Health Outcomes
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Michael Breger
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Despite technological breakthroughs, healthcare inequality remains a pressing public health challenge across developed and developing nations. Low levels of income or education mobility can exacerbate socioeconomic disparities, leaving children from disadvantaged families with fewer opportunities to improve their social and economic prospects. Moreover,  children in families with low-income backgrounds are also more likely to experience poor health outcomes, perpetuating a cycle of disadvantage.

Huixia Wang, a visiting scholar at Shorenstein APARC, sees this phenomenon as an opportunity to better understand the dynamics of intergenerational health and how to interrupt patterns of persistent health inequalities across generations. Her research aims to identify potential interventions to improve health outcomes in developing regions.

An associate professor at Hunan University, Wang has spent the 2024 fall quarter at APARC. She recently presented her research on the intricate dynamics of intergenerational health metrics, particularly in China and Indonesia. Watch her talk, “Intergenerational Persistence of Self-Reported Health Status and Biomarkers in Indonesia,” on our YouTube channel.

Barriers to Intergenerational Health

While much has been written about the transmission of income and education across generations, “much less is known about how health is passed down between generations," Wang notes, highlighting a gap in the existing research. Emphasizing that health is a crucial factor in determining overall well-being, as it affects everything from mental health to economic productivity and social mobility, she asserts that good health is linked to better educational outcomes, higher earning potential, and improved labor market performance. Poor health, on the other hand, is associated with lower educational attainment, reduced employment prospects, and higher rates of chronic illness.

Wang’s research approach centers on recognizing the multiple challenges in implementing maternal health-oriented policies. Having identified limited access to healthcare services as a significant barrier, she considers how, in many low-income and rural areas, “access to quality healthcare is constrained by poor infrastructure, lack of transportation, and shortages of healthcare professionals, making it difficult for pregnant women to receive essential care.”

Another obstacle is the prohibitive cost of healthcare. In countries where maternal health services are not subsidized or free, the financial burden of out-of-pocket expenses for transportation, medications, and other related costs can prevent women from accessing necessary care. Furthermore, Wang shows that low levels of maternal health education can contribute to poor health-seeking behaviors. “Many women may not recognize the warning signs of complications, may not fully understand the importance of prenatal care, or may be unaware of their rights to healthcare services,” she says.

Measuring Health Outcomes Across Generations

Wang acknowledges the difficulties in studying intergenerational health mobility, as it cannot be neatly defined and measured by observable metrics such as income or education. Health is much more subjective and varies from person to person. To gauge health outcomes, researchers must therefore rely on diverse and sometimes imprecise indicators, such as the presence of chronic diseases.

Moreover, to examine intergenerational mobility, researchers need data that includes health information for both parents and children. Such datasets are not always readily available, and those that do exist often lack the necessary granularity and long-term tracking to provide meaningful insights.

To overcome these challenges, Wang draws on a variety of panel data that tracks individuals over time, as well as survey data and self-reported status. For Wang, longitudinal studies are crucial for understanding how health disparities manifest and evolve over time. 

Using data from the Indonesia Family Life Survey, she combines subjective measures like self-reported health and objective measures such as pulse, BMI, hypertension, and anemia to capture a more complete picture of health mobility. This approach expands beyond previous studies, which typically relied on fewer health indicators and focused on developed countries. Her study includes a broad range of health variables and provides a unique look at the role of gender and socioeconomic factors in shaping health outcomes across generations.

Wang uses two primary methods for measuring intergenerational health mobility: one following the Intergenerational Health Association, which regresses children's health outcomes on those of their parents, and rank-rank regressions, which examine the persistence of health outcomes by analyzing percentile ranks. These techniques, adapted from income mobility research, allow her to assess health persistence and mobility across generations.

Future Directions and Policy Impact

Wang’s time at APARC has been instrumental in shaping and refining her research. "The opportunity to engage with experts from various fields [...] opened my eyes to new ways of thinking about my research," she shared. "The collaborative environment at APARC also made me realize how much I can learn from perspectives outside my immediate area of focus.”

