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In Beijing’s bustling Chaoyang District stands a multi-story building known as the Gonghe Senior Apartments: a 400-bed nursing home for middle-income seniors who are disabled or suffer from dementia. Why is Gonghe unique and why is it worth considering? Because Gonghe is a public-private partnership (PPP), a collaborative organizational structure supported by the District Civil Affairs Bureau Welfare Division that donated the land and building and the nonprofit Yuecheng Senior Living that operates the facility. And because PPPs like Gonghe might just be the right model to address the challenges surrounding elderly care in China as well as in other nations that face a looming burden of population aging.

This was a core message shared by Alan Trager, founder and president of the PPP Initiative Ltd., who spoke at a special workshop organized by Shorenstein APARC’s Asia Health Policy Program (AHPP). Focused on PPPs in health and long-term care in China, the workshop was part of a two-day convening related to the Innovation for Healthy Aging project, a collaborative research project led by APARC Deputy Director and AHPP Director Karen Eggleston that identifies and analyzes productive public-private partnerships advancing healthy aging solutions in East Asia and other regions.

The Innovation for Healthy Aging project is driven by the imperative to respond to a world that is aging rapidly. This demographic transition, reminded Trager at the opening of his talk, is a defining issue of our time, as aging is a multisectoral issue that increases the demand for health care, long-term care, and a large number of other social services. The aging challenge is exacerbated by its convergence with the rising prevalence of non-communicable diseases (NCDs), also known as chronic diseases. For while NCDs affect all age groups, they account for the highest burden among the elderly.

China: Ground Zero for Global Aging

Alan Trager in Highly Immersive Classroom Alan Trager discusses health and long-term care in China in the GSB's Highly Immersive Classroom
Alan Trager discusses health and long-term care in China in the GSB's Highly Immersive Classroom (Photo: Noa Ronkin)


The need to advance healthy aging and NCD prevention is a matter of grave concern in China, whose older population is larger than in any other country. Moreover, the aging challenge in China is interwoven with unique social trends. In particular, filial piety—which, for thousands of years, has been a fundamental family value and a mainstay of health and elder care—is under pressure, as young people strive to balance the demands of careers, fewer children per family, and migrating to cities for school and work, without affordable housing or long-term care financing support for their parents and other elderly relatives, who often stay in rural areas.

China’s health system is yet to adapt to the shift in the disease burden and health care needs driven by the aging population. Its existing health insurance programs are insufficient for outpatient management and care of chronic conditions, and as Trager emphasized, there is a lack of investment in training geriatric medicine professionals and incorporating geriatric principles into clinical practice.

How can China meet the high demand for elder care, increase workforce capacity, and promote healthy aging?

The answer, claims Trager, lies in developing multisector, integrated solutions to the challenges posed by population aging. While system-level efforts, such as building the social protection system and sustaining universal health coverage, continue to be led by the government, PPPs can play a major role in capacity building to ensure the sustainability of such systems through the advancement of technology, human resources, and innovation. Trager shared PPP Initiative Ltd.’s recent efforts to develop PPP solutions for aging populations in China and elsewhere. The workshop was held on October 10 at the Stanford GSB’s Highly Immersive Classroom, which is equipped with advanced video conferencing technology that allows participants in Palo Alto and at the Stanford Center at Peking University to collaborate in real-time. Experts from Beijing joined the discussion and followed Trager’s presentation with comments on how to move from awareness to action.

Private Efforts, Public Value

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John Donahue, Karen Eggleston, and Richard Zeckhauser in conversation at the entrance to Encina Hall, Stanford.

From left to right: John Donahue, Karen Eggleston, Richard Zeckhauser. (Photo: Thom Holme)

Public-private collaborations—or rather collaborative governance–in China as well as in the United States is the subject of an upcoming volume co-authored by Eggleston with Harvard scholars Richard Zeckhauser and John Donahue. Both Zeckhauser and Donahue joined Eggleston the following day, October 11, at an AHPP-hosted seminar to discuss this upcoming publication, titled Private Roles for Public Goals in China and the United States: Contracting, Collaboration, and Delegation.

