Colonel Patrick Winstead, the 2016-17 FSI senior military fellow at Shorenstein APARC, writes about the second annual orientation at U.S. Pacific Command headquarters

The mission of the Department of Defense (DoD) in the Indo-Asia-Pacific region recently became a bit clearer for 22 faculty and military fellows from Stanford, the Massachusetts Institute of Technology, the Naval Postgraduate School and the Daniel K. Inouye Asia-Pacific Center for Security Studies (APCSS). The U.S.-Asia Security Initiative at the Shorenstein Asia-Pacific Research Center (APARC) in the Freeman Spogli Institute (FSI) organized a group of faculty and fellows for a two-day orientation of United States Pacific Command (USPACOM) and its component military organizations in and around Honolulu, Hawaii, April 13-14, 2017. The purpose of the orientation was to provide researchers with a comprehensive understanding of how America’s armed forces both develop and implement U.S. national security strategy, doctrine and policy throughout Asia.

The trip began with a visit to the headquarters of USPACOM at Camp H.M. Smith. After receiving briefings about USPACOM's mission and operations, the group engaged in roundtable discussions with General Terrence O’Shaughnessy (Commander, U.S. Pacific Air Forces); Major General Kevin B. Schneider (Chief of Staff, USPACOM); Rear Admiral Mark Montgomery (Director for Operations, USPACOM); Major General Steven Rudd (Director for Strategic Planning and Policy, USPACOM); as well as other key joint directors and members of the command staff. The faculty and fellows provided short presentations on the situation in the South China Sea, U.S.-Philippine relations and cyber warfare to an audience of mid-grade military officers and civilian personnel assigned to USPACOM.

In addition to meeting with the leadership of USPACOM, the group was also afforded the opportunity to interact with personnel from the four separate component commands. Deputy Commanding General of U.S. Army Pacific, Major General Charlie Flynn, provided a command briefing at the U.S. Army Pacific headquarters at Fort Shafter. The briefing stimulated a wide-ranging discussion about Army initiatives and activities in support of USPACOM’s mission in the Indo-Asia-Pacific region. At Marine Corps Base Hawaii at Kaneohe Bay, under the guidance of trainers, the visitors took part in a hands-on experience operating Humvee simulators in a virtual-reality convoy setting and firing simulated weapons that Marines typically employ in combat operations. The first day of the trip ended with a working dinner at the historic Nimitz House with the Commander of the U.S. Pacific Fleet, Admiral Scott Swift, where the conversation ranged from Chinese military modernization to evolving U.S. naval doctrine.

Those themes carried into the second day, when the group met for several hours with faculty at APCSS for plenary presentations and multiple breakout sessions to facilitate in-depth dialogue on select topics including the threats posed by nuclear weapons on the Korean Peninsula and in South Asia. The day continued with a tour of the U.S.S Hopper, an Arleigh-Burke class guided missile destroyer, based at Pearl Harbor, Hawaii. Once onboard, the ship’s captain, Lieutenant Commander J.D. Gainey, provided briefings on Hopper’s mission and operational capabilities. In addition, the group spoke with members of the ship’s crew. The experience allowed the faculty and fellows to interact informally with sailors who serve in the Asia-Pacific theatre and to candidly discuss issues of concern. The second day of the orientation ended with a visit to the headquarters of U.S. Pacific Air Forces and a dialogue with O’Shaughnessy and his staff about the unique security challenges of the Indo-Asia-Pacific region, such as tyranny of distance, limited support bases and multiple emerging threats, and how those challenges impact the Air Force and the entire U.S. military’s preparations for contingencies in the region.

Overall, the orientation provided a unique opportunity to engage directly with high-level leaders of USPACOM and to learn first-hand about the challenges faced by those who serve in the armed forces. The orientation also provided a forum to discuss the United States’ national security interests in the region and its efforts to maintain peace and stability in the Indo-Asia-Pacific and to help maintain a rules-based, liberal democratic order.

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As expected, Moon Jae-in has been elected as South Korea’s 19th president. In a five-way contest, Moon garnered 41.1 percent of the vote, with strong support from those in their 20s to 50s, winning most of the regions in the country. 

