We examine health persistence between parents and their adult children in Indonesia using both subjective and objective health measures including biomarkers. Using Principal Components Analysis, we estimate the intergenerational persistence of the combination of these measures to be 0.30, providing some of the first estimates of the transmission of latent health for a middle income country. We also detect a highly significant second principal component suggesting that health has multiple dimensions. We find especially strong associations for biomarkers such as hemoglobin, the pulse rate and hypertension which have typically not been studied in prior intergenerational studies. Transmission is stronger from mothers, and to daughters. We find relatively little variation in intergenerational health transmission by family income or SES. However, we do find strong positive gradients between family SES and the pulse rate and obesity suggesting potential health pitfalls as low and middle income countries further develop. Our findings suggest a potentially important role for policies focused on maternal health in reducing the intergenerational transmission of health.
Keywords: Intergenerational persistence; health; biomarkers; Indonesia
The COVID-19 crisis was a profound stress test for health, economic, and governance systems worldwide, and its lessons remain urgent. The pandemic revealed that unpreparedness carries cascading consequences, including the collapse of health services, the reversal of development gains, and the destabilization of economies. The magnitude of global losses, measured in trillions of dollars and millions of lives, demonstrated that preparedness is not a discretionary expense but a foundation of macroeconomic stability. Countries that invested early in surveillance, resilient systems, and inclusive access managed to contain shocks and recover faster, proving that health security and economic security are inseparable.
For the Asia-Pacific, the path forward lies in transforming vulnerability into long-term resilience. Building pandemic readiness requires embedding preparedness within fiscal and development planning, not as an emergency measure but as a permanent policy function. The region’s diverse economies can draw on collective strengths in manufacturing capacity, technological innovation, and strong regional cooperation to institutionalize the four pillars— globally networked surveillance and research, a resilient national system, an equitable supply of medical countermeasures and tools, and global governance and financing—thereby maximizing pandemic prevention, preparedness, and response. Achieving this will depend on sustained political will and predictable financing, supported by the catalytic role of multilateral development banks and international financial institutions that can align public investment with global standards and private capital.
The coming decade presents a narrow but decisive window to consolidate these gains. Climate change, urbanization, and ecological disruption are intensifying the probability of new zoonotic spillovers. Meeting this challenge demands a shift from episodic response to continuous readiness, from isolated health interventions to integrated systems that link health, the environment, and the economy. Strengthening regional solidarity, transparency, and mutual accountability will be vital in ensuring that no country is left exposed when the next threat emerges.
A pandemic-ready Asia-Pacific is not an aspiration but an imperative. The lessons of COVID-19 call for institutionalized preparedness that transcends political cycles and emergency budgets. By treating health resilience as a global public good, the region can turn its experience of crisis into a model of sustained, inclusive security for the world.
Stanford University's Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to invite nominations for the 2026 Shorenstein Journalism Award. The award, which carries a cash prize of US$10,000, recognizes outstanding journalists and news media outlets for excellence in covering the complexities of the Asia-Pacific region. The 2026 award will honor a Western news media outlet or a journalist whose substantial body of work has primarily appeared in Western news media. APARC welcomes award nomination submissions from news editors, publishers, scholars, news outlets, journalism organizations, and entities focused on researching and analyzing the Asia-Pacific region. Entries are due by February 15, 2026.
The award defines the Asia-Pacific region broadly as including Northeast Asia, Southeast Asia, South Asia, Central Asia, and Australasia. Both individual journalists with a considerable body of work and news media outlets are eligible for the award. Nominees’ work may be in traditional forms of print or broadcast journalism and/or in new forms of multimedia journalism. The Award Selection Committee oversees the judging of nominees and is responsible for selecting honorees.
An annual tradition since 2002, the award honors the legacy of Mr. Walter H. Shorenstein, APARC's benefactor, and his twin passions for promoting excellence in journalism and understanding of Asia. Throughout its history, the award has recognized world-class journalists and news media who push the boundaries of coverage of the Asia-Pacific region and champion press freedom and human rights.
Recent honorees include Netra News, Bangladesh's premier public interest journalism outlet; Chris Buckley, the New York Times' chief China correspondent; The Caravan, India’s esteemed magazine of long-form journalism; Emily Feng, then NPR's Beijing correspondent; and Nobel Laureate Maria Ressa, CEO and president of the Philippines-based news organization Rappler. Visit the award page to learn more.
Award nominations are accepted electronically through Sunday, February 15, 2026, at 11:59 PM PST. Visit the award nomination entry page for information about the nomination procedures and to submit an entry.
Shorenstein Journalism Award Honors Netra News, Spotlights Public Interest Reporting Advancing Democracy and Accountability in Bangladesh
The 2025 Shorenstein Journalism Award recognized Netra News, Bangladesh’s premier independent media outlet, at a celebration featuring Tasneem Khalil, its founding editor-in-chief, who discussed its mission and joined a panel of experts in considering the prospects for democracy in Bangladesh.
Japan's Prime Minister Takaichi: A First-Month Report Card
Stanford sociologist Kiyoteru Tsutsui, director of the Shorenstein Asia-Pacific Research Center and the Japan Program, evaluates Japanese Prime Minister Sanae Takaichi's first month in office.
Reassessing the Rule of Law: How Legal Modernization Can Lead to Authoritarianism
Weitseng Chen of the National University of Singapore explores how legal modernization can entrench rather than erode authoritarian power, an unexpected result of a legal mechanism that underpins functioning democracies.
Sponsored by Stanford University’s Shorenstein Asia-Pacific Research Center, the annual award recognizes outstanding journalists and news media outlets for excellence in covering the Asia-Pacific region. News editors, publishers, scholars, and organizations focused on Asia research and analysis are invited to submit nominations for the 2026 award through February 15, 2026.
The Trans-Pacific Sustainability Dialogue convenes social science researchers and scientists from Stanford University and across the Asia-Pacific region, alongside policymakers, private and public sector experts, and emerging leaders to accelerate progress on achieving the United Nations-adopted 2030 Agenda for Sustainable Development. The Dialogue aims to generate new research and policy partnerships to expedite the implementation of the Agenda's underlying framework of 17 Sustainable Development Goals (SDGs).