Eggleston, Donahue, and Zeckhauser define collaborative governance as private engagement in public tasks on terms of shared discretion, where each partner bears responsibilities for certain areas. Their upcoming book explores public-private collaborations in China and the United States, two countries where public needs require solutions that far outstrip the capacities of their governments alone. Beyond considering merely health and elderly care, the book features research into public and private roles in the governance of multiple other sectors, including education, transport infrastructure, affordable housing, social services, and civil society.

At the seminar, the three scholars reviewed different models of private efforts providing public value, outlined the justifications for collaborative governance, and explained some of the conditions that make such collaborative partnerships productive and valuable. They emphasized the need to account for the unique contexts in China and the United States and to steer clear of one-size-fits-all solutions.

Imperative for the Young Generation

One thing, they all agree, applies to both countries: government collaboration with private entities is inevitable if China and the United States are to achieve their articulated goals and meet rapidly increasing demand for high-end public services.

This sentiment echoed a claim Trager made the preceding day: a tidal wave of noncommunicable diseases in an aging world is approaching us quickly and governments cannot handle it alone. Young people must care about advancing creative solutions to this pressing problem because they will be the ones who will pay for the consequences if we get it wrong.

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The Korea Program invites junior faculty, post-doctoral fellows, and graduate students to apply for travel awards to attend an upcoming two-day conference organized by the Korea Program at Stanford' Asia-Pacific Research Center. The workshop titled "Future Visions: Challanges and Possibilities of Korean Studies in North America" will be held on November 1st and 2nd, 2018 at Stanford University.

The awards will cover accepted applicants' lodging, domestic airfares, and/or ground transportation. To apply for the travel awards, please submit your CV and 2-page statement as a single file by July 15 here.

About the conference:

“Future Visions: Challenges and Possibilities of Korean Studies in North America,” is designed to bring together leading scholars in the fields of language education, literature, history, social sciences, and library studies. Each panel will consist of three-four scholars who will be tasked with presenting a report on the state of the field. The purpose of the panels is to generate discussion around some of the following questions: 

  • What are the research trends in each field?
  • What kinds of directions can we expect in the near future?
  • What are some of the disciplinary or other challenges in each field?
  • How does each field interact with related fields?
  • What are some of the limitations and possibilities around graduate student training?
  • How can faculty with graduate students cultivate supportive and critical scholarly communities?
  • ​How are junior faculty encouraged, and what institutional structures may offer better support?

Accepted applicants are expected to actively participate in discussion sessions and to engage in networking with other scholars during the 2-day conference.

Please direct questions on the conference to hjahn@stanford.edu.

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The development community has increased its focus on higher education over the past two decades, recognizing that education can contribute to building up a country’s capacity for participation in an increasingly knowledge-based world economy and accelerate economic growth. The value added by higher education to economies—job creation, innovation, enhanced entrepreneurship, and research, a core higher education activity—has been highlighted by an important body of literature. 

Yet experts remain concerned that investing in higher education in less-developed countries may lead to a “brain drain”--highly educated students and professionals permanently leaving their home countries. In the 2016 Kauffman report on international science, technology, engineering, and math (STEM) students in the United States, for instance, 48 percent among a randomly sampled survey of 2,322 foreign doctoral students in the United States wished to stay there after graduation, with only 12 percent wanting to leave and 40.5 percent being undecided. In fact, high percentages of foreign students in the United States with doctorates in science and engineering continue to stay in the United States, creating a brain drain problem for the sending countries. 

Because students tend to move from developing to developed countries to study, brain drain is more problematic for developing countries. In addition, given accelerated talent flows around the world and the increasing integration of less-developed countries into global value chains, the negative impact of brain drain could be further amplified. As demonstrated by the studies reviewed in this paper, the migration of high-skilled professionals from developing countries may indeed create brain drain for them, but at the same time can significantly enhance the social and economic development of their home countries, regardless of whether or not they decide to return home, thus complicating what used to be seen as a straightforward case of brain drain. 

From Brain Drain to Brain Circulation and Linkage examines how brain drain can contribute to development for the sending countries through brain circulation and linkage. It provides an overview of the conceptual framework to map out high-skilled labor flows, identifies empirical cases and policies in Asia that demonstrate high-skilled migrant professionals actually make significant contributions to their home countries (beyond monetary remittances), summarizes key social and economic enabling factors that are important in attracting and motivating migrant high-skilled professionals to return or engage with their home countries, and concludes with policy implications and suggestions for further research based on these findings.

