In conversation with Shorenstein APARC, Karen Eggleston, center fellow and director of the Asia Health Policy Program, reflects on her initial draw to Asian studies and eventual focus on comparative Asia health policy. She also shares perspectives on health reform in China and demographic change across East Asia, and talks about related upcoming activities.

How did you begin in Asia health policy?

I have long been interested in Asia in general. My initial appeal to the region came from my family’s roots (my grandfather taught Korean history at Berkeley) and early international travel. Only much later in graduate school did I come to the area of economics as a discipline and health policy as my specialty; however, I had been attracted to economic development and social policy in Asia earlier on. I started with an undergraduate degree in Asian studies, which followed with a Masters degree in Asian studies specifically focused on China and Korea. During graduate school, my father-in-law introduced me to unique perspectives, as he was a physician in China. When he visited the United States to present his work, I helped translate his findings. As my career developed, I had the privilege of working with many inspiring health economists, and economists interested in health policy, some of whom acted as my mentors at Harvard and here at Stanford - János Kornai, Victor Fuchs, Joseph Newhouse, Richard Zeckhauser, and Jay Bhattacharya, to name a few. These experiences helped to further narrow my focus and interests.

What led you to Stanford?

It was extremely exciting when the opportunity arose to come to Stanford. The university is a world-class learning environment and is unique in having a health policy program focused on Asia. I was recruited to the Shorenstein Asia-Pacific Research Center at the founding of the Asia Health Policy Program. The Program is distinctive given its comparative approach focusing on the Asia-Pacific region, which differs from most other institutions. The west coast is also geographically closer to Asia, so you get a ‘flavor’ and infusion of Asian studies here more so than on the east coast. Not to mention, it was a delight to come back to my home state of California after many long years of New England winters.

To be a successful scholar of global health policy, what tools or perspectives should one be informed about?

Global health policy is a very complex field, and can be approached many ways. This, of course, makes it both exciting and challenging. My own approach is through the lens of economics. If you are looking at research and evidence-based policy, it can be beneficial to have either a social science background or a medical-clinical discipline (or both), perhaps combined with a specific geographic focus. Knowing about the history, culture, and institutions are very important for understanding health policy challenges. It also helps to build capacity within that region of focus. Partnering with practitioners and scholars in the country or region allows you to know what is really happening on-the-ground, and feed the research back into local policy decisions. I also think it is important to emphasize evidence over ideology – for example, to keep clear in your mind whether you are more of a policy advocate or academic. A scholar can play varying roles at different times in their careers, but it isn’t easy to do both fully at once. 

As China’s population and social inequalities continue to grow, are its current governance structures sustainable?

Even though political economy is not my expertise, institutions and how they adapt to a society’s needs is pertinent to anyone looking at health reform. For example, in China, there has been a lot of debate since the leadership transition and its implications for national health administration. Should health policy be led solely by the Ministry of Health, now the Health and Family Planning Commission? The Ministry runs the hospitals but is not in charge of the urban insurance system – this falls to Labor and Human Resources. Other branches of government administer regulation, pricing and other aspects of health policy. And of course the Ministry of Finance, and National Development and Reform Commission, play key roles. Like many countries, China has over 14 different ministries and agencies that are involved in the organization of its health system. Thus a relevant question is: who is in charge of taking the next step and coordinating between those entities? A health reform office was established directly under the State Council. Population aging is another issue that spans multiple sectors and policymaking entities. The Chinese government will be impelled to adapt its policies to face new challenges.

What are the connections between health policy and demographic change? Can you tell us about your upcoming work?

One important connection between health policy and demographic change is that the burden of disease changes as the population changes. A country with a large young population (like India) will have a different burden of disease than a country with a large older population (like Japan). If fertility and mortality rates decline, the burden of disease shifts toward chronic, non-communicable disease incidence. Partly, this trend reflects a ‘triumph’ from control of infectious disease and the demographic transition (with longer lives and lower fertility), but then it presents a new set of challenges for society to deal with problems of that older population. Some of my work compares China and India, which have similarities in size and socio-economic diversity. This May, I am helping to organize a conference at the Stanford Center at Peking University in Beijing with my Stanford colleagues Jean Oi, Scott Rozelle and Xueguang Zhou, and our collaborators at the PRC National Development and Reform Commission. The conference will compare urbanization and demographic trends in China and India. It is envisioned that the conference will lead to two separate book projects – one on urbanization in China in comparative perspective and another on demographic change in China and India. We will also present findings that were an outcome of a three-year research project, with initial findings published in The Journal of Asian Studies.

