimba. “Role of risk and protective factors for risky sexual behaviors among high school students in Cambodia.” BMC Public Health, 2010. 10: 477.
- Siyan Yi, Krishna C. Poudel, Junko Yasuoka, Masao Ichikawa, Vutha Tan, and Masamine Jimba. “Influencing factors for seeking HIV voluntary counseling and testing among tuberculosis patients in Cambodia.” AIDS Care, 2009. 21: 529-534.
Yi holds an MHSc (2007) and a PhD (2010) in international health sciences from the School of International Health at the University of Tokyo’s Graduate School of Medicine. He also earned an MD in general medicine from the University of Health Sciences, Cambodia (2001). Yi has won research awards, including: the Young Investigator Award from the Asia Pacific Academic Consortium for Public Health (2008), the Montreux Prize from the Swiss Association for Adolescent Health and the International Association for Adolescent Health (2009), and the Scientific Research Award from the University of Tokyo (2009).
Innovative student research focusing on the Asia-Pacific region
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.