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The relationship between economic concentration and governance remains controversial. While some studies find that high economic concentration strengthens collective action and reform cooperation, others stress dangers of rent-seeking and state capture. In this paper I argue that effects are neither strictly positive nor negative: they are best described as an inverted-u-shaped relationship, where better governance performance emerges with moderate economic concentration. Decentralization reforms in Indonesia and the Philippines – unprecedented in scope and scale – provide a unique opportunity to test this hypothesis. Subnational case studies and cross-sections, from both countries, indicate that moderately concentrated polities are accompanied by better service and lower corruption. The presence of ‘contested oligarchies’ – small circles of multi-sectoral interest groups – creates a situation where economic elites are strong enough to influence policymakers and, at the same time, diverse enough to keep each other in check. The results of this paper suggest that contested oligarchies compensate for weakly-developed societal and juridical forces and can become a stepping stone to good governance.

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Christian von Luebke
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No crisis is uniformly global.  The suffering and the opportunity that a "global" crisis entails are always unevenly distributed across countries, and unevenly across the population inside any one country.  That said, one can nevertheless argue that we-not the old royal "we" but, more presumptuously, the new global "we"-are in January 2009 experiencing the latest of four dramatic changes that major parts of the world have undergone over the last twenty years.

Revised and updated as of late January 2009, this paper was originally presented at a conference on "Refreshing Thai-U.S. Relations" held in Thailand on 8-9 January 2009.

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American Studies Program, Chulalongkorn University (Bangkok, Thailand)
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Donald K. Emmerson
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Karen Eggleston
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In December 2009, the Asia Health Policy Program celebrates the first anniversary of the launch of the AHPP working paper series on health and demographic change in the Asia-Pacific. The series showcases research by AHPP’s own affiliated faculty, postdoctoral fellows, and visiting scholars, as well as selected works by other scholars from the region.

To date AHPP has released eleven research papers in the series, by authors from China, South Korea, Thailand, Taiwan, Pakistan, and the US, with more on the way from Japan and Vietnam. Topics range from “The Effect of Informal Caregiving on Labor Market Outcomes in South Korea” and “Comparing Public and Private Hospitals in China,” to “Pandemic Influenza and the Globalization of Public Health.”  The working papers are available at the Asia Health Policy website.

AHPP considers quality research papers from leading research universities and think tanks across the Asia-Pacific region for inclusion in the working paper series. If interested, please contact Karen Eggleston.

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Daniel and Nancy Okimoto Conference Room

Shorenstein APARC
Stanford University
Encina Hall, Room E-301
Stanford, CA 94305-6055

(650) 724-9747 (650) 723-6530
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Jim Hoesterey is a cultural anthropologist whose research explores the burgeoning industry of Islamic self-help in contemporary Indonesia. He recently completed his Ph.D. in Anthropology at the University of Wisconsin-Madison where he also received a M.A. in Anthropology. Hoesterey also holds an M.A. in Anthropology from the University of South Carolina and a B.A. in Psychology from Marquette University.

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

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

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

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

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

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

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

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

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

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Dr. Khoa Truong Assistant Professor of Department of Public Health Sciences Speaker Clemson University
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Donald K. Emmerson
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Islamism: Contested Perspectives on Political Islam was published by Stanford University Press in November 2009. But the story behind the book dates back five years to November 2004. It was then that Donald K. Emmerson and Daniel M. Varisco agreed to disagree.

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

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

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

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

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

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

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

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

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

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

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

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

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Global health disparities were the topic of a special event November 11th co-sponsored by the Asia Health Policy Program of the Shorenstein Asia-Pacific Research Center and the Center for Health Policy / Primary Care and Outcomes Research.

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

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

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

Examples from Asia include

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

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

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

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In 2005 the Indonesian government announced a program of unconditional cash transfers to its poor and near-poor citizens to help them overcome the adverse effects of fuel price hikes caused by a massive reduction in subsidies.  The program—the largest of its kind in the world, covering some 19 million households—was reintroduced in 2008 following another round of fuel subsidy cuts.

How successful was this effort to help poor Indonesians weather these economic shocks?  Did the transfers alleviate suffering to the desired extent?  Did their unconditional character ensure quick action and wide coverage?  Or did it foster dependence on public welfare and depress incentives to work?  Were deserving recipients chosen?  Or did corruption and conflict distort the process?  Are there lessons in Indonesia’s experience applicable to other developing countries?  Dr. Sudarno will mobilize quantitative and qualitative evidence to address these questions.

