Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Myanmar (Burma) is undergoing a complex political and economic transformation, from a long civil war and military regime to a peace process and democratisation. Since 2011, the Myanmar Ministry of Health has started to rehabilitate the fragile health system, setting the goal of achieving universal health coverage by 2030. To achieve this target, Myanmar will have to face substantial challenges; arguably one of the most important difficulties is how to allocate limited health-care resources equitably and effectively.

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The Lancet
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Phyu Phyu Thin Zaw
Pham Ngoc Minh
Karen Eggleston
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10008
Authors
Lisa Griswold
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China announced plans to discontinue its “one-child policy” in October, relaxing over three decades of controversial family planning policies and changing to a universal two-child policy. This new policy is a step forward, but China’s population aging and gender imbalance will create challenges for decades, according to a leading Stanford health researcher.

“China has reached a certain level of social and economic development where low fertility and population aging have become norms,” said Karen Eggleston, a senior fellow in the Freeman Spogli Institute (FSI) and director of the Asia Health Policy Program. “Similar trends are seen in Japan and South Korea, and governments are struggling to catch up.”

 

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The policy change comes amid concerns of potential labor shortages and a burgeoning aging population that could pressure the Chinese economy for years to come. 

The country has had record growth – China’s GDP growth rate averaged 8.6 percent over the past five years – which is now slowing. That trend coupled with China’s rising life expectancy reinforces the need for a healthy, economically productive population to support the elderly, experts say.

“Demographers who study China knew a policy change was coming, but not when,” said Eggleston. “The policy was strategically announced with the Five Year Plan – a sort of developmental roadmap for the country.”

A forthcoming book, Policy Challenges from Demographic Change in China and India, edited by Eggleston examines the policy challenges posed by demographic change in China and India, from family planning to social pensions systems that support the elderly. One chapter looks exclusively at population policy, sex ratio and fertility in China.

A spur to action?

A shift to a consistent, nationwide two-child policy is a step in the right direction, Eggleston said, and it is unlikely to translate to a boom in the birthrate.

Some areas of the country and specific couples already enjoyed a two-child policy due to local policy differences and an earlier national policy easing. In 2013, the Chinese government allowed couples with a husband or wife from a single-child family to have a second child.

Chinese cities that never had a one-child policy to begin with, like Hong Kong and Macau, have very low fertility. A recent article in China Journal noted that, despite the ubiquity of the one-child policy campaign, China’s rapid economic development since 1980 deserves the “lion’s share of credit” for reduced births as the country’s total fertility rate has declined.

“The real question is how responsive the Chinese will be,” Eggleston said. “It’s not clear that there will be a noticeable response in the short or medium-term.”

Implementation of the policy will take time, but China will work “quite expeditiously” to apply such policies so that people’s expectations are met. Alongside legal change of China’s varying local policies, it’s expected that China will employ several public education campaigns and its cadre of family planning staff as conduits for disseminating the new national policy, Eggleston said.


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Chinese Family Planning Poster

A 1986 poster highlights China's one-child policy.

Credit: Flickr/Collection Stefan R. Landsberger, International Institute of Social History (Amsterdam).


But other factors are at play, too, such as urbanization and changes in labor force participation.

“Young and middle-aged couples will be thinking twice about having another child because of education expense, job demands and the need to support aging parents,” Eggleston said.

A paper published by Eggleston and three other scholars in the Journal of Labor & Development analyzed how employment of females from rural areas affected fertility, using data from a survey of 2,355 married women in China. The survey examined “off-farm” employment, which was defined as travel to another village, town or city for work.

The researchers found that off-farm employment for those women reduced the probability of having more than one child by 54.8 percent and the probability of preferring more than one child by 49.6 percent. An earlier blog piece on VoxEU highlighted those research outcomes.

Another aspect of China’s demographic change is gender imbalance. Male preference has long been a cultural factor in China and, with the pressures of the one-child policy, a cause behind its skewed population.

That reality will not dramatically change soon, Eggleston said. Even if the end to the one-child policy brought the sex ratio at birth back to normal levels, the existing imbalance of the younger population will create millions of “forced bachelors” among poorer men who cannot find brides, as well as a whole set of related issues.

Choice restored

What the policy assuredly does, though, is remove a barrier. Many Chinese women who before did not have the opportunity to give birth to a second child, now have that opportunity.

 

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“This is a crucial arena of choice restored to the Chinese,” Eggleston wrote of the 2013 policy relaxation in a brief presented at the Federal Reserve Bank of Kansas City.

Previously, the absence of such a freedom led some couples to face substantial fines from the government, depending on the local variation of the one-child policy.

“Regardless of the new policy, demographic trends point to the importance of investing in child education, nutrition and skill development,” Eggleston said.

A similar message is carried in a chapter in Policy Challenges, co-authored by Sanghyop Lee and Qiulin Chen, who suggest that putting resources toward human capital development – education and health – can offset the destabilizing effects of demographic transition.

Research being done by FSI’s Rural Education Action Program led by Stanford professor Scott Rozelle works to directly inform education, health and nutrition policy in China.

Spending more on education – particularly for women and girls – is win-win. It complements pro-employment policies, and boosts productivity for women and the economy as a whole, Eggleston said.

