This press release was originally published by the University of Tokyo. It discusses a new study, published by Lancet Public Health and co-authored by researchers from the University of Tokyo along with FSI Senior Fellow Karen Eggleston, director of the Asia Health Policy Program at APARC, and Jay Bhattacharya, Professor of Health Policy and director of the Center for Demography and Economics of Health and Aging at Stanford.

A new detailed microsimulation, using a database of 40 million people, has examined the future of Japan’s aging population up to 2043. It projects that more people will live longer, and that overall years spent living with dementia will decrease. However, the model highlighted the diversity of impacts on different segments of the population, as Japanese women with a less than high school education aged 75 and over may be disproportionately affected by both dementia and frailty. Better understanding where health gaps like this exist can help inform public health planning, to minimize future economic costs and support those most in need.

Taking care of the older members of society is a common concern around the world. Japan is famous for its long-lived residents, the number of which continues to rise. In 2020, almost 30% of the Japanese population was aged 65 years or older, and this age group is not projected to peak until 2034. Caring for people with age-related ailments, such as dementia and frailty, poses a challenge both to individuals and public health care systems.

Microsimulation models, which are computer models that can provide detailed analysis on an individual basis, are currently used to project future population health in some countries, such as the U.K. and the U.S. Professor Hideki Hashimoto and researchers at the University of Tokyo, along with researchers from Stanford University in the U.S., wanted to create a new microsimulation model for Japan, which would take into account more diverse conditions than had been considered before.

“We developed a new Japanese microsimulation model that accounts for 13 chronic conditions (including heart disease, stroke, diabetes, depression and dependency), as well as frailty and dementia,” explained Hashimoto. “Using an ultralarge data system, we were able to ‘follow’ a virtual cohort of more than 40 million people aged 60 and over from 2016 to 2043.”

According to Hashimoto, projections of aging in Japan usually rely on the “average” status of older people and so don’t consider the diversity of the population. “I believe that problems of aging are a matter of health gaps over the course of people’s lives,” he said. “Our projection brings attention to a widening health gap among older people. It highlighted that women with a less than high school education aged 75 or over are more likely to be affected.”

Identifying where health gaps like this exist could be used to better inform public policy, not only about health care but other influential aspects of life. “Japan’s case may suggest that improvement in educational attainment, as well as population health, could be a key to making a healthier and more manageable aging society,” said Hashimoto.

Positively, this study shows hope for a future where many people live longer and more healthy lives. “People might believe that an increase in cases of dementia is inescapable, given population aging. However, in this study we found that in Japan, despite an aging population, the number of people with dementia is expected to decrease over the next two decades,” said Hashimoto. “Population aging does not necessarily mean an increase of social burden for care, but it does bring a diversity of problems that requires careful study and science-based policy attention, to close the health gap.”

U.S.-based donors and international organizations have long dominated the development sector, but their Asian peers are increasingly challenging Western hegemony in the field, argues APARC Postdoctoral Fellow in Contemporary Asia Mary-Collier Wilks.

Wilks is currently at work on a book project that examines variation in ‘aid chains,’ or the links through which programs travel from donors to international nongovernmental organizations (INGOs), and finally to implementing partners. Her ethnographic research examines two aid chains focused on the delivery of women’s health services in Cambodia. After completing her residency at APARC this summer, she will head to the University of North Carolina Wilmington to start a tenure track position at the Department of Sociology.

In the following Q&A, Wilks discusses her research and fellowship experience at Stanford. The interview was slightly edited for length and clarity.

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Your research centers on meaning-making and power dynamics in international organizations. What drew you to this topic?

Before going to graduate school, I worked at a Cambodian NGO, Social Services of Cambodia, that implemented social welfare programs for women and children. While there, I observed conversations between the foreign director, local staff, donors, and beneficiaries, and noticed how these interactions shaped SSC’s work. I was particularly struck by how differently donors from various nations defined gender empowerment. These questions evolved into a desire to go to graduate school and study how donor differences impact international development programs in Southeast Asia.

You are working on your first book. Can you tell us a bit about what to expect from it?

During my postdoctoral fellowship at APARC, I’m focusing on transforming my dissertation into a book. Learning to write a book is a difficult, unique, and rewarding process in and of itself! It’s still a work in progress, but the book argues that the global development sector is shifting. Donors and international organizations based in the United States, Europe, and Australia have long been dominant actors, producing prevailing global norms around “good development.” However, East Asian nations are increasingly vying for influence and offering new, alternative models for development. As a case study of these transformations, I conduct a multi-sited ethnography of two INGOs, one from the United States and the other from Japan, that implement development programs in Cambodia.

