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This event is part of the Asia Health Policy Program (AHPP) 2020-21 Colloquium series "Health, medicine, and longevity: Exploring public and private roles"

We will hear from distinguished speakers on public-private collaborations in accelerating improvements in palliative care in Singapore and parts of South Asia, as well as informal care and technology-enabled self-management of chronic illness among Asian-Americans. Joining us from Singapore is Mr. Laurence Lian, Chairman of the Lien Foundation, sharing evidence about the impact of the Foundation’s work on end of life care, collaborating with the public sector in palliative care training, improving access to pain medication, and other initiatives. Dr. Ranak Trivedi of Stanford will discuss her work to address the stress management needs of patients and their families and to improve culturally concordant care for South Asian women with breast cancer and their caregivers.

Speakers:

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Laurence Lien 4X4
Laurence Lien is Co-Chair and CEO of the Asia Philanthropy Circle (APC), a membership-based platform for Asian philanthropists to exchange, learn and collaborate.  Laurence is also the Chairman of Lien Foundation, a family foundation that has become well-regarded for its forward-thinking and radical approach in the fields of education, eldercare and the environment, as well as the Chairman of Lien AID, the foundation humanitarian arm for enabling sustainable access to clean water and sanitation for Asia’s rural poor.

Laurence was the CEO of the National Volunteer & Philanthropy Centre in Singapore from 2008-2014, and was the Chairman of the Community Foundation of Singapore from 2013-2019.  Prior to his work in the non-profit sector, Laurence served in the Singapore Government.  Laurence holds degrees from Oxford University, the National University of Singapore, and Harvard University’s Kennedy School of Government.  He was also a Nominated Member of Parliament in Singapore from 2012-2014. 

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Ranak Trivedi 4X4
Dr. Ranak Trivedi is a clinical health psychologist, assistant professor in the Dept. of Psychiatry and Behavioral Sciences, Stanford University and an investigator at the Center for Innovation to Implementation at the VA Palo Alto Health Care System. She completed her PhD in clinical health psychology at Duke University. Her NIH, VA and foundation-funded studies are focused on improving outcomes for Veterans with mental health conditions, and improving the self-management of serious illnesses by enhancing the collaboration and coping of patients and their caregivers. Her studies have provided insights into how caregivers and chronically and seriously patients collaborate around their mutual health, understanding the impact of their interpersonal relationship on chronic illness self-management, and the individual, dyadic, and systems-level barriers that they encounter. These insights have been used to develop two technology-enabled dyadic self-management programs to address the stress management needs of both patients and their framily. Dr. Trivedi is a Sojourns Scholars Leader, and she is using this platform to improving culturally concordant care for South Asian women with breast cancer and their caregivers. Dr. Trivedi was selected for the year long Leadership Institute for Women in Psychology hosted by American Psychological Association in 2020. Dr. Trivedi serves as the Director of Training and Education at the Center for Innovation to Implementation at the VA Palo Alto Health Care System, site PI and Training Director for the Elizabeth Dole National Center of Excellence for Veteran and Caregiver Research, and the Director of Caregiving and Family Systems at the Stanford Center for Asian Health Research and Education (CARE).

Via Zoom Webinar.
Register https: https://bit.ly/3slcunI

Laurence Lien Co-Chair & CEO, Asia Philanthropy Circle
Ranak Trivedi Assistant Professor, Stanford University, and Director of Caregiving and Family Systems, Stanford Center for Asian Health Research and Education
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APARC is pleased to announce the appointment of political scientist Dr. Diana Stanescu and doctoral candidate in sociology Mary-Collier Wilks as our 2021-22 Shorenstein postdoctoral fellows on contemporary Asia. They will begin their appointments at Stanford in autumn 2021.

The Shorenstein Postdoctoral Fellowship on Contemporary Asia supports recent doctoral graduates dedicated to research and writing on contemporary Asia, primarily in the areas of political, economic, or social change in the Asia-Pacific, or international relations in the region.

Fellows develop their dissertations and other projects for publication, present their research, and participate in the intellectual life of APARC and Stanford at large. Our postdoctoral fellows often continue their careers at top universities and research organizations around the world and remain involved with research and publication activities at APARC.

Meet our new postdoctoral scholars:


Diana Stanescu

Research Project: Do Bureaucratic Networks Matter for Market Access? The Effect of Informal Connections on Trade and FDI of Japanese Firms.

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Portrait of Diana Stanescu
Diana Stanescu is a postdoctoral fellow with the Program on U.S.-Japan Relations at Harvard University’s Weatherhead Center for International Affairs. She holds a B.A. in International Relations and Asian Studies from Mount Holyoke College and an M.A. and Ph.D. in Political Science from Princeton University. She is a former pre-doctoral exchange scholar in the Department of Government at Harvard.

Dr. Stanescu’s research interests include international trade, regulation, and lobbying with a focus on Japan. Using formal and quantitative methods, her research addresses the overarching question of how bureaucracies shape global economic governance, from a structural and agent-driven perspective. Her dissertation, “The Bureaucratic Politics of Foreign Economic Policymaking,” explains the mechanisms by which stakeholders shape international economic policy through bureaucratic channels of influence. Additional work looks at the micro-foundations of bureaucratic structure and its consequences for policy, examines the role of individual bureaucrats within domestic and international institutions, and develops micro-level data on bureaucratic careers and appointments.

