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

How did you begin in Asia health policy?

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

What led you to Stanford?

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

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

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

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

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

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

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

Tell us something we don’t know about you.

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

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

Asked to summarize his biography and career, Donald K. Emmerson notes the legacy of an itinerant childhood: his curiosity about the world and his relish of difference, variety and surprise. A well-respected Southeast Asia scholar at Stanford since 1999, he admits to a contrarian streak and corresponding regard for Socratic discourse. His publications in 2014 include essays on epistemology, one forthcoming in Pacific Affairs, the other in Producing Indonesia: The State of the Field of Indonesian Studies.

Emmerson is a senior fellow emeritus at the Freeman Spogli Institute for International Studies (FSI), an affiliated faculty member of the Center on Democracy, Development and the Rule of Law, an affiliated scholar in the Abbasi Program in Islamic Studies, and director of the Southeast Asia Program at the Shorenstein Asia-Pacific Research Center. Recently he spoke with Shorenstein APARC about his life and career within and beyond academe.

Your father was a U.S. Foreign Service Officer. Did that background affect your professional life?

Indeed it did. Thanks to my dad’s career, I grew up all over the world. We changed countries every two years. I was born in Japan, spent most of my childhood in Peru, the USSR, Pakistan, India and Lebanon, lived for various lengths of time in France, Nigeria, Southern Rhodesia (now Zimbabwe) and the Netherlands, and traveled extensively in other countries. Constantly changing places fostered an appetite for novelty and surprise. Rotating through different cultures, languages, and schools bred empathy and curiosity. The vulnerability and ignorance of a newly arrived stranger gave rise to the pleasure of asking questions and, later, questioning the answers. Now I encourage my students to enjoy and learn from their own encounters with what is unfamiliar, in homework and fieldwork alike. 

Were you always focused on Southeast Asia? 

No. I had visited Southeast Asia earlier, but a fortuitous failure in grad school play a key role in my decision to concentrate on Southeast Asia. At Yale I planned a dissertation on African nationalism. I applied for fieldwork support to every funding source I could think of, but all of the envelopes I received in reply were thin. Fortunately, I had already developed an interest in Indonesia, and was offered last-minute funding from Yale to begin learning Indonesian. Two years of fieldwork in Jakarta yielded a dissertation that became my first book, Indonesia’s Elite: Political Culture and Cultural Politics. I sometimes think I should reimburse the African Studies Council for covering my tuition at Yale – doubtless among the worst investments they ever made. 

Indonesia stimulated my curiosity in several directions. Living in an archipelago led me to maritime studies and to writing on the rivalries in the South China Sea. Fieldwork among Madurese fishermen inspired Rethinking Artisanal Fisheries Development: Western Concepts, Asian Experiences. Experiences with Islam in Indonesia and Malaysia channeled my earlier impressions of Muslim societies into scholarship and motivated a debate with an anthropologist in the book Islamism: Contested Perspectives on Political Islam. 

What led you to Stanford?

In the early 1980s, I took two years of leave from the University of Wisconsin-Madison to become a visiting scholar at Stanford, and later I returned to The Farm for shorter periods. At Stanford I enjoyed gaining fresh perspectives from colleagues in the wider contexts of East Asia and the Asia-Pacific region. In 1999, I accepted an appointment as a senior fellow in FSI to start and run a program on Southeast Asia at Stanford with initial support from the Luce Foundation.

As a fellow, most of your time is focused on research, but you also proctor a fellowship program and have led student trips overseas. How have you found the experience advising younger scholars?

In 2006, I took a talented and motivated group of Stanford undergrads to Singapore for a Bing Overseas Seminar. I turned them loose to conduct original field research in the city-state, including focusing on sensitive topics such as Singapore’s use of laws and courts to punish political opposition. Despite the critical nature of some of their findings, a selection was published in a student journal at the National University of Singapore (NUS). NUS then sent a contingent of its own students to Stanford for a research seminar that I was pleased to host. I encouraged the NUS students to break out of the Stanford “bubble” and include in their projects not only the accomplishments of Silicon Valley but its problems as well, including those evident in East Palo Alto.

That exchange also helped lay the groundwork for an endowment whereby NUS and Stanford annually and jointly select a deserving applicant to receive the Lee Kong China NUS-Stanford Distinguished Fellowship on Contemporary Southeast Asia. The 2014 recipient is Lee Jones, a scholar from the University of London who will write on regional efforts to combat non-traditional security threats such as air pollution, money laundering and pandemic disease.

Where does the American “pivot to Asia” now stand, and how does it inform your work? 

Events in Iran, Iraq, Afghanistan, Syria and now in Crimea as well, have pulled American attention away from Southeast Asia. Yet the reasons for priority interest in the region have not gone away. East Asia remains the planet’s most consequential zone of economic growth. No other region is more directly exposed to the potentially clashing interests and actions of the world’s major states – China, Japan, India and the United States. The eleven countries of Southeast Asia – 630 million people – could become a concourse for peaceful trans-Pacific cooperation, or the locus of a new Sino-American cold war. It is in that hopeful yet risky context that I am presently researching China’s relations with Southeast Asia, especially regarding the South China Sea, and taking part in exchanges between Stanford scholars and our counterparts in Southeast Asia and China. 

Tell us something we don’t know about you.

Okay. Here are three instructive failures I experienced in 1999, the year I joined the Stanford faculty. I was evacuated from East Timor, along with other international observers, to escape massive violence by pro-Indonesian vigilantes bent on punishing the population for voting for independence. The press pass around my neck failed to protect me from the tear gas used to disperse demonstrators at that year’s meeting of the World Trade Organization – the “Battle of Seattle.” And in North Carolina in semifinal competition at the 1999 National Poetry Slam, performing as Mel Koronelos, I went down to well-deserved defeat at the hands of a terrific black rapper named DC Renegade, whose skit included the imaginary machine-gunning of Mel himself, who enjoyed toppling backward to complete the scene. 