The 2025 Dialogue focuses on advancing SDG 11: Sustainable Cities and Communities. It will be held in Manila, Republic of the Philippines, on November 10 and 11, 2025 (PHT), and is free and open to the public.
Steering Committee: Ambassador Kim Bong-hyun, BKMF; Dr. Cheryll Alipio, Stanford APARC; Professor Kiyoteru Tsutsui, Stanford APARC; Dean Noel Moratilla, UP Asian Center; Professor Ariel Lopez, UP Asian Center; Professor Michelle Palumbarit, UP Asian Center and UP-CIFAL Philippines
🔍 View the program agenda using the menu tabs below.
Join the conversation! Tag @stanfordaparc on LinkedIn/ @StanfordSAPARC on Facebook / @stanford_aparc on Instagram and mention #TPSD2025.
Isabela Ballroom (Lower Lobby) Makati Shangri-La, Manila Makati City, Republic of the Philippines
Master of Ceremonies Cheryll Alipio Associate Director for Program and Policy Walter H. Shorenstein Asia-Pacific Research Center Stanford University
8:00–8:30 a.m. — Arrival and Check-In of Speakers 8:30–9:00 a.m.— Registration of General Attendees
9:00–9:50 a.m. — Opening Session
Welcome Remarks Ban Ki-moon The 8th Secretary-General of the United Nations Chairman, Ban Ki-moon Foundation for a Better Future
Kiyoteru Tsutsui Director of the Walter H. Shorenstein Asia-Pacific Research Center, Director of the Japan Program, Senior Fellow at the Freeman Spogli Institute for International Studies, Professor of Sociology, and the Henri H. and Tomoye Takahashi Professor and Senior Fellow in Japanese Studies, Stanford University
Keynote Speaker Arsenio M. Balisacan Secretary of the Department of Economy, Planning, and Development (DEPDev) of the Republic of the Philippines, Vice Chair of the Economy and Development Council and the National Innovation Council, and former Dean and Professor of the School of Economics at the University of the Philippines, Diliman
9:50–10:30 a.m. — Plenary 1 Envisioning the Future of Livable Cities: World Leaders on Accelerating Action on SDG 11 Target 11.3: By 2030, enhance inclusive and sustainable urbanization and capacity for participatory, integrated and sustainable human settlement planning and management in all countries.
Moderator Kiyoteru Tsutsui Director of the Walter H. Shorenstein Asia-Pacific Research Center, Director of the Japan Program, Senior Fellow at the Freeman Spogli Institute for International Studies, Professor of Sociology, and the Henri H. and Tomoye Takahashi Professor and Senior Fellow in Japanese Studies, Stanford University
Keynote Speakers Endo Kazuya Ambassador Extraordinary and Plenipotentiary of Japan to the Republic of the Philippines Angelo A. Jimenez President of the University of the Philippines
10:30–11:00 a.m. — Coffee and Tea Break
11:00–12:00 p.m. — Plenary 2 From Vision to Action: Advancing Climate-Resilient Cities Target 11.b: By 2020, substantially increase the number of cities and human settlements adopting and implementing integrated policies and plans towards inclusion, resource efficiency, mitigation and adaptation to climate change, resilience to disasters, and develop and implement, in line with the Sendai Framework for Disaster Risk Reduction 2015-2030, holistic disaster risk management at all levels
Moderator Gita Wirjawan Former Minister of Trade of the Republic of Indonesia, Visiting Scholar at the Precourt Institute for Energy of the Doerr School of Sustainability at Stanford University, Founder of Ancora Group and Ancora Foundation, and Founding Partner at Ikhlas Capital
Panelists Guillermo Luz Chairman of Liveable Cities Philippines, Chief Resilience Officer at the Philippine Disaster Resilience Foundation, Consultant at Ayala Corporation, Chairman of the Board of Advisors of the Rizalino S. Navarro Policy Center for Competitiveness at the Asian Institute of Management, and Trustee of the Ramon Magsaysay Award Foundation Gwendolyn T. Pang Secretary General of the Philippine Red Cross Nominchimeg Odsuren Member of the State Great Hural (Parliament) of Mongolia
12:00–1:30 p.m. — Public Luncheon for Attendees (Isabela Ballroom, Lower Lobby)
Private Luncheon for Speakers (Manila Room, Level 1) Hosted by The Honorable Loren Legarda, Senator of the Philippines
Keynote Speaker Loren Legarda She is the only woman in Philippine history to have topped two senatorial elections (1998 and 2007) and the only female to have served as Senate Majority Leader. In the 20th Congress, she serves as Chairperson of (1) the Committee on Culture and the Arts, (2) the Committee on Higher, Technical, and Vocational Education, and (3) the Committee on National Defense and Security, Peace, Unification, and Reconciliation, where she is the first woman to serve as Chairperson.
Commemorative Photo of Speakers
1:30–2:30 p.m. — Plenary 3 Driving Urban Innovation: Sustainable Solutions for Cleaner, Smarter Cities Target 11.6: By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management
Moderator Ariel C. Lopez Associate Professor and Assistant to the Dean for Research, Publications, and Information at the Asian Center of the University of the Philippines, Diliman
Panelists Chang Sug Park Vice President for Management of the Korea Environment Institute Gita Wirjawan Former Minister of Trade of the Republic of Indonesia, Visiting Scholar at the Precourt Institute for Energy of the Doerr School of Sustainability at Stanford University, Founder of Ancora Group and Ancora Foundation, and Founding Partner at Ikhlas Capital Shari Yamaguchi Vice Director of the Global Management Division, El Camino Real Co. Ltd.
