Society

FSI researchers work to understand continuity and change in societies as they confront their problems and opportunities. This includes the implications of migration and human trafficking. What happens to a society when young girls exit the sex trade? How do groups moving between locations impact societies, economies, self-identity and citizenship? What are the ethnic challenges faced by an increasingly diverse European Union? From a policy perspective, scholars also work to investigate the consequences of security-related measures for society and its values.

The Europe Center reflects much of FSI’s agenda of investigating societies, serving as a forum for experts to research the cultures, religions and people of Europe. The Center sponsors several seminars and lectures, as well as visiting scholars.

Societal research also addresses issues of demography and aging, such as the social and economic challenges of providing health care for an aging population. How do older adults make decisions, and what societal tools need to be in place to ensure the resulting decisions are well-informed? FSI regularly brings in international scholars to look at these issues. They discuss how adults care for their older parents in rural China as well as the economic aspects of aging populations in China and India.

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Pharmaceutical policies are interlinked globally, yet deeply rooted in local culture. The newly published book Prescribing Cultures and Pharmaceutical Policy in the Asia-Pacific, edited by Karen Eggleston, examines how pharmaceuticals and their regulation play an important and often contentious role in the health systems of the Asia-Pacific.

In this colloquium, contributors to Prescribing Cultures discuss how the book analyzes pharmaceutical policy in China, Korea, Japan, Thailand, Taiwan, Australia, and India, focusing on two cross-cutting themes: differences in “prescribing cultures” and physician dispensing; and the challenge of balancing access to drugs with incentives for innovation.

As Michael Reich of Harvard University says in his Forward to Prescribing Cultures,

“The pharmaceutical sector…promises great benefits and also poses enormous risks.… Conflicts abound over public policies, industry strategies, payment mechanisms, professional associations, and dispensing practices—to name just a few of the regional controversies covered in this excellent book.

The tension between emphasizing innovation versus access -- a topic of hot debate on today’s global health policy agenda -- is examined in several chapters…

This book makes a special contribution to our understanding of the pharmaceutical sector in China… Globalization is galloping forward, with Chinese producers pushing the pace at breakneck speed. More and more, our safety depends on China’s ability to get its regulatory act together…”

The colloquium features presentations by Naoko Tomita (Keio University), Anita Wagner (Harvard University), and Karen Eggleston (Stanford FSI Shorenstein Asia-Pacific Research Center). They will give specific examples of how pharmaceutical policy serves as a window into the economic tradeoffs, political compromises, and historical trajectories that shape health systems, as well as how cultural legacies shape and are shaped by the forces of globalization.

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Anita Wagner Speaker Harvard University
Naoko Tomita Speaker Keio University

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Stanford University
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Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
karen-0320_cropprd.jpg PhD

Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director of the Asia Health Policy Program, Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
Faculty Fellow at the Stanford Center at Peking University, June and August of 2016
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The year 2009 is a big one for China and the ruling Communist Party (CCP), as years ending in the number 9 mark several important anniversaries. In 1919, May 4 witnessed the patriotic, “modernizing” youth movement that catalyzed the formation of the CCP. In 1949 the People’s Republic of China (PRC) was established, and 1979 saw the inauguration of reform and opening, which re-legitimized the Party after the Cultural Revolution debacle and set China on the path to record-breaking economic growth and international power and status.

These are not the only “9” years, however, that mark milestones in recent Chinese history. 1959 saw Beijing crush the Tibetan uprising against PRC rule that led the Dalai Lama to flee into exile; it was also the first of three years of mass starvation in the Great Leap Forward. In 1979, the brief but bloody Sino-Vietnamese War took place. And in 1989 the leadership of the Chinese People’s Government ordered the People’s Liberation Army to fire on unarmed Chinese people demonstrating in Tiananmen Square.