At APARC, Stanescu will further assess how politicians and interest group representatives maneuver within bureaucratic channels to have influence over foreign economic policy. In particular, she will examine how bureaucratic-interest group networks help firms obtain market access abroad, with evidence from trade and foreign direct investment in Japan.

Mary-Collier Wilks

Research project: How do conceptions of gender, sexuality, and women’s advancement shape the construction of development knowledge and foreign aid?

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Portrait of Mary-Collier Wilks
Mary-Collier Wilks is currently a doctoral candidate in Sociology at the University of Virginia. Her research agenda centers on meaning-making and power dynamics in international organizations, with a particular focus on the ways in which people encounter international development in everyday lives and the gendered meanings, divisions, and struggles that arise from such encounters.

It was Wilk’s work as a grant writer at a local NGO, Social Services of Cambodia, that first sparked her interests in globalization, gender, and the politics of international development. Having seen how resources and ideas from all over the world flow through NGOs to affect the lives of people in Cambodia, she began thinking about the complicated process of foreign aid and international development. She also gained experience as a consultant in the development sector, performing a gender analysis for a USAID health project and serving as a trainer for a USAID Women’s Leadership Conference.

For her dissertation, which is funded by the National Science Foundation and the Fulbright IIE, Wilks conducted a multi-sited ethnography comparing U.S. and Japanese international NGOs that advance women's health in Cambodia. Her work contributes to scholarly theories of global civil society and international development, contending that to adequately analyze and improve development outcomes, we must attend to national variation in international NGO programs and practices.

At APARC, Wilks will transform her dissertation manuscript into a book and extend her comparative research agenda to investigate how NGO practices are shaped by the business cultures in which their donors are embedded.

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China may now be able to prevail in cross-strait contingencies even if the United States intervenes in Taiwan’s defense, Chinese security expert Oriana Skylar Mastro tells the U.S.-China Economic and Security Review Commission. Changes must be made to U.S. military capabilities, not U.S. policy, she argues.
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[Left] Radhika Jain, [Right] Postdoc Spotlight, Radhika Jain, Asia Health Policy Program
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Postdoctoral Fellow Spotlight: Radhika Jain on Reducing Inequalities in Health Care and Outcomes

Radhika Jain, a postdoctoral fellow with the Asia Health Policy Program, shares insights on her research into India’s health care system and how it is responding to both the COVID-19 pandemic and standard healthcare needs of citizens.
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[Left] Postdoc Spotlight, Jeffrey Weng, Shorenstein Postdoctoral Fellow in Contemporary Asia, [Right] Jeffrey Weng
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Postdoc Spotlight: Jeffrey Weng on Language and Society

Shorenstein Postdoctoral Fellow in Contemporary Asia Jeffrey Weng shares insights from his research into how language and society shape one another, particularly how the historical use of Mandarin affects contemporary Chinese society and linguistics.
Postdoc Spotlight: Jeffrey Weng on Language and Society
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Political scientist Dr. Diana Stanescu and sociologist Mary-Collier Wilks will join APARC as Shorenstein postdoctoral fellows on contemporary Asia for the 2021-22 academic year.

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Noa Ronkin
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China and the United States are usually cast as fierce rivals, but there are broad areas of society where the two nations share profound similarities. As they confront growing demands to provide their citizens with goods and services such as healthcare, education, housing, and transportation, both the Chinese and U.S. governments engage the private sector in the pursuit of public value, although they do so in different ways.

This type of engagement, in which the government calls on the private sector to meet public goals, is known as collaborative governance and it is becoming an increasing share of the economy in both China and the United States. A new book, The Dragon, the Eagle, and the Private Sector (Cambridge University Press), analyzes the application of collaborative governance in a wide range of policy arenas in China and the United States.

The book itself is the result of collaborative research by three co-authors: APARC Deputy Director Karen Eggleston, Harvard Kennedy School Raymond Vernon Senior Lecturer in Public Policy John Donahue, and Harvard Kennedy School’s Frank P. Ramsey Professor of Political Economy Richard Zeckhauser. On March 5, 2021, the three co-authors gathered for a virtual book launch, an event co-sponsored by Shorenstein APARC and the Mossavar-Rahmani Center for Business and Government at the Harvard Kennedy School.

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Introducing the new book, Lawrence H. Summers, president emeritus of Harvard University and the Charles W. Eliot University Professor at the Kennedy School, called the co-authors’ analysis of collaborative governance “micro microeconomics” that shows how particular tasks and particular commitments of resources, once decided on, are going to be best accomplished. This work, Summers noted, sheds light on situations involving both cooperation and competition — aspects that affect almost any complex problem yet are rarely considered by economists.

