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The Walter H. Shorenstein Asia-Pacific Research Center’s (Shorenstein APARC) Japan Studies Program kicked off its inaugural academic year with a lineup of major events and meetings at Stanford and in Japan.

Here are some highlights from the autumn:

Corporate Affiliates Alumni Reunion in Tokyo

In early September, Shorenstein APARC Corporate Affiliates Program alumni from 1997 to 2011 gathered for a lively reunion in Tokyo. Participants introduced their current positions and jobs, and outlined how their experience at the Center has enhanced their work and life. Shorenstein Distinguished Fellow Michael H. Armacost, associate director for research Daniel C. Sneider, and Takahashi Research Associate Kenji E. Kushida hosted the event on behalf of Shorenstein APARC.

U.S.-Japan Strategic Exchange with Japanese Policymakers

On October 10, a delegation of Japanese Diet members from several different parties and representatives from the Japan Institute of International Affairs, the Ministry of Foreign Affairs, and the San Francisco Consulate of Japan visited Shorenstein APARC. The delegates exchanged views with Stanford and Center scholars, focusing on the U.S. political situation and the strategic environment facing Japan. David Kennedy, a Stanford professor of American history, presented a luncheon keynote on U.S. politics.

Japanese Academic Delegation Speaks with Shorenstein APARC China and Japan Experts

A delegation of Japanese scholars spoke on October 11 with Shorenstein APARC experts on China and Japan. The scholars were part of a group invited by the Japan Institute of International Affairs (JIIA), and included professors from Aoyama Gakuin University and research fellows at JIIA. Shorenstein APARC participants included China scholars Scott Rozelle, Jean C. Oi, and Xueguang Zhou along with international relations and Japan experts Phillip Lipscy and Kenji Kushida. 

Post-Catastrophe Japan: Economic and Political Prospects  

Richard Katz, editor of the Oriental Economist Report, gave a seminar on November 14 about the broader global economic and political prospects for Japan after the March 11 triple disaster. He also presented lessons from Japan for U.S. policymakers fighting the current slump.

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Corporate Affiliates Program Visiting Fellows from 1997 to 2011, Tokyo.
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Asia’s demographic landscape is changing in a big way. Japan’s population is shrinking, as people are living longer, marrying later, and choosing to have fewer or no children. Korea is moving in the same direction, while China and the countries of South and Southeast Asia face similar issues in the coming decades. As this takes place, more people are moving to, from, and across Asia for job, education, and marriage opportunities.

These demographic changes present policymakers with new challenges and questions, including: What are the interrelationships between population aging and key macroeconomic variables such as economic growth? How will it impact security? What are the effects on employment policy and other national institutions? How have patterns of migration affected society and culture? What lessons can Asia, the United States, and Europe learn from one another to improve the policy response to population aging?

The Walter H. Shorenstein Asia-Pacific Research Center (Shorenstein APARC) focused its third annual Stanford Kyoto Trans-Asian Dialogue on addressing the possible economic, social, and security implications of Asia’s unprecedented demographic transition. Thirty scholars, government figures, journalists, and other opinion leaders from Stanford, the United States, and countries across the Asia-Pacific region gathered September 8–9, 2011, in Kyoto, Japan, to discuss key issues related to the question of demographic change.

Comparative Demographics and Policy Responses

Japan’s shrinking workforce calls for labor policy changes, stressed presenters during the opening Dialogue session. Stanford Center for Population Research director Shripad Tuljapurkar stated that Japan’s population could decrease by as much as 25 percent and that its government has a window of approximately 40 years in which to act. In describing Japan’s demographic shift, Ogawa Naohiro, director of the Nihon University Population Research Institute, also emphasized the importance of good financial education for individuals as life expectancy increases.

