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Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital’s probability of receiving government financial support is inversely associated with the hospital’s previous net revenue, an association consistent with soft budget constraints.

Published inInternational Journal of Healthcare Finance and Economics special issue on provider payment incentivesKaren Eggleston, Yu-Chu Shen, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, 2009. “Soft Budget Constraints in China: Evidence from the Guangdong Hospital Industry,” International Journal of Healthcare Finance and Economics 9(2): 233-42.

 

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Asia Health Policy Program working paper #8
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Karen Eggleston
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Government and private roles in health service delivery remain controversial in China, as in many countries.  Using 2004 data from over 360 government-owned and private hospitals in Guangdong Province, we find that non-government hospitals serve an overlapping but distinct market.  They are smaller, newer market entrants, more likely to specialize, and less likely to be included in urban social insurance networks. We also document differences in staffing and financial performance, but no systematic ownership differences in simple measures of quality, controlling for size, location, case-mix and other confounding factors.

UPDATED VERSION PUBLISHED:
BMC Health Services Research 2010, 10:76doi:10.1186/1472-6963-10-76
http://www.biomedcentral.com/1472-6963/10/76

Background

The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care.

Methods

We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes.

Results

Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix.

Conclusions

In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of hospital ownership type.

Published: Eggleston, Karen, et al. "Comparing public and private hospitals in China: evidence from Guangdong." BMC Health Services Research 10.1 (2010): 1.

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Asia Health Policy Program working paper #7
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Karen Eggleston
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On December 18, tobacco control was the theme of the 2009 Kunming Health and Development Conference, co-convened by the Yunnan Health and Development Research Association, Pioneers for Health, and ThinkTank Research Center for Health Development. “Pioneers for Health” is a health policy non-governmental organization (NGO) founded in China a year ago with help from AHPP faculty affiliate Matthew Kohrman, Associate Professor of Anthropology. Pioneers for Health also received the good news that Tobacco-Free Kids/Bloomberg Initiative to Reduce Tobacco Use has renewed it for another two-year grant to cover all operational and health advocacy costs.

Article in Translation (Source:  The Economic Daily 经济日报):

More than sixty specialists and academicians from the fields of medicine, economy and sociology convened in Kunming (YunnanProvince) on December 18 for the 2009 Kunming Health and Development Conference, jointly hosted by the Yunnan Health and Development Research Association, Pioneers for Health, and ThinkTank Research Center for Health Development. The theme of the conference was "Tobacco Control for the Creation of a Healthy Lifestyle".  The conference was divided into three parts. For the first part a short film was shown. Titled "Tobacco: From Global Epidemic to Global Control", the film detailed the history of the global tobacco epidemic and its development up to the current day. It looked at the background and significance of the Framework Convention on Tobacco Control. The specialists and academicians present all agreed that a global consensus has been reached regarding the need for tobacco control. As a signatory of the FCTC and as a large nation, China is now responsible for carrying out a huge task. Tobacco control in Yunnan Province will be especially arduous. The second part -- Tobacco Control in Yunnan; Taking the First Step -- focused on the tobacco control effort in Yunnan Province. Topics for discussion included an analysis of ideas and methods to prevent youth from smoking. In the third part -- The Challenges and Opportunities for Tobacco Control in Yunnan Province; a Multi-disciplinary Perspective -- economists, sociologists and health experts engaged in a discussion of issues regarding tobacco control. During the discussion the participants stressed that tobacco control concerns not only public health, but also community development, the domestic economy, the people's livelihood, and the government's image. The most popular topics in this segment were "Tobacco and the Economy", "Tobacco and Health", and "The Influence of Popular Culture on the Behavior of Smoking". A multi-disciplinary approach was used when delving into the issues surrounding tobacco control.

