At present, the tobacco industry produces some six trillion cigarettes worldwide every year. Six trillion cigarettes per annum, each ready to release smoke filled with highly addictive nicotine and powerful carcinogens. A third of all these sticks were produced in China last year. In 2011, the world’s largest cigarette maker by volume, the China National Tobacco Corporation, contributed an all-time high of U.S. $214 billion in profits and taxes to the Chinese government, up 22 percent year-on-year. Currently the greatest cause of preventable death in the world, the cigarette is likely to kill ten times as many people in the 21st century as it did in the 20th century, epidemiologists tell us, with China bearing the largest burden. Until now, much global health research and intervention has focused with limited success on the cigarette consumer—addressing how one or another variable prompts people to take up or quit smoking, whether the cue for the consumer is biological, psychological, spatial, financial or symbolic. What though of the industrial sources of tobacco-related diseases? Where are the six trillion cigarettes that are released into circulation each year manufactured? Where are they rolled, wrapped, and boxed for shipment? This presentation will introduce the Cigarette Citadels Project, an innovative application of participatory GIS. With special attention given to China’s network of cigarette factories, Matthew Kohrman will explain how the Cigarette Citadels Project not only reveals conceptual roadblocks in public health policy but also lacuna in social theory pertaining to the state and the politics of life.

Matthew Kohrman joined Stanford’s faculty in 1999. His research and writing bring multiple methods to bear on the ways health, culture, and politics are interrelated. Focusing on the People's Republic of China, he engages various intellectual terrains such as governmentality, gender theory, political economy, critical science studies, and embodiment. His first monograph, Bodies of Difference: Experiences of Disability and Institutional Advocacy in the Making of Modern China, examines links between the emergence of a state-sponsored disability-advocacy organization and the lives of Chinese men who have trouble walking. In recent years, Kohrman has been conducting research projects aimed at analyzing and intervening in the biopolitics of cigarette smoking and production. These projects expand upon analytical themes of Kohrman’s disability research and engage in novel ways techniques of public health.

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

Venue Changed to the Philippines Conference Room

China has recently reformed its health care system with the intent of providing universal coverage for basic health care to every Chinese citizen. Three separate health insurance plans have recently been launched to achieve this objective: the rural newly cooperative medical scheme, urban resident health insurance, and urban employee-based health insurance. Each plan differs substantially in terms of insurers, insured population, premiums, and benefits packages. Using data from the 2009 China Health and Nutrition Survey, Hai Fang will discuss a study that investigates whether and to what extend different health insurance plans have created disparities in health care utilization and expenditure.

Hai Fang is an assistant professor in the Department of Health Systems, Management, and Policy at the University of Colorado Denver, and a research associate in the Kennedy School of Government at Harvard University. He earned his doctorate in economics and master of public health from the State University of New York at Stony Brook in 2006. Before joining the University of Colorado Denver, he taught at the University of California, Davis, and the University of Miami. His research interests include health economics, labor economics, and public health.

This colloquium will discuss the state of evidence, challenges, and research agenda regarding the growth of private hospitals and public-private hospital partnerships in developing Asia.

Dominic Montagu is an assistant professor of epidemiology and biostatistics and lead of the Health Systems Initiative at the Global Health Group of the University of California, San Francisco (UCSF). His work is focused on private delivery of health services in developing countries and on market function for health services and health commodities. He has active field research projects ongoing in Nigeria and Myanmar. Montagu holds masters degrees in business administration and public health, as well as a doctorate in public health, from the University of California, Berkeley (UC Berkeley). He has worked extensively in Africa and Asia, and teaches on the private sector in developing countries, and on the regulation of private hospitals and public-private-partnerships at UCSF, UC Berkeley, and on behalf of the World Bank Institute.

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.

The new health reform started in 2009 has shown the determination of the Chinese government, especially the central government, to increase its responsibility in the health sector. The most obvious manifestation of this commitment would be to increase government health expenditure (GHE). But there is still a hot debate about whether the government should allocate more public finds to health or just deepen the marketization of the health sector. Moreover, commitments at the central and local levels are not the same: local government responsibility for GHE is high, and commitments by the central government to increase GHE have not translated into increases in local government GHE as much as proposed in the national health reform.

Our research seeks to answer two questions: What was the actual pattern of GHE? And why did China’s local governments respond as they did? We first discuss the necessity of public financing for health care, and then analyze how intergovernmental economic competition affects local governments’ behavior under “Chinese-style decentralization” (known as fiscal decentralization with political centralization). Empirically, we apply a dynamic panel data model to provincial panel data from 1991 to 2007 to identify the effect of GHE on health performance in each province over time, using infant mortality and some morbidity metrics as health performance variables. We also examine differences across regions, as well as before and after the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003.

Our analysis provides evidence that Chinese-style decentralization negatively impacted GHE. The main findings are as follows:

1. Increasing GHE did improve health performance, and this improvement was mainly driven by the GHE through the health department directly, not through spending by other governmental departments that also impact health. However, pursuit of economic performance lowered local governments’ GHE, mainly by decreasing GHE through local health departments.
   
2. Compared with in the eastern and western regions, this health improvement was not significant in China’s middle regions, where the intergovernmental economic competition leads to much less GHE through health departments.
   
3. The outburst of SARS in 2003 further increased the positive effect from GHE through local health departments, while the effect from GHE through other departments was not equally significant.
   

All these results suggest that adjusting the structure of public health financing, reforming the fiscal system, and improving the performance evaluation system for local governments are critical for the success of China’s on-going health reform.