I see Cambodian practitioners render the above geopolitical transformations meaningful in their own lives by discussing two “development imaginaries” or narratives about the best way for society to develop, one “Asian” and the other “Western.” Consequently, I contend Cambodia is a case of a larger phenomenon in which Asian donors and development organizations are playing a more prominent role, challenging Western hegemony in the development sector and producing new development norms. This book is therefore trying to tell a dual story about the macro-level geopolitical transformations taking place in the development space in Cambodia, and Asia more generally, and the micro-level meanings, practices, and contradictions that these changes create in the lives of the people living through them.

You have mentioned your interest in how people encounter international development and foreign aid in their everyday lives. What are some aspects of those encounters that you find revealing about the dynamics of global development?

Cambodia is a nation where international donors have a lot of power. But, that’s never the whole story. Development is never just donor-driven. In my work, I try to center the ways Cambodian practitioners make sense of, adapt, or resist donor visions of their nation’s development.

For instance, during my fieldwork, I met an NGO director who I’ll call Rith and whose career trajectory can provide us with some insights. Rith was born in 1979, at the very end of the Khmer Rouge regime. In his twenties, he decided to become a monk to bring merit to his family. In the late 1990s, Rith started noticing the influx of foreign aid funding and the proliferating numbers of international and local NGOs in his country. In 2000, he decided to quit being a monk to open an NGO. He turned out to be a savvy fundraiser, securing funding for his NGO to implement multiple health, education, and economic empowerment projects. However, when I met him in 2019, Rith told me he thought “it might be time to change paths” because NGO funding from Western donors “is not like it was ten years ago.” Two years later, he became the co-CEO of a private construction and sourcing company that takes advantage of the numerous infrastructure development loans China provides to Cambodia.

You can therefore observe how the larger geopolitical changes Cambodia undergoes play out in a micro-way in Rith’s strategic career choices as he shifts from being a monk to an NGO director to a CEO.

What do you see as some of the biggest challenges to delivering aid via INGOs?

There are several answers to this question floating around in my data. One that immediately comes to mind is synchronization. Despite a shared aim of improving women’s health, INGOs from the United States and Japan implement very different kinds of programs in Cambodia. Japanese INGOs focus on strengthening government-provided maternal health services in Cambodia. In contrast, U.S. organizations are more likely to promote a diverse maternal and reproductive healthcare sector, including private providers and civil society advocacy. I’ve also found that INGOs that originate in the United States and Japan are unaware of each other’s distinctive projects. Often, U.S. INGO directors and donors don’t even know Japanese NGOs exist!

While they work with different stakeholders, I believe that projects that support a strong state and those that encourage the market and nonprofit actors could be synchronized for more effective aid. To start with, U.S.-based INGOs sometimes try to upgrade private clinics, provide education, and refer beneficiaries to women’s health services in the same regions where Japanese INGOs support public clinics. On a basic level, if you could just get the INGO directors from Japan and the U.S. organizations that are working in the same areas to sit down together, U.S. INGO health educators might be able to do things like referring to improved private and public clinics if they know which public clinics the Japanese INGO works with, or collaborate on healthcare provision training for private and public clinic doctors.  

Beyond your book project, what are you working on while at APARC? How has your time here advanced your research?

The main thing a postdoctoral fellowship affords is the privilege of time to read and write. Outside of the book project, I have been able to work on two other papers while here at Stanford. One article proposes to theorize the process of “script decoupling” and why INGOs might formally adopt the same global script but enact it very differently in implementation. The second paper investigates how the meanings of aid money in NGOs is shaped by the business cultures of donor and recipient nations. I plan to have both papers under review before I leave APARC at the end of July.

Being at APARC has provided me with numerous opportunities to discover insightful, new perspectives on my research projects and career prospects from my postdoctoral advisor, Kiyoteru Tsutsui, as well as various other faculty, fellows, and associates here. For instance, Kiyo is starting a Japanese studies lunch-and-learning session where fellows get to meet and discuss their research. I’m particularly interested in the policy-oriented lectures and learning how to articulate that side of my research since that’s something I wasn’t taught to do in graduate school. Overall, my time at Stanford has been invigorating for my research and writing process. I’ve enjoyed being part of the learning community at FSI and the university at large, and have greatly benefited from connecting with different scholars and working groups across campus.

