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This is a chapter in the second edition of The National Security Enterprise, a book edited by Roger Z. George and Harvey Rishikof that provides practitioners' insights into the operation, missions, and organizational cultures of the principal national security agencies and other institutions that shape the U.S. national security decision-making process. Unlike some textbooks on American foreign policy, it offers analysis from insiders who have worked at the National Security Council, the State and Defense Departments, the intelligence community, and the other critical government entities. The book explains how organizational missions and cultures create the labyrinth in which a coherent national security policy must be fashioned. Understanding and appreciating these organizations and their cultures is essential for formulating and implementing it. Taking into account the changes introduced by the Obama administration, the second edition includes four new or entirely revised chapters (Congress, Department of Homeland Security, Treasury, and USAID) and updates to the text throughout. It covers changes instituted since the first edition was published in 2011, implications of the government campaign to prosecute leaks, and lessons learned from more than a decade of war in Afghanistan and Iraq. This up-to-date book will appeal to students of U.S. national security and foreign policy as well as career policymakers.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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A group of participants from the workshop, “Net Value in Diabetes Management,” at Stanford Center at Peking University, March 24, 2017, from left to right: Zheng Yi Lau from the Ministry of Health of Singapore; Chao Quan (University of Hong Kong); Jui-fen Rachel Lu (Chang Gung University); Emily Nguyen, Karen Eggleston, and Katie Hastings (Stanford); and Stefan Ma (Ministry of Health of Singapore).
Courtesy of Emily Tuong-Vi Nyugen
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Dr. Sayuri SHIRAI is currently a professor of Keio University and is also a visiting scholar at the Asian Development Bank Institute. She was a Member of the Policy Board of the Bank of Japan (BOJ) from April 2011 to March 2016, who is responsible for making policy decisions. She also taught at Sciences Po in Paris in 2007–2008 and was an economist at the International Monetary Fund (IMF) from 1993 to 1998.

She is the author of numerous books on a variety of subjects including the People’s Republic of China’s exchange rate system, Japan’s macroeconomic policy, IMF policy, and the European debt crisis. Her most recent book (translated title: Unwinding Super-Easy Monetary Policy), published in August 2016, is about the monetary policies of the BOJ, the European Central Bank, and the Federal Reserve System. She regularly appears on CNBC, Bloomberg, Reuters, BBC, and features in many Japanese TV programs and newspapers, commenting on the Japanese economy and monetary policy. URL: http://www.sayurishirai.jp

Her most recent book in English is Mission Incomplete: Reflating Japan’s Economy published by the Asian Development Bank Institute in February 2017. It is a complete analysis of BOJ’s unconventional monetary easing from the late 1990s to the present. Free Download is available at https://www.adb.org/publications/mission-incomplete-reflating-japan-economy.

Sayuri Shirai Professor at Keio University and Visiting Scholar at Asian Development Bank Institute
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Sex differences in mortality vary over time and place as a function of social, health, and medical circumstances. The magnitude of these variations, and their response to large socioeconomic changes, suggest that biological differences cannot fully account for sex differences in survival. Drawing on a wide swath of mortality data across countries and over time, we develop a set of empiric observations with which any theory about excess male mortality and its correlates will have to contend. We show that as societies develop, M/F survival first declines and then increases, a “sex difference in mortality transition” embedded within the demographic and epidemiologic transitions. After the onset of this transition, cross-sectional variation in excess male mortality exhibits a consistent pattern of greater female resilience to mortality under socio-economic adversity. The causal mechanisms underlying these associations merit further research.

 

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The Asia Health Policy Program at Stanford’s Shorenstein Asia-Pacific Research Center, in collaboration with scholars from Stanford Health Policy's Center on Demography and Economics of Health and Aging, the Stanford Institute for Economic Policy Research, and the Next World Program, is soliciting papers for the third annual workshop on the economics of ageing titled Financing Longevity: The Economics of Pensions, Health Insurance, Long-term Care and Disability Insurance held at Stanford from April 24-25, 2017, and for a related special issue of the Journal of the Economics of Ageing.

The triumph of longevity can pose a challenge to the fiscal integrity of public and private pension systems and other social support programs disproportionately used by older adults. High-income countries offer lessons – frequently cautionary tales – for low- and middle-income countries about how to design social protection programs to be sustainable in the face of population ageing. Technological change and income inequality interact with population ageing to threaten the sustainability and perceived fairness of conventional financing for many social programs. Promoting longer working lives and savings for retirement are obvious policy priorities; but in many cases the fiscal challenges are even more acute for other social programs, such as insurance systems for medical care, long-term care, and disability. Reform of entitlement programs is also often politically difficult, further highlighting how important it is for developing countries putting in place comprehensive social security systems to take account of the macroeconomic implications of population ageing.