2:30–3:00 p.m. — Coffee and Tea Break
3:00–4:00 p.m. — Plenary 4 Designing Energy Efficient Infrastructure: Advancing Climate-Adapted Solutions Target 11.c: Support least developed countries, including through financial and technical assistance, in building sustainable and resilient buildings utilizing local materials
Moderator Rie Hiraoka Adjunct Professor at Kyoto University of Advanced Science, former Visiting Scholar at the Walter H. Shorenstein Asia-Pacific Research Center at Stanford University, and former Director of the Social Sector Division for Central and West Asia Department and former Country Director for the Kyrgyz Resident Mission at the Asian Development Bank
Panelists Sohail Hasnie Managing Director of Energypreneurs Advisory and former Principal Energy Specialist of the Southeast Asia Department and Central West Asia Department at the Asian Development Bank Dave H. Kim Senior Advisor to the President of the Assembly and Chair of the Council, Global Green Growth Institute Priyantha Wijatunga Senior Director of the Energy Sector Group, Asian Development Bank
4:00–4:30 p.m. — Coffee and Tea Break
4:30–5:30 p.m. — Policy Roundtable From Policy to Practice: Developing Accessible Urban Environments and Housing Target 11.1: By 2030, ensure access for all to adequate, safe and affordable housing and basic services and upgrade slums
Moderator David Cohen Co-Program Director of the Southeast Asia Program at the Walter H. Shorenstein Asia-Pacific Research Center, Professor of Environmental Social Sciences at the Doerr School of Sustainability, and WSD-HANDA Professor of Human Rights and International Justice, Stanford University
Panelists Henry L. Yap Senior Undersecretary of the Department of Human Settlements and Urban Development (DHSUD) of the Republic of the Philippines Cezar P. Consing President and CEO of Ayala Corporation Norio Yamato Vice Senior Chief Researcher at the Institute for Urban Strategies, The Mori Memorial Foundation
5:30–5:40 p.m. — Closing Session
Closing Remarks Kim Sook Executive Director of the Ban Ki-moon Foundation for a Better Future and former Ambassador and Permanent Representative of the Republic of Korea to the United Nations
5:40–5:50 p.m. — Commemorative Photo of Speakers
6:00–8:00 p.m. — Private Reception and Dinner
Manila Room (Level 1) Makati Shangri-La, Manila Makati City, Republic of the Philippines
Hosted by the Walter H. Shorenstein Asia-Pacific Research Center
Reception
Welcome Remarks Kiyoteru Tsutsui Director of the Walter H. Shorenstein Asia-Pacific Research Center, Director of the Japan Program, Senior Fellow at the Freeman Spogli Institute for International Studies, Professor of Sociology, and the Henri H. and Tomoye Takahashi Professor and Senior Fellow in Japanese Studies, Stanford University
Dinner and Cultural Performance
GT-Toyota Asian Center Auditorium University of the Philippines, Diliman Quezon City, Republic of the Philippines
Master of Ceremonies Danae M. Pantano University Researcher, Asian Center, University of the Philippines, Diliman
9:00-9:30 a.m. — Welcoming of Guests Registration, Check-In, and Breakfast for Speakers and Attendees
9:30–10:00 a.m. — Opening Session
Welcome Remarks Noel Christian Moratilla Dean and Professor, Asian Center, University of the Philippines, Diliman
Kiyoteru Tsutsui Director of the Walter H. Shorenstein Asia-Pacific Research Center, Director of the Japan Program, Senior Fellow at the Freeman Spogli Institute for International Studies, Professor of Sociology, and the Henri H. and Tomoye Takahashi Professor and Senior Fellow in Japanese Studies, Stanford University
Commemorative Photo of Speakers
10:00–11:00 a.m. — Expert Panel 1 Living Legacies: Bridging Tradition and Urban Growth in Cities Target 11.4: Strengthen efforts to protect and safeguard the world’s cultural and natural heritage
Moderator Ariel C. Lopez Associate Professor and Assistant to the Dean for Research, Publications, and Information at the Asian Center of the University of the Philippines, Diliman
Panelists Glecy Atienza Professor in the College of Arts and Letters at the University of the Philippines, Diliman and former Director for Research and Creative Work at the UP Resilience Institute Redento B. Recio Associate Professor in the College of Social Work and Community Development at the University of the Philippines, Diliman, and Research Fellow at InfUr- The Informatl Urbanism Research Hub at the Melbourne School of Design at The University of Melbourne Gita Wirjawan Former Minister of Trade of the Republic of Indonesia, Visiting Scholar at the Precourt Institute for Energy of the Doerr School of Sustainability at Stanford University, Founder of Ancora Group and Ancora Foundation, and Founding Partner at Ikhlas Capital
11:00 a.m.–12:00 p.m. — Expert Panel 2 Transforming Urban Transit: From Sustainable Mobility to Social Equity Target 11.2: By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, women, children, persons with disabilities and older persons
Moderator David Cohen Co-Program Director of the Southeast Asia Program at the Walter H. Shorenstein Asia-Pacific Research Center, Professor of Environmental Social Sciences at the Doerr School of Sustainability, and WSD-HANDA Professor of Human Rights and International Justice, Stanford University
Panelists Maria Golda Hilario Director for Urban Development, Institute for Climate and Sustainable Cities (ICSC) Robert Siy Advisor and Co-Convenor of Move As One Coalition; Consultant for The Asia Foundation; Columnist for The Manila Times; former Senior Advisor at the Department of Transportation of the Republic of the Philippines; and former Director of the Human Resources Division, Director of Country Coordination and Regional Cooperation Division (Central/West Asia Department), and Director of Programs and Projects (Pacific Department) of the Asian Development Bank Lloyd Wright Senior Transport Specialist of the Transport and Energy Sectors Group, Asian Development Bank
12:00 - 1:30 p.m. — Public Luncheon for Attendees (GT-Toyota Asian Center Auditorium)
Private Luncheon for Speakers (Asian Center ASEAN-Japan Hall) Hosted by UP-CIFAL Philippines
Welcome Remarks Michelle Palumbarit Associate Professor and Assistant to the Dean for Curriculum and Quality Assurance at the Asian Center of the University of the Philippines, Diliman, and Director of UP-CIFAL Philippines
Keynote Speaker Arnaud Peral United Nations Resident Coordinator in the Philippines, United Nations Philippines
Commemorative Photo of Speakers
1:30–2:30 p.m. — Emerging Leaders Workshop 1 Reimagining Public Spaces: Critical Approaches for Accessible and Responsive Urban Environments Target 11.7: By 2030, provide universal access to safe, inclusive and accessible, green and public spaces, in particular for women and children, older persons and persons with disabilities
Moderator Cheryll Alipio Associate Director for Program and Policy, Walter H. Shorenstein Asia-Pacific Research Center, Stanford University