Tell us something we don’t know about you.

In my youth, I was very much into equestrian vaulting and played the violin. As one of my mentors said to all his students, ‘you might not be the world’s best at any one category, but if you look at the overlap between different categories, you could be distinctive.’ So I might very well be one of the world’s only horse-vaulting, violin-playing health economists, for what it’s worth.

The Faculty Spotlight Q&A series highlights a different faculty member at Shorenstein APARC each month giving a personal look at his or her scholarly approaches and outlook on related topics and upcoming activities.

President Barack Obama’s trip to four Asian nations – Japan, South Korea, Malaysia and the Philippines – set out to address an ambitious agenda, including trade negotiations, territorial disputes, and the threat of North Korea. Scholars at the Shorenstein Asia-Pacific Research Center in the Freeman Spogli Institute provided commentary to local and international media about the state tour.

Ambassador Michael Armacost, a distinguished fellow at Shorenstein APARC, evaluated the goals of the trip, saying it aimed to deliver a message of reassurance to East Asia that the U.S. rebalance is intact. Armacost highlighted the efforts to negotiate a 12-nation trade pact, the Trans-Pacific Partnership (TPP) as the centerpiece of the Obama trip to Asia. He was interviewed by Weekly Toyo Keizi, a Japanese political economy magazine. An English version of the Q&A is available on Dispatch Japan.

Many foreign policy issues shadowed the outset of President Obama’s Asia trip, the crisis in Ukraine and Syria, among others. Daniel Sneider, associate director of research at Shorenstein APARC, said in Slate that Asian nations notice where the United States focuses its time. Obama’s commitment to the region may have come across as distracted given the breadth of his current foreign policy agenda.

Sneider also spoke with LinkAsia on Obama’s stop in Tokyo. President Obama met with Japanese Prime Minister Shinzo Abe; the two leaders addressed issues surrounding territorial disputes and attempted to reach an agreement on outside market access issues in the TPP negotiations.

Donald Emmerson, director of Shorenstein APARC’s Southeast Asia Forum, offered an assessment of America’s ‘pivot to Asia’ and on the significance of the Malaysia and Philippines visits. He said the trip most notably reinforced America’s efforts to upgrade security commitments and promote freer trade negotiation in that region. The Q&A was carried by the Stanford News Service.

Emmerson spoke with McClatchyDC on two occasions about the Philippines leg of the tour. He commented on Obama’s statement reaffirming the United States’ security commitment to Japan, which recognized Japan’s administrative control over the Senkaku Islands. Emmerson suggested the greater context of claims in the South China Sea must be considered, including Manila’s. He also said maintenance of the security alliance is a positive step, but trade is a an essential part of the the pivot's sustainablility.

When President Barack Obama this week began a high-profile visit to Asia, it called into question how effective the "Asian pivot" in America's foreign policy has been. A few years ago, Obama announced that a rebalancing of U.S. interests toward Asia would be a central tenet of his legacy. Now he is visiting Japan, South Korea, Malaysia and the Philippines to reassert the message that America is truly focused on Asia – despite finding itself repeatedly pulled away by crises in Ukraine and the Middle East, and political battles in Washington, D.C.

Stanford political scientist Donald K. Emmerson, an expert on Asia, China-Southeast Asia relations, sovereignty disputes and the American "rebalance" toward Asia, sat down with the Stanford News Service to discuss Obama's trip. Emmerson is a senior fellow emeritus at the Walter H. Shorenstein Asia-Pacific Research Center in the Freeman Spogli Institute for International Studies.

President Obama started his Asian pivot a few years ago. Have problems in Ukraine, Syria, Iran and at home detracted from this new approach?