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Huashan Chen joins the Walter H. Shorenstein Asia-Pacific Research Center as visiting scholar.  He currently serves as Associate Professor at the National Institute of Social Development, Chinese Academy of Social Sciences.  He is also the Director of Social Development and Evaluation Lab and Vice Director of the Research Center for Social Climate.  He will be conducting research on Chinese state bureaucracy and personnel flows.

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The same institutions that enabled China’s massive urbanization and spurred its economic growth now require further reform and innovation.

To address the issues facing the next phase of the nation’s transformation, the National New Urbanization Plan (2014–20) set ambitious targets for sustainable, human-centered, and environmentally friendly urbanization. This volume explores the key institutional and governance challenges China will face in reaching those goals. Its policy-focused contributions from leading social scientists in the United States and China explore aspects of urbanization ranging from migration and labor markets to agglomeration economies, land finance, affordable housing, and education policy. Subjects covered in the eleven chapters include:

  • Institutional problems leading to fiscal pressures on local governments and unequal provision of social services to migrant families
  • The history of land financing and threats to its sustainability
  • The difficulty of sorting out property rights in rural China
  • How administrative redistricting has allowed the urbanization of geographical administrative places to outpace the urbanization of populations within those areas
  • How the hukou system may not be the sole, or even primary, mechanism restricting migrants from public goods, such as their childrens’ education
  • Whether the nation’s food security is threatened by its ongoing urbanization
  • The current state of the provision of low-income housing, and future challenges
 
Karen Eggleston is the director of the Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center (Shorenstein APARC). She is a fellow at Stanford's Center for Health Policy/Primary Care and Outcomes Research and a faculty research fellow of the National Bureau of Economic Research.
Jean C. Oi is the William Haas Professor in Chinese Politics in the department of political science and a senior fellow of the Freeman Spogli Institute for International Studies at Stanford University. Oi is the founding director of the China Program at Shorenstein APARC and the Lee Shau Kee Director of the Stanford Center at Peking University.
Wang Yiming is vice president and senior research fellow at the Development Research Center of the State Council, People’s Republic of China. Previously he was with the National Development and Reform Commission (NDRC), where he served for many years as executive vice president of the Academy of Macroeconomics Research and deputy secretary general of the NDRC.
 

Examination copies: Shorenstein APARC books are distributed by Stanford University Press. You can obtain information on obtaining an examination copy at their website.

 

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A new book published by the Shorenstein Asia-Pacific Research Center (APARC) explores the future of China’s urbanization. Addressing the complex challenges facing Chinese cities will require updated institutions and unparalleled innovation, researchers say.

China’s growth in cities has been unprecedented over the past decade, and the urbanization policies the government put in place, while achieving notable successes, continue to face systemic obstacles that challenge the effectiveness of central and local governments. How the government will resolve the complex sets of conflicting interests will considerably shape Chinese society and politics for decades.
 
That is the premise of a new book co-edited by Karen Eggleston, senior fellow in Stanford’s Freeman Spogli Institute for International Studies; Jean C. Oi, the William Haas Professor in Chinese Politics; and Yiming Wang, deputy director general and senior research fellow at the State Council Development and Research Center.
 
In the book Challenges in the Process of China’s Urbanization, eleven chapters authored by 21 authors feature urbanization challenges ranging from property rights and affordable housing to food security and the environment.

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“Urbanization is not merely a process of financial engineering or rational decision-making, but a complicated ‘dance’ of power and politics,” the editors write in the introductory chapter.
 
The book is one of two publications that emerged from a conference in May 2014 at the Stanford Center at Peking University, that was part of a joint five-year research initiative between the Shorenstein Asia-Pacific Research Center and the National Development and Reform Commission (NDRC) – a government agency in China that formulates and implements strategies of national economic and social development.  
 
Wang, who was the deputy chief of staff at the NDRC and executive director of its Institute of Macroeconomic Research, facilitated ongoing scholarly exchanges, including workshops and conferences as well as joint fieldwork in China. At one point, the NDRC came to the Bay Area to interview local government officials about urbanization and affordable housing policies.  
 