Wang credits Stanford’s vibrant academic environment, with its rich array of seminars and talks, to broadening her understanding of Southeast Asian health systems, a subject she was less familiar with. She expressed gratitude to APARC faculty for their “invaluable guidance for both my research and my life at Stanford.” In particular,  APARC’s Asia Health Policy Program Director Karen Eggleston “dedicated a significant amount of time to advising my work, introducing me to key researchers in my field, and sharing the valuable resources that I might benefit from on campus,” Wang said.

Looking ahead, she is excited to continue exploring the role of health in intergenerational mobility, particularly in the Southeast Asian context, and plans to expand her research into the health effects of pollution, an area she has already begun to investigate. Wang also hopes to contribute to policymaking that addresses health inequality. By providing a deeper understanding of how health disparities are perpetuated across generations, she aims to inform policies that could improve health outcomes and reduce inequality in developing countries.

Wang’s research on intergenerational health mobility offers a fresh and much-needed perspective on the crucial yet understudied role of health in social mobility. She hopes her research helps policymakers and scholars address health inequalities that perpetuate socioeconomic disadvantage across generations.

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2025 Shorenstein Journalism Award Open to Nomination Entries

Sponsored by Stanford University’s Shorenstein Asia-Pacific Research Center, the annual Shoresntein Award promotes excellence in journalism on the Asia-Pacific region and carries a cash prize of US $10,000. The 2025 award will honor an Asian news media outlet or a journalist whose work has primarily appeared in Asian news media. Nomination entries are due by February 15, 2025.
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Digital Health Innovations: A Pathway to Improving Healthcare in Underserved Communities

In a new paper, a research team including Stanford health economist Karen Eggleston discusses the challenges and opportunities digital health technologies present in South and Southeast Asia, sharing evidence-based recommendations for shaping effective digital health strategies in low- and middle-income countries.
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Driving Climate-Resilient Infrastructure and Inclusive Industrialization: Highlights from the Third Annual Trans-Pacific Sustainability Dialogue

Held at Stanford and hosted by the Shorenstein Asia-Pacific Research Center, the third annual Dialogue convened global leaders, academics, industry experts, and emerging experts to share best practices for advancing Sustainable Development Goal 9 in support of economic growth and human well-being.
cover link Driving Climate-Resilient Infrastructure and Inclusive Industrialization: Highlights from the Third Annual Trans-Pacific Sustainability Dialogue
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Economist Huixia Wang, a visiting scholar at APARC, discusses her research into healthcare economics and the reverberating effects of poor healthcare access on health outcomes across generations.

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Asia Health Policy Postdoctoral Fellow, 2024-2025
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Ph.D.

Mai Nguyen joins the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as Asia Health Policy Postdoctoral Fellow for the 2024-2025 academic year. She holds a PhD in health services and health policy from Queensland University of Technology (QUT), Australia, and a Master of Science from Heller School for Social Policy and Management, Brandeis University.

Her doctoral research focused on how the expanding private healthcare sector can be managed more effectively to better supplement public health services to achieve universal health coverage in Vietnam. The study analyzed large and complex national health datasets from two consecutive Household Living Standard Surveys, clinical hospital data at national levels and in-depth interviews with key stakeholders of Vietnam's health system to investigate consumers' choice for private and public health care services in Vietnam. Her research findings have implications for policy change in terms of harnessing and regulating private health services in Vietnam and other Asia-Pacific countries, especially low and middle-income countries.

Dr. Nguyen has worked as a senior health specialist at Vietnam Ministry of Health. Her research interest stems from her professional experience in health policy and program management, including health policy and management, health services, private healthcare and health equity. Her works have been published in many Q1-international journals such as BMC Public Health, BMC Health Services Research, Human Resources for Health and International Journal of Health Policy and Management.

At APARC, Dr. Nguyen will extend her research on the roles of private healthcare to supplement the public health sector to address the growing burden of chronic diseases and conditions in Vietnam.

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Visiting Scholar at APARC, 2024
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Ph.D.