Panelists Kevin Bautista M.A. Student in Asian Studies, Asian Center, University of the Philippines, Diliman Kristine S. Calleja M.A. Student in Asian Studies, Asian Center, University of the Philippines, Diliman Lordivine Marie Pineda B.A. Student in Communication Research, College of Mass Communications, University of the Philippines, Diliman Daisy Mae R. Bongtiwon Master of Science Teaching Student, Department of Physics, De La Salle University
Discussant Carmeli Marie C. Chaves Assistant Professor at the School of Urban and Regional Planning and Vice Chancellor for Planning and Development, University of the Philippines, Diliman
2:30–3:30 p.m. — Emerging Leaders Workshop 2 From Risk to Readiness: Strengthening Urban Systems for Disaster Resilience Target 11.5: By 2030, significantly reduce the number of deaths and the number of people affected and substantially decrease the direct economic losses relative to global gross domestic product caused by disasters, including water-related disasters, with a focus on protecting the poor and people in vulnerable situations
Moderator Enkh-Undram Bayartogtokh Programs and Partnership Advisor to the Prime Minister of Mongolia
Panelists Gaea Morales Shorenstein Postdoctoral Fellow, Walter H. Shorenstein Asia-Pacific Research Center, Stanford University Junna Queen Prudenciado M.A. Student in Asian Studies, Asian Center, University of the Philippines, Diliman Rebecca Anne Verzola M.A. Student in Asian Studies, Asian Center, University of the Philippines, Diliman
Discussants Yasmin Wirjawan Visiting Scholar at the Walter H. Shorenstein Asia-Pacific Research Center of Stanford University, Independent Commissioner of TBS Energi Utama, Advisor to Ancora Group and Sweef Capital, and Head of the Ancora Foundation
3:30–3:45 p.m. — Special Keynote Address
Introduction Noel Christian Moratilla Dean and Professor, Asian Center, University of the Philippines, Diliman
Keynote Speech Ban Ki-moon The 8th Secretary-General of the United Nations and Chairman of the Ban Ki-moon Foundation for a Better Future
3:45–4:00 p.m. — Awarding of Emerging Leaders Certificates
Commemorative Photo of Students and Speakers
Coffee & Tea Break
4:00–5:00 p.m. — Policy Roundtable Connecting Urban and Rural Futures: Regional Planning for Sustainable Integration Target 11.a: Support positive economic, social and environmental links between urban, peri-urban and rural areas by strengthening national and regional development planning
Moderator Michelle Palumbarit Associate Professor and Assistant to the Dean for Curriculum and Quality Assurance at the Asian Center of the University of the Philippines, Diliman, and Director of UP-CIFAL Philippines
Panelists Alfredo Mahar Francisco Lagmay Executive Director, UP Resilience Institute, University of the Philippines, Diliman Francisco A. Magno Professor of Political Science and Development Studies at De La Salle University, Director of the Jesse M. Robredo Institute of Governance, and Coordinator of the UN Sustainable Development Goals Localization Project of DLSU with the City Government of Manila
5:00–5:15 p.m. — Closing Session
Moderator Noel Christian Moratilla Dean and Professor, Asian Center, University of the Philippines, Diliman
Closing Remarks Angelo A. Jimenez President of the University of the Philippines Kiyoteru Tsutsui Director of the Walter H. Shorenstein Asia-Pacific Research Center, Director of the Japan Program, Senior Fellow at the Freeman Spogli Institute for International Studies, Professor of Sociology, and the Henri H. and Tomoye Takahashi Professor and Senior Fellow in Japanese Studies, Stanford University Kim Bong-hyun Former Ambassador of the Republic of Korea to Australia, former President of Jeju Peace Institute, and Advisor to Mr. Ban Ki-moon
For inquiries about the Trans-Pacific Sustainability Dialogue, contact Cheryll Alipio, Shorenstein APARC’s Associate Director for Program and Policy: calipio@stanford.edu.
For press inquiries, contact Noa Ronkin, Shorenstein APARC’s Associate Director for Communications and External Relations: noa.ronkin@stanford.edu.
The world’s health systems face a complex and interconnected set of challenges that threaten to outpace our capacity to respond. Geopolitical fragmentation, climatic breakdown, technological disruption, pandemic threats, and misinformation have converged to strain the foundations of global health. Building resilient global health systems requires five urgent reforms: sharpening the mandate of the World Health Organization (WHO), operationalizing the One Health concept, modernizing procurement, addressing the climate–health nexus, and mobilizing innovative financing. Together, these shifts can move the world from fragmented, reactive crisis management to proactive, equitable, and sustainable health security.
Emerging and Escalating Threats
While the global community demonstrated remarkable resilience in weathering the COVID-19 pandemic, the crisis also exposed profound structural weaknesses in global health governance and architecture. Chronic underinvestment in health systems led to coverage gaps, workforce shortages, and inadequate surveillance systems. The pandemic also revealed a fragmented global health architecture, plagued by institutional silos among key agencies (Elnaiem et al. 2023).
Years later, the aftershocks of the pandemic still resonate worldwide, with the ongoing triple burden of disease—the unfinished agenda of maternal and child health, the rising silent pandemic of noncommunicable diseases, and the reemergence of communicable diseases. These challenges, combined with the persistent challenge of malnutrition, unmet needs in early childhood development, growing concerns around mental health, and the threat of other emerging diseases, as well as the rising toll of trauma, injury, and aging populations, have placed countries across the world under immense strain. Health systems face acute infrastructure gaps, critical workforce shortages, and persistent inequities in service delivery, making it increasingly difficult to address the complex and evolving health needs of their populations. Post-pandemic fiscal tightening has constrained health budgets with debt-to-GDP ratios exceeding 70–80% in parts of the region (UN ESCAP 2023).
Global development assistance for health has significantly declined by more than $10 billion, with sharp cuts driven by the United States. This decline is likely to continue over the next five years.
Furthermore, climate change is fundamentally redefining the risk landscape. Rising temperatures, more frequent floods, intensifying storms, and shifting vector ranges for organisms like mosquitoes and ticks are disrupting food systems, displacing populations, and driving new patterns of disease transmission. Over the next 25 years in low- and middle-income countries, climate change could cause over 15 million excess deaths, and economic losses related to health risks from climate change could surpass $20.8 trillion (World Bank 2024). The cost of inaction has never been higher.