Eggleston and Oi responded to a few questions about the book.
 
What patterns are shaping urbanization in China?
Oi: A primary pattern shaping China’s urbanization is the movement of people from rural areas to megacities – Beijing, Shanghai and elsewhere.  There also is movement from poorer to richer areas within the countryside. Rural to urban migration has been taking place in China since the 1970s, but the difference now is that the government is encouraging it. The Chinese government has an officially sanctioned program that is advocating migration. A second pattern shaping China’s urbanization is administrative redistricting. Redistricting is a government-led process that changes the administrative makeup of a municipality. For example, areas originally designated as ‘rural’ can be redistricted to qualify as ‘urban.’ Additionally, smaller cities can become larger by absorbing surrounding areas. Counties can also be combined into districts.
 
Why are cities and counties pursuing redistricting?
Oi: One of the main factors driving redistricting in China is the perks and power that are linked to the size of an administrative unit. Government officials in charge of smaller cities or counties have incentives to become larger. The larger the municipality, the more power and resources the municipality has. Smaller cities that become larger cities gain resources; yet on the other hand, counties that become part of a district lose certain local-level rights. Municipalities are essentially competing with each other. The book dives into the incentive structures at play and other political economy issues embedded in the urbanization process.
 
What kind of disciplinary approaches are undertaken in the book?
Eggleston: One of the book’s strengths is its array of disciplinary approaches. Drawn primarily from the social sciences, the book includes theoretical and empirical analyses of evidence gathered from case studies and fieldwork. 
 
Oi: The book is a true collaboration of scholars from the United States and China. About half of the chapter authors are officials from the National Development and Reform Commission (NDRC), including our co-editor, Yiming Wang, who was NDRC deputy-secretary when we did the work for the volume. Each chapter attempts to offer a balanced perspective of the policy implications of China’s urbanization experience at both national and local levels.

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Karen Eggleston, FSI senior fellow and director of the Asia Health Policy Program, speaks on a panel about demographic change and health at the conference, "Challenges in Process of Urbanization: China in Comparative Perspective," Stanford Center at Peking University, May 2014.


What do you hope the book will achieve?

Oi: The book offers an analysis of the intricacies of and potential solutions to problems related to the process of China’s urbanization. We hope the book taken as a whole gives a sense of the magnitude of these problems, why there are no easy solutions, as well as what will be needed to address them going forward.  Some of the solutions are not just about money. 
 
Eggleston: The book aims to sketch an interesting picture of the varied aspects of China’s urbanization. Each chapter looks at a select issue, for example, land financing, spatial growth and housing security, and sets it in the broader context of urbanization. We purposely decided not to cover everything that falls under the banner of urbanization. Most of the topics could very well be made into a whole book alone. We hope the book will enliven conversation amongst scholars, policy influencers and China and urbanization enthusiasts.
 

What do “people-centered” solutions to urbanization challenges in China include?

Eggleston: “People-centered” is the term used in China’s official urbanization plan, the New National Urbanization Plan, published in 2014. We defined the term “people-centered” to include what makes life in urban areas attractive. “People-centered” urbanization emphasizes well-being and the factors that lead to a good livelihood, including access to public goods. For example, from a health perspective, cities around the world were historically less healthy locations to live in during the industrial revolution, before basic knowledge of how to control infectious disease with clean water and other population health measures. Now, cities can be healthier places to live in compared to rural areas. The Chinese government has a successful record of building basic infrastructure, but faces many challenges in harnessing the requisite resources to innovate and truly achieve people-centered development.

 

"In trying to reach a public goal like low-income housing, the Chinese government is trying to set up an incentive system so that the goal can be reached not just with taxpayer money but also by bringing in the private sector to build housing in a way that includes affordable units and doesn’t lead to segregation."  