Macroeconomic Implications

Economists Masahiko Aoki and Cai Fang addressed changes to East Asia’s economic landscape. Aoki, an FSI senior fellow, spoke of the transition from agriculture to industry that has occurred at different stages in Japan, Korea, and China and of the increasing cost of human capital that has followed. Cai, a Chinese Academy of Social Sciences labor and population expert, stated that after several decades of industrial growth China is now at a turning point in terms of its global competitiveness.

Labor and Migration

Scott Rozelle, codirector of Stanford’s Rural Education Action Program (REAP), opened the next day with a discussion of China’s rural human capital investment. Offering Mexico’s situation after the mid-1990s peso crisis as a comparison, he emphasized the immediate need for allocating more health and education resources to China’s rural areas. Ton-Nu-Thi Ninh, president of Tri Viet University, discussed the socioeconomic and cultural aspects of labor migration—a growing trend in Asia—and advocated that governments factor it more into their foreign policy development.

Security

The security impact of Asia’s demographic transition will take several decades to understand, but it will eventually lead to the need for significant policy re-strategization, stated Yu Myung Hwan, Korea’s former minister of foreign affairs and trade, during the closing Dialogue session. He suggested focusing on impacts that could result from the major changes taking place in fertility, urbanization, and migration. Concurring with many of Yu’s views, Stanford’s Shorenstein Distinguished Fellow Michael H. Armacost also noted the current lack of literature on the link between security and demography. In addition, he emphasized the need for the United States to continue pursuing good relations with China and Russia during this time of transition.

“Low fertility rates are not because women are all out there working. In fact, a number of countries have lots of females in the labor force and have achieved a resurgence of fertility. Achieving work-life balance is important, not just for women, but for men as well, and might play a role in lessening the gap in life expectancy between men and women.”

-Karen Eggleston, Director, Asia Health Policy Program

Throughout the event, Dialogue participants unanimously acknowledged the serious challenges facing policymakers as they look for ways to meet the evolving needs of individuals, families, and organizations. The demographic outlook is not entirely gloomy, however. Numerous participants also pointed to the potential for exciting advances and innovations in technology and international cooperation.

As in previous years, the event concluded with a lively public symposium and reception attended by students from Stanford and local universities, Shorenstein APARC guests and affiliates, and members of the general public. Speaking during the reception, Kadokawa Daisaku, mayor of Kyoto, and Kim Hyong-O, member and former speaker of the Korean National Assembly, acknowledged the significance of the Stanford Kyoto Trans-Asian Dialogue as a forum for addressing issues of mutual importance to the United States and Asia.

The Dialogue is made possible through the generosity of the City of Kyoto, FSI, and Yumi and Yasunori Kaneko. To read the final report from this and previous Dialogues, visit the event series page below.

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A worker stands on steel rods at a superblock construction site in Jakarta in February 2010. Increasing urbanization is one of many aspects of Asia's demographic change.
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We construct quarterly series of the revenues, expenditures, and debt outstanding for Japan from 1980 to 2010, and analyze the sustainability of the fiscal policy. We pursue three approaches to examine the sustainability. First, we calculate the minimum tax rate that stabilizes the debt to GDP ratio given the future government expenditures. Using 2010 as the base year, we find that the government revenue to GDP ratio must rise permanently to 40–47% (from the current 33%) to stabilize the debt to GDP ratio. Second, we estimate the response of the primary surplus when the debt to GDP ratio increases. We allow the relationship to fluctuate between two “regimes” using a Markov switching model. In both regimes, the primary surplus to GDP ratio fails to respond positively to debt, which suggests the process is explosive. Finally, we estimate a fiscal policy function and a monetary policy function with Markov switching. We find that the fiscal policy is “active” (the tax revenues do not rise when the debt increases) and the monetary policy is “passive” (the interest rate does not react to the inflation rate sufficiently) in both regimes. These results suggest that the current fiscal situation for the Japanese government is not sustainable.

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Takeo Hoshi
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Japan leads, chased closely by South Korea, with China, on a vastly larger scale, not far behind. Not as mercantilist development states nor as threats to America’s high-tech industry, but rather as the world’s most rapidly aging societies.