A key element of collaborative governance, noted Zeckhauser, is the sharing of discretion. Rather than contracting at one pole and complete laissez-faire at the opposite pole, in a collaborative governance process, the two parties involved play a role in determining what is produced and how it is produced. It is a process that calls on the best capabilities of both the private and public sectors and that grants each of them an element of control. Sometimes that process results in triumphs, sometimes in tragedies, and other times in outcomes that are “in-between.” The book analyses cases of this entire gamut. “We hope that this volume provides guidance on how the triumphs can become more common, the tragedies more scarce, and the in-between outcomes improved,” said Zeckhauser.

This book provides a key to understanding how to achieve [...] quality-public-private collaboration, done right. Delving deep into two very different societies, the US and China, the authors provide lessons that illuminate and should inform scholars and policymakers alike.
Fareed Zakaria
Journalist and Author

Collaborative Governance in the Time of COVID-19

The unfolding of the COVID-19 pandemic provides dramatic current illustrations of collaborative governance. The urgent need for an effective vaccine created the conditions for a successful partnership between the U.S. government and the pharmaceutical sector, with the former offering both regulatory processes and significant financing, the latter its innovation. Consider the Moderna vaccine, which, based on evidence from clinical trials, is over 90% effective at preventing laboratory-confirmed COVID-19 illness. The vaccine was created within less than a year using a new approach, based on Messenger RNA technology, by a company that had never before produced a commercial product. “This is a triumph of collaborative governance,” said Zeckhauser.

The vaccine distribution process in the United States, however, has proved to be challenging and chaotic. Zeckhauser contrasted this experience with China’s activation of technology giant Tencent, which is using its ubiquitous WeChat application to allow individuals to easily find where the vaccine is distributed and sign up for vaccination appointments. “There is probably a lesson here in the way these two outcomes came about. We hope that individuals in both China and the United States will examine the lessons in this volume to see how they can achieve outcomes for their citizens that produce public benefits more effectively.”

A Spectrum of Policy Domains

The book details how China and the United States grapple with the complexity of producing the goods and services they need to meet a broad array of public goals. Eggleston surveyed the five broad policy domains she and her co-authors examine in the book through detailed historical legacies and case studies of the application of collaborative governance in both countries.

These domains include the railroads that build the nation historically in both countries and China’s high-speed rail network; real estate's intricate tangle of public and private partnerships; hosting the Olympic Games and the experience of the public and private sectors in that endeavor in both countries; education provision; and state and market in population health and health care in both countries. The book spotlights the different ways in which both countries produce public goods and services in these broad policy domains.

It is crucial for China to embrace the transparency imperative because the evil twin of collaborative governance is cronyism or corruption.
John Donahue
Harvard University

East and West

Professor Yijia Jing of Fudan University, an expert on privatization, governance, and collaborative service delivery, participated in the discussion with the book co-authors and shared insights on public-private relationships in China. Collaborative governance in the country, he said, has undergone a gradual process of institutionalization. He observed that Chinese local governments apply different strategies in collaborating with private companies. For example, local governments like Guangdong and Shanghai partner in different ways with digital giants Tencent and Alibaba to build up their digital capacities — collaborations through which they have been learning how to balance their multiple roles as partners, policymakers, and market regulators.

Jing noted that China uses collaborative governance not only in domestic arenas but also in areas of international development, through entities such as the BRICS Development Bank and the Asian Infrastructure Investment Bank. China is also promoting collaborative governance as part of its Belt and Road initiative.

A Call for Transparency

The Dragon, the Eagle, and the Private Sector helps decision-makers apply the principles of collaborative governance to effectively serve the public. The book's overarching conclusion is that transparency is the key to the legitimate growth of collaborative governance. In the United States, said Donahue, the principle of governmental transparency is widely accepted as a broad-spectrum accountability device. He recognized that he and his co-authors do not expect China to adopt the U.S. approach to transparency, but expressed their hope to see more transparency “with Chinese characteristics.” “It is crucial for China to embrace the transparency imperative because the evil twin of collaborative governance is cronyism or corruption,” Donahue argued.

In many countries and policy arenas, collaborative governance could effectively increase innovation but is not available because the populace is convinced that any interaction between the public and private sectors amounts to corruption on the part of elites against the public interest. The potential in China to create public value through interaction between its public and private sectors is enormous, concluded Donahue. ”It would be a shame to squander that.”

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[Left] A nurse assists an elderly woman in a wheel chair; [Right] Oliver Hart
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In their new book, APARC Deputy Director Karen Eggleston and co-authors John Donahue and Richard Zeckhauser of Harvard University seek to empower decision-makers to more wisely engage the private sector in the pursuit of public value by analyzing how China and the United States use collaborative governance strategies to meet growing demands for public services.

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A quarter-century ago in a seminal paper, Hart, Shleifer, and Vishny (NBER1996, QJE1997) developed a theory of the ‘Proper Scope of Government.’ Oliver Hart, 2016 Nobel Laureate, reflects on that framework and its place in economics, as well as the inspiration for his more recent work on norms, guiding principles, and contracts as reference points. In discussion with Karen Eggleston, Hart answers questions posed by economists who have built upon Hart, Shleifer and Vishny (1997) and offers insights on how the theory applies to understanding public and private roles in healthcare, education, and other publicly-financed services.