Meanwhile, deepening political polarization is amplifying conflict and weakening the global cooperation essential for scientific progress. The number of geopolitical disturbances worldwide is at an all-time high, displacing over 122 million people and eroding access to essential health services (UNHCR 2024). In 2023, false and conspiratorial health claims amassed over 4 billion views across digital platforms, compromising vaccine uptake and fueling health-related conspiracy theories. (Kisa and Kisa 2025). Furthermore, exponential technological advances in artificial intelligence are outpacing public health governance systems, creating new ethical and equity dilemmas. Global development assistance for health has significantly declined by more than $10 billion, with sharp cuts driven by the United States. This decline is likely to continue over the next five years (Institute for Health Metrics and Evaluation 2025).
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Note: Development assistance for health is measured in 2023 real US dollars; 2025 data are preliminary estimates.
Source: Institute for Health Metrics and Evaluation 2025.
Five Critical Reform Directions for Future-Proofing Global Health Systems
1. WHO matters more than ever — but only if it sharpens its focus.
The World Health Organization remains the technical backbone of global health, with a mandate to set norms and standards, shape research agendas, monitor health trends, coordinate emergency responses and regulation, and provide technical assistance. COVID-19 underscored both its indispensability and its limitations. During the pandemic, WHO convened states, disseminated guidance, and spearheaded initiatives like the Solidarity Trial and COVAX to promote vaccine equity, illustrating why it remains vital as the only neutral platform where 194 member states can cooperate on pandemics, antimicrobial resistance, or climate-related health risks. Its work on universal health coverage, the “triple burden” of disease, and global health data continues to anchor policy across countries.
At the same time, the crisis exposed structural weaknesses: WHO lacks enforcement authority, relies heavily on voluntary donor-driven funding, and sometimes stretches beyond its comparative strengths. When it shifts from convening and technical guidance into direct fund management, logistics, or large-scale program delivery, it risks diluting its mandate and eroding trust. Critics argue this reflects a broader challenge of an expansive mandate and donor-driven mission creep, pushing WHO beyond what 7,000 staff and a modest budget can realistically deliver. The way forward lies in sharpening focus: leveraging its convening power and legitimacy, providing technical expertise and evidence-based guidance, coordinating emergencies under the International Health Regulations, and advocating for equity in access to medicines and care. Anchored in these core strengths, a more agile WHO can better lead during crises, sustain credibility, and ensure that global health standards are consistently applied across diverse national contexts.
2. Animal Health as the Next Frontier
More than 70 percent of emerging infectious diseases are zoonotic in origin, with roughly three-quarters of newly detected pathogens in recent decades spilling over from animals into humans (WHO 2022; Jones, Patel, Levy, et al. 2008). The economic costs are staggering: the World Bank estimates that zoonotic outbreaks have cost the global economy over $120 billion between 1997 and 2009 through crises such as Nipah, SARS, H5N1, and H1N1 (World Bank 2012). The drivers of spillover are intensifying due to deforestation and land-use change, industrial livestock farming, wildlife trade, and climate change. These are further accelerating the emergence of novel pathogens.
However, the governance of animal health remains fragmented. While WHO, the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (WOAH) each hold mandates, they often operate in silos. The Quadripartite, expanded in 2021 to include the United Nations Environment Programme, launched a One Health Joint Plan of Action (2022–26), but it remains underfunded and lacks strong political commitment.
There is an urgent need to move One Health from principle to practice. To fill this governance gap, the world should consider establishing an independent intergovernmental alliance for animal health with a clear mandate. This could strengthen global One Health response by augmenting joint surveillance, building veterinary workforce capacity, and integrating environmental data into early warning systems. Such an alliance should avoid creating new bureaucratic layers and instead leverage the Quadripartite as its operational backbone. Embedding One Health into national health strategies and cross-sectoral policies would enable animal, human, and environmental health systems to work in tandem and address risks at their source. Preventive investments are also very cost-effective; the World Bank estimates that annual One Health prevention investments of $10–11 billion could save multiple times that amount in avoided pandemic losses (World Bank 2012). Strengthening One Health is both a health and economic necessity.
COVID-19 revealed how vital procurement and financial management are to global health security [...] Reform must begin by making procurement agile, transparent, and equitable.
3. Agile Procurement: The Missing Link in Global Health Security
COVID-19 revealed how vital procurement and financial management are to global health security. A system built for routine procurement was suddenly called upon to handle crisis response on a worldwide scale, and it struggled to keep up. When vaccines became available, strict procedures, fragmented supply chains, and export restrictions meant access was uneven and often delayed. Developed countries’ advance purchase agreements stockpiled most of the supply, leaving many low- and middle-income countries waiting for doses. Within the UN system and its partners, overly complex procurement rules slowed the speed to market, and the lack of harmonized regulatory recognition caused further delays. As a result, those least able to handle shocks faced the longest waits and highest costs.
Reform must begin by making procurement agile, transparent, and equitable. Emergency playbooks should be pre-cleared to ensure that indemnity clauses and quality assurance requirements can be activated immediately when the next crisis arises. Regional pooled procurement mechanisms, like the Pan American Health Organization’s Revolving Fund or the African Union’s pooled initiatives, should be expanded to diversify supply sources and anchor distributed manufacturing. End-to-end e-procurement platforms would provide real-time shipment tracking, facility-level stock visibility, and open dashboards to strengthen accountability. Financial management must be integrated with procurement so that contingency funds, countercyclical reserves, and fast-disbursing credit lines can release resources in tandem with purchase orders. Together, these reforms would ensure that in future health emergencies, these procurement systems act as lifelines rather than bottlenecks.