Needless to say, some anniversaries are celebrated with great fanfare, as moments in the nation’s history of which all citizens can and should be proud. Massive parades to commemorate the sixtieth anniversary of the PRC’s founding can certainly be expected this October. In the run-up to anniversaries of events-that-should-be-forgotten, by contrast, dissidents are detained, the media muzzled, websites suddenly shut down for “maintenance,” and public security intensified at sensitive venues such as the Potala Palace in Lhasa and Tiananmen Square in Beijing. This month, angered by what it perceives as interference in its internal affairs, China has rebuked foreign dignitaries, including Taiwan’s President Ma Ying-jeou and U.S. Secretary of State Hillary Clinton, for their calls on the CCP leadership to acknowledge those killed at Tiananmen. According to Foreign Ministry spokesman Qin Gang, China has already reached a verdict on that history. The Party has set the country on “the proper socialist path that serves the fundamental interests of the Chinese people,” and there is nothing more to be said.

Enforcing historical forgetting, however, requires more than clampdowns at anniversary time and stony assertions that matters are resolved. Efforts to silence critical voices are ongoing, and the so-called Great Firewall of China routinely blocks access to sensitive information on the Internet. Meanwhile, despite liberalization—which has allowed professional historians considerable freedom to address many hitherto taboo topics—the content of museums, memorials, historical films and television dramas, and, above all, school textbooks remain restricted through a battery of laws, regulations, and vetting mechanisms. In line with official diktats, these officially authorized histories generally gloss over unhappy episodes or rewrite them to present a mostly happy tale of inexorable progress since 1949, and to portray the Party and the country in a positive light. If mentioned at all, acts of state violence or suppression are represented as necessary measures taken to safeguard national territory, unity, and stability. At the same time, in order to emphasize a common national bond against external threats, they highlight past acts of aggression that foreign countries committed against China. This patriotic history is not “my country, right or wrong;” rather, it is “my country (and the Party) has always been right.”

Despite these concerted efforts, it has proved difficult to erase unhappy memories of domestic repression or disaster from public consciousness, or to prevent the dissemination of unofficial histories. Research shows that omitting past events or persons from public commemoration does not guarantee they will be forgotten, especially if they are focal points of group identity; indeed, they may serve as the foundations for counter-histories. For example, the year 1959 is central to the Tibetan narrative of resistance to Chinese domination. Furthermore, even when official histories are forcibly and repeatedly imposed, such as through compulsory education and examinations, they may not necessarily be remembered or deployed as originally intended, particularly if they run counter to personal or community experiences. In fact, they may be used in ways that actually challenge the official narrative. Students in Tiananmen Square in 1989 saw themselves—not the CCP—as inheritors of the spirit of May 4th, 1919. Not coincidentally, May 4th radicalism has been somewhat downplayed in recent years, and its ninetieth anniversary this year astonishingly low-key.

Ruling regimes often seek to use history both to legitimize their political authority and to suppress dissent. Nevertheless, controlling the past is considerably more complicated than merely adding or deleting events from the historical record and commemorating or silencing them on key anniversaries. In China, 2009 will certainly not be the last year in which tensions arise between those who want to remember and those who would have them forget.

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The 2008-09 academic year was a busy time for the Southeast Asia Forum (SEAF).  A dozen on-campus lectures by Southeast Asianists from Australia, Germany, Malaysia, Thailand, and the United States ranged from country-specific topics such as labor resistance in Vietnam, political opposition in Malaysia, and the 2009 elections in Indonesia, to broader-brush treatments of Southeast Asian identities and modernities, regional repercussions of the global economic slowdown, and the wellsprings of “late democratization” across East Asia.

The lecture on “late democratization” was delivered to a capacity audience by the 2008-09 National University of Singapore-Stanford University Lee Kong Chian (LKC) Distinguished Fellow, Mark Thompson.  Mark is a political science professor in Germany at the University of Erlangen-Nuremberg.  He and another 08-09 SEAF speaker, Australian National University Prof. Ed Aspinall, jointly with State University of New York-Albany Prof. Meredith Weiss, will lead a 28-30 August 2009 workshop in Singapore under the auspices of the NUS-Stanford Initiative (NSI).  The workshop will review and analyze the record and prospects of student movements in Asia.  Attendees will include authors of chapters of a book-in-progress stemming from the research and writing on democratization done by Thompson during his fellowship at Stanford.