Watch the webinar featuring Hart's keynote: https://youtu.be/sDp7ytudbsE

Oliver Hart is currently the Lewis P. and Linda L. Geyser University Professor at Harvard University, where he has taught since 1993. He is the 2016 co-recipient of the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel, a Fellow of the Econometric Society, the American Academy of Arts and Sciences, the British Academy, and the American Finance Association, a member of the National Academy of Sciences, a Distinguished Fellow of the American Economic Association, and has several honorary degrees. Hart works mainly on contract theory, the theory of the firm, corporate finance, and law and economics. His research centers on the roles that ownership structure and contractual arrangements play in the governance and boundaries of corporations. He has published a book (Firms, Contracts, and Financial Structure, Oxford University Press, 1995) and numerous journal articles. He has used his theoretical work on firms and contracts in several legal cases. He has been president of the American Law and Economics Association and a vice president of the American Economic Association.

This keynote is part of the Stanford Asia Health Policy Program colloquium series entitled Health, Medicine, and Longevity: Exploring Public and Private Roles

Oliver Hart, Andrei Shleifer, Robert W. Vishny, The Proper Scope of Government: Theory and an Application to Prisons, The Quarterly Journal of Economics, Volume 112, Issue 4, November 1997, Pages 1127–1161, https://doi.org/10.1162/003355300555448.

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Asia Health Policy Program working paper # 64

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Co-sponsored with the Harvard Kennedy School

This event is part of the Asia Health Policy Program (AHPP) 2020-21 Colloquium series "Health, medicine, and longevity: Exploring public and private roles"

Introduced by Lawrence H. Summers (President Emeritus, Harvard University), Richard Zeckhauser, Jack Donahue and Karen Eggleston discuss their recently published book, The Dragon, the Eagle, and the Private Sector: Public-Private Collaboration in China and the United States with Professor Yijia Jing of Fudan University, China's leading expert on public-private relationships will also participate. The governments of China and the United States - despite profound differences in history, culture, economic structure, and political ideology - both engage the private sector in the pursuit of public value. This book employs the term collaborative governance to describe relationships where neither the public nor private party is fully in control, arguing that such shared discretion is needed to deliver value to citizens. This concept is exemplified across a wide range of policy arenas, such as constructing high speed rail, hosting the Olympics, building human capital, and managing the healthcare system. This book will help decision-makers apply the principles of collaborative governance to effectively serve the public, and will enable China and the United States to learn from each other's experiences. It will empower public decision-makers to more wisely engage the private sector. The book's overarching conclusion is that transparency is the key to the legitimate growth of collaborative governance.

"It has become increasingly clear over the last few years that in tackling a country’s problems, what matters most is the quality of government rather than the quantity. This book provides a key to understanding how to achieve that quality-public-private collaboration, done right. Delving deep into two very different societies, the US and China, the authors provide lessons that illuminate and should inform scholars and policymakers alike." -- Fareed Zakaria

"This important book addresses how the two most important countries, the U.S. and China, address what may be their most important question: How can their public and private sectors cooperate most effectively with each other to create value. This is the rare book that is both analytic and a pleasure to read. It makes a lasting impression. It deserves a very wide readership among all those concerned about the future of the global economy." -- Lawrence H Summers, President Emeritus, Harvard University

"Eggleston, Donahue, and Zeckhauser offer an authoritative and intriguing account of why and how collaborative governance, a key modern instrument that engages public and private actors for comparative advantages in coping with complex public affairs, has been widely and deeply practiced in two vastly different countries, China and the US. An essential reading with profound academic inspirations and rich empirical inquiries." -- Yijia Jing, Fudan University.

Speakers

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Lawrence H. Summer 4X4
Lawrence H. Summers is President Emeritus of Harvard University. During the past two decades he has served in a series of senior policy positions, including Vice President of development economics and chief economist of the World Bank, Undersecretary of the Treasury for International Affairs, Director of the National Economic Council for the Obama Administration from 2009 to 2011, and Secretary of the Treasury of the United States, from 1999 to 2001. 

 

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Richard J. Zeckhauser is the Frank Ramsey Professor of Political Economy at the Harvard Kennedy School.  

 

 

 

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John Donahue 4X4
John D. Donahue is Faculty Chair for the Master’s in Public Policy program at the Harvard Kennedy School.

 

 

 

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Karen Eggleston 4X4
Karen Eggleston is Senior Fellow at the Freeman Spogli Institute for International Studies and Director of the Asia Health Policy Program in the Shorenstein Asia-Pacific Research Center at Stanford University.

 

 

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Yijia Jing 4X4
Yijia Jing is a Chang Jiang Scholar, Seaker Chan Chair Professor in Public Management, Dean of the Institute for Global Public Policy, and Professor of the School of International Relations and Public Affairs, Fudan University. He conducts research on privatization, governance, and collaborative service delivery. He is the founding editor-in-chief of the journal Global Public Policy and Governance.