South Koreans’ longing for change had been expressed through the now-famous candlelight demonstrations that lasted for almost twenty consecutive weekends culminating in the impeachment of now former president Park Geun-hye. It was also reflected in the highest voter turnout in two decades, at 77.2 percent.

Just hours after his decisive victory, Moon began his five-year term without the usual practice of a transition team. Moreover, he took office during turbulent times — domestically and internationally — perhaps even more so than when former president Kim Dae-jung took office in 1998 when the nation was struggling with the Asian financial crisis.

First and foremost, Moon must deal with the mounting social and economic challenges that the country is facing. Having entered a period of low-growth coupled with an aging population, the economy confronts a host of difficult issues, including high levels of youth unemployment, income inequality, household debt, elderly poverty and rising social welfare expenditures.

The Moon administration immediately established a ‘job creation committee’ and pledged to create 810,000 jobs in the public sector. But it will not be easy to amass the financial resources needed by a government already struggling with serious budget deficits. Most agree that ‘economic democratisation’ is needed, but the details of how to achieve that — including reforming the chaebol — remain unclear.

Economic uncertainties have been a key factor contributing to social unrest. Words in vogue among South Koreans in their 20s and 30s reflect the social discontent with youth unemployment and inequality that ultimately erupted in the demonstrations.

‘Hell Joseon’ captures a sentiment of what it means to live in South Korea’s hellish reality. ‘Golden Spoons Dirt Spoons’ levels the charge that one’s life course is decided for good by one’s family background. ‘Gapjil’ refers to acts of impunity by the powerful against the weak, while the ‘Sampo generation’ is a generation forced to give up three things: courtship, marriage and children. If Moon fails to live up to the expectations of the country’s youth, a bloc that widely supported him, social discontent and symptoms of unrest will likely return.

Moon also faces daunting tasks in national security matters. North Korea has continued to develop weapons of mass destruction and relations have been all but completely severed. As controversy over the deployment of THAAD (Terminal High Altitude Area Defense) has shown, South Korea remains caught in the middle of a hegemonic struggle between the United States and China.

If that wasn’t enough, South Korea made a deal with Japan on the comfort women issue in late 2015 but the public now demands its renegotiation. South Korean–Russian relations are also at their grimmest. To top it all off, Moon must deal with a formidable set of nationalist and populist leaders — Donald Trump, Xi Jinping, Shinzo Abe, Kim Jong-un and Vladimir Putin — all known for their very strong characters, in stark contrast to Moon’s nice-guy, everyman personality.

The most urgent but also most challenging task is managing inter-Korean relations. As Pyongyang steps up its nuclear and missile programs, Seoul must reaffirm to the international community that it will continue its efforts to denuclearise the North. At the same time, relations between the two Koreas must be improved to strengthen South Korea’s strategic position in the region as well as reduce tensions on the peninsula.

Trump has been sending out confusing messages probably because he has no suitable plan to deal with Pyongyang. As such, if Seoul were to bring to the table a persuasive policy of engagement, Washington would be receptive unless it weakens US efforts towards denuclearisation. Both Beijing (pressured by Washington to solve the North Korean nuclear issue) and Pyongyang (concerned about becoming overly dependent on China) would welcome Seoul taking the initiative to improve inter-Korean relations.

Some pundits at home and abroad worry that the Moon administration might follow in the footsteps of the Roh administration (2003–2008), whose outcomes lagged too far behind its good will to bring about reform. Moon served as Roh’s chief of staff and the two administrations overlap in manpower. But Moon and his team have also learned many lessons from the trial and error of the Roh administration, preparing themselves over the past ten years of conservative rule.

With the new administration in place, political turmoil over the last six months has finally ended. Moon’s first moves as president, including key appointments in the Blue House and opening up communication channels with the public, have been well received. A public poll conducted by Gallup Korea one week after the inauguration showed that 87 percent of the respondents expected him to do well. Despite mounting challenges, South Koreans remain hopeful that their new leader can take the nation to the next level.

This piece was originally carried by East Asia Forum on May 23, 2017, and reposted with permission.