     — Karen Eggleston; FSI senior fellow, Asia Health Policy Program director

 
An issue highlighted in the book is China’s household registration system. Why is it an issue and what is being done to address it?
Oi: Because China’s urbanization has been so rapid, institutions have not yet fully caught-up. There is a disjuncture between the institutions that exist and those that are actually necessary. One pressing example is the household registration system. Citizens who live in rural areas have a different kind of residency status than citizens in urban areas. Everyone has rights, but rights differ depending on where primary residence was originally listed. A Chinese citizen is only able to enjoy all of his or her rights where he or she is registered. So migrants tend to lose out as soon as they move away from their home locality. However, the central government has started to make changes to this system. For example, children of migrants now have access to public services such as primary education. Some localities have begun to implement a points-based system wherein families accumulate points over time and, after reaching a certain level, become eligible for citizenship in that place of residence.
 
Can you describe the state of housing in Chinese cities?
Eggleston: Affordable housing is a key issue of urbanization across the world, not just in China. So, the glass is half-full or half-empty depending on how you look at it. China has been remarkably successful in avoiding the development of large urban slums common in lower income countries with rapid urbanization. That said, problems associated with housing are not going to go away quickly. The macro nature of China’s population amplifies the problem, and coincides with a dramatic increase in housing prices. Continued government investment in affordable housing will help address scarcity, and could help tackle interrelated problems such as assisted living for the elderly population in China.
 
Oi: The central government began to offer affordable housing in 2007 with the intention of providing housing for the neediest portion of the population. In theory, it works, but in reality, it has faults. Supply and demand sometimes isn’t in sync. For example, quotas were used as a way to decide the location of its affordable housing, but some cities found that housing units remain unused. The local government builds a number of affordable housing units but then discovers no one wants them because commercial housing is less expensive or factories provide dormitory space. Part of this mismatch in supply and demand is rooted in the issue of resident permits. In most cases, the neediest portion of the population is typically migrants but they are not eligible for affordable housing in the cities where there is most need for low cost housing such as Beijing or Shanghai. As a result, migrants often live in inadequate housing in city centers – small, windowless spaces with many people living together in one room. 
 
One of the chapters in the book focuses on food security. As Chinese migrants continue to move from rural to urban areas, are fears of declining food security founded?
Eggleston: Food security is an important issue. In the book, one chapter written by 9 co-authors applies rigorous methods to understand whether urbanization threatens food security in China. They found that fear of declining food security is mostly overblown. Continued government investment in agricultural production such as irrigation systems can help address those fears, and help enable sustainable food production.

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Jean Oi, FSI senior fellow and director of the China Program, (Center), and Xueguang Zhou, FSI senior fellow and professor of sociology, (Left of Center), take a tour of housing developments during fieldwork with the National Development and Reform Commission in August 2012. Oi is speaking with one of the village leaders about a "new rural community" concept developed in a housing development in Chengdu, where this photo was taken.


Another chapter in the book references pollution. Beijing has faced unprecedented levels of air pollution lately. Does it coincide with urbanization?

Eggleston: Although issues of pollution and “green growth” merit separate book-length treatment and are not central to this book, pollution illustrates the broader issue of concentrations of industry and people living in one area. Everyone has to share public space. Both a migrant and someone working at the top levels of government in Beijing breathe the same air. Things that are less visible like water quality are avoidable by some of the population, but air pollution is not, and therefore, quickly reveals how hard it is for the government to efficiently fix a problem. Policies to mitigate pollution often take awhile to have an effect, and in the mean time, people begin to doubt government accountability. Local governments have made strides within the past few years in revising evaluation structures so that officials are incentivized to react to public problems like air pollution. Historically, an official’s performance was based largely if not solely on GDP growth of his or her municipality, but it has since expanded to include other factors such as health insurance enrollment.
 
Infrastructure spending has been a driver of China’s economic growth. Has China’s rush to build quickly come at the expense of safety?
Oi: Economic growth is intimately tied to the process of China’s urbanization. Growth of cities has been driven by the ambitions of local officials who want to see their municipalities expand. But the question remains over how they’re going to finance rising needs for and costs of public goods. Each municipality receives funding from the central government and it’s based on the quantity of citizens – a number that excludes migrants. Any migrant is then – administratively speaking – a burden on the system. Municipalities have to determine how they’re going to fund public goods. This is where fiscal politics comes in. China’s fiscal system is really the most important institution in need of reform. Each chapter of the book touches upon the issue of public funding in some way.
 