4. Addressing the Health–Climate Nexus
Climate change poses severe health risks, disproportionately affecting women and vulnerable populations in developing countries through heatwaves, poor air quality, food and water insecurity, and the spread of infectious diseases. Climate-related disasters are increasing in frequency and severity worldwide, reshaping both economies and health systems. In 2022, there were 308 climate-related disasters worldwide, ranging from floods and storms to droughts and wildfires (ADRC 2022). These events generated an estimated $270 billion in overall economic losses, with only about $120 billion insured—underscoring the disproportionate burden on low- and middle-income countries where resilience and coverage remain limited (Munich Re 2023). Over the past two decades, Asia and the Pacific have consistently been the most disaster-prone regions, accounting for nearly 40% of all global events, but every continent is now affected, from prolonged droughts in Africa and mega storms in North America to record-breaking heatwaves in Europe (UNEP n.d.).
Meeting this challenge requires a dual agenda of adaptation and mitigation. Health systems must be made climate-resilient by hardening infrastructure against floods and storms, ensuring reliable, clean energy in clinics and hospitals, and building climate-informed surveillance and early-warning systems that can anticipate disease outbreaks linked to environmental change. Supply chains need redundancy and flexibility to withstand shocks, and frontline workers require training to manage climate-driven health crises. At the same time, health systems must rapidly decarbonize. This means greening procurement and supply chains, phasing out high-emission medical products like certain inhalers and anesthetic gases, upgrading buildings and transport fleets, and embedding sustainability into financing and governance. Momentum is growing. The 2023 G20 Summit in Delhi, supported by the Asian Development Bank (ADB), recognized the health–climate nexus as a global priority, and institutions such as WHO, the World Bank, and ADB have begun to advance this agenda. The next step is to translate commitments into operational change by embedding climate-health strategies into national health plans, financing frameworks, and cross-sectoral policies. Climate action, sustainability, and resilience need to be integrated into the foundation of health systems.
5. Mobilizing Innovative Financing
Strengthening health systems and preventing future pandemics will require massive financing, but global health funding is in decline. Innovative mechanisms to mobilize new resources are essential. This requires stronger engagement with finance ministries, development financing institutions, and the private sector to design models that attract and de-risk investment while enabling rapid disbursement during emergencies. International financing institutions (IFIs) need to unlock innovative financial pathways to amplify health investments. They need to deploy blended finance initiatives, public-private partnerships, guarantees, debt swaps, and outcome-based financing tools to mobilize private capital for health. Over the past few years, IFIs have committed billions in health-related financing worldwide. This has included landmark support for vaccine access facilities, delivery of hundreds of millions of COVID-19 vaccine doses, and mobilization of large-scale response packages that combine grants, loans, and technical assistance.
Embedding health into climate policies and climate resilience into health strategies will ensure that future systems are both sustainable and resilient to shocks.
There is a need to broaden the financing mandate beyond investing in universal health coverage and mobilize capital for emerging areas, including the climate-health nexus, mental health, nutrition, rapid urbanization, demographic shifts, digitization, and non-communicable diseases. By leveraging their balance sheets, IFIs can generate a multiplier effect in fund mobilization and attract new financing actors. Innovative instruments are already demonstrating potential. For example, the International Finance Facility for Immunisation (IFFIm), which issues “vaccine bonds” backed by donor pledges, has raised over $8 billion for Gavi immunization programs (IFFIm 2022; Moody’s 2024). Debt-for-health and debt-for-nature swaps have redirected debt service into social outcomes. For example, El Salvador’s 2019 Debt2Health agreement with Germany channeled approximately $11 million into strengthening its health system, while Seychelles’ debt-for-nature swap created SeyCCAT to finance marine conservation, yielding social and resilience co-benefits for coastal communities (Hu, Wang, Zhou, et al. 2024). Similarly, contingent financing facilities—such as the Innovative Finance Facility for Climate in Asia and the Pacific (IF-CAP) and the International Financing Facility for Education (IFFEd)—also hold significant potential for health (IFFEd n.d.; ADB n.d.). These examples demonstrate how contingent financing and swaps can expand fiscal space without exacerbating debt distress.
This can create a virtuous cycle of facilitating investments that create regional cooperation for sustainable and scalable impact. In this vein, the G20 Pandemic Fund is a beacon of catalytic multilateralism funding in a fragmented world. Launched in 2022 with over $2 billion pooled from governments, philanthropies, and multilaterals, it strengthens pandemic preparedness in low- and middle-income countries. Every $1 awarded from the Pandemic Fund has mobilized an estimated $7 in additional financing. The fund demonstrates that nations can still unite around shared threats, offering hope and a template for collective action on global challenges.
Equally important is the ability to deploy funds rapidly in emergencies. During the COVID-19 pandemic, reserve and countercyclical funds, used by countries such as Germany, the Netherlands, and Lithuania, along with the Multilateral Development Bank’s fast-track financing facilities with streamlined approval and disbursement processes, provided urgent and timely financing support (Sagan, Webb, Azzopardi-Muscat, et al. 2021; Lee and Aboneaaj 2021). These mechanisms should be institutionalized in national financial management systems as well as IFIs to ensure rapid funding disbursement in future health emergencies
Moving Forward
Delivering on this reform agenda requires more than technical fixes—it demands political will, sustained financing, and cross-sectoral collaboration. Member states must empower WHO to lead within its comparative strengths, while reinforcing One Health through stronger mandates and funding. Governments, IFIs, and the private sector should jointly design agile procurement and financing mechanisms that can be activated at speed during crises. Embedding health into climate policies and climate resilience into health strategies will ensure that future systems are both sustainable and resilient to shocks. Above all, reform efforts must be anchored in equity, so that the most vulnerable are protected first.
The opportunity before the global community is to reimagine health as the backbone of resilience and prosperity in the 21st century. A whole-of-systems approach is necessary to clarify mandates, integrate animal and environmental health, develop agile and fair procurement systems, embed climate action into health systems, and mobilize innovative financing. The steps taken in the next few years can lead to a more connected, cooperative, and future-ready global health architecture.
When the Storm Hit: How COVID Exposed China’s Flawed Fiscal System
A co-authored study by a team including Stanford political scientist Jean Oi traces how the Chinese central government’s shifting policies during the COVID pandemic exposed its fiscal fault lines and created a local government liquidity crisis.
Spending More, Gaining Less: Lowest-Income Koreans Derive the Least Value from Health Care Investment, New Research Reveals
Despite rising health care spending, adults in South Korea’s lowest-income quintile experience the smallest relative improvement in life expectancy and well-being, according to a new study. The co-authors, including Stanford health economist Karen Eggleston, call for the country’s health policy to prioritize both equity and value, and highlight lessons for other health systems.