Lawrence H. Summers President Emeritus of Harvard University
Richard J. Zeckhauser Frank P. Ramsey Professor of Political Economy, Harvard Kennedy School
John D. Donahue Raymond Vernon Senior Lecturer in Public Policy, Harvard Kennedy School

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
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Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
karen-0320_cropprd.jpg PhD

Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director of the Asia Health Policy Program, Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
Faculty Fellow at the Stanford Center at Peking University, June and August of 2016
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Senior Fellow, the Freeman Spogli Institute for International Studies (FSI), Stanford University
Yijia Jing Dean of the Institute for Global Public Policy, and Professor of the School of International Relations and Public Affairs, Fudan University
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We often think of language as a democratic field, but it is not quite the common property of its speakers, argues Jeffrey Weng, APARC’s 2020-21 postdoctoral fellow on contemporary Asia. Rather, language is a skill that must be learned, says Weng, and it creates social divisions as much as it bridges divides. 

Weng studies the social, cultural, and political nature of language, with a focus on the evolution of language, ethnicity, and nationalism in China. His doctoral dissertation investigates the historical codification of Mandarin as the dominant language of contemporary mainland China. This summer, he will begin his appointment as an assistant professor at National Taiwan University. In this interview, Weng discusses the dynamics between linguistic and social change and the implications of his research for Asian societies today.


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What has shaped your interest and research into the study of language and linguistic dissemination?

As a first-grade student in the early 1990s attending Chinese school in central New Jersey on Saturday mornings, I learned how to write my first complete sentence in the language: “I am an overseas Chinese.” Now, this was a curious sentence to teach to a class full of American-born children of Taiwanese parents, and it’s a reminder that language is never a neutral conveyor of meaning. Language cannot but be freighted with social, cultural, and political import, a lesson reinforced in my high-school Spanish classes, in which I made my first forays into literature in a foreign language: stories by the great writers of Spain and Latin America not only spoke a wholly different language, but they told wholly different stories from those of their British and American counterparts.

Linguistic difference also is a signal of individual and social difference: my childhood visits with family in Taiwan opened my ears to a cacophonous Babel in the media and on the streets—though we spoke Mandarin at home, whenever we went out, people speaking Taiwanese were everywhere to be seen and heard. This was further amplified when I visited mainland China for the first time in my early 20s. Beijing, the supposed wellspring of the nation’s language, was bewildering—I could not understand much of the unselfconscious speech of the locals. And traveling several hundred miles in any direction would only deepen my incomprehension. And yet, on the radio and on TV, during formal events and on university campuses, there was always Mandarin to clear the way. I wanted to learn more about how this language situation came to be. For me, studying the social, cultural, and political nature of language is a way to a deeper understanding of how people are united and divided in vastly different contexts across the globe.

As you’ve looked deeper into how language shapes society and society shapes language, what is something surprising you’ve come to realize about that relationship?

People often see language as the ultimate democratic field when it comes to cultural practice. No matter how much you might tell people not to split their infinitives or end their sentences with prepositions, popular practice will always win the day. Or so we English speakers think. Ever since Merriam-Webster came out with its infamously descriptivist Third New International Dictionary in 1961, Anglophone language nerds have fought over whether dictionaries should be “prescriptive”—that is, rule-setting—or “descriptive”—reflective of popular usage. But really, these are two sides of the same coin. We take it for granted that privately-owned publishers of dictionaries spell out the supposed norms of our language. Not only that, we even think this ought to be the case. French is the usual counterexample: when government language authorities in Quebec or Paris try to stem the Anglophone tide, we think it absurd that so-called authorities would ever try to rule over something so fundamentally unruly as language.

In my research, however, I learned how fundamentally invented Mandarin as a language is—from its highly artificial pronunciation to the way its orthography has been stabilized. There used to be a lot of variability in how characters were written and how they could be used, much like English spelling before the 18th century. Mandarin, both spoken and written, was standardized only in the 1920s to facilitate mass literacy and national cohesion. So linguistic change might often follow and reflect social change, but the process can also operate in reverse—a government can change language in hopes of facilitating social change.

In your latest journal publication, you argue that language nationalization in Japan, Korea, and Vietnam between 1870-1950 was a state-led, top-down process directed at remaking society rather than the more traditional view of diffusion through trade, economics, and cultural exchange. Why is this an important distinction to make?

Again, we often see language as a democratic field, the common property of its speakers, but it isn’t really. Sociolinguists are often quick to remind us that linguistic differences reflect class differences—“proper” language is that of “educated” speakers. But language is a skill, and skills must be learned. Some people can learn skills more easily than others, whether through natural ability or, more importantly, the life circumstances they were born into. Rich people can more easily get a good education. Educational disparities are now part and parcel of today’s broader debates about inequality. But the very fact that we think this is a problem is a product of developments in the late 19th and early 20th centuries.

Before then, broad swaths of humanity were totally illiterate and had no chance at being educated, and most people did not think this was a problem. In Europe, the language of the Church and academia, even to some extent in Protestant areas, was Latin until the 18th century. Local vernaculars had gradually developed as independent media of communication in government chancelleries and popular literature since the Middle Ages, but they did not really gain ascendancy until the age of print-capitalism and nationalism in the 18th and 19th centuries. Marxian-influenced scholars have therefore concluded that the rise of national languages coincided with the rise of the bourgeoisie, whose own languages became those of the nations they constructed.