The objective of the workshop is to explore the economics of ageing from the perspective of sustainable financing for longer lives. The workshop will bring together researchers to present recent empirical and theoretical research on the economics of ageing with special (yet not exclusive) foci on the following topics:

  • Public and private roles in savings and retirement security
  • Living and working in an Age of Longevity: Lessons for Finance
  • Defined benefit, defined contribution, and innovations in design of pension programs
  • Intergenerational and equity implications of different financing mechanisms for pensions and social insurance
  • The impact of population aging on health insurance financing
  • Economic incentives of long-term care insurance and disability insurance systems
  • Precautionary savings and social protection system generosity
  • Elderly cognitive function and financial planning
  • Evaluation of policies aimed at increasing health and productivity of older adults
  • Population ageing and financing economic growth
  • Tax policies’ implications for capital deepening and investment in human capital
  • The relationship between population age structure and capital market returns
  • Evidence on policies designed to address disparities – gender, ethnic/racial, inter-regional, urban/rural – in old-age support
  • The political economy of reforming pension systems as well as health, long-term care and disability insurance programs

 

Submission for the workshop

Interested authors are invited to submit a 1-page abstract by Sept. 30, 2016, to Karen Eggleston at karene@stanford.edu. The authors of accepted abstracts will be notified by Oct. 15, 2016, and completed draft papers will be expected by April 1, 2017.

Economy-class travel and accommodation costs for one author of each accepted paper will be covered by the organizers.

Invited authors are expected to submit their paper to the Journal of the Economics of Ageing. A selection of these papers will (assuming successful completion of the review process) be published in a special issue.

 

Submission to the special issue

Authors (also those interested who are not attending the workshop) are invited to submit papers for the special issue in the Journal of the Economics of Ageing by Aug. 1, 2017. Submissions should be made online. Please select article type “SI Financing Longevity.”

 

About the Next World Program

The Next World Program is a joint initiative of Harvard University’s Program on the Global Demography of Aging, the WDA Forum, Stanford’s Asia Health Policy Program, and Fudan University’s Working Group on Comparative Ageing Societies. These institutions organize an annual workshop and a special issue in the Journal of the Economics of Ageing on an important economic theme related to ageing societies.

 

More information can be found in the PDF below.


 

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Drawing on twenty-four years of experience in government, Michael H. Armacost explores how the contours of the U.S. presidential election system influence the content and conduct of American foreign policy. He examines how the nomination battle impels candidates to express deference to the foreign policy DNA of their party and may force an incumbent to make wholesale policy adjustments to fend off an intra-party challenge for the nomination. He describes the way reelection campaigns can prod a chief executive to fix long-neglected problems, kick intractable policy dilemmas down the road, settle for modest course corrections, or scapegoat others for policies gone awry.

Armacost begins his book with the quest for the presidential nomination and then moves through the general election campaign, the ten-week transition period between Election Day and Inauguration Day, and the early months of a new administration. He notes that campaigns rarely illuminate the tough foreign policy choices that the leader of the nation must make, and he offers rare insight into the challenge of aligning the roles of an outgoing incumbent (who performs official duties despite ebbing power) and the incoming successor (who has no official role but possesses a fresh political mandate). He pays particular attention to the pressure for new presidents to act boldly abroad in the early months of his tenure, even before a national security team is in place, decision-making procedures are set, or policy priorities are firmly established. He concludes with an appraisal of the virtues and liabilities of the system, including suggestions for modestly adjusting some of its features while preserving its distinct character.

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Karl Eikenberry, a distinguished fellow at Stanford’s Freeman Spogli Institute for International Studies, will serve on the Commission on Language Learning at the American Academy of Arts and Sciences (AAAS). The new commission is part of a national effort to examine the state of American language education.

The commission will work with scholarly and professional organizations to gather research about the benefits of language instruction and to initiate a national conversation about language training and international education.

Eikenberry joins eight other commissioners, including: Martha Abbott, executive director of the American Council on the Teaching of Foreign Languages; Nicholas Dirks, chancellor of the University of California at Berkeley; and Diane Wood, chief judge, of the 7th U.S. Circuit Court of Appeals. The group is led by Paul LeClerc, director of Columbia University’s Global Center in Paris.

