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In the four years since a State Council think tank, the Development Research Center, bluntly declared the failure of three decades of healthcare reform, China has placed a high political priority on designing, building and financing a modern, equitable health delivery system that serves every last one of its 1.3 billion people. As publisher of practice-building trade magazines for medical specialists in China and India, Jeffrey Parker has developed unique and valuable perspectives on what's wrong with China's healthcare system -- and how Indian practitioners are able to deliver results despite a per-capita GDP that is roughly half of China's. Through an unprecedented China-India training exchange, Mr. Parker has begun testing whether Indian models of self-financed grassroots medical startup practices can help doctors shake free of China’s Stalinist paralysis without having to wait for sweeping programmatic reforms that are always on the horizon, but seem never to come. What's more, would such grassroots empowerment models not create unprecedented opportunities for participation by international investors who up to now have been largely marginalized in China's healthcare development?

In this lunchtime colloquium, Mr. Parker reviews his experiences in China and India over the past six years and looks at several exciting recent developments in China. These include:

  • An ambitious rural reimbursement scheme that already has begun to complete a nationwide healthcare safety net. The program is creating a vast pool of funds to finance rural medical services, but how will Beijing populate the countryside with sustainable grassroots practices?
  • The first domestic healthcare IPO, by which Aier Ophthalmology raised some $50 million as one of 28 debut listings in the Shenzhen's new "ChiNext" Growth Enterprise Market. New wind in the sails of healthcare privatization?
  • Licensing reforms that have begun delinking doctors' certification from their "work unit" hospitals under trials in Beijing and Yunnan, removing a vexing obstacle to hands-on surgical training of young practitioners. Will the breaking of senior doctors' "skills monopoly" create opportunities for private-sector training programs that will shake up China's Soviet-style residency programs?

Jeffrey Parker has lived in Greater China since 1990, first as a journalist and since 2003 as a publisher. His transition from chronicler of China's historic rise to active proponent of its economic development gives him a unique perspective on the opportunities still opening up in China -- and the challenges facing anyone keen to participate. With a twin B.A. in Asian Studies and Geography from U.C. Santa Barbara and Masters training in Journalism from Columbia University, Parker trimmed his sails for a China career from an early age. After early editorial jobs in New York and Washington, D.C., he was dispatched to Beijing by United Press International as senior correspondent in 1990. During the next 10 years with UPI and then Reuters, he covered a wide range of political, economic and social stories from postings in Hong Kong, Taiwan and the Peoples Republic. In his final two years at Reuters, Parker got his first taste of media development, launching local-language multimedia news and video feeds in China, Japan, Korea, India and Southeast Asia. Since 2003, Parker has built up a family of world-class doctors' magazines serving more than 50,000 specialists in China and India from the Shanghai base of ILX Media Group, where he is editorial director, chief operating officer, a corporate director and investor. Among his objectives is to help foster a badly needed transformation of medical practice across China by inspiring grassroots doctors to deliver high-quality, cost-effective services in rural and less-developed communities left behind by government health care.

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Jeffrey Parker Speaker ILX Media Group, Shanghai, PRC
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Shorenstein APARC
Stanford University
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Jim Hoesterey is a cultural anthropologist whose research explores the burgeoning industry of Islamic self-help in contemporary Indonesia. He recently completed his Ph.D. in Anthropology at the University of Wisconsin-Madison where he also received a M.A. in Anthropology. Hoesterey also holds an M.A. in Anthropology from the University of South Carolina and a B.A. in Psychology from Marquette University.

During two years of ethnographic fieldwork (2005-07) at the Islamic school and “Heart Management” training complex of television preacher Abdullah Gymnastiar, Hoesterey sought to understand how a new generation of popular preachers and Muslim “trainers” has garnered novel forms of psycho-religious authority within the market niche of Islamic self-help.

As a postdoctoral fellow at the Shorenstein Asia-Pacific Research Center, Hoesterey worked on his book manuscript, "Sufis and Self-help Gurus: Religious Authority and the Cultural Politics of Morality in Indonesia."