Sudarno Sumarto co-founded The SMERU Research Institute and served as its director for nearly ten years.  Under his leadership, SMERU played a vanguard role in helping to reduce poverty in Indonesia through careful empirical research on behalf of improved public policy.  His more than fifty publications include studies of economic growth, poverty and unemployment reduction, and the performance of primary-school pupils, among other topics, in the Journal of Development Economics (2009), Beyond Food Production (2007), and SMERU’s own working paper series, among other venues.  He has also been active as an advisor to the Indonesian government on poverty issues and as a lecturer at the Bogor Institute of Agriculture.

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Sudarno Sumarto is the Shorenstein APARC / Asia Foundation fellow for 2009-10.  He has a PhD and an MA from Vanderbilt University and a BS from Satya Wacana Christian University (Salatiga), all in economics.  Prior to joining Shorenstein APARC he was the director of SMERU for nearly 10 years. SMERU is an independent institution for research and public policy studies which professionally and proactively provides accurate and timely information, as well as objective analysis on various socioeconomic and poverty issues considered most urgent and relevant for the people of Indonesia. The institute has been at the forefront of the research effort to highlight the impact of government programs and policies, and has actively published and reported its research findings. The work expanded to include other areas of applied and economic research that are of fundamental importance to contemporary development issues. He was also a lecturer at Bogor Institute of Agriculture (IPB), Bogor, Indonesia.

Sumarto has contributed to more than sixty co-authored articles, chapters, reports, and working papers, including "Agricultural Growth and Poverty Reduction in Indonesia," in Beyond Food Production (2007); "Reducing Unemployment in Indonesia," SMERU Working Paper, 2007; "Improving Student Performance in Public Primary Schools in Developing Countries:  Evidence from Indonesia," Education Economics, December 2006; and “The Effects of Location and Sectoral Components of Economic Growth on Poverty: Evidence from Indonesia.” Journal of Development Economics, 89(1), pp. 109-117, May 2009.  As well as conducting research and writing papers, Sumarto has worked closely with the Indonesian government, giving advice on poverty issues and government poverty alleviation programs.

Sumarto has spoken on poverty and development issues in Australia, Chile, Peru, China, Egypt, Ethiopia, France, Japan, Morocco, Thailand, and the United Kingdom, among other countries.

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The Asia Society has organized a Task Force on U.S. Policy toward Burma/Myanmar, co-chaired by retired U.S. Army General Wesley Clark and Holsman International Chair (and former USAID Administrator) Henrietta H. Fore.  The panel comprises a dozen or so individuals from various occupations and backgrounds, including SEAF's director, Donald K. Emmerson.  Assisting the Task Force is an also diverse Advisory Group of some thirty experts in Southeast Asian and other countries.  The Asia Society expects to release the Task Force's final report early in 2010.  

The timing of the study is of interest in view of the Obama administration’s willingness to meet with Myanmar’s rulers. 

America’s top diplomat on Asia is Assistant Secretary of State for East Asian and Pacific Affairs Kurt Campbell.  Deputy Assistant Secretary Scot Marciel covers Southeast Asian and ASEAN affairs.  In early November 2009 the two men traveled to Myanmar.  There they met not only with the iconic opposition figure and Nobel Prize winner Daw Aung San Suu Kyi, but also with Burmese Prime Minister Thein Sein.  The latter meeting was the highest-level contact between the two governments since 1995.  An even higher-level meeting was being planned for later in November at a US-ASEAN summit in Singapore, which would bring President Obama face to face with Myanmar’s head of state, Senior General Than Shwe.

Further enhancing the timeliness of the Task Force’s work is the announced prospect of national elections in Myanmar in 2010.  No independent observers expect the exercise to bring about anything resembling liberal democracy.  But some hold out hope that the balloting could yield a marginally more representative and accountable system. 

In early November 2009 it remained to be seen whether the current shifting of American policy toward dealing directly with the Burmese junta would prove effective in nudging its leaders toward political reform, or not. 

The Task Force’s report, scheduled for release early in 2010, should at least provide food for policymaking thought, as U.S. officials continue to review what has been and could be done with regard to a regime that has so far resisted both isolation and engagement.

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