Eikenberry, who is also a member of the AAAS Commission on Humanities and Social Sciences, contributed to “The Heart of the Matter,” a 2013 report that aims to advance dialogue on the importance of humanities and social sciences for the future of the United States.

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The United States and European countries can take steps to avoid making the same economic mistakes that Japan committed during the latter's "lost decade," a Stanford economist wrote in a new paper.

The study, published in the IMF Economic Review, describes the reasons Japan was not able to pull out of its long recession in the 1990s, offering some lessons for U.S. and European leaders in the wake of the 2007-09 meltdown.

In particular, the delay in bank recapitalization and the lack of structural reforms in the economic sphere kept Japan from realizing a full recovery, wrote Takeo Hoshi, the Henri and Tomoye Takahashi senior fellow at Stanford's Freeman Spogli Institute for International Studies.

"Bank recapitalization" refers to a governmental reorganization of failing banks, often involving the use of public money to keep them solvent. "Structural reforms" describes how a government might overhaul its economic structures to increase business competition – such as deregulation to cut costs for firms.

The shortcomings in these two policy areas "retarded Japan's recovery from the crisis and were responsible for its stagnant post-crisis growth," said Hoshi, whose co-author was Anil K. Kashyap, an economics professor at the University of Chicago Booth School of Business.

Risky bank lending

Japan's "lost decade" originally referred to the 1990s, though the country has still not regained the economic power it enjoyed in the 1970s and 1980s. Some say Japan has actually experienced two lost decades if the 2000s are counted as well.

Faced with a huge financial crisis at the dawn of its lost decade, Japan had to navigate challenges that other advanced economies had not confronted since the Great Depression, Hoshi and Kashyap wrote.

However, government leaders made mistakes, Hoshi said. One was failure to rehabilitate the banks and another was to misunderstand the nature of the problems afflicting the Japanese economy. For example, much like the United States in 2007-09, the Japanese banks had made many dubious loans to risky customers.

"Instead of recognizing that major structural adjustments were needed, much of the policy response was calibrated under the assumption that Japan faced a simple cyclical problem that could be addressed with indiscriminate fiscal stimulus," wrote Hoshi, the director of the Japan Program at the Walter H. Shorenstein Asia-Pacific Research Center.

For example, on the demand side, monetary policy was not as expansionary as it could have been, he said. Deflation persisted for a long time. And fiscal stimulus packages – such as tax cuts – were inconsistent. Meanwhile, much of Japan's fiscal spending took the form of public works projects that had low productivity.

As for structural reforms, the Japanese government lacked a sense of urgency. For example, even in the reform-minded administration of former Prime Minister Junichiro Koizumi, only eight of the proposed 35 reform initiatives would have directly boosted growth. Of the others, 16 might have indirectly supported growth and 11 would have had no effect on growth, Hoshi said.

Drastic change needed

Unfortunately, some European nations seem to be following Japan's lead, Hoshi said.

"In France, Italy and Spain, bank recapitalization has been delayed and the structural reforms have been slow. Without drastic changes, they are likely to follow Japan's path to long economic stagnation," Hoshi and Kashyap wrote.

The problems that held back Japan seem to be less serious in the U.S., Hoshi said: "Employment protection is low in the United States and the labor market shows high mobility. The regulatory advantage for incumbent firms is smaller than in Europe or Japan and starting new business is relatively easy."

As the researchers noted, the United States and Germany are in a bit better economic shape, partly due to the fact that they did undertake structural reforms sooner rather than later. The U.S. was able to recapitalize its banks more quickly, for example.

Still, five years after the failure of the Lehman Brothers investment bank left the world's financial markets in chaos, the U.S. and Europe are not yet back to what had looked normal before the crisis, according to the research. For instance, employment levels have not reached the levels seen before the 2007-09 crash.

"The U.S. recovery has been tepid despite a number of extraordinary macroeconomic policies (at least in the traditional sense). This suggests that the U.S. economy also has problems, but they are just different from those in Japan and in Europe," Hoshi said.

In the years leading up to the financial crisis, the researchers wrote, U.S. growth was fueled by a consumption boom from rapid housing price increases and rising debt levels.

"In a broad sense, the U.S. economy before the crisis was similar to the Japanese or Spanish economies," noted Hoshi, adding that in Japan, the speculative investment boom in the late 1980s masked structural problems.

Clifton Parker is a writer for the Stanford News Service.

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