Despite technological breakthroughs, healthcare inequality remains a pressing public health challenge across developed and developing nations. Low levels of income or education mobility can exacerbate socioeconomic disparities, leaving children from disadvantaged families with fewer opportunities to improve their social and economic prospects. Moreover,  children in families with low-income backgrounds are also more likely to experience poor health outcomes, perpetuating a cycle of disadvantage.

Huixia Wang, a visiting scholar at Shorenstein APARC, sees this phenomenon as an opportunity to better understand the dynamics of intergenerational health and how to interrupt patterns of persistent health inequalities across generations. Her research aims to identify potential interventions to improve health outcomes in developing regions.

An associate professor at Hunan University, Wang has spent the 2024 fall quarter at APARC. She recently presented her research on the intricate dynamics of intergenerational health metrics, particularly in China and Indonesia. Watch her talk, “Intergenerational Persistence of Self-Reported Health Status and Biomarkers in Indonesia,” on our YouTube channel.

Barriers to Intergenerational Health

While much has been written about the transmission of income and education across generations, “much less is known about how health is passed down between generations," Wang notes, highlighting a gap in the existing research. Emphasizing that health is a crucial factor in determining overall well-being, as it affects everything from mental health to economic productivity and social mobility, she asserts that good health is linked to better educational outcomes, higher earning potential, and improved labor market performance. Poor health, on the other hand, is associated with lower educational attainment, reduced employment prospects, and higher rates of chronic illness.

Wang’s research approach centers on recognizing the multiple challenges in implementing maternal health-oriented policies. Having identified limited access to healthcare services as a significant barrier, she considers how, in many low-income and rural areas, “access to quality healthcare is constrained by poor infrastructure, lack of transportation, and shortages of healthcare professionals, making it difficult for pregnant women to receive essential care.”

Another obstacle is the prohibitive cost of healthcare. In countries where maternal health services are not subsidized or free, the financial burden of out-of-pocket expenses for transportation, medications, and other related costs can prevent women from accessing necessary care. Furthermore, Wang shows that low levels of maternal health education can contribute to poor health-seeking behaviors. “Many women may not recognize the warning signs of complications, may not fully understand the importance of prenatal care, or may be unaware of their rights to healthcare services,” she says.

Measuring Health Outcomes Across Generations

Wang acknowledges the difficulties in studying intergenerational health mobility, as it cannot be neatly defined and measured by observable metrics such as income or education. Health is much more subjective and varies from person to person. To gauge health outcomes, researchers must therefore rely on diverse and sometimes imprecise indicators, such as the presence of chronic diseases.

Moreover, to examine intergenerational mobility, researchers need data that includes health information for both parents and children. Such datasets are not always readily available, and those that do exist often lack the necessary granularity and long-term tracking to provide meaningful insights.

To overcome these challenges, Wang draws on a variety of panel data that tracks individuals over time, as well as survey data and self-reported status. For Wang, longitudinal studies are crucial for understanding how health disparities manifest and evolve over time. 

Using data from the Indonesia Family Life Survey, she combines subjective measures like self-reported health and objective measures such as pulse, BMI, hypertension, and anemia to capture a more complete picture of health mobility. This approach expands beyond previous studies, which typically relied on fewer health indicators and focused on developed countries. Her study includes a broad range of health variables and provides a unique look at the role of gender and socioeconomic factors in shaping health outcomes across generations.

Wang uses two primary methods for measuring intergenerational health mobility: one following the Intergenerational Health Association, which regresses children's health outcomes on those of their parents, and rank-rank regressions, which examine the persistence of health outcomes by analyzing percentile ranks. These techniques, adapted from income mobility research, allow her to assess health persistence and mobility across generations.

Future Directions and Policy Impact

Wang’s time at APARC has been instrumental in shaping and refining her research. "The opportunity to engage with experts from various fields [...] opened my eyes to new ways of thinking about my research," she shared. "The collaborative environment at APARC also made me realize how much I can learn from perspectives outside my immediate area of focus.”