Lab technician Martin Agunda tests a viral load sample from Ruth Gweyi, a mother living with HIV, in Kisumu, Kenya, where U.S. funding cuts to HIV programs strain local health services.
This event is co-sponsored by the Korea Program and Taiwan Program at Shorenstein APARC.
For decades, Taiwan and South Korea have been celebrated as proof that strengthening the rule of law can move authoritarian regimes toward democracy. This talk challenges that view by revisiting the legal histories of Taiwan, South Korea, and China. It identifies two paradigms of rule-of-law promotion: the Cold War “state-first” approach and the post–Cold War “democracy-first” approach. Different in style but similar in outcome, both shared the same flaw: foreign legal aid often reinforced authoritarianism. Taiwan and South Korea’s democratization was not evidence of legal modernization theory, but an outlier. Law is a neutral infrastructural power, and future rule-of-law promotion must be recalibrated to prevent authoritarian capture.
Speaker:
Weitseng Chen teaches at the National University of Singapore, specializing in comparative studies of law, politics and economic development in Asia. His published books include Regime Type and Beyond: The Transformation of Police in Asia (CUP 2023), Authoritarian Legality in Asia (CUP 2019), The Beijing Consensus? How China Has Changed the Western Ideas of Law and Economic Development (CUP 2017), Property and Trust Law in Taiwan (Kluwer 2017), and Law and Economic Miracle: Interaction Between Taiwan’s Development and Economic Laws After WWII (in Chinese, 2000). Chen was a Hewlett Fellow at Stanford’s Center for Democracy, Development, and the Rule of Law, and practiced as a lawyer at Davis Polk & Wardwell. He was also a fellow of the Institute for Advanced Study in Berlin. Chen earned his JSD from Yale Law School.
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Join us for a special screening of The Six, the award-winning documentary, with film co-creator and lead researcher Steven Schwankert. The Six uncovers the story of the six Chinese survivors of the Titanic. Combining meticulous research, archival footage, and powerful storytelling, the film sheds light on issues of race, immigration, and forgotten history, offering a fresh perspective on one of the world’s most famous maritime tragedies.
The evening will begin with opening remarks and will conclude with an audience Q&A with Steven, an opportunity to hear firsthand about the making of the film, the challenges of historical research in and about China, and the surprising discoveries behind this extraordinary story. Following its acclaimed festival run, The Six has been praised for both its historical significance and its timely resonance in today’s conversations about migration and identity.
Steven Schwankert is an award-winning writer, explorer, and documentary filmmaker. Based in Beijing for more than two decades, his work has appeared in The Wall Street Journal Asia, The New York Times, and The South China Morning Post. He is the co-creator of The Six and author of “Poseidon: China’s Secret Salvage of Britain’s Lost Submarine.” Schwankert’s projects often focus on uncovering hidden histories and connecting them to contemporary issues.
The event is presented by: China Program, Walter H. Shorenstein Asia-Pacific Research Center (APARC) Co-sponsored by: Center for East Asian Studies (CEAS) and Department of Art & Art History
Oshman Hall McMurtry Building 355 Roth Way, Stanford, CA 94305
Taiwan’s National Health Insurance (NHI), now in its 30th year, is internationally recognized for achieving universal coverage, providing comprehensive, low-cost, and accessible care to more than 99% of the population. Its strong digital infrastructure—most notably the smart card system—proved instrumental during the COVID-19 pandemic, significantly enhancing the program’s effectiveness.
Yet alongside these achievements, the NHI faces pressing challenges in financial sustainability and care delivery. Taiwan’s rapidly aging population, combined with the emergence of new medical technologies and therapeutics, has heightened public expectations and demand for better care, further straining the system’s finances. Over three decades, stringent expenditure controls have helped contain costs but at the expense of workforce adequacy, timely adoption of innovations, and quality management of chronic diseases.
Future reforms will inevitably need to focus on raising premiums, diversifying funding sources, and optimizing healthcare delivery to balance quality with sustainability. The core dilemma, however, lies in how public finance instruments can be leveraged to ensure adequate and sustainable funding to meet the population’s growing healthcare needs. Paradoxically, the NHI’s consistently high public approval rating—hovering around 90% in recent years—may make substantive reform politically more difficult if not impossible.
Taiwan’s experience offers important lessons for other countries. First, strong political commitment is essential for both the establishment and ongoing success of universal health coverage. Second, robust information technology infrastructure is critical to efficiency. Third, there is no “free lunch”: in a system like Taiwan’s, where health expenditure is kept at a relatively low at 7% of GDP, stringent cost controls inevitably carry serious adverse consequences. Finally, Taiwan demonstrates that even the most celebrated and popular systems face continual challenges, reforms are rarely straightforward, and long-term sustainability can never be taken for granted.
Hongjen Chang is the current Chairman and CEO of YFY Biotech Management Co., in addition to serving as the Chairperson for several other private biotech firms. Before joining the YFY Group—which has grown from a paper mill into a conglomerate with interests in electronics, finance, biotech, and agriculture—Dr. Chang dedicated over 16 years to Taiwan’s Health Ministry. From 2005 to 2021, he also led Taiwan Global BioFund as its CEO. Widely recognized in Taiwan for his extensive public health administration experience, Dr. Chang is credited with implementing the smart card program during his time as President and CEO of BNHI, the country’s universal health care institution. This initiative was crucial to Taiwan's early success in containing the COVID-19 pandemic in 2020. Dr. Chang holds a medical degree from National Yang-Ming Medical College, an M.S. in Public Health from National Taiwan University, and an M.S. in Health Policy and Management from Harvard School of Public Health.
Government healthcare payors in Asia and globally may face financial incentives to restrict use of high-cost medications. Yet, restrictions on access to high-value medications may have deleterious effects on population health. Advance purchase commitments (APCs), wherein a payor commits to purchase a certain quantity of medications at lower prices, offer payors incentives to increase access to high-value medications and companies guaranteed revenue; a potential win-win-win for patients, business and society.