In France, for example, while revolutionaries in the 1790s advocated the use of Parisian French to unify a country divided by hundreds of local forms of speech, into the mid-19th century, even journeying 50 miles outside Paris found travelers having trouble making themselves understood to the locals. It took more than a century for French to gain a foothold in most of the country. Asia, too, was a polyglot patchwork for millennia, unified at the top by an arcane language much like Latin—Classical Chinese. This situation became politically untenable in the 19th century as European imperialism encroached on traditional sovereignties in China, Japan, Korea, and Vietnam. In order to counter the foreign threat, governments sought to strengthen their societies by educating their populations, which required making it easier to learn how to read and write. While standard languages have been described by historians and sociolinguists as “artificial” for less-privileged learners, Asia’s standard languages were artificial even to their bourgeois inventors.

Our understanding of the present is invariably colored by our interpretation of the past: if we understand a national language to be a bourgeois imposition that diffused via economic development, then we more easily see its continued imposition as a perpetuation of class prejudices. If on the other hand, we see an invented national language as a tool for bridging regional divisions and expanding economic opportunity for our children, then we feel much more positively about the spread of such languages. Both interpretations can be true at the same time, but we must remember that one is inseparable from the other.

Do you see any parallels between how language nationalization has occurred in the past to how language and society are shaping one another in the present?

The number of “standard” Mandarin speakers in the early 1930s could be counted on one hand. Today, it’s the world’s largest language by a number of “native” speakers. Though it began as an elite nationalizing project that was largely ignored by the masses of people in China, Mandarin is now more often seen as a hegemonic threat to local languages and cultures. Language can thus bridge divides, but also create new divisions. People in China are often ambivalent about the pace of change these days. When I visited cousins in rural Fujian during the Lunar New Year a few years ago, I noticed that all my nieces and nephews spoke Mandarin in almost all situations, to their parents, and especially to one another. Only my grandparents’ generation used the local Fuqing dialect as a matter of course. My parents’ generation spoke dialect to their parents, but a mix of Mandarin and dialect to their children—the cousins of my generation, who were able to speak the dialect, but were more comfortable speaking Mandarin among themselves and to their children. One of my young nieces who’d grown up in Beijing, where her parents had moved for work, even had a perfect Beijing accent. In a span of three generations, migration due to expanded opportunity had wrought enormous change in language habits. Much had been gained, but also much had been lost.

How has your time at APARC as one of our Shorenstein Postdoctoral Fellows aided your research project?

It’s certainly been a strange year to be a postdoc, given how we’ve all been operating remotely. Nevertheless, life and work have continued, and we’ve all been able to find new ways of building community and getting things done. I’ve personally benefited from the access to the vast academic resources of Stanford—library access, even online alone, is a lifeline to any researcher. Moreover, I’ve had the opportunity to chat on Zoom with Stanford faculty about research and connect with my fellow postdocs to support one another as we figure out how to move forward in our careers in these challenging times.

With your recent appointment as an assistant professor at National Taiwan University in Taipei, how do you anticipate your research interests growing and developing given the tension between Taiwan and China?

I am gratified to begin my academic career in a place of such diversity and openness as Taiwan. Language and identity are constant sites of contention in Taiwan's politics, and I look forward to expanding my on-the-ground understanding of these issues as I begin teaching in the sociology department at National Taiwan University. It is nothing short of miraculous that democracy has flourished at such an intersection of empires, colonialism, repressions, and struggles. And it is unsettling to see that flourishing takes place in such a precarious geopolitical location. NTU's sociology department is at the forefront of understanding all of these vital issues as we barrel forward into an ever more uncertain future.

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[Left] Radhika Jain, [Right] Postdoc Spotlight, Radhika Jain, Asia Health Policy Program
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[Left] Postdoc Spotlight, Jeffrey Weng, Shorenstein Postdoctoral Fellow in Contemporary Asia, [Right] Jeffrey Weng
Jeffrey Weng's research examines the relationship between how language shapes society and society shapes language.
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Shorenstein Postdoctoral Fellow in Contemporary Asia Jeffrey Weng shares insights from his research into how language and society shape one another, particularly how the historical use of Mandarin affects contemporary Chinese society and linguistics.

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In one of the first studies of service sector robotics using establishment-level data, we study the relationship between robots and staffing in Japanese nursing homes. We utilize variation in robot subsidies across prefectures as an instrumental variable to explore the impact of robot adoption on nursing homes’ staffing decisions. We find that robot adoption appears to decrease difficulty in staff retention and to increase employment by augmenting the number of care workers and nurses on flexible employment contracts. Robot adoption is negatively correlated with the monthly wages of regular nurses, consistent with reduced burden of care such as fewer night shifts. Our findings suggest that robots may not be detrimental to labor and may help to remedy challenges posed by rapidly aging populations.