James Hoesterey Shorenstein Fellow, Shorenstein Asia-Pacific Research Center Speaker Stanford University
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In this third session of the Forum, former senior government officials and other leading experts from the United States and South Korea discussed current developments in North Korea and North Korea policy, the future of the U.S.-South Korean alliance, and a strategic vision for Northeast Asia.  The session was hosted by Sejong Institute, a top South Korean think tank, in association with Shorenstein APARC.

Grand Hyatt Hotel, Seoul, Korea

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The principal-agent problem in health care asserts that providers, being imperfect agents for patients, will act to maximize their profits at the expense of the patients’ interests. This problem applies especially where professional regulations are lacking and incentives exist to directly link providers’ actions to their profits, such as a fee-for-service payment system. The current analysis tests for the existence of the principal-agent problem in the private health market in Vietnam by examining the prescribing patterns of the private providers. We show that

  1. private providers were able to induce demand by prescribing more drugs than public providers for a similar illness and patient profile;
  2. private providers were significantly more likely to prescribe injection drugs to gain trust among the patients; and
  3. patients’ education as a source of information and empowerment has enabled them to mitigate the demand inducement by the providers.

Our hypotheses were supported with evidence from Vietnam National Health Survey 2001 and 2002, the first and, so far, only comprehensive health survey in the country.

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The health sector's successes in Vietnam have been described as "legendary" by international donors, but there is always the other side of the story. One can question the objectivity of reports from the government of Vietnam, the World Bank, and the World Health Organization. One can wonder in what areas the health sector has failed, who has paid for a "success story" and at what cost, and how much information is well documented and has been made public. Are there "stylized facts" regarding those aspects of health that have been successfully reformed compared with those where reform has lagged? Given these concerns, how can the research community contribute to improving health policy in Vietnam?

Dr. Truong will share his thought on recent socioeconomic development in Vietnam, discuss key health policy issues, and reflect upon his experiences including a research project in which the University of Queensland collaborated with Ministry of Health of Vietnam. Additional evidence will be drawn from a study of the cost-effectiveness of interventions to reduce tobacco use in Vietnam.

Khoa Truong was a visiting faculty member at the Hanoi School of Public Health and a research fellow at the Health Strategy and Policy Institute in 2008-2009.  Prior to that he spent six years as a doctoral fellow at the RAND Corporation.  His research interests include tobacco, alcohol, and illicit drug control policies; the impacts of built environments on health; international health issues; and economic development.

He received his doctorate and master of philosophy in policy analysis from the Pardee RAND Graduate School and earned a master's degree in development economics from Williams College. A native of Vietnam, he began his career working with NGOs in bilateral and multilateral development projects in Southeast Asia. He was awarded a Fulbright scholarship and wrote “most outstanding paper” submitted at an AcademyHealth's Annual Research Meeting (acknowledged as the premier forum for sharing the results of scholarship on health services).

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Dr. Khoa Truong Assistant Professor of Department of Public Health Sciences Speaker Clemson University
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In five new books -- three of which were produced as part of Shorenstein APARC's in-house publishing program, distributed through the Brookings Institution Press -- Center academics tackle an array of issues related to Asia's past, present, and future, from both policy and historical perspectives.

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Donald K. Emmerson
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Islamism: Contested Perspectives on Political Islam was published by Stanford University Press in November 2009. But the story behind the book dates back five years to November 2004. It was then that Donald K. Emmerson and Daniel M. Varisco agreed to disagree.

Emmerson spoke on "Islamism: What Is to Be Said and Done?" (video link and discussion) at the Woodrow Wilson International Center for Scholars in Washington DC on 30 November 2009.

Varisco, a Hofstra University anthropologist with expertise on Islam and the Middle East, had invited Emmerson to join a panel on "Islam and Political Violence: The ‘Ismhouse' of Language" at the 2004 annual meeting of the Middle East Studies Association.