The pivot as practiced continues unabated. The pivot as perceived has suffered from its displacement on various attention spans by superseding events and concerns, both foreign and domestic. President Obama's current trip to Asia is itself a reflection of these distractions. Originally planned for October, it was postponed by extreme political discord in Washington. But the chief elements of the pivot remain in place and in progress. They are most notably the upgrading of American security commitments and the effort to negotiate freer trade.

Why does this rebalancing in U.S. foreign policy make sense – or not?

The pivot certainly serves U.S. interests. Americans cannot afford to deny themselves, or be denied by others, the opportunities for trade and investment that Asia's most dynamic economies will continue to generate. The U.S. also needs to work with China and its neighbors to help ensure that China's rise serves the wider security interests of Americans, Chinese, Asians and the world, however dissonant the day-to-day advocacy of those interests may be. Ironically, by obliterating Obama's proposed reset of U.S.-Russia relations, Vladimir Putin has become an unintentional friend of the rebalance toward Asia. His aggression in Crimea and eastern Ukraine has made all the more urgent the need for Washington to pursue mutually beneficial relations with Beijing and the rest of Asia that could moderate China's willingness and ability to force its ownfaits accomplis in the East and South China Seas.

Do Chinese leaders view Obama's Asian pivot as a de facto containment approach to a rising China?

China's leaders do question U.S. intentions. But one ought not ignore the dozens and dozens of venues and ways in which the two countries' governments continue to cooperate on multiple fronts. In domestic terms it is politically convenient for Chinese hardliners to disparage American motives. As with the pivot itself, however, perception and practice are not the same thing.

Are Asian countries more rattled than ever by China's behavior in places like the South and East China Seas?

Concerned, yes; rattled, no. There are six or seven different claimants to contested land features and/or sea space in the South China Sea, not to mention the territorial tensions that also bedevil interstate relations in Northeast Asia. East Asian leaders are not lined up in a united front against Beijing. They are themselves divided. The more assertive China becomes, the more pushback it can expect. But most of the states in Southeast Asia do not want to ally with the U.S. against China, or with China against the U.S.

The U.S. and the Philippines are poised to sign a treaty that will expand America's military presence in the island country. What's the significance of the treaty?

Articles 4 and 5 of the treaty commit Washington and Manila to "act to meet the common dangers" implied by "an armed attack in the Pacific Area" on the "metropolitan territory" of either party, or on the "island territories under its jurisdiction," or on "its armed forces, public vessels or aircraft in the Pacific," and to do so "in accordance with its constitutional processes." But these provisions are hardly self-implementing; they require interpretation. Even if China were to forcibly evict the Philippine marines who now occupy Second Thomas Shoal in the South China Sea, the treaty would not automatically trigger an American military response. Applied to that scenario, the treaty would not instantly entrap the U.S. in a war with China. But the treaty would require some action or statement on the part of Washington. In Manila, Obama will try to reassure his Philippine host in this regard without enraging its Chinese neighbor.

Obama will be the first U.S. president in five decades to visit Malaysia. What does that visit mean for that country?

Of the four countries that Obama is visiting, it is in Malaysia that the pivot's third face after security and economy – namely democracy – will be most visible. Obama will be careful not to appear to enter into the domestic political turbulence Malaysia is experiencing, but his visits with civil society actors and university students in Kuala Lumpur will send the nonpartisan message that America remains committed to democratic values for itself and for Asians as well.

Clifton Parker is a writer for the Stanford News Service.

Relations between China, Japan and South Korea are at one of their worst points in recent history. Stanford scholars at the Shorenstein Asia-Pacific Research Center in the Freeman Spogli Institute have been sought for insight on why negative public sentiment toward each nation has grown – providing commentary to both local and international media.

The territorial disputes in the East China Sea and Japanese Prime Minister Shinzo Abe’s visit to Yasukuni Shrine have added to the growing friction. Reconciliation now seems a far prospect, and there is a real chance of an accidental spark setting off conflict. At the heart of the matter are propaganda or global ‘PR’ wars that those countries are waging, associate director for research Daniel C. Sneider says.