Huixia Wang joined the Walter H. Shorenstein Asia-Pacific Research Center (APARC) as a visiting scholar for the 2024 calendar year. She is currently Associate Professor of Economics at Hunan University. While at APARC, she conducted research examining the effects of air pollution on healthcare expenditure and children's health in China.

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Front cover of the book "Who Shall Live?"

Since the first edition of Who Shall Live? (1974), over 100,000 students, teachers, physicians, and general readers from more than a dozen fields have found this book to be a reader-friendly, authoritative introduction to economic concepts applied to health and medical care.

Health care is by far the largest industry in the United States. It is three times larger than education and five times as large as national defense. In 2001, Americans spent over 12,500 per person for hospitals, physicians, drugs and other health care services and goods. Other high-income democracies spend one third less, enjoy three more years of life expectancy, and have more equal access to medical care.

In this book, each of the chapters of the original edition is followed by supplementary readings on such subjects as: "Social Determinants of Health: Caveats and Nuances", "The Structure of Medical Education — It's Time for a Change", and "How to Save 1 Trillion Out of Health Care".

The ten years following publication of the 2nd expanded edition in 2011 were arguably more turbulent for US health and health care than any other ten-year period since World War II. They span the implementation of the Affordable Care Act, the deepening opioid epidemic, and the physical, psychological, and socio-economic traumas of the COVID-19 pandemic.

An important new contribution to this book is to describe and analyze the changes in five sections: "The Affordable Care Act and the Uninsured", "Health Care Expenditures", "Health Outcomes", "The COVID-19 Pandemic", and "Health and Politics". This part includes 24 tables and figures.

This book will be welcomed by students, professionals, and life-long learners to gain increased understanding of the relation between health, economics, and social choice.

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Health, Economics and Social Choice

Authors
Victor R. Fuchs
Karen Eggleston
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World Scientific
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Noa Ronkin
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Do increases in medical spending improve health outcomes? To answer this question, analysts need to quantify the net value of medical spending and measure the productivity of medical care with the output of improvement in survival and quality of life, thereby deducing for what medical conditions the “bang for the buck” is greatest and for what conditions spending outstrips gains in health improvement.

This condition-specific, quality-adjusted net value approach to health spending is known as a “satellite account for health” because it “orbits around” the national income and product accounts that include aggregate health spending to provide a clearer picture of productivity in the health sector. Thus far, researchers have applied this account to the U.S. health sector only, but it would be highly beneficial for many economies. One notable beneficiary would be South Korea, one of the most rapidly aging societies globally. Now new research by Karen Eggleston, the director of APARC’s Asia Health Policy Program, studies the link between medical spending and health outcomes in South Korea, providing evidence on the productivity of medical spending over recent decades.

The research, published by the East-West Center, develops an estimate of the net value of Korean medical spending, which has outpaced most other countries in recent decades. To generate this estimate, Eggleston compares the gains in life expectancy at birth to the increases in medical spending for 2000–2019. Data comes from Korean lifetables and medical expenditures per capita, available from the Korean Statistical Information Services.


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Korea can develop an accurate measure of medical productivity and a more accurate measure of overall economic productivity while becoming a global pioneer of “health satellite accounts” for overall populations.
Karen Eggleston

Eggleston shows that, even with the most conservative assumptions ($50,000 per life-year and only 10 percent of health gains due to medical care), the net value of Korean medical spending is positive and substantial. Korean life expectancy at birth increased from 76 in 2000 to 83.3 in 2019, while lifetime medical spending increased by over $19,000. The value of 7.3 additional years of life far outweighs even this rapid increase in spending, implying substantial productivity growth in Korea’s health sector.

Moreover, evidence on condition-specific spending changes and health improvements suggests that Korea’s rapid spending increases yield significant net value. Eggleston’s research indicates that improvements in survival for key conditions afflicting Koreans, such as stroke and cancer, point to productivity gains. “Korea could be a pioneer in developing a national health account that accurately measures net value by medical condition,” she writes.