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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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In the four years since a State Council think tank, the Development Research Center, bluntly declared the failure of three decades of healthcare reform, China has placed a high political priority on designing, building and financing a modern, equitable health delivery system that serves every last one of its 1.3 billion people. As publisher of practice-building trade magazines for medical specialists in China and India, Jeffrey Parker has developed unique and valuable perspectives on what's wrong with China's healthcare system -- and how Indian practitioners are able to deliver results despite a per-capita GDP that is roughly half of China's. Through an unprecedented China-India training exchange, Mr. Parker has begun testing whether Indian models of self-financed grassroots medical startup practices can help doctors shake free of China’s Stalinist paralysis without having to wait for sweeping programmatic reforms that are always on the horizon, but seem never to come. What's more, would such grassroots empowerment models not create unprecedented opportunities for participation by international investors who up to now have been largely marginalized in China's healthcare development?

In this lunchtime colloquium, Mr. Parker reviews his experiences in China and India over the past six years and looks at several exciting recent developments in China. These include:

  • An ambitious rural reimbursement scheme that already has begun to complete a nationwide healthcare safety net. The program is creating a vast pool of funds to finance rural medical services, but how will Beijing populate the countryside with sustainable grassroots practices?
  • The first domestic healthcare IPO, by which Aier Ophthalmology raised some $50 million as one of 28 debut listings in the Shenzhen's new "ChiNext" Growth Enterprise Market. New wind in the sails of healthcare privatization?
  • Licensing reforms that have begun delinking doctors' certification from their "work unit" hospitals under trials in Beijing and Yunnan, removing a vexing obstacle to hands-on surgical training of young practitioners. Will the breaking of senior doctors' "skills monopoly" create opportunities for private-sector training programs that will shake up China's Soviet-style residency programs?

Jeffrey Parker has lived in Greater China since 1990, first as a journalist and since 2003 as a publisher. His transition from chronicler of China's historic rise to active proponent of its economic development gives him a unique perspective on the opportunities still opening up in China -- and the challenges facing anyone keen to participate. With a twin B.A. in Asian Studies and Geography from U.C. Santa Barbara and Masters training in Journalism from Columbia University, Parker trimmed his sails for a China career from an early age. After early editorial jobs in New York and Washington, D.C., he was dispatched to Beijing by United Press International as senior correspondent in 1990. During the next 10 years with UPI and then Reuters, he covered a wide range of political, economic and social stories from postings in Hong Kong, Taiwan and the Peoples Republic. In his final two years at Reuters, Parker got his first taste of media development, launching local-language multimedia news and video feeds in China, Japan, Korea, India and Southeast Asia. Since 2003, Parker has built up a family of world-class doctors' magazines serving more than 50,000 specialists in China and India from the Shanghai base of ILX Media Group, where he is editorial director, chief operating officer, a corporate director and investor. Among his objectives is to help foster a badly needed transformation of medical practice across China by inspiring grassroots doctors to deliver high-quality, cost-effective services in rural and less-developed communities left behind by government health care.

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Jeffrey Parker Speaker ILX Media Group, Shanghai, PRC
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In five new books -- three of which were produced as part of Shorenstein APARC's in-house publishing program, distributed through the Brookings Institution Press -- Center academics tackle an array of issues related to Asia's past, present, and future, from both policy and historical perspectives.

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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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An integrated approach based on a case study of a new neighborhood in the provincial capital of Jinan in Shandong, China

As part of SPRIE's current research on entrepreneurship and innovation in the green/cleantech space, we are pleased to present this seminar in cooperation with the Precourt Institute for Energy.

About the talk

This presentation will discuss an effort to integrate building energy and emission models with traffic simulation tools, in order to develop integrated urban energy and emission models. The assessment of the environmental impacts of transportation systems does not commonly include an analysis of the effects on building energy use. Similarly, neighborhood level building energy simulations often overlook the impacts of the density of the built environment and the configuration of the street network. Based on a case study of a masterplan for a new neighborhood in Jinan, Shandong Province, China, the modeling approach presented here aims to capture the way the built environment and transportation networks influence each other in terms of energy use and carbon emissions. The goal is to develop a more accurate method to evaluate and compare the environmental performance of various transportation and land use projects.