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

Myanmar's opening to the outside world and the country's tentative steps from military rule to democracy has captivated many observers of the region. But Aung Zaw, an exiled Burmese journalist pushing for democratic change, warns that the image of rapid reform does not necessarily match reality these days.

“What we see now is serious backsliding,” Zaw told a packed house at the Bechtel Conference Center on March 6.  “The changes have become more superficial; the changes are not real.” 

Zaw, the founding editor of The Irrawaddy newsmagazine, delivered these remarks at Stanford upon receiving the Shorenstein Journalism Award. This annual award is conferred upon a journalist who promotes mutual understanding between the U.S. and Asia, and also honors Asian journalists who have been at the forefront of the effort to create an independent media in the Asia-Pacific.

Zaw joined scholars Donald K. Emmerson and Daniel C. Sneider from the Walter H. Shorenstein Asia Pacific Research Center in the Freeman Spogli Institute for International Studies and Yale University’s Nayan Chanda at a lunchtime panel discussion of the question – “Burma's Democracy: How Real?”

Zaw, who was forced into exile after the abortive democratic revolt of 1988, described Myanmar’s dynamic history as “up and down.” During the long period of military rule in the country, “Burma was a pariah,” he observed. The military government repressed all opposition, enriching itself while Burma slide into deep poverty, while the country was largely cut off from the outside world except for a trickle of tourists. But the regime made a clear decision to open the doors to the outside and, in response to international and domestic pressure, take tentative steps toward political change, including releasing political prisoners and allowing the media to operate more freely.

The panelists agreed that the uprisings within Burma, such as the Buddhist monk led revolt in 2007, and the leadership of Burmese human rights activist Aung San Suu Kyi pushed the regime toward change. In addition, Chanda and Emmerson pointed to the geopolitics of Burma, the desire of the regime to free itself from isolation and dependence only on China and North Korea as backers.

Zaw credited these changes with bringing some semblance of “communal balance” to the society. Emmerson argued, however, that the West has colored their view of Burma with a romantic notion of democratization that tends to overlook the still tentative, and somewhat transient, nature of the changes to date.

“The regime has carefully manipulated… international [public] opinion in trying to open the doors to the international community,” Zaw said. Especially in the past year, there have been efforts by the government to curb public protest and censorship has become pervasive once again. A commentary piece written by Zaw provides an analysis of the contemporary media environment in Myanmar.

The panel members pointed in particular to the rise of tensions between the Buddhist Burmese majority and ethnic and religious minorities in the country. In particular, they expressed concern over the discrimination against and violence suffered by minority Muslims, the ethnic Rohingya who live along the border with Bangladesh, often taking place with the complicity of government officials, or at least with their indifference. They suggested the government played upon anti-Muslim feelings to boost its popularity among the majority Buddhist populace.

With elections looming in 2015, the government may now feel it has been “moving too fast” toward reform and begun to ratchet back, warned Zaw. Conservative factions in Myanmar’s leadership who fear losing power may be gaining influence.

Nayan Chanda, the former editor of the Far Eastern Economic Review and a previous recipient of the Shorenstein Award, pointed to Myanmar’s long tradition of despotism. “Burmese rulers have had a way of governing the country that is still present among the generals we see in Burma today,” he said.

Emmerson focused his remarks on the significance of the changes in Burma to American foreign policy in the region. The Burmese shift away from Chinese domination and its opening to the West has been seen as a key part of the so-called U.S. “pivot” to Asia and its attempts to balance Chinese influence in East Asia. These changes allowed Myanmar to assume its role as chairman of the Association of Southeast Asian Nations (ASEAN), an annual rotation in leadership. But it is far from clear if the Burmese leadership is prepared to go toward a deeper democratic transformation. The upcoming presidential elections in 2015 remain an uncertainty. Aung San Suu Kyi is still constitutionally barred from running for president but she has been allowed to resume a powerful role in the system itself, no longer simply a “Joan of Arc” symbol of purity sitting on the outside.

In all this, the role of a free press in Burma is even more vital than ever. After his arrest in 1988 for his role in the uprising against General Ne Win’s regime, Zaw had to flee to neighboring Thailand where he has spent 25 years in exile. Zaw created The Irrawaddy, an émigré-based publication that is widely acclaimed for its on-the-ground analysis of Myanmar. In 2012, the publication reopened offices in Burma. 

The Irrawaddy’s diverse contributors offer an independent platform to unravel the complex developments within the country. The Shorenstein Award given to Zaw recognizes his history of leadership as a journalist in Burma.

“It is very exciting for us this year to give this award to Aung Zaw,” said Sneider, a member of the jury that selects the awardees. “He has been intimately involved in the process of not only creating independent media for Burma but also in the process of independent change itself, starting with his own activism in the 1980s.”

Zaw received the award at a dinner ceremony later on March 6 attended by students, faculty and prominent members of the Stanford community. “I feel very humbled,” Zaw told the Voice of America in an interview. “It is an acknowledgement to our work, our commitment and our independent journalism as we try to make things different [in Myanmar].”

The video and transcript of the event, and the original press release on Zaw being named the 2013 Award recipient are posted below.

An article was published by The Irrawaddy on Zaw’s acceptance of the award. Interviews conducted with Voice of America's Kyaw Zan Thaw in Burmese and Kaye Lin in English aired internationally on March 13 and are posted below. An interview was also conducted with LinkAsia and is scheduled to air in the upcoming week and will be subsequently posted online.