Condition-specific metrics of health gain per won spent on treatment can help to guide the allocation of investments to promote longer, healthier lives. In the future, analysts could also link condition-specific improvements in survival and morbidity to earnings. Such linkage would particularly benefit South Korea, where focusing on the productivity of older adult employment is crucial given its high labor force participation and relatively low income of older Koreans.

Eggleston advocates for the Korean government to develop a national satellite account for health that can provide valuable evidence for prioritizing investments to address the country’s most pressing health challenges so that productivity improvement will contribute to longer, healthier lives. “By linking National Health Insurance and health outcome data, Korea could develop an accurate measure of medical productivity and a more accurate measure of overall economic productivity, while pioneering development of ‘health satellite accounts’ for overall populations,” Eggleston argues.

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New Study Shows Health and Economic Benefits of Controlling Diabetes Risk Factors in Chinese Adults

Using recent data from the China Chronic Disease and Nutrition Surveillance survey and applying the Chinese Hong Kong Integrated Modelling and Evaluation microsimulation model, a new study co-authored by APARC's Karen Eggleston found that substantial health improvements and medical savings could be achieved in China by better control of glycemia and blood pressure, two modifiable risk factors for diabetes.
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Look South

Opportunities for Korea-India Relations
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Most Japanese Support Same-Sex Marriage, New Public Opinion Survey Finds

The initial set of results of the Stanford Japan Barometer, a new periodic public opinion survey co-developed by Stanford sociologist Kiyoteru Tsutsui and Dartmouth College political scientist Charles Crabtree, indicate that most Japanese are in favor of recognizing same-sex unions and reveal how framing can influence the public attitude toward LGBTQ communities.
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Research by Stanford health economist Karen Eggleston, the director of APARC's Asia Health Policy Program, offers evidence on the link between medical spending and health outcomes in South Korea, showing how the country can benefit from developing a “satellite account for health” to promote high-value innovations for longer, healthier lives.

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George Krompacky
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The incidence of diabetes has risen sharply in China from 1% in 1980 to 12.8% in 2017, and it is expected to continue to rise, despite the disease being one of four targeted by the Chinese government in its Healthy China Action Plan 2019-2030. Diabetes takes a high toll, both economically and in terms of healthy years of life. The disease is a major cause of strokes, heart attacks, blindness, and lower limb amputations. Although diabetes is on the rise, treatment and control remain relatively low in China, especially in rural areas.

In a new paper in The Lancet Regional Health—Western Pacific, a research team, which included APARC's Asia Health Policy Program Director Karen Eggleston, examined how improved control of glycemia and blood pressure, two modifiable risk factors for diabetes, could improve health outcomes in China. They performed a microsimulation analysis of more than 20,000 Chinese adults with diabetes, with data taken from the China Chronic Disease and Nutrition Surveillance survey (CCDNS), looking at the increased control of glycemia and blood pressure in 31 different scenarios.


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Similar studies had previously relied upon simulated risk factor levels that did not accurately reflect a representative Chinese population or used non-Asian models that have been known to over-predict medical complications in Chinese populations. The CCDNS data the authors used in their study was collected in 2018-19 from national disease surveillance points in mainland China, and their microsimulation used the CHIME (Chinese Hong Kong Integrated Modelling and Evaluation) model, which has been validated in East Asian populations.

Based on the CCDNS data, only one in five (20.1%) of people with diabetes in China had achieved optimal control of both glycemia and blood pressure in 2018-19. The study modeled control rates of 70%, 80%, and 100% to see the effects on the population’s health. The authors found that control of the two risk factors in people with type 2 diabetes was associated with considerable improvement in health, a reduced number of early deaths, and savings in medical costs. For example, if China were to achieve 70% control of these risk factors (based on current WHO/Chinese Diabetes Society targets for blood glucose and blood pressure), deaths before age 70 could be cut by 7.1% and medical costs by 14.9% over the next 10 years.

The study provides more impetus for China to reach its control targets outlined in the Healthy China plan, which aims for the nation to reach by 2030 health indicator performance comparable to high-income countries like the United States. The authors demonstrate that the health and economic burdens associated with diabetes can be substantially reduced or avoided if glycemia and blood pressure are better regulated in the Chinese population.