About the speaker

Nicolae Duduta is a dual Master’s candidate in Transportation Planning and Architecture at UC Berkeley’s College of Environmental Design. He has an undergraduate degree in Architecture and Sustainable Development from the National School of Architecture in Lyon, France.

For the past three years, he has worked as a research assistant  to Prof. Elizabeth Deakin at the Berkeley Center for Global Metropolitan Studies. Recent projects include developing planning guidelines for future High-Speed Rail stations in the Central Valley of California, and advising local governments in China to assess the environmental impacts of new urban developments.

His interests include sustainable transportation and urban design, and his recent work has focused on developing tools to evaluate the environmental performance of neighborhoods, by analyzing the performance of buildings, transportation systems, water and waste treatment and infrastructure.

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Nicolae Duduta Speaker University of California, Berkeley
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China 2.0 at Stanford University, May 24-25, 2010

This two-day forum looks at the rise of China as a digital superpower.

May 2010 marks 15 years of China's first connection to the public Internet and 15 years of digital mobile communications. Home to 400 million online and 750 million mobile consumers, China is giving birth to innovative start-ups and established multi-billion dollar enterprises in social networking, games, video, music and e-commerce.

Companies thriving in China will increasingly shape the global digital economy, either by their sheer scale at home or through investments and mergers and acquisitions in the United States and other developed economies.

Join this invitation-only forum to meet with industry leaders from China and overseas to assess the likely future shape and implications of China's rise for consumers, industry players, investors, researchers and policy makers.

Conference Video Overviews 

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China 2.0 Introduction

Video: Tencent, Taobao and Baidu 

Enabling China's Mobile Market 

Chinese Digital Music Scene 

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TV & Online Video 

e-Commerce 

Online Games 

 
  MONDAY, MAY 24, 2010
8:30 - 9:00 Registration and Light Breakfast
9:00 - 9:15 Session 1--Welcome Remarks and Introductory Presentation
  Marguerite Gong Hancock, Forum Co-Chair/Associate Director, SPRIE, Stanford University
  Duncan Clark, Forum Co-Chair/Chairman, BDA China; Visiting Scholar, SPRIE, Stanford University
9:15 - 10:00 Session 2--Case Studies of China 2.0 Leaders: Tencent, Taobao & Baidu
  Duncan Clark & Liu Ning, BDA China Presentation
  Moderator: Gady Epstein, Beijing Bureau Chief, Forbes
10:00 - 10:45 Special Session--Reporting China 2.0
  Loretta Chao, Reporter, Beijing Bureau, The Wall Street Journal
  Gady Epstein, Beijing Bureau Chief, Forbes
  Moderator: Daniel Sneider, Associate Director for Research, Shorenstein Asia-Pacific Research Center, Stanford University
11:00 - 12:15 Session 3--Enabling China 2.0: Infrastructure, Devices and Access
  Håkan Eriksson, CTO, Ericsson presentation
  Stanley Chia, Senior Technology Consultant, Vodafone Group R&D
  Moderator: Duncan Clark, Forum Co-Chair/Chairman, BDA China; Visiting Scholar, SPRIE, Stanford University
12.15 - 1.15 Lunch
1.15 - 2.15 Session 4--Digital Music in China
  Gary Chen, CEO, Top100.cn presentation
  Eric Priest, Assistant Professor, University of Oregon presentation
  Moderator: Loretta Chao, Reporter, Beijing Bureau, The Wall Street Journal
2.15 - 3.45 Session 5--China's Future TV Landscape
  Graham Kill, CEO, Irdeto presentation
  Caroline Pan, Director-China Strategy Office, Intel presentation
  David Strehlow, Director of Marketing, Media Solutions, Huawei
  Moderator: Andrew Lih, Associate Professor, USC Annenberg School of Communication and Journalism
3.45 - 4.00 Break
4.00 - 5.30 Session 6--e-Commerce in China
  James Jianzhang Liang, Co-Founder and Chairman, Ctrip
  Alan Tien, General Manager, PayPal Beibao China
  Fritz Demopoulos, CEO, Qunar.com
  Moderator: Mei Fong, Wall Street Journal Correspondent & Visiting Professor, USC Annenberg School of Communication & Journalism
5.30 - 6.30 Networking Reception
  TUESDAY, MAY 25, 2010
8:30 - 9:00 Registration and Light Breakfast
9.00 - 10.30 Session 7--Online & Mobile Games
  Jason Wang, Partner, Cypress River Advisors, LLC
  Ben Sternberg, Executive Director, Raine Group
  Lisa Cosmas Hanson, Managing Partner & Founder, Niko Partners
  Liu Ning, Principal Analyst - New Media, BDA China
  Moderator: Loretta Chao, Reporter, Beijing Bureau, The Wall Street Journal
10.45 - 12.15 Session 8--Financing China 2.0: VC & IPO Outlook
  York Chen, Founding Managing Partner, iDTechVentures presentation
  Olivier Glauser, Managing Director, Steamboat Ventures presentation
  Richard Hsu, Managing Director, Intel Capital China presentation
  David Lam, Managing Director, WI Harper Group presentation
  Moderator: Martin Haemmig, Senior Advisor on Venture Capital, Stanford Program on Regions of Innovation and Entrepreneurship
12.15 - 1.15 Lunch
1.15-2:45 Session 9--How Can Global Firms Thrive In & With China
  Alan Tien, General Manager, PayPal Bei Bao China
  Graham Kill, CEO, Irdeto
  Carter Agar, Former VP, GM, Walt Disney Internet Group (China), VP, Altius Education
  Jason Wang, Partner, Cypress River Advisors, LLC
  Moderator: Gady Epstein, Beijing Bureau Chief, Forbes
3:00 - 4:30 Session 10--China 2.0 Firms: The Talent Dimension
  Mark Baldwin, CEO, Oxus and Founder, Zhaopin.com
  Kelly Sang, former General Manager, Alibaba.com Americas
  David Strehlow, Director of Marketing, Media Solutions, Huawei
  Moderator: Kyung H. Yoon, CEO, Talent Age Associates LLC
4:30 - 4:45 Wrap-up

