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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.

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Local NGO staff teaching sex workers about the risk of HIV/AIDS, Cambodia. | Masaru Goto/World Bank
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**Due to space restrictions, this event has reached capacity and we will no longer be taking RSVPs. Everyone is still welcome to attend but please plan to arrive early as seating is on a first come, first serve basis.**

Under the Hu-Wen leadership, China announced a shift in its development policy from a policy program that mainly emphasizes economic growth to one that pursues a “harmonious society.” The harmonious society program was a response to rapid increases in inequality during the 1990s, and its aim has been to ensure that the benefits from growth are widely shared.    

In recent years have the benefits from growth been widely shared? Has income inequality increased or decreased during the Hu-Wen era?

Drawing on recent findings from the China Household Income Project, a collaborative survey research project monitoring changes in incomes and inequality, Professor Terry Sicular will discuss recent trends in inequality and poverty in China. 

Terry Sicular is professor of economics at the University of Western Ontario. She received her doctorate at Yale and has taught at Stanford and Harvard. She is a specialist on the Chinese economy, speaks Mandarin, and has been studying and travelling to China for more than 30 years. Her recent research examines incomes and inequality in China, as well as related topics such as educational attainment and its intergenerational transmission, and the impact of housing reforms on household income and wealth. She has published widely in scholarly journals and books, and is as a contributor to and co-editor of Inequality and Public Policy, published by Cambridge University Press (2008). She has served as a consultant to international donor organizations, and is a leader in the ongoing, China Household Income Project, a collaborative research project that conducts a nationwide household survey and monitors trends in China’s incomes and inequality.

This event is part of the China's Looming Challenges series. 

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Terry Sicular Professor Speaker Department of Economics, University of Western Ontario
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The global health community has been aiming at ensuring health coverage for all. To achieve universal health care coverage, the German Social Health Insurance model is one solution. However, one major disadvantage of Social Health Insurance is the fragmented insurance plans, exemplified by 3,500 insurance plans in Japan’s public universal health insurance system. To improve the financial sustainability of Japan’s public universal health insurance, policy options include consolidating fragmented plans as already implemented in Germany and South Korea.

This presentation has two major goals. One is to evaluate the optimal health insurance size in consolidating 3,500 insurance plans in Japan through a simulation analysis using the best available micro data in Japan. The other goal is to discuss the global policy implications based on the experiences of Japan's public universal health insurance.

Dr. Byung-Kwang Yoo is an associate professor in health policy in the Department of Public Health Sciences at the UC Davis School of Medicine. Yoo’s unique career includes clinical medicine (MD) in Japan and research experience as a health services researcher/health economist in the United States. He obtained an MS in health policy and management from Harvard University, and a PhD in health policy and management (concentration on health economics) from Johns Hopkins University. Yoo used to work as a research associate at the Center for Health Policy at Stanford University, as a health economist at the Centers for Disease Control and Prevention in Atlanta, and as an assistant professor in the Division of Health Policy at the University of Rochester School of Medicine in New York State. He has published his work in leading journals such as Lancet, Health Economics, Health Services Research, the American Journal of Public Health, and the American Journal of Preventive Medicine.

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Byung Kwang Yoo Associate Professor in Health Policy in the Department of Public Health Sciences, School of Medicine Speaker UC Davis
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Japan Colloquium Series Inaugural Event  
 

Japan is facing a major set of challenges in the aftermath of its triple disaster of earthquake, tsunami, and nuclear crisis. It had just begun recovering from the 2008 global financial crisis when the disasters hit. Richard Katz will discuss the economic and political prospects for Japan after this catastrophe in a broader global context. He will also be presenting lessons from Japan for U.S. policymakers fighting the current slump. 
 

Richard Katz is editor of the Oriental Economist Report, a monthly newsletter on Japan, as well as the semi-weekly TOE Alert e-mail service on Japan. He is also a special correspondent at Weekly Toyo Keizai, a leading Japanese business weekly. Katz is the author of two books on Japan. The first is Japan: The System That Soured--The Rise and Fall of the Japanese Economic Miracle (M.E. Sharpe,1998); it was published in a Japanese edition as Kusariyuku Nihon To Iu System (Toyo Keizai, 1999). His second book, entitled Japanese Phoenix: The Long Road to Economic Revival (M.E. Sharpe, 2002), was published in English, and in Japanese as Fushicho no Nikon Keizai (Toyo Keizai). Katz has taught about Japan as an adjunct professor in economics at the State University of New York at Stony Brook and at the New York University Stern School of Business. He regularly writes op-eds for newspapers such as the Asian Wall Street Journal and the Financial Times, as well as essays for a variety of journals, including the article “The Japan Fallacy?” for the March-April 2009 issue of Foreign Affairs. He has testified about in Japan in Congress on several occasions. Katz received his MA in economics from New York University in 1996.

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Richard B. Katz Editor Speaker The Oriental Economist Report
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A condensed version of this paper is published in the Journal of Institutional Economics (2012) 8(2): 247-270.

Abstract: Health systems provide a rich field for testing hypotheses of institutional economics. The incentive structure of current healthcare delivery systems have deep historical and cultural roots, yet must cope with rapid technological change as well as market and government failures. This paper applies the economic approach of comparative and historical institutional analysis (Aoki, 2001; Greif, 2006) to health care systems by conceptualizing physician control over dispensing revenues as a social institution. The theory developed -- emphasizing the interplay between cultural beliefs, interest groups, technological change, insurance expansion and government financing -- offers a plausible explanation of reforms since the 1960s separating prescribing from dispensing in societies such as Japan, South Korea, Taiwan, and China. Technological change and adoption of universal coverage trigger reforms by greatly increasing the social opportunity costs of physician overprescribing and reshaping the political economy of forces impinging on the doctor-patient relationship.