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Karen Eggleston

Senior Fellow at the Freeman Spogli Institute for International Studies and Director of the Asia Health Policy Program
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Using recent data from the China Chronic Disease and Nutrition Surveillance survey and applying the Chinese Hong Kong Integrated Modelling and Evaluation microsimulation model, a new study co-authored by APARC's Karen Eggleston found that substantial health improvements and medical savings could be achieved in China by better control of glycemia and blood pressure, two modifiable risk factors for diabetes.

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Background

The prevalence of diabetes has risen sharply in China. Improving modifiable risk factors such as glycaemia and blood pressure could substantially reduce disease burden and treatment costs to achieve a healthier China by 2030.

Methods

We used a nationally representative population-based survey of adults with diabetes in 31 provinces in mainland China to assess the prevalence of risk factor control. We adopted a microsimulation approach to estimate the impact of improved control of blood pressure and glycaemia on mortality, quality-adjusted life-years (QALYs), and healthcare cost. We applied the validated CHIME diabetes outcomes model over a 10-year time horizon. Baseline scenario of status quo was evaluated against alternative strategies based on World Health Organization and Chinese Diabetes Society guidelines.

Findings

Among 24,319 survey participants with diabetes (age 30–70), 69.1% (95% CI: 67.7–70.5) achieved optimal diabetes control (HbA1c <7% [53 mmol/mol]), 27.7% [26.1–29.3] achieved blood pressure control (<130/80 mmHg) and 20.1% (18.6–21.6) achieved both targets. Achieving 70% control rate for people with diabetes could reduce deaths before age 70 by 7.1% (5.7–8.7), reduce medical costs by 14.9% (12.3–18.0), and gain 50.4 QALYs (44.8–56.0) per 1000 people over 10 years compared to the baseline status quo. The largest health gains were for strategies including strict blood pressure control of 130/80 mmHg, particularly in rural areas.

Interpretation

Based on a nationally representative survey, few adults with diabetes in China achieved optimal control of glycaemia and blood pressure. Substantial health gains and economic savings are potentially achievable with better risk factor control especially in rural settings.

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A Microsimulation Modelling Study

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The Lancet Regional Health - Western Pacific
Authors
Jianchao Quan
Zhenping Zhao
Limin Wang
Carmen S. Ng
Harley H. Y. Kwok
Harley H. Y. Kwok
Mei Zhang
Sunyue Zhou
Jiaxi Ye
Xin Jiong Ong
Robyn Ma
Gabriel M. Leung
Karen Eggleston
Maigeng Zhou
Number
100690
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Shorenstein APARC's annual report for the academic year 2020-21 is now available.

Learn about the research, publications, and events produced by the Center and its programs over the last academic year. Read the feature sections, which look at APARC's research on democratic decline in South Korea, the continuing crisis in Myanmar, and U.S.-China tensions; learn about the research our postdoctoral fellows engaged in; and catch up on the Center's policy work, education initiatives, and policy outreach. Download your copy or browse below:

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Michael Breger
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As healthcare costs for patients with non-communicable diseases such as diabetes have risen, governments and healthcare providers have sought creative measures to align financial incentives with better patient outcomes. One incentive payment system known as “pay-for-performance” (P4P), in which providers are beholden to metric-driven outcomes, represents a potential path forward for healthcare providers to improve healthcare processes, resulting in higher quality and better patient health outcomes. The evidence on the effectiveness of P4P programs, however, is mixed.

To address this uncertainty, a new study, published in The European Journal of Healthcare Economics, assesses the effectiveness, in monetary terms, of a P4P program for patients with diabetes at a hospital system in Taiwan. 

The study coauthors, including APARC’s Asia Health Policy Program Director and FSI Senior Fellow Karen Eggleston, employed new patient-level data on clinical indicators, utilization, and expenditures, combined with data from the national death registry, to better understand the costs and benefits of the P4P program. Their results show that Taiwan’s implementation of the P4P program for diabetic care yielded positive results in terms of net value, defined as the value of life years gained minus the cost of care.