A wave of unprecedented demographic change is sweeping across East Asia. The region is at the forefront of a trend towards longer life expectancy and declining birthrates, which, combined, yield a striking rate of aging. Japan already confronts a shrinking population. Korea is graying even more quickly. And although China is projected to grow for another few decades, demographic change races against economic development. Could China become the first country to grow old before growing rich? In Southeast Asia, Singapore also confronts a declining birthrate and an aging society. Increasingly, Asia’s aging countries look to its younger societies, such as Vietnam, Indonesia, and India, as sources of migrant labor and even wives. Those countries in turn face their own demographic challenges, such as how to educate their youth for a globally competitive
economy.

Held September 8–9, 2011 in Kyoto, Japan, the third Stanford Kyoto Trans-Asian Dialogue focused on demographic change in the region and its implications across a wide range of areas, including economies, societies, and security. Asia’s experience offers both lessons and warnings for North America and Europe, which face similar problems. Questions addressed included:
 

  • What are the interrelationships between population aging and key macroeconomic variables such as economic growth, savings rates, and public and private intergenerational transfers?
     
  • How and why do policy responses to population aging differ in Japan, South Korea, and across different regions of China?
     
  • What are the effects of demographic change on national institutions such as employment practices, pension and welfare systems, and financial systems?
     
  • What policies can or should be pursued to influence future outcomes?
     
  • How will demographic change affect security in the Asia-Pacific region?
     
  • How have patterns of migration impacted society and culture in East Asia, in comparative perspective?
     
  • How will demographic change influence the movement of people across the region and the prevalence of multicultural families?
     
  • What lessons can Asia, the United States, and Europe learn from each other to improve the policy response to population aging?
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The global balance of power is undergoing a gradual but dramatic shift. While the United States will likely remain a preeminent economic and geopolitical power, the long era of American hegemony is coming to an end. In particular, managing the rise of Asia will likely prove to be the central challenge of international politics in the 21st century. In the face of such striking change, rigidity threatens to make international organizations relics of a bygone era. A substantial update of the international organizational architecture is needed. As two of the world’s leading democracies and economic powers, there is much that the United States and Japan can contribute toward such an effort. This paper will examine how U.S.-Japan cooperation can reinvigorate and update international organizations to meet contemporary challenges.

The first section discusses distributional imbalance as a serious shortcoming of several major international organizations, most prominently the United Nations Security Council and the International Monetary Fund (IMF). Uneven representation can lead to needless tension and undermine the ability of international organizations to facilitate interstate cooperation. The major international organizations must be updated to reflect 21st century realities. The next section examines the economic and geopolitical rise of Asia and potential implications for institutionalized cooperation. Asia is a region with comparatively weak international organizations and inferior representation in universalistic institutions. Without deeper regional institutionalization and commensurate representation in global institutions, Asia’s rise may prove destabilizing for international cooperation. Accordingly, the paper then presents several policy prescriptions for how the United States and Japan can cooperate to update and reform the international organizational architecture.

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Japan Center for International Exchange
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Phillip Lipscy
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Health systems provide a rich field for testing hypotheses of institutional economics. The incentive structure of current healthcare delivery systems have deep historical and cultural roots, yet must cope with rapid technological change as well as market and government failures. This paper applies the economic approach of comparative and historical institutional analysis (Aoki, 2001; Greif, 2006) to health care systems by conceptualizing physician control over dispensing revenues as a social institution. The theory developed—emphasizing the interplay between cultural beliefs, interest groups, technological change, insurance expansion and government financing—offers a plausible explanation of reforms since the 1960s separating prescribing from dispensing in societies such as Japan, South Korea, Taiwan and China. Technological change and adoption of universal coverage trigger reforms by greatly increasing the social opportunity costs of physician over-prescribing and reshaping the political economy of forces impinging on the doctor–patient relationship.