A second NSI awardee this past academic year was the 2008 NUS-Stanford LKC Distinguished Lecturer Joel Kahn, professor of anthropology emeritus at La Trobe University, Melbourne, who gave three talks at SEAF this year: 

His insightful interpretations of identity and modernity in Southeast Asia may be heard via the relevant audio icons at the links above.

Off-campus lectures involving SEAF included three panel discussions convened to launch Hard Choices: Security, Democracy, and Regionalism in Southeast Asia (introductory chapter and information on ordering the title are available), published by Stanford’s Shorenstein APARC and the Institute of Southeast Asian Studies (ISEAS), Singapore, in 2008-09.  The book was edited by SEAF Director Donald K. Emmerson.  

Hosting these launches in their respective cities were ISEAS in Singapore, the Asia Society in New York, and Johns Hopkins University’s School of Advanced International Studies in Washington, D.C.  Panelists at these events included Ellen Frost (Peterson Institute for International Economics), Mike Green (Georgetown University School of Foreign Service), Alan Chong Chia Siong (NUS), and Joern Dosch (Leeds University).  

Another panelist was John Ciorciari, a Shorenstein Fellow at Shorenstein APARC in 2007-08 and a National Fellow at the Hoover Institution in 2008-09.  In 2009, despite the U.S. recession and a correspondingly competitive academic marketplace, he published several Southeast Asia-related pieces, completed and submitted to a university press the manuscript he had worked on at APARC, and won a tenure-track assistant professorship at the University of Michigan’s School of Public Policy starting in September 2009.  Congratulations, John! 

Apart from speaking at the launches of Hard Choices, Don Emmerson gave papers on Indonesian foreign policies and Asia Pacific regionalism in Jakarta and Manila, and discussed these and other topics at events in Chicago and Los Angeles among other venues.  At two conferences in Washington,D.C. on a proposed U.S.-Indonesian “comprehensive partnership,” he addressed what such a relationship could and should entail.  In Spring 2009 at Stanford, he served as faculty sponsor and lecturer in a student-initiated course on Thailand.  His interviewers during the year included the BBC, Radio Australia, The New York Times, and various Indonesian media.

SEAF organized its final on-campus event of the 2008-09 academic year in June 2009 — an invitation-only roundtable co-sponsored with the U.S.-ASEAN Business Council.  Nine scholars met with three current American ambassadors to Southeast Asian countries for off-the-record conversations on seven topics of mutual interest regarding the region and its relations with the United States.

None of the above could have happened without the talent, friendliness, and all-round indispensability of SEAF’s administrative associate, Lisa Lee.  Thank you, Lisa!

Prospect:  2009-2010

As of June 2009, SEAF anticipated hosting, directly or indirectly, these scholars of Southeast Asia during academic year 2008-09:

  • Sudarno Sumarto is the director of the SMERU Research Institute, Jakarta.  He will be at Stanford for the full academic year as the 2009-10 Shorenstein APARC-Asia Foundation Visiting Fellow. While on campus, Sudarno will do research and write on the political economy of development in Indonesia.  He is likely to focus within that field on the economic consequences of violent conflict, policy lessons to be drawn from the record of cash-transfer welfare programs, and whether and how such aid has affected its recipients’ voting behavior. 
  • James Hoesterey will spend academic year 2009-10 at APARC as the year’s Shorenstein Fellow.  He will revise for publication his University of Wisconsin-Madison doctoral dissertation in anthropology on “Sufis and Self-help Gurus:  Postcolonial Psychology, Religious Authority, and Muslim Subjectivity in Indonesia.” Jim researched this topic in Indonesia over two years of fieldwork focused on the outlook and activities of a popular, charismatic, media-savvy Muslim preacher, Abdullah Gymnastiar.  Jim’s aim is to understand and interpret how a new generation of Muslim preachers and trainers in Indonesia has found a marketable niche and acquired personal and religious authority by combining piety with practical advice. 
  • Thitinan Pongsudhirak is an associate professor in international relations at Chulalongkorn University, Bangkok, where he also heads the Institute of Security and International Studies.  He will be at Stanford in Spring 2010, one of four visiting experts from overseas in a new joint effort by the Stanford Humanities Center and the Freeman Spogli Institute for International Studies to bring “high-profile international scholars into the intellectual life of Stanford.” 