Wang credits Stanford’s vibrant academic environment, with its rich array of seminars and talks, to broadening her understanding of Southeast Asian health systems, a subject she was less familiar with. She expressed gratitude to APARC faculty for their “invaluable guidance for both my research and my life at Stanford.” In particular,  APARC’s Asia Health Policy Program Director Karen Eggleston “dedicated a significant amount of time to advising my work, introducing me to key researchers in my field, and sharing the valuable resources that I might benefit from on campus,” Wang said.

Looking ahead, she is excited to continue exploring the role of health in intergenerational mobility, particularly in the Southeast Asian context, and plans to expand her research into the health effects of pollution, an area she has already begun to investigate. Wang also hopes to contribute to policymaking that addresses health inequality. By providing a deeper understanding of how health disparities are perpetuated across generations, she aims to inform policies that could improve health outcomes and reduce inequality in developing countries.

Wang’s research on intergenerational health mobility offers a fresh and much-needed perspective on the crucial yet understudied role of health in social mobility. She hopes her research helps policymakers and scholars address health inequalities that perpetuate socioeconomic disadvantage across generations.

Donald Trump’s decisive victory in the 2024 U.S. presidential election has reignited debates about the United States' role in a world increasingly defined by geopolitical tensions, economic uncertainty, and democratic recession. The return of Trump to the White House will have profound implications for Asia. To assess the stakes for the region, APARC convened a panel of experts who weighed in on the potential risks and opportunities the second Trump administration’s policies may pose for Asian nations and how regional stakeholders look at their future with the United States. Another panel, organized by APARC’s China Program, focused on what’s ahead for U.S.-China relations.

High Stakes for the Asia-Pacific

APARC’s panel, The 2024 U.S. Presidential Elections: High Stakes for Asia, examined how the return of Trump’s political ideology and the macroeconomic effects of his foreign policy will affect Asia.

“We are witnessing the solidification of Trumpism as an influential political ideology,” stated APARC and Korea Program Director Gi-Wook Shin at the opening of the discussion, “one that has begun to transcend traditional  American conservatism. Trumpism — marked by a blend of economic nationalism, nativism, and a strongman approach to leadership —could have a huge impact not only in American society but also on the liberal global order.”

According to Shin, Trump’s policies, particularly his focus on unilateralism and economic self-interest, could significantly alter the political and economic dynamics of the Asia-Pacific region.

Political scientist Francis Fukuyama, the Olivier Nomellini Senior Fellow at the Freeman Spogli Institute, argued that Trump’s victory was no longer an anomaly but part of a larger trend of working-class voters shifting allegiance from the Democratic to the Republican Party. Fukuyama expressed concerns about Trump’s aggressive economic policies, including imposing broad tariffs on allies and adversaries alike, and warned that such policies could result in inflation, trade tensions, and long-term economic instability. In addition, he asserted that Trump’s reluctance to engage in foreign conflicts could undermine the United States’ commitments to security alliances, particularly in Asia.

APARC Deputy Director and Japan Program Director Kiyoteru Tsutsui emphasized the broader geopolitical implications of Trump’s policies, noting that Trump’s "America First" approach could further erode the international liberal order. He suggested that Japan would face significant challenges navigating the unpredictability of Trump’s foreign policies. According to Tsutsui, “There might be greater pressure to line up with the United States in dealing with China economically, which would  put a great deal of strain on the Japanese economy.” Such an alignment might also muddle Japan’s own diplomatic and security interests.

Gita Wirjawan, a visiting scholar with Stanford's Precourt Institute for Energy and former visiting scholar at APARC, focused on the stakes for Southeast Asia. Wirjawan argued that Trump’s economic policies, such as protectionism and prioritizing economic growth over democratic principles, could embolden right-wing populist movements in Southeast Asia. He suggested that parts of Southeast Asia could be a natural beneficiary of a reallocation of financial capital from the U.S. as companies diversify supply chains by establishing operations outside China in response to Trump’s planned tariffs. Yet, growing economic inequality in Southeast Asia, particularly in urban areas, could fuel the rise of similar nationalist policies, undermining efforts to promote inclusive, democratic development.