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Journal of Institutional Economics, FirstView Article
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Karen Eggleston
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Two Stanford graduates with close ties to FSI’s centers have been named 2012 Rhodes Scholars. A third was selected as a Mitchell Scholar.

Anand Habib was a graduate of the 2011 CISAC honors program in international security studies and a 2010 Dachs undergraduate intern. Habib and Katherine Niehaus – who is now a research assistant for a CHP/PCOR project evaluating whether HIV medication increases the risk of cardiovascular disease – will study at the University of Oxford in England under the Rhodes program. 

Philippe de Koning, who will study in Ireland as a Mitchell fellow, wrote a manuscript about Japan’s defense and financial crisis with Shorenstein APARC faculty member Phillip Lipscy. Lipscy, a political scientist, was de Koning’s advisor through his undergraduate career and also advised him on his senior thesis. De Koning was also a 2010 CISAC honors student.

More about the scholars:

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Anand R. Habib, 22, of Houston, Texas, is a 2011 graduate of Stanford, where he earned a bachelor's degree in biology, with honors in international security studies. He plans to pursue a master's degree in public policy and in medical anthropology at Oxford.

Habib is working on community health programs at St. Joseph's Clinic in Thomassique, Haiti, under a one-year global health fellowship awarded by Medical Missionaries. The nonprofit organization is a volunteer group of more than 200 doctors, nurses, dentists, and others who work to improve the health of the poor in the United States and throughout the world.

In 2011, he won a Deans' Award for Academic Accomplishment, which honors extraordinary undergraduate students for "exceptional, tangible" intellectual achievements. One of the professors who nominated him for the award described him as a "superb critical thinker" whose work is characterized by "creative genius" and "mature insights," adding that he "exemplifies exactly the kind of deeply informed, pragmatic and caring leadership that the world needs and Stanford enables."

As a Stanford student, Habib worked on behalf of politically and medically disenfranchised people in India, Mexico and Guatemala. His field research internship in Guatemala’s indigenous region during summer 2010 was carried out under the supervision of Paul Wise, professor of pediatrics and FSI senior fellow, as part of FSI’s Dachs mentored undergraduate research program.  On campus, he turned the Stanford tradition of the annual Dance Marathon into a vehicle dedicated to addressing the HIV/AIDS pandemic by engaging not only Stanford students but also local communities and corporations, raising more than $100,000. His exceptional work was recognized by his participation in the Clinton Global Initiative University Conference in April, 2011.

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Katherine "Kate" Niehaus, 23, of Columbia, S.C., earned a bachelor's degree in biomechanical engineering in 2010 and a master's degree in bioengineering in 2011 – both at  Stanford. Her class and research work focused on biomechanics and her interests lie in its applications to high technology entrepreneurship.

She plans to pursue a doctorate of philosophy in systems approaches to biomedical science at Oxford.

At Stanford, Niehaus captained Stanford's varsity track and cross country teams, won the Pac-10 5,000 meters, and won Academic-All American status. She also served as a mentor and tutor for students in low-income families.

Working with faculty in the Center for Health Policy, Kate led a project to evaluate how well newer HIV antiretroviral drugs work compared with older drugs.  Her work was among the first to evaluate comprehensively all of the trials of new drugs in treatment of experienced patients, and showed that these drugs have substantial benefits.

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Philippe de Koning, 22, of Paris, France, earned a bachelor's degree in international relations at Stanford in 2010. He plans to pursue a master's degree in international security and conflict resolution at Dublin City University.

He is a Herbert Scoville Jr. Peace Fellow at the Nuclear Threat Initiative in Washington, D.C. The nongovernmental organization works to prevent nuclear, chemical, and biological threats from materializing. De Koning is researching nuclear materials security and the U.S.-China dialogue on nuclear issues.

De Koning, who earlier was awarded a Fulbright Scholarship, spent the 2010-2011 academic year at Hiroshima University in Japan. He examined various components of Japanese security policy, with emphasis on current evolution of Japanese Self-Defense Forces, policies on nuclear issues and approaches toward peacekeeping.