JEL Code: I11, J14, J23, O30,
Key words: Robots, jobs, nursing homes, automation, aging, healthcare

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Asia Health Policy Program working paper # 63
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Karen Eggleston
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Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management in primary health care (PHC). We provide evidence on China’s efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% fewer inpatient admissions, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.

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Asia Health Policy Program working paper # 62
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Karen Eggleston
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Of the many issues that the COVID-19 pandemic has brought into focus, foremost in the spotlight is the vital role that healthcare systems play in societal wellbeing and security. Around the world, health systems of all types have had to rapidly adapt, reassess, and react to constantly changing needs.

The 2020-21 Asia Health Policy Program (AHPP) colloquium series, “Health, Medicine, and Longevity: Exploring Public and Private Roles,” brings together academics, theorists, on-the-ground NGO leaders, and government advisors to explore how partnerships between public providers and private organizations affect the quality and access to healthcare the world over.

The series recently featured a keynote address by Harvard economist Oliver Hart, the 2016 co-recipient of the Nobel Prize in Economics for his work on contract theory — a framework known as ‘The Proper Scope of Government.’ Hart joined AHPP Director and APARC Deputy Director Karen Eggleston to reflect on the impact his theory has had across disciplines in the 25 years since its publication and on the future of research into contract theory. Watch the conversation with Hart below.

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Oliver Hart and the ‘Proper Scope of Government’

Hart’s seminal economic theory, ‘The Proper Scope of Government,” underpins much of the research into public-private partnerships in healthcare. Hart developed this touchstone framework jointly with Andrei Shleifer and Robert W. Vishny to better evaluate when a government should provide a service itself and when it should contract with a private provider for support and execution of services.

The model outlined in Hart, Shleifer, and Vishny’s original 1996 working paper is designed to help providers and contractors consider the costs and benefits of a proposed contractual service agreement. While this model was originally applied to the case of prison privatization, the framework has served as an invaluable tool for researchers in multiple sectors including health policy and provision.

Reflections and Updates to the Theory

In reflecting on ‘The Proper Scope of Government,’ there are things Hart would like to see more fully incorporated into the theory to enrich its real-world applicability. Chiefly among these is better accounting for contractual incompleteness or the reality that a contract cannot anticipate and outline every possible unforeseen event or area of ambiguity. However, modeling contractual incompleteness is notoriously difficult given the almost-limitless factors of variability.

Some of Hart’s recent work on guiding principles responds to this challenge. Rather than trying to predict every aspect of a contractual relationship within the framing and language of a standard contract model, Hart argues that mutually agreed-upon guiding principles —such as equity, loyalty, and honesty — can serve as a foundation for navigating inevitable areas of ambiguity and potential conflict that a contract does not specifically state or that the original theory does not fully account for.

These guiding principles also help preserve space for renegotiation and innovation, which are necessary in an era of rapid technological advances and explosion of measurable data. In this context, Hart cautions against the mentality of ‘more is more:’

“If you put more and more things into the contract and then something happens that wasn’t in the contract, the fact that you put so much more in may make it more difficult to negotiate about the thing that you didn’t put in.”

 Applying ‘The Proper Scope of Government’

Hart shared a prime example of his theory at work in health systems in a case study of the Vancouver Island Health Authority. Traditionally, family physicians would continue as the primary care provider for their patients even if a patient needed hospitalization. But a change of law in 2006 required all specialized in-hospital care be contracted to hospitalists with little to no crossover with care provided by family practice physicians.

The result was a rise in caseload and stress levels amongst hospital specialists and repeated failed negotiations of the standard contract. The addition of guiding principles to the contract, however, provided avenues where reasonable solutions and additional communications could happen beyond the limits of the formal contract.

This is just one case of innumerable where Hart’s work has helped inform and contextualize how policymakers consider relationships between the public and private spheres of healthcare. Responding to the praise and input from fellow economists presented in a tribute documentary to the impact of his framework, Hart remarked:

“I hadn't realized how many people have been influenced by this paper and how they've been using it in different contexts. I knew some of the applications, but there were others I didn't, and it’s been truly amazing to see that.”

Looking Toward the Future

The tradeoffs between public and private partnerships in healthcare systems across the world will continue to be a dynamic and evolving area of research that will rely on theories such as ‘The Proper Scope of Government’ for framing and application. Looking towards the future, Hart was hopeful but cautious about the vitality of the kind of theoretical tradition which allowed for the development of his original theory. He recognizes that specialties such as contract theory and contractual incompleteness are inherently “messy” and somewhat out of vogue with current trends in economics which tend to favor theories that are “impressive, clever, and non-obvious,” regardless of whether they address important questions.

As he iterated in his Nobel Prize lecture, the incomplete world of contracts nonetheless “underlies numerous significant phenomena, some of which have great policy relevance,” and therefore fully deserving of upcoming economists’ time and efforts.

Further Research into Public-Private Partnerships

The Asia Health Policy Program’s 2020-21 colloquium series focuses on the roles and impacts of public-private partnerships in healthcare and the tradeoffs in equity, accessibility, and cost that come with contracted agreements in health systems. All of the events from the colloquium series are available on our YouTube channel. Click the thumbnails below to start exploring.