Together with SEAF, the Center for East Asian Studies and the Center for Democracy, Development, and the Rule of Law will co-host Thitinan during his stay.  While at Stanford he will lecture and write on Thai politics and foreign policy, among other possible topics.  His op ed in the 18 April 2009 New York Times, “Why Thais Are Angry,” may be accessed at the New York Times.

Christian von Luebke, a 2008-09 Shorenstein Fellow, will remain at Stanford in 2009-2010 as a visiting scholar on a German Science Foundation fellowship.

He will enlarge, for publication, the focus of his doctoral dissertation, on the political economy of subnational policy reform in Indonesia, to encompass the Philippines and China as well.  To that end, he did preparatory fieldwork in Manila in Summer 2009.

SEAF is happy to congratulate all four of these 2009-2010 scholars for winning these intensely competitive awards!  

In addition to sponsoring the lectures these scholars are expected to give, SEAF will host a full roster of occasional speakers from the United States and other countries in AY 2009-2010.  These speakers will analyze and assess, for example, the (in)efficacy of ex-Prime Minister Thaksin Shinawatra’s welfare programs in Thailand, the role of intra-military tensions in propelling Asian transitions from authoritarian to democratic rule, and aspects of Japan’s occupation of Southeast Asia during World War II that need reconsideration.

As for the 2009-10 iteration of the NUS-Stanford Initiative and its fellowship and lectureship awards, as of June 2009 this prospect was on hold pending clarification of NSI’s financial base, which has been affected by the global economic downturn.  Whatever the status of NSI in 2009-10, SEAF’s speakers, whether resident on campus or invited for one-time talks, should make up in quality for the modest shortfall in quantity—not filling one slot for a visitor—that the possible absence of an NSI-funded scholar would imply.

Controversy:  “Islamism” and Its Discontents

SEAF expects to learn in 2009-10 of the publication of one or more books written wholly or partly at Stanford under its auspices.  One of these titles is Islamism: Contested Perspectives on Political Islam.  It is set to appear by November 2009 and can be ordered now from Stanford University Press at http://www.sup.org/book.cgi?id=11926.  

In this volume, SEAF’s director debates a friend and colleague, Middle Eastern and Islamic studies expert and Hofstra University anthropologist Dan Varisco.  They disagree over the meaning of the term “Islamism” and the (un)desirability of its use in discourse about Muslims and their faith.  Of particular sensitivity in this context is the (mis)use of “Islamism” to describe or interpret instances of violence that have been or may be committed by Muslims in the name of Islam.  A dozen other experts on Islam, mostly Muslims, contribute shorter comments on “Islamism” and on the positions taken by Emmerson and Varisco.  If one early reviewer turns out to be right, “this lively work will be a great help for anyone concerned with current debates between Islamic nations and the West.” 

At Stanford in February 2009, Don Emmerson conveyed his and Dan Varisco’s views to a standing-room-only lecture and discussion hosted by the Abbasi Program in Islamic Studies entitled “Debating Islamism: Pro, Semi-pro, Con, and Why Bother?” (audio recording available).  One listener later commented anonymously on the talk.  Also relevant, in the context of larger questions regarding how best to convey Muslims’ lives and religion to non-Muslims, is Jonathan Gelbart's article "Who Speaks For Islam? Not John Esposito".