Audience 

Media & tech executives, entrepreneurs, academics and researchers, venture capitalists/private equity investors, policymakers.

Format 

  • Presentations by the on-the-ground pioneers of China 2.0 
  • Roundtable discussions on key issues and emerging trends
  • Premiere of "vox pop" video interviews of Chinese Internet users filmed in Beijing, Chengdu, Nanjing, Wuhan, Xiamen and Xi'an
  • Conference highlights to be available online (subject to speaker approval)
  • Interactive event, including a mobile application custom-made for participants

Participation and Pricing

Participation is by invitation-only. For more information, please contact SPRIE by email at sprie-stanford@stanford.edu.

The USD $50 fee covers conference sessions and materials, continental breakfast, lunch, and refreshments. A limited number of free spaces are available for current Stanford faculty, students and staff.

Agenda (subject to change)

Map and parking:

The conference is being held in the Bechtel Conference Center, located at 616 Serra Street on the first floor of Encina Hall. Free event parking is available at the Galvez Field Event Parking Lot, located at Galvez and Campus Drive East. It is less than .5 mile from the parking lot to the event. If you park at a meter, be aware that parking is $1.50/hour and is monitored from 8:00 a.m. to 4:00 p.m.

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We are pleased to bring you the second dispatch of the year in our series of Shorenstein APARC Dispatches. This month's piece, "Forced Labor Redress in Japan and the United States" comes from Matt Augustine, the Northeast Asian History Fellow for 2009-10 at Shorenstein APARC.