Shin highlighted the challenges South Korea might face under a second Trump presidency. Trump will likely demand higher defense payments from South Korea, potentially straining the U.S.-ROK alliance. This could put President Yoon in a tough spot, especially as trilateral U.S.-Japan-Korea cooperation has been progressing well but faces uncertainty. Economically, South Korean firms may struggle if U.S. policies like the Inflation Reduction Act and CHIPS Act are rolled back, as subsidies were crucial for their investments in the U.S. On North Korea, Shin noted that Trump may resume summit diplomacy with Kim Jong Un, leaving South Korea sidelined and potentially sparking an arms race in Northeast Asia. 

The panelists all emphasized that Asia, with its diverse political landscapes, would need to navigate a new era of economic nationalism and geopolitical unpredictability, with potential challenges to economic stability and democratic norms.

A Focus on U.S.-China Relations 

The second panel, "Crossroads of Power: U.S.-China Relations in a New Administration," focused specifically on the evolving dynamics of U.S.-China relations in the wake of the election. Moderated by APARC China Program Director Jean Oi, the discussion featured Shorenstein APARC Fellow Thomas Fingar, and Peking University's Yu Tiejun, the APARC's China Policy Fellow during fall 2024. The panelists analyzed the potential trade, security, and diplomacy shifts between the two global superpowers, particularly in light of Washington's bipartisan consensus on China. 

Central to the discussion was the continuity of U.S. policy toward China under the first Trump administration and the Biden administration. Examples of this continuity included recent tariff increases on Chinese imports, a new U.S. Department of the Treasury program to screen U.S. outbound foreign investments in key sectors, and tighter export controls on critical technologies like quantum computing and advanced semiconductors. The panelists explored the economic and strategic ramifications, noting that these policies could disrupt existing trade patterns. 

Another area of concern was China’s uneven implementation of the 2020 Phase One  trade deal it negotiated with the U.S., in which China had committed to domestic reforms and $200 billion of additional U.S. imports. This failure could buttress the new administration’s plan to increase tariffs, complicating diplomatic efforts between Washington and Beijing. Fingar noted that while China has made efforts to diversify its supply chains, these changes might not be enough to shield it from the effects of U.S. economic policies, which could include escalating tariffs or additional restrictions on Chinese exports. 

The conversation also touched on broader geopolitical considerations, particularly concerning China’s role in the ongoing war in Ukraine. The panelists discussed the potential for cooperation or de-escalation in U.S.-China relations, with China’s positioning on the war serving as both a point of contention and a possible avenue for diplomatic engagement. 

Underscoring the deepening complexities in U.S.-China relations post-election, the panelists highlighted the uncertainty surrounding U.S. foreign policy under a second Trump administration, particularly regarding the role of people-to-people exchanges in fostering mutual understanding.

Both events emphasized the multifaceted consequences of Trump’s return to power for Asia and the global international order. While the discussions highlighted the challenges posed by the rise of economic nationalism, trade tensions, and shifting security priorities, they also pointed to potential areas of cooperation and the evolving dynamics of global diplomacy.

In the Media

From Center Fellow Oriana Skylar Mastro:

What a Second Trump Term Means for the World
OnPoint – WBUR, Nov 12 (interview)

Race to the White House: How the US Election Will Impact Foreign Policy
UBS Circle One, October 23 (interview)

From Visiting Scholar Michael Beeman:

On Korea-U.S. Economic Cooperation in the Era of Walking Out
Yonhap News, Nov 20 (featured)

Trump Looking for Trade 'Reset' with Most Countries: Ex-USTR Official
Nikkei, Nov 16 (interview)

How Southeast Asia Can Weather the Trump Trade Typhoon
The Economist, Nov 14 (quoted)