In 2009, he was a member of the Stanford delegation to the United Nations Climate Change Conference in Copenhagen.

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When Siyan Yi was a medical student in Cambodia 12 years ago, he volunteered with a collaborative government-NGO project to provide young women at high risk for HIV/AIDS—the victims of sexual exploitation—with housing, vocational training, medical care, and psychological support. Cambodia at that time had one of Asia’s highest HIV-infection rates.

That rate has dropped by half, thanks to government policy measures, international NGO support, and the efforts of medical professionals like Yi. Cambodia’s government must now find ways to curb HIV infection in new segments of the population, says Yi, who is the Shorenstein Asia-Pacific Research Center’s inaugural Developing Asia Health Policy Fellow. Sustaining funding for the long-term care of HIV-infected individuals also poses a future challenge, he explains, and new health issues associated with development are beginning to crop up.

Cambodia’s first HIV case was detected in 1991 in a blood donor, and the rate of HIV/AIDS increased dramatically throughout the decade. HIV/AIDS hit Thailand slightly earlier, and was spread through the commercial sex trade. The epidemic reached an even greater scale there than it ever did in Cambodia.

Thailand’s government struck back with a 100-percent condom use promotion program, which Cambodia successfully adopted in the late 1990s. Brothels are illegal in Cambodia, but the government worked cooperatively with owners to provide basic HIV/AIDS education to sex workers. These efforts significantly reduced the transmission of HIV.

Since then, a more indirect form of prostitution has sprung up in places such as karaoke halls, massage parlors, restaurants, and even in factories. HIV prevalence remains high among some sentinel groups such as female sex workers, beer promoters, men who have sex with men (MSM), injected-drug users, and migrant workers.

Yi advocates that the government expand the scope of its HIV/AIDS prevention programs to encompass these new at-risk populations. He even suggests that the government consider creating a system of licensed brothels such as previously existed in Hong Kong and Taiwan. “It would provide the government with an easier means of controlling prostitution, and allow it to work with brothel owners to control HIV-infection rates,” states Yi.

HIV increases the risk of contracting or developing symptoms of tuberculosis; a large proportion of Cambodia’s population carries the disease but shows no signs of it. Tuberculosis went largely undetected during the decades of the Khmer Rouge regime, but with the advent of HIV/AIDS it has become more prevalent. Yi has been involved in government-NGO projects to provide tuberculosis screening for HIV patients, including a tuberculosis control project with the Japan International Cooperation Agency.

Tuberculosis screening and HIV treatment advances may greatly prolong the life—and even improve the health—of patients. But heartening as Cambodia’s success against HIV/AIDS has proven in the past decade, the government largely bears the responsibility for funding the expensive treatment and care for the low-income individuals most affected by it. A critical portion of government funding for its HIV/AIDS prevention programs comes from external organizations. 

“I think that the main issue for the government of Cambodia in the battle against HIV and AIDS is financial sustainability,” says Yi, who worries that donor agencies will withdraw support as the HIV-infection rate continues to improve. Prevention is less expensive, he explains, but long-term care is costly to a developing country such as Cambodia.

Yi, however, feels less concerned now about the HIV/AIDS epidemic and speaks hopefully of working to help the government find ways to measure and treat non-communicable diseases associated with economic development, such as diabetes and hypertension. While he is at Stanford, he will collaborate with Asia Health Policy Program researchers to move his work toward solving Cambodia’s new health challenges.

Inaugurated in 2011, the Siyan Yi is designed to bring leading health policy experts from low-income Asian countries to Stanford for three to 12 months. Fellows will work on conceptualizing and launching collaborative research on a topic of importance for health policy in their country. Details about the 2011–12 application will become available during Winter Quarter 2012.

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Local NGO staff teaching sex workers about the risk of HIV/AIDS, Cambodia.
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