Don does not know the authors of these posts; ran across their comments by chance while cyber-surfing; and does not necessarily endorse their views, let alone views to be found in the sources to which these comments may be electronically linked.  But the blog and the article do contribute to a debate whose importance was illustrated at the very end of Stanford’s 2008-09 academic year by Barack Obama’s own treatment of Islam and Muslims in the unprecedented speech that he gave at Cairo University on 4 June 2009.  After he spoke, in conversation with an Indonesian journalist, Obama promised to visit—actually, to revisit—Jakarta on his next trip to Asia.  That stop is most likely to take place before or after he attends the Asia Pacific Economic Cooperation forum in nearby Singapore in November 2009.  Viewers interested in a commentary can also read Don's Obama's Trifecta: So Far, So Good.

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US President Barack Hussein Obama's speech on 4 June 2009 in Cairo, the second of three planned trips to Muslim-majority countries, was outstanding.

First, it opened daylight between the US and Israel. Israeli settlements on the West Bank are impediments to a two-state solution and a stable peace with Palestine. Obama did not split hairs. He did not distinguish between increments to existing settler populations by birth versus immigration with or without adding a room to an existing house. The United States, he said, does not accept the legitimacy of continued Israeli settlements. Period.

The American Israel Political Affairs Committee, which advertises itself as America’s pro-Israel lobby, cannot have been pleased to hear that sentence. But without some semblance of independence from Israel, the US cannot be a credible broker between the two sides. It is not necessary to treat the actions of Israeli and Palestinian protagonists as morally equivalent in order to understand that they share responsibility for decades of deadlock. New settlements and the expansion of existing ones merely feed Palestinian suspicions that Israel intends permanently to occupy the West Bank. Nor did Obama’s criticism of Israeli settlements prevent him from also stating: Palestinians must abandon violence. Period.

Second, alongside his candor, he showed respect. The most effective discourse on controversial topics involving Islam and Muslims is both sensitive to feelings and frank about facts, as I argue in a forthcoming book (Islamism: Contested Perspectives on Political Islam). Inter-faith dialogues that rely on mutual self-censorship–an agreed refusal to raise divisive topics or speak hard truths – resemble sand castles. Empathy based on denial is unlikely to survive the next incoming tide of reality. Respect without candor, in my view, is closer to fawning than to friendship.

As Obama put it in Cairo, ‘In order to move forward, we must say openly to each other the things we hold in our hearts and that too often are said only behind closed doors. As the Holy Quran tells us, ‘Be conscious of God and speak always the truth.” His listeners applauded – most of them, perhaps, because he had cited their preferred Book, but some at least because he had defended accuracy regardless of what this or that Book might avow.

In the partnership that Obama offered his audience, sources of tensions were not to be ignored. On the contrary, we must face these tensions squarely. He then followed his own advice by noting that extremists acting in the name of Islam had in fact killed more adherents of their own religion than they had Christians, Jews, or the followers of any other faith. In the same candid vein, he noted with disapproval the propensity of some Muslims to repeat vile stereotypes about Jews, the opposition of Muslim extremists to educating women, and the fact of discrimination against Christian Copts in Egypt, the very country in which he spoke.

Third, his speech was notable for what it did not contain. The word ‘terrorism’,’ a fixture of the Manichean rhetoric of George W. Bush, did not occur once. Back in Washington, in his 26 January televised interview with Al Arabiya, Obama had used the phrase Muslim world 11 times in 44 minutes – an average of once every four minutes. In the run-up to his Cairo speech, the White House had repeatedly hyped it as an address to ‘the Muslim world.’ Yet in the 55 minutes it took him to deliver the oration, the words ‘Muslim world’ were never spoken. He must have been advised to delete the reference from an earlier draft of his text.

I believe the excision strengthened the result, but not because a ‘Muslim world’ does not exist. Admittedly, one can argue that 1.4 billion Muslims have too little in common to justify speaking of such a world at all. But the already vast and implicitly varied compass of any ‘world’ diminishes the risk of homogenization. One can easily refer to ‘the Muslim world’ while stressing its diversity. Many Muslims and non-Muslims already use the phrase without stereotyping its members. No, the reasons why Obama avoided the phrase were less definitional than they were political in nature.