Emmerson was pleased to accept. Not since graduating from high school in Beirut had he lived in the Middle East. He had specialized instead on Indonesia, famously known as having more Muslims than any other country, yet spatially and spiritually peripheral to the Middle Eastern locations of Mecca, Medina, and the Al-Aqsa Mosque. Emmerson relished the chance to interact with experts whose knowledge of Muslim societies had been acquired mainly in Arab settings. He also shared Varisco's interest in discussing the controversial and contested meanings of the words "Islamism" and "Islamist." Since 9/11 these terms had become increasingly common in English-language discourse on Islam, Muslims, and violence by Muslims claiming to be acting in the name of their religion.

On the panel, before some two hundred MESA attendees, Varisco and Emmerson politely disagreed. Varisco argued that "Islamism" and "Islamist" were invidious terms that falsely linked Islam to terrorism. For the sake of consideration and accuracy, he said, they should not be used. Without advocating self-censorship, he defended his refusal to use "Islamism" or "Islamist" in his own writing and teaching.

"Inventing Islamism: The Violence of Rhetoric" is the title of Varisco's MESA paper as it appears in the book. "Why," he asks, "do we need a term that uniquely brands Muslims as terrorists rather than just calling them terrorists and militants, the way we could easily do for followers of any religion or any ideology? As scholars and students of religion, should we not be doing all we can to refute the notion that Islam is intrinsically more violent than other religions?" (Islamism, p. 33.)

Emmerson agreed with Varisco that the terms "Islamism" and "Islamist" were often used to conflate Islam, Muslims, and violence. But Emmerson argued that the words were not so uniformly and falsely invidious as to warrant their deletion. In his view, in addition to referencing radical views and acts, the terms usefully named a variety of mostly peaceful ways of expressing and advancing subjective interpretations of Islam in public life. Phrases such as "democratic Islamism" and "moderate Islamists," hr argued, were already fairly common in scholarship and the media. His chapter is entitled, accordingly, "Inclusive Islamism: The Utility of Diversity."

After the session at MESA, Varisco, Emmerson, and copanelist Richard C. Martin, an Islamic studies professor at Emory University, spoke of someday turning the discussion into a book. Busy with other projects, they postponed this one, but eventually took it up again as an experiment with an unusual format: As a neutral party, Martin (with the later addition of one of his graduate students, Abbas Barzegar) would edit the book, which would open with chapters by Emmerson and Varisco stating their views. Scholars of Islam from around the world would be invited to comment briefly on the dispute. More than a dozen experts in or from the Middle East, North Africa, North America, and Southeast Asia contributed remarks, which fill the middle of the book. Varisco and Emmerson end the volume with chapters that update and extend their respective arguments in response to each other's and the commentators' views.

An anonymous reviewer of the manuscript for Stanford University Press suggested that Islamism as a phenomenon was on the decline, implying that the relevance of Islamism would follow suit. In Emmerson's opinion, this may not happen soon. Juxtapositions of Islam, Muslims, and violence continue to occur in a range of Muslim-majority countries. At the same time, a great variety of Muslim leaders and organizations committed to peace, dialogue, and democracy continue to demonstrate the civility of Islam as they understand it. This rich spectrum of motives and associations will continue to challenge analysts around the world -- scholars, journalists, and policymakers alike.

Is Islam a religion of peace? War? Neither? Both? In the case of those Muslims who do carry out acts of violence or intolerance in the name of Islam, should their claims to have been motivated by religious imperatives be accepted as true, rejected as false, or bracketed as subjective? How considerate and how accurate is it to assert that any Muslim who engages in terrorism must not be a true Muslim? What is a "true Muslim"? By whose standards?

Is it appropriate to argue, with Emmerson, that to speak of "Islamic terrorism" wrongly and hurtfully implies that terrorism is intrinsic to Islam as a religion, whereas the notion of "Islamist terrorism" merely links such violence to one among many possible ways of interpreting Islam as an ideology? Or should these distinctions about words be ignored in favor of actions, including possible revisions of American policy, that can help to diminish the incidence of supposedly religious violence, whatever its actual nature may be?

In months and years to come, Muslims accused of having planned or committed violence against American targets will be judged in a series of civilian and military trials here in the United States. The defendants will likely include high-profile individuals such as Khalid Sheikh Mohammed, charged with plotting 9/11, and Nidal Malik Hassan, accused of the November 2009 rampage at Fort Hood. Some of the accused may admit responsibility for acts of violence and portray what they did as required by Islam. Some may accuse the US government of waging war against Islam. Some may claim innocence, or attribute what they did to personal reasons unrelated to religion. Stimulated by these proceedings, commentators on the Internet, in the press, and on talk shows can be expected to debate "Islamic terrorism" versus "Islamophobia."