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Assessing Net Value of Taiwan’s P4P

Taiwan’s Bureau of National Health Insurance (now National Health Insurance Administration) introduced P4P in 2001 and enhanced the program in 2006 with an incentive for pay-for-reporting of outcomes. Financial incentives were used to encourage continuity of care with metrics such as new patient enrollment, follow-up visits, and annual reports, each tied to a specific monetary value. The program’s features are common across P4P, so the study’s findings have implications in other settings that incorporate similar designs in their P4P programs.

The study compares two different groups of patients at a large regional hospital in Taiwan, one consisting of newly enrolled P4P patients and another using P4P patients who have been enrolled since the beginning of the program. The researchers leverage detailed clinical data not used in previous assessments of the P4P program to better identify both costs and longer-term clinical outcomes based on measured biomarkers and predicted mortality.

Using an economic cost-benefit analysis conducted from a budgetary perspective, the study is the first analysis of any P4P program that estimates changes in the quality-adjusted price index relative to usual care. The authors consider health benefits in terms of survival and predicted survival and convert them into monetary terms. This net value approach is especially useful for policymakers and healthcare administrators who implement value-based purchasing and monitor outcomes for any service delivery innovation over time.

“These encouraging findings of the positive value of quality improvement net of expenditures adds evidence to the literature that has found mixed results of P4P programs.”

The study finds that Taiwan’s P4P program provided a positive net value for payers and patients, ranging from $40,084 USD to $348,717 USD. These positive net value results are primarily derived from health outcomes as measured by lower mortality rates in the P4P versus non-P4P cohorts, across both newly enrolled and continuously enrolled groups of patients. According to the authors, “these encouraging findings of the positive value of quality improvement net of expenditures adds evidence to the literature that has found mixed results of P4P programs.” 

 This study develops a new model for assessing the net value of service delivery innovations like P4P programs that can be applied in other contexts globally, providing healthcare systems researchers with new tools to better understand an emergent option for incentivized care. With a more economically-translatable understanding of P4P programs, this research helps build the bridge between the oft-disparate worlds of healthcare and policy.

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Education Level Will Widen Disparity in Health Outcomes of the Future Elderly Population, New Study Projects

In the first study to compare the progression of educational disparities in disability across two rapidly aging Asian societies, APARC coauthors Cynthia Chen and Karen Eggleston project that from 2015 to 2050, elders with high educational attainment will have a lower prevalence of functional disability and chronic conditions compared to elderly with low educational attainment.
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New Approaches to Aging: Understanding and Managing Society-Level Characteristics in Elderly Populations

Broadening the existing scholarship on aging and the needs of different societal groups, Cynthia Chen, Visiting Scholar at APARC’s Asia Health Policy Program, presents nuanced and comprehensive aging metrics that account for the critical factors that influence societal function.
cover link New Approaches to Aging: Understanding and Managing Society-Level Characteristics in Elderly Populations
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Japanese Population Projected to Live Longer Without Dementia

A new microsimulation projects that over the next 20 years, Japanese people will live longer without dementia, but older women with a less than high school education will benefit less than men.
cover link Japanese Population Projected to Live Longer Without Dementia
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In the first study to evaluate pay-for-performance implementation at a hospital system in Taiwan, APARC’s Asia Health Policy Program Director Karen Eggleston and co-authors reveal how incentive-based measures to ensure continuity and quality of care resulted in positive health outcomes.

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This press release was originally published by the University of Tokyo. It discusses a new study, published by Lancet Public Health and co-authored by researchers from the University of Tokyo along with FSI Senior Fellow Karen Eggleston, director of the Asia Health Policy Program at APARC, and Jay Bhattacharya, Professor of Health Policy and director of the Center for Demography and Economics of Health and Aging at Stanford.


A new detailed microsimulation, using a database of 40 million people, has examined the future of Japan’s aging population up to 2043. It projects that more people will live longer, and that overall years spent living with dementia will decrease. However, the model highlighted the diversity of impacts on different segments of the population, as Japanese women with a less than high school education aged 75 and over may be disproportionately affected by both dementia and frailty. Better understanding where health gaps like this exist can help inform public health planning, to minimize future economic costs and support those most in need.