Emily Tuong-Vi Nguyen, a Stanford student studying human biology, writes about the Asia Health Policy Program’s international conference on diabetes

The Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center hosted the Net Value in Diabetes Management Workshop in March to discuss progress on an international research collaboration. Research teams from Hong Kong, Singapore, China, Taiwan, South Korea and the United States convened at the Stanford Center at Peking University (SCPKU) in Beijing to work on research that compares utilization and spending patterns on diabetes across different countries and to develop a method for measuring the net value of diabetes internationally, based on previous methods discussed in a Eggleston and Newhouse et al. 2009 study with Mayo Clinic Data for Type 2 diabetes.

The research teams from various Asian countries are attempting to calculate the net value of diabetes in those countries by observing the changes in diabetes value and spending. These calculations include monetizing the value of health benefits of new treatments and improvements in health, as well as avoided spending on treatments when prevention was effective, and associated mortality and probability of survival. Previous models used to measure diabetic values and risks, such as the United Kingdom Prospective Diabetes Study (UKPDS) risk engine that was created from U.K. data and populations, are not very relevant for Asian populations. The goal is to create separate risk models specifically suited for populations from Hong Kong, Singapore, China, Taiwan and South Korea.

During the workshop that spanned two days, the research teams had an opportunity to share updates on their individual projects and to discuss methods and ideas for future collaboration.

On the first day, each research team presented its work, describing data sets and explaining the risk models that were used or developed. Karen Eggleston, director of the Asia Health Policy Program, delivered introductory remarks and shared current progress by the Japan and Netherlands research teams on calculating value and risk for diabetes with data from the Netherlands and Japan. The data sets from those two countries were best estimated by the JJ Risk Engine for the Japan data and the UKPDS model for the Netherlands data.

Chao Quan of the University of Hong Kong presented the risk model used for Hong Kong populations. His work primarily looked at how the UKPDS risk engine predicted risk in Hong Kong populations as compared to a local Hong Kong risk engine and how to best calibrate the Hong Kong risk engine. His next step will be to monetize the value for improved survival in diabetes in Hong Kong. He offered to re-estimate the model using the risk factors available on others’ datasets so that the Hong Kong risk model could potentially be used by other teams as well.

Stefan Ma and Zheng Li Yau of the Ministry of Health of Singapore discussed the 5-year prediction model and statistical methods they used for all-cause mortality of Singaporean individuals with diabetes. Their work is based on Singapore’s extensive administrative and claims data as well as data provided by the national health surveys conducted every six years by the National Health Service of Singapore. The researchers plan to look into how their overall risk model compares with models for specific subpopulations, such as Chinese, Malay and Indian populations in Singapore.

Katherine Hastings from the Stanford University team, led by principal investigator Latha Palaniappan, presented preliminary ideas about measuring cardiovascular risk with the Atherosclerotic Cardiovascular Disease Risk Score in analyses of Stanford health system diabetic patients. The researchers are collaborating with a clinical bioinformatics team at Stanford to use machine learning to expedite the analysis.

Min Yu and Haibin Wu of the Zhejiang Center for Disease Control and Prevention shared results from their analysis of health data collected from community health centers for diabetes management, diabetes surveillance data, cause of death data and insurance claims data that showed relationships between different patient characteristics and insurance types. The researchers then estimated the annual cost of Type 2 diabetes and its complications in Tongxiang province, China.

Hai Fang and Huyang Zhang of Peking University worked with claims data of diabetic patients insured by the New Cooperative Medical Scheme in Beijing, and at the workshop, shared regression analyses on the relationship between outpatient visits and inpatient admissions.

Jianqun Dong of the People’s Republic of China Center for Disease Control and Prevention presented ongoing research about diabetes management in China, including preliminary results of a randomized control trial of diabetes self-management strategies.

Wankyo Chung of Seoul National University shared preliminary estimates of a risk model for mortality among diabetic patients in South Korea and discussed next steps for estimating net value of diabetes management using the detailed clinical and claims data available in South Korea.

On the second day, the workshop concluded with a videoconference between workshop participants in Beijing and collaborators at Stanford Graduate Business School, including Stanford professor Latha Palaniappan and Harvard visiting professor Joseph P. Newhouse, using the Highly Immersive Classroom.