Has the Covid-19 pandemic affected your ability to travel and do research? How have you adapted?

I was incredibly lucky because I completed my international fieldwork in the fall of 2019. So I was able to collect all the data I needed for my dissertation before the pandemic hit us hard. But, due to Covid, I was not able to do the follow-up field visits that I wanted to do in order to find out what happened when the two INGOs I studied completed their projects. Also, continuing connections in the field for new ideas and the next research project is important for an ethnographer. I have done what I could to catch up with Cambodian friends and practitioners over Zoom. Now that Cambodia has lifted its quarantine requirements, I may be able to return this summer. 

What is on the horizon for you? What's next?

As I have wanted to be a college professor since I was 19 (after I gave up my dream of being a pop singer), I’m extremely happy to share I was offered a tenure track position in the Department of Sociology at the University of North Carolina Wilmington! I’ll be starting there in the fall and continuing my research on international development and Southeast Asia.

On March 22, 2022, APARC's Japan Program welcomed a delegation from the Embassy of Japan in the United States and the Consulate-General of Japan in San Francisco, including Ambassador Koji Tomita and Consul-General Hiroshi Kawamura, who met with a joint panel of scholars and administrators from Stanford and the University of California, Berkeley for a discussion about fostering a greater understanding of Japan studies in the United States.

APARC Deputy Director and Japan Program Director Kiyoteru Tsutsui presented data on enrollment and employment statistics for Japanese studies in higher education. According to the report, Japanese studies have been in a slow state of decline since the late 1980s, when many in the United States viewed Japan as an economic threat and the country was not as well-understood as it is today. Despite this decline, students today are still very interested in studying Japan and are eager to visit the country.

Naomi Funahashi, Manager of the Reischauer Scholars Program and Teacher Professional Development at the Stanford Program on International and Cross-Cultural Education (SPICE), presented outcomes from SPICE's outreach efforts and promotion of Japanese studies in the K-14 context. Funahashi indicated strong interest in and engagement with SPICE curricular units focused on Japan and with its local student programs in six regions, one university, and two high schools in Japan.

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Professor Junko Habu, Chair of the Center for Japanese Studies (CJS) and Professor of Anthropology at UC Berkeley, along with Kumi Sawada Hadler, Program Director of CJS, described logistical challenges Japan scholars have faced during the COVID-19 pandemic, including the inability to access the country under lockdown, and indicated that, across the board, universities are not providing as much support for Japanese studies as they used to, especially in terms of endowed faculty positions and departmental "slots" specifically for Japan specialists.

Ambassador Tomita and Consul-General Kawamura agreed that more support was needed to bolster scholarships of Japan. Ambassador Tomita stated that over his long career, he has seen the theoretical focus of Japan studies in the United States shift away from bilateral relations between the two countries toward the region at large. He noted that the public discussion is increasingly directed at Japan as part of a broader complex of nations in East Asia. Consul-General Kawamura indicated that the pandemic has posed a host of challenges for his office but that Japan will continue to open its doors to scholars in the future. 

The meeting concluded with a reaffirmation of the longstanding and crucial relationship between the two nations and of the importance of Japan studies in the United States in fostering fruitful collaboration between the two nations. 

Your new book examines the paradox of the global diffusion of universal human rights. Could you explain this paradox and its origins?

The main paradox here is that states have unwittingly promoted universal human rights to a near-sacred status when these principles do nothing but constrain their sovereignty. I should note that throughout the history of human rights, it was civil society that pressed states hard to establish human rights and limit their arbitrary exercise of power. Gradually, civil society actors expanded their vision of rights-holders such that it’s not just Christians, whites, and men but also non-Christians, non-whites, and women who are seen as deserving of rights, and that universe of obligations expanded to include all humanity by the time of the 1948 Universal Declaration of Human Rights. States resisted this process every step of the way but had to make concessions to legitimize their authority and, in the era of World Wars, to mobilize the public toward war efforts. When women contributed to domestic mobilization for World War I in Europe or when Black people contributed to World War II in the United States, the governments’ arguments for discriminatory treatments against them began to lose legitimacy.