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Asia Health Policy Program working paper #24
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Karen Eggleston
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Indonesia is strategically positioning itself to play an even greater role in global economics and politics, particularly by promoting its stable political system and the opportunities for foreign investment there. Southeast Asia Forum director Donald K. Emmerson spoke recently with the Straits Times about the Indonesian government's strategy and about the global conditions favoring the country's growth.
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Jakarta's Stock Exchange building, July 2011. | Flickr/nSeika
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The Association of Southeast Asian Nations has challenged itself is to become a single integrated community by 2015.  The prospect has raised high hopes inside the region.  Will they be met?  Efforts to build the community have intensified, yet the clock ticks and the deadline looms.  Although the result will not match what local enthusiasts of regional unification want to see, but it will likely exceed the expectations of skeptical outsiders.  ASEAN is the linchpin of East Asian regionalism, by design and by default.  What happens to the Association over the next several years has far-reaching implications for the United States, China, and not least for the states and peoples of Southeast Asia.  In his talk, Prof. Pongsudhirak will tease out these dynamics, assess their significance, and explore possible futures beyond 2015.

Thitinan Pongsudhirak heads the Institute of Security and International Studies and teaches international political economy at Chulalongkorn University in Bangkok.  In 2010 he was an FSI-Humanities Center International Visitor at Stanford and, in spring 2011, a visiting professor at Johns Hopkins University’s School of Advanced International Studies.  He has written many articles, chapters, and books on ASEAN and East Asian affairs, and on Thai politics, political economy, and foreign policy.  He has worked for The Nation newspaper (Bangkok), The Economist Intelligence Unit, and Independent Economic Analysis (London).  He currently serves on the editorial boards of Asian Politics & Policy, Contemporary Southeast Asia, the Journal of Current Southeast Asian Studies, and South East Asia Research.  His degrees are from the London School of Economics (PhD), Johns Hopkins University (School of Advanced International Studies, MA), and the University of California, Santa Barbara (BA). 

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Thitinan Pongsudhirak is a high-profile expert on contemporary political, economic, and foreign-policy issues in Thailand today  He is also a prolific author; witness his op ed, "Moving beyond Thaksin," in the 25 February 2010 Wall Street Journal.

Pongsudhirak is not senior in years, but he is in stature.  His career path has been meteoric since he earned his BA in political science with distinction at UC-Santa Barbara not long ago. In 2001 he received the United Kingdom's Best Dissertation Prize for his doctoral thesis at the London School of Economics on the political economy of Thailand's 1997 economic crisis.

Since 2006 he has held an associate professorship in international relations at Thailand's premier institution of higher education, Chulalongkorn University, while simultaneously heading the Institute of Security and International Studies, the country's leading think tank on foreign affairs.

His many publications include: "After the Red Uprising," Far East Economic Review, May 2009; "Why Thais Are Angry," The New York Times, 18 April 2009; "Thailand Since the Coup," Journal of Democracy, October-December 2008; and "Thaksin: Competitive Authoritarian and Flawed Dissident," in Dissident Democrats: The Challenge of Democratic Leadership in Asia, ed. John Kane et al. (2008).  He has written on bilateral free-trade areas in Asia, co-authored a book on Thailand's trade policy, and is admired by Southeast Asianist historians for having insightfully revisited, in a 2007 essay, the sensitive matter of Thailand's role during World War II.

He was a Salzburg Global Seminar Faculty Member in June 2009, Japan Foundation's Cultural Leader in 2008, and a Visiting Research Fellow at the Institute of Southeast Asian Studies (Singapore) in 2005.  For ten years, in tandem with his academic career, he worked as an analyst for The Economist's Intelligence Unit.

Thitinan Pongsudhirak Professor of International Political Economy, Faculty of Political Science, Chulalongkorn University, Thailand Speaker
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A series of events over the last few years, including attempts to deny non-Muslim rights to use the term "Allah," arson attacks on Christian churches, curbs on conversions of Muslims, and confiscation of bibles, alert us to disconcerting trends that have emerged in Muslim-Christian relations in multicultural Malaysia.  The purpose of this presentation is to analyze the underlying drivers behind these events, and to understand how and why the Christian community has mobilized in recent years in the face of perceived constriction of religious space.

Joseph Chinyong Liow is Associate Dean and Professor of Comparative and International Politics at the S. Rajaratnam School of International Studies, Nanyang Technological University, Singapore.  He was a visiting scholar at Stanford in 2007.  Among his forthcoming publications are “Malaysia’s 2008 General Election: Understanding the New Media Factor,” Pacific Review; “Creating Cadres:  Mobilization, Activism, and the Youth Wing of the Pan-Malaysian Islamic Party,” Pacific Affairs; and “Islamist Ambitions, Political Change, and the Price of Power:  Recent Successes and Challenges for the Pan-Malaysian Islamic Party,” Journal of Islamic Studies.  Earlier works include Islam, Education, and Reform in Southern Thailand: Tradition and Transformation (2009); Piety and Politics:  Islamism in Contemporary Malaysia (2009); and Islam in Southeast Asia (co-ed., 4 vols, 2009).  His PhD is from the London School of Economics.


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Joseph Chinyong Liow Visiting Fulbright Scholar, Shorenstein Asia-Pacific Research Center Speaker Stanford University
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