Shorenstein APARC director Gi-Wook Shin and Sneider lead the Divided Memories and Reconciliation project, an ongoing research initiative, that attempts to understand how historical memory of the World War II period came to exist, and in turn, informs people’s perspectives in Northeast Asia.

Shin and Sneider write in Foreign Affairs that wartime narratives cannot and will not easily change. They highlight urgent issues such as compensation for victims of forced labor in wartime Japan, and the coordination of public apologies.

On the Asan Forum, Shin says that the perception gap continues to widen between the countries. Historical memories are not only rooted in the colonial and wartime injustices, but more complex historical, cultural and political relations.

The United States may play a pivotal role in facilitating diplomacy and breaking through the stalemate of the reconciliation process. As U.S. President Barack Obama travels to Asia later this week, now is the time to confront the questions of history. Sneider makes a similar suggestion in the Washington Post, saying the United States should abandon its position of neutrality and step forward.

Research findings from the Divided Memories and Reconciliation project have been incorporated into a textbook and two volumes, one of which was co-edited with Daniel Chirot of the University of Washington. Confronting Memories of World War II: European and Asian Legacies (University of Washington Press, April 2014) compares the lasting influence of World War II in Asia and Europe. Sneider was interviewed upon the release of the book, covered by the Stanford Report.

Shorenstein APARC postdoctoral fellowships offer a unique opportunity for recent graduates to reside at Stanford for a year to further their research and engage with scholars. The Center annually offers multiple Shorenstein Postdoctoral Fellowships in Contemporary Asia, and one Postdoctoral Fellowship in Asia Health Policy.

Fellows develop their dissertations for publication, present their research, and participate in Center activities related to and beyond their specialty. Most importantly, they establish valuable connections with professionals that continue long after they leave Stanford.

Postdoctoral fellows go on to pursue teaching positions and advisory roles at top universities and research organizations around the world. They often continue to contribute to Shorenstein APARC publications, and participate in conferences and related activities into the future.

Shorenstein APARC is delighted to welcome its latest group of exceptional postdoctoral fellows this autumn:

Shorenstein Postdoctoral Fellows

Jianzhi (Jason) Zhao is completing his PhD in international development and economic policy at the University of Maryland. His current research interests are focused on development economics and empirical and international corporate finance, particularly China. His dissertation focuses on how China’s financial system interacts with state-owned enterprises, and policy perspectives of China’s banking sector and macroeconomic stability. At Stanford, Zhao will continue his dissertation work and extend his research analyzing how a firm’s connection to government affects performance and investment behavior. Zhao holds BAs in finance and business administration from Jiangzi University of Science and Technology, and an MA in economics from Fudan University.

Paul Schuler is a political scientist whose current research focuses on liberalization under authoritarian rule and political change in Southeast Asia, particularly Vietnam. His dissertation focuses on how the Vietnam Communist Party has liberalized the legislature in order to gain information, co-opt opposition and stabilize power sharing. At Stanford, Schuler will develop his dissertation work into a book manuscript and pursue other projects related to governance under authoritarian rule. Schuler will receive his PhD in political science from the University of California, San Diego – Graduate School of International Relations and Pacific Studies in 2014. He holds a BA in journalism and government & politics from the University of Maryland, and an MA in Pacific international affairs from UC – San Diego. 

Developing Asia Health Policy Postdoctoral Fellow 

Pham Ngoc Minh is a health researcher and administrator. His main interests are public health, disease prevention and the rural-urban divide in developing countries. At Stanford, Pham will be studying epidemiological trends and policy perspectives of diabetes in Vietnam, particularly those among adults in mountainous areas of that country. Pham has more than six years of experience working as a medical lecturer at the Thai Nguyen University of Medicine and Pharmacy in Vietnam, and spent two and a half years conducting postdoctoral research in Japan. He received a Bachelor of Medicine from the Thai Nguyen University of Medicine and Pharmacy, a BA in English from Hanoi University, an MPH from the University of Melbourne, and a PhD in medical science from Kyushu University.