Then, as many human rights treaties emerged since the 1960s, states across the globe ratified these treaties in droves, often to deflect criticisms against their domestic human rights practices. The Cold War context gave them a false sense of security, as they thought that these treaties are toothless and if anything happens, either the United States or the Soviet Union would protect them from serious sanctions. This may have been an accurate calculation at the time, but the large number of states parties to these treaties elevated the legitimacy of human rights norms enshrined in these treaties, making human rights a near orthodoxy.

The end of the Cold War enabled the United Nations to engage in human rights activities free from Cold War constraints, and now those states that committed to human rights without thinking about the consequences have to face a world in which their violations can become a real liability for them, a world that they helped create with their empty promises for human rights. All these miscalculations by states constitute this paradox, what I have called in a co-authored paper the paradox of empty promises.

What is your assessment of the efficacy of international human rights instruments and human rights diplomacy in the 21st century? Have some strategies been more effective than others in improving human rights practices?

If you look at the history of international human rights instruments in the post-World War II era, it is fairly clear that those instruments are often powerless when powerful states — permanent members of the UN Security Council — are not willing to act. The international community has repeatedly failed to stop major human rights violations, even universally condemned crimes like genocide, by these powerful states and their allies and protectorates. The international human rights regime’s track record for large-scale, intense human rights violations is not good.

On the other hand, international human rights instruments have been effective in making incremental improvements when sustained campaigns of naming and shaming can be mounted. These changes take a long time and do not necessarily result in dramatic improvements, but all over the world, indigenous peoples have gained more rights, women have voted in more countries than ever, and extreme poverty has declined. International human rights treaties and institutions have been instrumental in bringing about these changes and their contributions should be acknowledged, although we should be aware that there is always the potential for backlashes against all the progress. 

How has Japan been involved in international human rights? How do human rights diplomacy and education in Japan compare with world standards?

Japan’s first international statement that can be seen as a contribution to human rights may have been the proposal to include a racial equality clause at the 1919 Paris Peace Conference. As the only non-white major power, it was an important proposal, even if it was made for its own strategic calculations, and minority groups all over the world, including Black people in the United States, applauded it. It did not pass, unfortunately, and the disillusionment contributed to Japan’s aggressive behavior in Asia after this period.

In the post-World War II period, Japan had an engagement policy, which meant that it would prioritize communication with rights-violating regimes rather than condemn and impose sanctions on them. This was often criticized by the human rights community, as Japan engaged with apartheid South Africa, Myanmar’s military regime, and post-Tiananmen Square China. Over the last decade or so, more politicians and diplomats have been interested in moving Japan toward values diplomacy, largely in an effort to counter China. Some of them have been vocal in criticizing China and North Korea for their human rights violations, and this momentum might spill over to a fuller commitment to human rights diplomacy that has eluded Japan.

Japan’s human rights diplomacy is still emerging for the most part, but it has been a relatively good listener to criticisms about its human rights violations. Primarily because of pressures from UN human rights instruments, Japan has acknowledged Ainu as an indigenous people and promoted their culture, accorded more rights to resident Koreans in Japan, compensated victims of discrimination against leprosy patients, and addressed inequality in legally marriageable ages between men and women.

How do you think Japan will contribute to the future of international human rights? Do you believe that Japan may play a larger role in advancing human rights on a global scale?

Japan has an opportunity to become a leader in human rights in Asia and in the world. The more inwardly oriented United States is creating a vacuum in promotion and protection of liberal values, especially with China’s influence surging, and Japan should carry the torch taking the mantle of human rights, democracy, and rule of law. Japan is the largest contributor to the budget of the International Criminal Court, which prosecutes individuals responsible for major human rights violations, and it is an interesting symbolic example of Japan’s potential contributions to international human rights. That budget is allocated according to national wealth, and the two richer countries, the United States and China, are not members of the ICC, so Japan becomes the largest contributor. This could be a dynamic that plays out in other areas, and Japan should embrace that role of becoming the biggest contributor to international human rights efforts.

What did you find surprising as you were researching your book?

When Japan made the aforementioned proposal for racial equality in 1919 at the Paris Peace Conference, it received majority support and was about to be adopted. It was U.S. President Wilson who nixed this clause, making the argument that such an important resolution requires unanimous support. We tend to think of President Wilson as an architect of the League of Nations at the Conference, and although that might be true, his role in this episode might be indicative of his thinking around the issues of race.