Had Obama explicitly addressed the Muslim world in Cairo, he would have risked implying that his host represented that Muslim world, as if Egypt were especially authentic–quintessentially Muslim–in that sphere. That would have been poorly received in many of the other Muslim-majority societies that diversely span the planet from Morocco to Mindanao.

Several years ago a professor from Cairo’s Al-Azhar University, which co-sponsored Obama’s appearance, told me in all seriousness that Indonesian Muslims, because they did not speak Arabic, were not Muslims at all. Obama did not wish to be read by the followers of ostensibly universalist Islam as endorsing such a parochially Arabo-centric conceit.

The US president could, of course, have mentioned the Muslim world and in the next breath denied that it was represented by Egypt, a country under an authoritarian regime with a reputation for corruption of near-Nigerian proportions. But it was far smarter and more effective for Obama to have shunned the phrase altogether, thereby avoiding the need to clarify it and risk implying that his hosts were somehow less than central to Islam, less than paradigmatically Muslim. Such a candid but insensitive move would have triggered nationalist and Islamist anger not only in his Egyptian audience, but in other Muslim-majority countries as well. Indonesian Muslims, for example, would have wondered with some apprehension whether to expect comparably rude behavior were he to visit their own country later this year.

Obama’s listeners at Cairo University were, instead, subjected to twin eloquences of absence and silence: Egyptian President Hosni Mubarak’s not being present, and Obama’s not mentioning him at all. Eloquent, too, was the absence of Israel from his itinerary. This omission was not a sign of hostility toward Tel Aviv, however. He termed the US-Israel bond ‘unbreakable.’ Not visiting Israel merely signaled that Washington on his watch would not limit its foreign-policy horizon to what any one country would allow.

Obama mispronounced the Arabic term for the head covering worn by some Muslim women. The word is hijab not hajib. But that small slip was trivial compared with the brilliance and timeliness of what he had to say. Rhetoric is one thing, of course; realities are quite another. The tasks of resolving the Israeli-Palestinian conundrum and improving relations with the heterogeneous Muslim world are more easily discussed than done. Illustrating that Muslim world’s extraordinary diversity are the many and marked differences between Turkey, where Obama spoke on 6 April on his first overseas trip, his Egyptian venue two months later, and Indonesia, which he is likely to visit before the end of 2009.

Before his choice of Cairo was announced, several commentators advised him to give his Muslim world speech in June in the Indonesian capital, Jakarta. Rather than risk legitimating Mubarak’s autocracy, they argued, he should celebrate Indonesia’s success in combining moderate Islam with liberal democracy.

Following their advice would have been a mistake. Not only did speaking in Cairo enable Obama boldly to address the Israeli-Palestinian conflict from a podium close to its Middle Eastern epicenter. Had he traveled to Indonesia instead, his visit would have been tainted by an appearance of American intervention in the domestic politics of that country, whose President Susilo Bambang Yudhoyono is up for re-election on 8 July.

Earlier in his career, Yudhoyono completed military training programs in the US, at Fort Benning and Fort Leavenworth, and earned a master’s in management from Webster University in St. Louis. No previous Indonesian head of state has had a closer prior association with the United States. Yudhoyono’s rivals for the presidency are already berating him and his running mate as neo-liberals who have pawned Indonesia’s economy to the capitalist West. Obama could feel comfortable keeping the autocrat Mubarak at arm’s length in Cairo, but in campaign-season Indonesia the US president would have been torn between behaving ungraciously toward his democratically chosen host and appearing to back him in his race for re-election.