Quite apart from whether fresh acts of terror occur, interest in the questions that Islamism features seems, at least to Emmerson, unlikely to decrease.

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Daniel C. Sneider: Since the Democratic Party of Japan won in the country's August national election, Japan watchers have worried that the new government might try to upset the status quo and ease away from the United States. The DPJ is implementing a new paradigm -- but not the one people think.

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David Straub, associate director of Korean Studies Program, told a Korea Foundation-organized seminar in Seoul that he sees "no indication that North Korea, in the foreseeable future, is prepared to give up its nuclear weapons programs on terms that the US will find politically acceptable." While supportive of Ambassador Bosworth's upcoming visit to Pyongyang, Straub, a former State Department Korean affairs director, noted that North Korea's recent words and deeds had left most American observers increasingly skeptical about North Korean intentions.
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Inspectors from the International Atomic Energy Agency (IAEA) return to the DPRK after a period of absence of more than four years, here the IAEA convenes a meeting in Vienna to discuss matters.
Flickr/IAEA Dean Calma
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Karen Eggleston
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Global health disparities were the topic of a special event November 11th co-sponsored by the Asia Health Policy Program of the Shorenstein Asia-Pacific Research Center and the Center for Health Policy / Primary Care and Outcomes Research.

Sir Michael Marmot, internationally renowned Principal Investigator of the Whitehall Studies of British civil servants (investigating explanations for the striking inverse social gradient in morbidity and mortality), spoke about research on the social determinants of health and taking action to promote policy change. Pointing out the extreme disparities in life expectancy for peoples in different parts of the world – including the “haves” and “have-nots” within the high-income world – he presented an overview of “Closing the gap in a generation: Health equity through action on the social determinants of health” (http://www.who.int/social_determinants/en/). That report was commissioned by the World Health Organization (WHO) and released last year; Sir Marmot served as the Chair of the Commission on Social Determinants of Health.

Criticizing those who justify initiatives in global health solely on economic grounds, Sir Marmot argued that addressing the social determinants of health is a matter of social justice.

He presented data and discussed the report’s three primary recommendations: 1. Improve daily living conditions; 2. Tackle the inequitable distribution of power, money, and resources; and 3. Measure and understand the problem and assess the impact of action.
Stating that the World Health Assembly resolution on the social determinants of health was only meaningful as a first “baby step,” Marmot urged the audience to consider how research and policy advocacy can address the social determinants of health so that all individuals can lead flourishing lives.

Examples from Asia include

  • the high risk of maternal mortality (1 in 8) in Afghanistan;
  • the steep gradient in under-5 mortality in India (with the rate almost three times higher for the poorest quintile than for the wealthiest quintile);
  • less than half of women in Bangladesh have a say in decision-making about their own health care;
  • a large share of the world’s population living on less than US$2 a day reside in Asia;
  • social protection systems like pensions are possible in lower and middle-income countries, with Thailand as an example;
  • more can be done to address the millions impoverished by catastrophic health expenditures, such as in southeast Asia; and
  • conflict-ridden areas and internally displaced people, such as in Pakistan and Myanmar, are among the most vulnerable.

He also responded to questions about the role of freedom and liberty in social development – contrasting India and China – and commented on the peculiar contours of the US health reform debate.

Professor Marmot closed by noting that, in exhorting everyone to strive for social justice and close the gaps in health inequalities all too apparent in our 21st century world, he hoped he was not too much like Don Quixote, going around “doing good deeds but with people all laughing at him.” 
Professor Sir Michael Marmot MBBS, MPH, PhD, FRCP, FFPHM, FMedSci, is Director of the International Institute for Society and Health and MRC Research Professor of Epidemiology and Public Health at University College, London. In 2000 he was knighted by Her Majesty The Queen for services to Epidemiology and understanding health inequalities.

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