Collaborative governance — that is, relationships involving both the private and public sectors in the pursuit of public value — is part of ongoing research by Karen Eggleston. Her forthcoming book, The Dragon, the Eagle, and the Private Sector (Cambridge University Press), co-authored with Harvard’s John D. Donahue and Richard J. Zeckhauser, examines the ways in which collaborative governance works across a wide range of policy arenas in China and the United States, with the goal of empowering public decisionmakers to more wisely engage the private sector. Join us for the book launch event, which will be held jointly with the Harvard Kennedy School on March 5 

 

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Thumbnail images for the webinar events in the AHPP's 2020-21 colloquium series, "Health, Medicine, and Longevity: Exploring Public and Private Roles."

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Robots May Be the Right Prescription for Struggling Nursing Homes

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[Left] A nurse assists an elderly woman in a wheel chair; [Right] Oliver Hart
The AHPP 2020-21 colloquium series explores the roles of the public and private sectors in providing equitable and accessible health services. The keynote address was given by Nobel laureate Oliver Hart.
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In its 2020-21 colloquium series, the Asia Health Policy Program weighs the balance, benefits, and considerations in providing health services through national governments and contracting with private organizations.

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4:00-5:00pm California, 18-February 2021
7:00-8:00pm Washington DC, 18-February 2021
3:00-4:00am  Kenya, 19-February 2021
11:00am-12:00pm Sydney, Australia 19-February 2021

 

The Bay of Bengal, while split by national boundaries and even our concepts of distinct South and Southeast Asian regions, is re-emerging as a connected geographic and demographic space. Some of Asia’s most consequential transnational policy challenges will be most starkly presented here, across the borders of India, Bangladesh, and Burma – and traditional policy-making structures are already struggling to cope with environmental disasters, the mass movement of people, and the yawning need for economic connectivity. This webinar will examine these policy challenges, from the fragility of the Sundarbans ecosystem to the transnational implications of the Burma coup, and whether existing state and multilateral institutions are capable of addressing them.

SPEAKERS:

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Kelley Eckels Currie
Kelley Eckels Currie served as U.S. Ambassador-at-Large for Global Women’s Issues and the U.S. Representative at the United Nations Commission on the Status of Women.  Prior to her appointment, she led the Department of State’s Office of Global Criminal Justice (2019) and served under Ambassador Nikki Haley as the United States’ Representative to the UN Economic and Social Council and Alternative Representative to the UN General Assembly (2017-2018).  Throughout her career, Ambassador Currie has specialized in human rights, political reform, development and humanitarian issues, with a focus on the Asia-Pacific region. She has held senior policy positions with the Department of State, the U.S. Congress, the Project 2049 Institute, and several international and non-governmental human rights and humanitarian organizations.  Ambassador Currie holds a Juris Doctor from Georgetown University Law Center.

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Tanaya D Gupta
Tanaya Dutta Gupta is a PhD Candidate in Sociology at the University of California, Davis. Tanaya’s dissertation research focuses on climate change, (im)mobilities and borders in the Bengal delta region of Bangladesh and India. Her educational background includes MA in Sociology and Geography. As visiting researcher with the International Centre for Climate Change and Development and collaborator with the Observer Research Foundation, Tanaya participates in policy conversations through her research. Her research has been funded by the National Geographic Society and UC Davis Graduate Program Fellowships. 

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Constantin Xavier
Constantino Xavier is a Fellow in Foreign Policy and Security Studies at the Centre for Social and Economic Progress, in New Delhi, where he leads the Sambandh Initiative on regional connectivity. He is also a non-resident fellow in the Foreign Policy program at the Brookings Institution. His research and publications focus on India’s changing role as a regional power, and the challenges of security, connectivity and democracy across South Asia and the Indian Ocean. Dr. Xavier regularly lectures at various Indian, European and American universities, as well as at civilian and military training institutions in India. He holds a Ph.D. in South Asian studies from the Johns Hopkins University, School of Advanced International Studies, and an M.A. and M.Phil. from Jawaharlal Nehru University.  

MODERATOR:

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Arzan Tarapore
Arzan Tarapore is the South Asia research scholar at the Shorenstein Asia-Pacific Research Center at Stanford University, where he leads the newly-restarted South Asia research initiative. He is also a senior nonresident fellow at the National Bureau of Asian Research. His research focuses on Indian military strategy and contemporary Indo-Pacific security issues. He previously held research positions at the RAND Corporation, the Observer Research Foundation, and the East-West Center in Washington. Prior to his scholarly career, he served as an analyst in the Australian Defence Department, which included operational deployments as well as a diplomatic posting to Washington, DC. Arzan holds a PhD in war studies from King’s College London.

 

This event is co-sponsored by: Center for South Asia 
 

 

 

 

This is a virtual event via Zoom.  Please  Register at: https://bit.ly/3txBBVq
Kelley Eckels Currie former Ambassador-at-Large for Global Women's Issues
Tanaya Dutta Gupta University of California, Davis
Constantino Xavier Centre for Social and Economic Progress- New Delhi
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