Taking care of the older members of society is a common concern around the world. Japan is famous for its long-lived residents, the number of which continues to rise. In 2020, almost 30% of the Japanese population was aged 65 years or older, and this age group is not projected to peak until 2034. Caring for people with age-related ailments, such as dementia and frailty, poses a challenge both to individuals and public health care systems.

Microsimulation models, which are computer models that can provide detailed analysis on an individual basis, are currently used to project future population health in some countries, such as the U.K. and the U.S. Professor Hideki Hashimoto and researchers at the University of Tokyo, along with researchers from Stanford University in the U.S., wanted to create a new microsimulation model for Japan, which would take into account more diverse conditions than had been considered before.

“We developed a new Japanese microsimulation model that accounts for 13 chronic conditions (including heart disease, stroke, diabetes, depression and dependency), as well as frailty and dementia,” explained Hashimoto. “Using an ultralarge data system, we were able to ‘follow’ a virtual cohort of more than 40 million people aged 60 and over from 2016 to 2043.”

According to Hashimoto, projections of aging in Japan usually rely on the “average” status of older people and so don’t consider the diversity of the population. “I believe that problems of aging are a matter of health gaps over the course of people’s lives,” he said. “Our projection brings attention to a widening health gap among older people. It highlighted that women with a less than high school education aged 75 or over are more likely to be affected.”

Identifying where health gaps like this exist could be used to better inform public policy, not only about health care but other influential aspects of life. “Japan’s case may suggest that improvement in educational attainment, as well as population health, could be a key to making a healthier and more manageable aging society,” said Hashimoto.

Positively, this study shows hope for a future where many people live longer and more healthy lives. “People might believe that an increase in cases of dementia is inescapable, given population aging. However, in this study we found that in Japan, despite an aging population, the number of people with dementia is expected to decrease over the next two decades,” said Hashimoto. “Population aging does not necessarily mean an increase of social burden for care, but it does bring a diversity of problems that requires careful study and science-based policy attention, to close the health gap.”

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Karen Eggleston

Senior Fellow at FSI and Director of the Asia Health Policy Program, Shorenstein APARC
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Education Level Will Widen Disparity in Health Outcomes of the Future Elderly Population, New Study Projects

In the first study to compare the progression of educational disparities in disability across two rapidly aging Asian societies, APARC coauthors Cynthia Chen and Karen Eggleston project that from 2015 to 2050, elders with high educational attainment will have a lower prevalence of functional disability and chronic conditions compared to elderly with low educational attainment.
cover link Education Level Will Widen Disparity in Health Outcomes of the Future Elderly Population, New Study Projects
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New Cross-Country Study Underscores the Importance of Health Workforce Development and Socioeconomic Factors in Affecting Health Outcomes

Analyzing data from 191 World Health Organization member countries, a new study from APARC’s Karen Eggleston indicates that strengthening the health workforce is an urgent task in the post-COVID era critical to achieving health-related Sustainable Development Goals and long-term improvement in health outcomes, especially for low- and lower-middle-income countries.
cover link New Cross-Country Study Underscores the Importance of Health Workforce Development and Socioeconomic Factors in Affecting Health Outcomes
A makeshift barricade is seen in front of a residential area to restrict movement and control COVID-19 spread in Hanoi, Vietnam.
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COVID-19 Disproportionately Affected Marginalized and Rural Populations in Asia, New Study Shows

In the first report of its kind comparing the impacts of the pandemic on people with chronic conditions in five Asian regions, researchers including APARC’s Karen Eggleston document how the pandemic’s broad social and economic consequences negatively affected population health well beyond those directly suffering from COVID-19.
cover link COVID-19 Disproportionately Affected Marginalized and Rural Populations in Asia, New Study Shows
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A new microsimulation projects that over the next 20 years, Japanese people will live longer without dementia, but older women with a less than high school education will benefit less than men.

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