Yudhoyono’s popularity ratings among Indonesians are even better than Obama’s are among Americans. The July election is Yudhoyono’s to lose. But the winner’s new government will not be in place until October. The US president was wise to postpone visiting Indonesia until after its electoral dust has cleared and the next administration in Jakarta has taken shape. A gathering of leaders of the Asia Pacific Economic Cooperation forum, which Obama is expected to attend, is conveniently scheduled for mid-November in Singapore. He could easily visit Indonesia en route to or from that event.

An Indonesian journalist in Cairo interviewed Obama shortly after his speech. The president virtually confirmed this November itinerary by saying that his next trip to Asia would include Indonesia. He said he looked forward to revisiting the neighborhood in Jakarta where he had lived as a child, and to eating again his favorite Indonesian foods – fried rice, bakso soup, and rambutan fruit among them.

A trifecta happens when a gambler correctly predicts the first three finishers of a race in the correct order. Obama appears to have bet his skills in public diplomacy on this sequence: Ankara first, then Cairo, then Jakarta.

One can ask whether his actions will match his words, and whether the US Congress will go along with his prescriptions. But with two destinations down and one to go, Obama is well on his way to completing a trifecta in the race for hearts and minds in the Muslim world.

A version of this essay appeared in AsiaTimes Online on 6 June 2009.

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A keynote speech delivered on 19 March 2009 to a conference on  “The Philippines and Japan in East Asia and the World:  Interests, Identity, and Roles” organized by the Philippines’ Asian Center with support from the Japan Foundation Manila, the Philippines, March 19-20, 2009.

Published in Aileen S. P. Baviera and Rowena R. Pangilinan, eds, The Philippines and Japan in East Asia and the World: Interests, Identity and Roles (Quezon City: University of the Philippines Asian Center / Japan Foundation, 2009).

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As part of health reforms announced in April 2009, China plans to expand and strengthen primary care (i.e., provision of first contact, person-focused, ongoing care over time, and coordinating care when people receive services from other providers). Other nations of Asia continue to grapple with how to promote population health and constrain healthcare spending. What is the evidence about the effectiveness of primary care in improving population health and making healthcare accessible and affordable?

In this talk, Dr. Starfield will speak about the robust evidence of the association between primary care and better health outcomes at lower cost; ways of measuring the effectiveness of primary care; how selected Asian countries compare in such rankings; and the broader implications of primary care research for health policy in Asia.

Dr. Starfield, a physician and health services researcher, is internationally known for her work in primary care; her books, Primary Care:  Concept, Evaluation, and Policy and Primary Care: Balancing Health Needs, Services, and Technology, are widely recognized as the seminal works in the field.  She has been instrumental in leading projects to develop important methodological tools, including the Primary Care Assessment Tool, the CHIP tools (to assess adolescent and child health status), and the Johns Hopkins Adjusted Clinical Groups (ACGs) for assessment of diagnosed morbidity burdens reflecting degrees of  co-morbidity.   She was the co-founder and first president of the International Society for Equity in Health, a scientific organization devoted to furthering knowledge about the determinants of inequity in health and ways to eliminate them.  Her work thus focuses on quality of care, health status assessment, primary care evaluation, and equity in health. She is a member of the Institute of Medicine and has been on its governing council, and has been a member ofthe National Committee on Vital and Health Statistics and many other government and professional committees and groups. She has a BA from Swarthmore College, an MD from the State University of New York, Downstate Medical Center, and an MPH from Johns Hopkins University School of Public Health.

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Barbara Starfield University distinguished professor and professor of health policy and pediatrics Speaker Johns Hopkins University
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The Walter H. Shorenstein Asia-Pacific Research Center is pleased to announce that Kevin Y. Kim has been awarded the Shorenstein APARC Predoctoral Fellowship for 2009-2010.