The workshop was a good opportunity for the research teams to discuss preliminary models, to offer each other suggestions regarding research methods, and to discuss the future direction of the international collaboration on the net value of diabetes. All research teams are preparing comparative research papers that will be included in the working paper series of the Asia Health Policy Program. A follow-up event will be held at Stanford in November 2017 in recognition of World Diabetes Day.

China is encountering a religious resurgence. Its revival symbolizes tension between the past and the present, as people search for purpose in a country that’s been shaken by expansive reforms and modernization efforts over the past four decades.

That was the message shared by veteran journalist Ian Johnson, the 2016 winner of the Shorenstein Journalism Award, who gave a keynote speech followed by panel discussion titled “Religion after Mao,” part of the Award’s 15th anniversary ceremony at the Shorenstein Asia-Pacific Research Center on Monday.

Johnson, who has spent 30 years as a journalist, has written extensively about Chinese history, religion and culture, and is also a teacher and published author, most recently releasing the book The Souls of China: The Return of Religion after Mao.

“Ian is maybe one of the most remarkable awardees we’ve had in recent years,” said Daniel Sneider, Shorenstein APARC associate director for research, who introduced the event by talking about Johnson’s distinguished career, which has included writing for the New York Times, Wall Street Journal and New York Review of Books and led to a Pulitzer Prize win in 2001.

Xueguang Zhou, a Stanford professor of sociology and senior fellow at the Freeman Spogli Institute, and Orville Schell, the director of the Asia Society’s Center on U.S.-China Relations and former dean of the Graduate School of Journalism at U.C. Berkeley, joined Johnson on the panel, while Sneider moderated the discussion.

In a wide-ranging conversation, the panelists discussed the varied history of religion in Chinese society during the 20th and 21st centuries, offering stories of their experiences living and working in China.

According to Johnson, religious persecution in China is often thought to be associated with the anti-religious campaigns of Mao Zedong following the Chinese Communist Party’s assumption of power in 1949, but in reality, it existed decades before and has lingered in national memory.

Into the late 1980s and early 1990s, the Chinese government remained superstitious of religion, trying to redefine religious groups as “culture” alone, under the assumption that religion could be desensitized enough to eventually disappear, Johnson said.

But that did not happen, he said, and instead an opposite trend did. Reaching a high point in the 2000s, China’s economic reforms – both sweeping and fast-paced – brought growing angst and anxiety and prompted people across every socioeconomic background to turn to religion as an outlet.

Johnson, who has spent weeks at a time living among religious groups, noted a shift from the time he was in China in the mid-1980s to the past decade, where now “the government sees that religious groups can provide some sort of moral framework for some people.”

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Chinese people today are searching for meaning, the panelists said, and are driven to join religious groups amid resource competition and mass migration that has usurped traditional family structures and disquieted many people who have moved from close-knit rural towns to alienating urban centers.

“Everybody is out there…trying to reify that part of life which isn’t filled by bread alone, by commerce alone,” said Schell, who has written about China since the 1970s as an author and journalist. “It’s a pretty chaotic quest and it’s very hard to know where it will all end.”

At the moment, religious groups in China remain heterogeneous and fragmented, Zhou said, but cohesion is growing in some regions and participation of local government leaders has drawn greater attention to the practice of faith.

“In grassroots China, religion, spiritual life and the Party, really go hand-in-hand – they’re intertwined,” said Zhou, whose research focuses on Chinese bureaucracy and economic development. “Local elites are involved both in the spiritual world and the Party world, and they shift back and forth simultaneously.”

However, the future of the relationship between religion and the government remains to be seen, according to the panelists.

Religious groups could fracture, or the government could continue to favor “native” religious groups, which if exacerbated over time, could lead to quasi-state religions, Johnson said. (Today, China recognizes five religions: Buddhism, Catholicism, Daoism, Islam and Protestantism).

While religious groups increasingly provide a service to some people, the Chinese government continues to be wary of them as an alternative source of knowledge and values, Johnson said, which hold the potential to coalesce into a nascent civil society.

“Every dynasty in China knows that one way dynasties usually ended was with some millenarian movement,” Schell added of the government’s apprehension. “They are afraid of religious movements because they do bespeak of higher values, higher loyalties and different organizational structures that don’t owe fealty to the Party.”

A video of the keynote speech is posted at this link.