Eggleston: China is generally known for its investment in infrastructure projects, but the goal of rapid growth can seemingly clash with a concern for safety. One of the main themes of the book is to think carefully about the incentives that govern the process. I think that theme certainly rings true with regard to infrastructure and safety. Put simply: if officials and contractors do not have incentive to prioritize safety, then safety problems are going to arise. The Chinese government efforts to develop and improve specific regulatory structures should continue, as several authors point out in different chapters of the book.

 

"Economic growth is intimately tied to the process of China’s urbanization. Growth of cities has been driven by the ambitions of local officials who want to see their municipalities expand. But the question remains over how they’re going to finance rising needs for and costs of public goods."  

     — Jean C. Oi; Stanford professor of political science, China Program director

 
How can a balance be struck between public and private sector led projects that address urbanization challenges?
Oi: The Chinese government is increasingly looking to establish public-private partnerships as a way to deal with urbanization challenges. Affordable housing is one area that could experiment further with the public-private model. Instead of going to local governments, the central government is now talking directly with housing developers. They say to the developers “we’ll give you permission to develop a housing estate, but within that housing estate, you’re going to have to set aside ‘X’ number of units for affordable housing.” Depending on the city, this approach has had mixed effects. Some high-end housing developers don’t want to include affordable housing because the price per unit could drop as a result.
 
Eggleston: It’s critical to think about public-private partnerships in the context of urbanization-related policy goals. I think we’re bound to see them grow. The government has an opportunity to harness the innovation of the private sector through such partnerships.
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A man pushes his bicycle past a construction site in the Central Business District in Beijing, China.
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Japanese and American scholars and practitioners gathered at Stanford recently for “Womenomics, the Workplace, and Women,” a full-day conference seeking to find pathways to advance opportunity for women in society and the workplace.

Nearly 75 people attended the public conference, which included 20 speakers and was co-sponsored by Stanford’s Shorenstein Asia-Pacific Research Center and the Clayman Institute for Gender Research, as well as the United States-Japan Foundation and the Japan Society for the Promotion of Science.

Takeo Hoshi, director of the Japan Program at Shorenstein APARC, noted that women in Japan and the United States have long encountered obstacles related to gender. Currently, the United States and Japan rank 45th and 111th, respectively, on the Global Gender Gap Index.

“The conference is a unique opportunity for experts from Japan and Silicon Valley to learn from each other and their countries’ recent attempts to tackle gender diversity, particularly in the areas of business and technology,” Hoshi said.

The Japanese government’s inclusion of women’s advancement in its economic growth strategy 'Abenomics,' named after Prime Minister Shinzo Abe, is “one of the few good policies,” Hoshi said, yet complex cultural constraints and workplace policies need to change in order for it to work. Similarly, in Silicon Valley, while strides have been made, gender diversity still lags in corporate leadership and boards of directors especially in the areas of STEM (science, technology, engineering and mathematics).

Panelists shared perspectives on women’s status, leadership and work-life balance in both countries throughout four panel discussions led by Hoshi, and Shelley Correll, director of the Clayman Institute and professor of sociology; Kenji Kushida, Japan Program research scholar; and Mariko Yoshihara Yang, a visiting scholar at Shorenstein APARC.

One broad theme that emerged in the discussions: gender equity progress takes time. Closing the gender gap will come incrementally and a multidisciplinary approach could help the process. 

Areas highlighted by the panelists included a need to address unconscious bias and to improve programs that support women in the workplace as well as those seeking to re-enter the labor force after taking time off, such as increased access to childcare and elimination of “evening work” for those who hold full-time jobs.

Panelists suggested expanding educational opportunities, mentorship and peer-to-peer networks among women, as well as training centered on gender equity for all employees. Quotas and government incentives for organizations that adopt equity practices were also proposed to achieve greater female representation.

Additional discussions took place between the panelists in a closed-door workshop the following day. A report that details outcomes and a set of policy recommendations is expected in 2017; the full list of panelists, topics addressed and conference agenda can be viewed here.

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Japan Program visiting scholar Mariko Yoshihara Yang chairs a panel discussion at the conference "Womenomics, the Workplace, and Women" on Nov. 4, 2016, at the Bechtel Conference Center.
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