The Fellowship supports a Stanford University predoctoral student’s research within a broad range of topics related to the political economy of contemporary East Asia. Fellows whose main focus is Japan are called Takahashi Fellows, in honor of the Takahashi family, whose generous gift has made this fellowship possible. Fellows studying other regions are called Shorenstein APARC Fellows

Kevin Kim is a Ph.D. candidate in history at Stanford University. He specializes in 20th century U.S. foreign relations, with an emphasis on U.S.-Asia relations. He currently is completing a dissertation titled, “Forging the Free World: Korea, U.S. Leaders, and the World, 1948-1954.” This study examines the impact of the Korean War upon the evolution of U.S. national leaders’ foreign policy ideas on strategy, economy, race, and world politics. Influenced by “constructivist” approaches and traditional historical methods, his dissertation explores the Korean War period as a formative moment in the construction of contemporary U.S. liberal and conservative foreign policy beliefs.

Before entering graduate school, Kim was a Fulbright fellow in South Korea from 2001 to 2002, where he taught English in a Daejeon public middle school and studied Korean language and U.S.-Asia relations at various institutions. He also briefly pursued a career in journalism, and has written on culture, domestic politics, and international affairs for publications such as The Nation, The Progressive, Far Eastern Economic Review, South China Morning Post, and The Village Voice.

Kim received his M.A. in history from Stanford University and a B.A. in English and Comparative Literature from Columbia University. He was born and raised in the New York City metropolitan area.

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East and Southeast Asia are aging rapidly. South Korea, for example, has become one of the fastest aging societies in the world. In France, 115 years (1865–1980) were required for the proportion of population aged 65 and over to rise from 7 percent to 14 percent, but in South Korea, it is expected that a comparable change will occur in only eighteen years (2000–2018). More strikingly, it will take only eight years (2018–2026) for the proportion of South Korea’s elderly to increase from 14 percent to 20 percent. The nation’s old-age dependency ratio grew from 5.7 percent in 1970 to 12.6 percent in 2005, and is projected to further increase to 72.0 percent by 2050. At the macroeconomic level, these figures suggest an increasing burden on the working-age population to support the elderly population.

Such figures, however, do not tell the whole story about the burden shouldered by the working-age population. The lives of elderly and working-age individuals are not separate but rather, are linked by the institution of the family. Working-age adult children often take on the role of caring for elderly parents, who may have functional limitations and cognitive impairments. Such informal family caregiving is embedded in traditional Korean culture, as it is in many Asian societies that uphold traditional norms of filial piety.

As the elderly population grows, the demand for elderly long-term care will increase sharply. The supply of informal care, however, is decreasing for a number of reasons. Declining fertility rates have already diminished the potential pool of family caregivers. Further reducing the availability of family caregivers is an array of socioeconomic changes, such as increased migration, decreasing rates of intergenerational co-residence, and increasing labor force participation rates among women, who have historically served as the main family caregivers. Adult children, therefore, will increasingly experience a conflict between parental care responsibilities and their own work. Anecdotal evidence suggests that many daughters or daughters-in-law give up their professional employment to care for their disabled parent(s) or parent(s)-in-law. The work-family conflict also has important implications for the economy—informal caregiving may have additional negative effects on the labor force participation of the already shrinking working-age population.

I recently conducted a study using data from the Korean Longitudinal Study of Aging. My study indicated that providing at least ten hours of care per week reduces the probability of female labor force participation by 15.2 percentage points. I concluded that informal care is already an important economic issue in South Korea even though its population aging is still at an early stage. If the current trend continues, the labor market costs of informal caregiving will increase as the country experiences the full force of the demographic transition. One of the expected benefits of the public long-term care insurance implemented in July 2008 is to help family caregivers participate more easily in the labor force. In Japan, there is some evidence that long-term care insurance positively affects female labor force participation, but such beneficial effects have not yet materialized clearly in Korea. In both countries, there is much to learn from early experience with long-term care insurance.

In most parts of Asia, informal caregivers remain invisible on the policy agenda, not only because of cultural norms that perpetuate family-centered care but also because informal care incurs no public cost. However, the demographic transition, coupled with socioeconomic changes in the region, underscores the need to examine whether informal care is really without costs, at both individual and societal levels. Throughout Asia, the challenge for public policy will be finding the optimal mix of informal, family-based and formal, socially supported elder care.

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