Dr. Conti will discuss the United States payor experience with subscription models, a type of APC, to support increased access to high-value medicines. She will focus on direct-acting antivirals (DAAs), available since 2013, that can cure chronic infection with Hepatitis C virus (HCV). With prices upwards of $90,000 for a treatment course, many payors struggle to ensure access to DAAs to populations in need of treatment. Since 2018, several U.S. states have implemented HCV subscription models, and a national HCV elimination strategy featuring a DAA subscription model has been announced.
Dr. Conti will review the empirical evidence on impacts and lessons learned from implementation to date, as well as provide a framework for payors interested in pursuing subscription models targeting DAAs and other high-value, high-cost medicines.
Rena Conti is an associate professor of markets, public policy, and law at Questrom School of Business, Boston University. Professor Conti is the co-director of the Technology Policy and Research Initiative, a joint program between Questrom School of Business and the Law School, and the life sciences markets co-lead at the Ravi K. Mehrotra Institute for Business Markets and Society at Questrom School of Business.
Professor Conti holds a Ph.D. from Harvard University Graduate School of Arts and Sciences in health policy and economics. She was a faculty at the University of Chicago between 2006 and 2018. Professor Conti has published extensively on biopharmaceutical pricing, competition, and innovation. Professor Conti has testified on the economics of biopharmaceutical markets in hearings held by the U.S. Senate, the U.S. House of Representatives, the U.S. Food and Drug Administration, the Federal Trade Commission, and numerous state legislative houses. Professor Conti served as Special Government Advisor to the Centers for Medicare and Medicaid Services (CMS) 2022-2023 and has held additional advisory roles at the U.S. Food and Drug Administration (FDA). Professor Conti served as the lead economist on the establishment of the State of Louisiana’s landmark Subscription Model for Hepatitis C Virus Elimination (HepCfreeLa). Professor Conti currently serves as an appointed member of the New Jersey Drug Affordability Council and is an elected member of the Conference on Research in Income and Wealth. She currently serves as a board member of the Boston University Medical Group.
The research of Professor Conti has been featured in the New York Times, the Wall Street Journal, the Washington Post, Bloomberg News, USA Today, the Chicago Tribune, the Boston Globe, the LA Times, 60 Minutes, the Daily Show, Vox, the Atlantic, Statnews, and the Colbert Report, among other print and media outlets. Grants and awards from the National Cancer Institute, the National Institute of Mental Health, the National Institute on Drug Abuse, the National Science Foundation, the Sloan Foundation, the Commonwealth Fund, American Cancer Society, and Arnold Ventures, among other sources, support her research.
The Walter H. Shorenstein Asia-Pacific Research Center (APARC) is pleased to invite applications for a suite of fellowships in contemporary Asia studies to begin in fall quarter 2026.
The Center offers postdoctoral fellowships that promote multidisciplinary research on Asia health policy, contemporary Japan, and contemporary Asia broadly defined, as well as postdoctoral fellowships and visiting scholar positions with the Stanford Next Asia Policy Lab and a visiting fellow position on contemporary Taiwan. Learn more about each opportunity and its specific application requirements:
2026-27 Asia Health Policy Program Postdoctoral Fellowship
Hosted by the Asia Health Policy Program at APARC, the fellowship is awarded to one recent PhD recipient undertaking original research on contemporary health or healthcare policy of high relevance to countries in the Asia-Pacific region, especially developing countries. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.
Hosted by the Japan Program at APARC, the fellowship supports research on contemporary Japan in a broad range of disciplines, including political science, economics, sociology, law, policy studies, and international relations. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.
2026-27 Shorenstein Postdoctoral Fellowship on Contemporary Asia
APARC offers two postdoctoral fellowship positions to junior scholars for research and writing on contemporary Asia. The primary research areas focus on political, economic, or social change in the Asia-Pacific region (including Northeast, Southeast, and South Asia), or international relations and international political economy in the region. Appointments are for one year beginning in fall quarter 2026. The application deadline is December 1, 2025.
2026-28 Next Asia Policy Postdoctoral Fellowships and 2026-27 Visiting Fellow Positions
The Stanford Next Asia Policy Lab (SNAPL) is committed to addressing Asia's emergent social, cultural, economic, and political challenges. Housed at Shorenstein APARC, the lab is led by Korea Program Director Gi-Wook Shin.
SNAPL invites applications for two postdoctoral fellowships (two years in length) to begin in fall quarter 2026. There are four fellowship tracks, and applicants can apply for any of them: "Talent Flows and Development,” "Nationalism and Racism," "U.S.-Asia Relations," and "Democratic Crisis and Reform." Each postdoctoral fellow will lead one thematic research group and support student programming for SNAPL alongside general research and publication activities. The deadline to apply for the 2026-2028 postdoctoral fellowships is December 1, 2025.
SNAPL also offers two visiting fellow positions (one year in length) to begin in fall quarter 2026. These positions are open to researchers and professionals from the Asia-Pacific region who hold a PhD or a substantial record of achievement related to the Lab's four research themes. One of the two positions will be specifically dedicated to research on the Philippines. The deadline to apply for the 2026-2027 visiting fellow positions is March 1, 2026.
Hosted by the Taiwan Program at APARC, the fellowship is awarded to one mid-career to senior-level expert with extensive experience studying contemporary Taiwan. The fellowship research focus is on issues related to how Taiwan can meet the challenges and opportunities of economic, social, technological, environmental, and institutional adaptation in the coming decades, using a variety of disciplines, including the social sciences, public policy, and business. The application deadline is March 1, 2026.
Taiwan Studies Students and Scholars Gather at Stanford to Advance New Directions for the Field
The North American Taiwan Studies Association’s 2025 conference invited participants to embrace the “otherwise,” elevating overlooked aspects of Taiwan and reimagining the field of Taiwan studies to challenge dominant narratives and disciplinary methodologies.
The center offers multiple fellowships in Asian studies to begin in fall quarter 2026. These include a postdoctoral fellowship on political, economic, or social change in the Asia-Pacific region, postdoctoral fellowships focused on Asia health policy and contemporary Japan, postdoctoral fellowships and visiting fellow positions with the Stanford Next Asia Policy Lab, and a visiting fellow position on contemporary Taiwan.