Last month, on October 23, the Nishimatsu Construction Company reached an agreement in the Tokyo Summary Court to set up a trust fund for Chinese who had been forced into labor in Japan during World War II. According to the Asahi Shimbun, the trust fund—worth ¥250 million—will compensate 360 Chinese citizens who were compelled to work at a hydroelectric power plant in Hiroshima Prefecture. Under the terms of the summary settlement, Nishimatsu acknowledged that these Chinese workers were forcibly brought to Japan and apologized for their suffering.This outcome was both overdue and unexpected, particularly since Japan's Supreme Court in 2007 rejected the original lawsuit that five Chinese plaintiffs brought against the construction company in 1998.  Nishimatsu officials maintain that they want to set a new precedent for "social responsibility" in the wake of the corporation's recent scandal involving political donations.  The timing of Nishimatsu's decision coincides with the rise of the new Hatoyama administration, which has promised to improve Japan's relations with China and other Asian neighbors.

Former forced laborers and their bereaved families have pursued litigation against the Japanese government and the corporations that employed them, not only in Japan but also in the United States. The Hayden Bill, which passed the California State Senate in July 1999, opened the door for Chinese and Korean victims to sue Japanese corporations and demand compensation for their hard labor in inhumane working conditions. Although the U.S. Supreme Court thus far has rejected such cases, the unresolved issue of Asian forced labor redress has now been introduced into the U.S. legal system, indicating that the United States has become involved in Japan’s historical disputes.

In fact, the United States was intimately involved in the issue of Asian forced laborers during the Allied Occupation of Japan between 1945 and 1952. U.S. Occupation forces initially attempted to retain Korean coal miners until Japanese repatriates replaced them, but riots in Hokkaido and elsewhere forced authorities to abandon this policy in November 1945. Responding to strong Korean demands, in May 1946 a military government team in Hokkaido gathered over ¥3 million worth of wages, bonuses, and death benefits owed to Korean miners. This amount was but a small fraction of the more than ¥215 million that corporations throughout Japan deposited into an account at the Bank of Japan by 1948. Occupation authorities made several unsuccessful attempts to persuade unwilling Japanese officials to pay back the financial assets owed to Koreans, while U.S. policy gradually changed to oppose reparations demands against Japan. Article 14(b) of the American-drafted San Francisco Peace Treaty signed in September 1951 waived all reparations claims, and the unpaid wage deposits of forced laborers remained a well-kept secret of the Japanese government.

When former forced laborers from South Korea and China began appearing in Japanese courts in the 1990s, their lawsuits helped to clarify the historical record of wartime abuse and postwar cover-up. Lawyers, journalists, and researchers supporting the redress movement dug up hidden official documents, such as the voluminous reports by the Foreign Ministry on Chinese forced labor and by the Welfare Ministry on the unpaid financial deposits of Korean laborers, both compiled in 1946. Although the Japanese government refuses to make such ministry reports public, the Tokyo High Court in 2005 confirmed that the state continues to hold the ¥215 million deposits, which have never been disbursed. While Japanese records remain largely closed, declassified American records can help to answer important questions, including how closely the United States was involved in the process of postwar Japan’s forgetting and neglecting Asian victims of forced labor.

An Asahi Shimbun editorial on October 24, 2009 admonished the Japanese state to take action in the wake of Nishimatsu settlement, since other corporations facing litigation have vowed not to pay reparations unless the government becomes involved. The new Hatoyama administration should first make an unambiguous apology, the editorial contends, then propose a new framework whereby the government and corporations can establish a joint trust fund to compensate former forced laborers and bereaved families. The United States can support this reconciliation process by revisiting the unresolved issue of forced labor—which also included Allied POWs—and reinterpreting the San Francisco Peace Treaty to enable these victims to file legal claims in American and international courts. Proactive U.S. involvement at the government level should also be matched by an enhanced effort toward nongovernmental cooperation between researchers in the United States and Northeast Asia. Shorenstein APARC has been contributing to this effort through its Divided Memories and Reconciliation research project, now in its third year. The Center will also host a colloquium series titled “The American Role in Northeast Asian Reconciliation” during the 2010 winter quarter.

 

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Shorenstein APARC Dispatches are regular bulletins designed exclusively for our friends and supporters. Written by center faculty and scholars, Shorenstein APARC Dispatches deliver timely, succinct analysis on current events and trends in Asia, often discussing their potential implications for business.

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