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A woman in Beijing, China, holds children's balloons. | Flickr/Michael Abshear
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The lecture aims to introduce the prevalence of Non-communicable Diseases (NCDs) in Zhejiang Province in China, and also share experience of Control and Prevention of NCDs. The lecture is composed by five parts. Firstly, NCDs surveillance system in Zhejiang will be introduced, including its establishment history and system coverage. Then, epidemiological characteristics of major NCDs (such as diabetes, cancer, stroke, and acute coronary heart disease events) will be presented, as well as NCDs related behavioral risk factors and hospital-based injury surveillance. Next, current work of NCDs prevention and control in Zhejiang Province will be described, including work network, human resources, community management and pilot programs for NCDs. Fourthly, economic cost of diabetes will be illustrated. Finally, countermeasures for NCDs Prevention and Control will be discussed.

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Min Yu is deputy director of Zhejiang Provincial Center for Disease Control and Prevention. He was awarded as New-Century 151 Talents of Zhejiang Province, China. He is a committee member of Epidemiology Branch of Chinese Preventive Medicine Association. He is the leader of key discipline of Non-Communicable Diseases epidemiology (NCDs), and led the establishing of NCDs and behavioral risk factor surveillance system in Zhejiang province.  

Yu got Medical degree in Zhejiang University and Master degree of Public Health in Peking Medical University. Now his research focuses on epidemiology of NCDs, strategy for NCDs control and prevention, and disease burden.

Min Yu Deputy director of Zhejiang Provincial Center for Disease Control and Prevention
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Co-sponsored by the Asia Health Policy Program & the Southeast Asia Program
 
This paper analyzes the effects of an early-life shock in Indonesia on children’s human capital formation and parental responses to these shocks. We exploit the geographical variation of Indonesia’s forest fires during the El Nino phenomenon in 1997, as well as cohort variation in exposure. Children affected by these shocks in utero and in early years have worse health outcomes relative to children not exposed to these shocks. We find that the health effects persist, but other factors mitigate the initial effect on cognitive skills.
 
My main research interest lies at the intersection of development and health economics. I am particularly interested in how social policies affect health outcomes for the poor, early health investments, and health-seeking behavior in limited resource settings, focusing on the evaluation of different strategies that seek to promote health investments and the effects of these interventions. Specifically, I have analyzed the effects of Indonesia’s household conditional cash transfer program on health outcomes, local health care price, and quality of care. I have also analyzed the long-term effects of a large-scale midwifery program in Indonesia. Current projects study the effects of early life shocks on children’s human capital outcomes in Indonesia and the Philippines.
 
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Margaret Triyana is currently Assistant Professor of Economics at Nanyang Technological University, Singapore. Triyana graduated from the Harris School of Public Policy at the University of Chicago. She was previously the Asia Health Policy Postdoctoral Fellow at the Shorenstein Asia Pacific Research Center in 2013-14.
Margaret Triyana Assistant Professor of Economics, Nanyang Technological University, Singapore
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As we look toward year 2016, the Walter H. Shorenstein Asia-Pacific Research Center documents highlights from the 2014-15 academic year. The latest edition of the Center Overview, entitled "Asia in Flux," includes special research, people, events and outreach features, and is now available for download online.

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Denise Masumoto
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As the new academic year gets underway, the Walter H. Shorenstein Asia-Pacific Research Center’s Corporate Affiliates Program is excited to welcome its new class of fellows to Stanford University:

  • Yuta Aikawa, Ministry of Economy, Trade & Industry, Japan
  • Wataru Fukuda, Shizuoka Prefectural Government
  • Huang (Catherine) Huang, Beijing Shanghe Shiji Investment Company
  • Avni Jethwa, Reliance Life Sciences
  • Satoshi Koyanagi, Ministry of Economy, Trade & Industry, Japan
  • An Ma, PetroChina
  • Huaxiang Ma, Peking University
  • Yuichiro Muramatsu, Mitsubishi Electric
  • Tsuzuri Sakamaki, Ministry of Finance, Japan
  • Tsuneo Sasai, The Asahi Shimbun
  • Ravishankar Shivani, Reliance Life Sciences
  • Aki Takahashi, Nissoken
  • Mariko Takeuchi, Sumitomo Corporation
  • Hideaki Tamori, The Asahi Shimbun
  • Ryo Washizaki, Japan Patent Office
  • Hung-Jen (Fred) Yang, MissionCare

During their stay at Stanford University, the fellows will audit classes, work on English skills, and conduct individual research projects; at the end of the year they will make a formal presentation on the findings from their research. During their stay at the center, they will have the opportunity to consult with Shorenstein APARC's scholars and attend events featuring visiting experts from around the world. The fellows will also participate in special events and site visits to gain a firsthand understanding of business, society and culture in the United States.

 

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Rod Searcey
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Professor MENG Qingyue, Dean of the Peking University School of Public Health and Director of the China Center for Health Development Studies at Peking University, will share his deep experience with research and policy advising about health and healthcare in the PRC. In the colloquium, Professor Meng will summarize the achievements of China’s health system reforms as well as the formidable challenges remaining -- strengthening primary care, reforming payment incentives, and multiple other reform priorities.

Professor Meng is lead author of the first-ever comprehensive overview of the PRC health system [http://www.wpro.who.int/asia_pacific_observatory/hits/series/chn/en/], which documents that the PRC has made great strides in raising health status and improving access to medical care, in large part thanks to emphasis on cost- effective public health programs, renewed commitments of government financing, expansion of social health insurance and other forms of financial protection, and investments in the healthcare delivery system. However, challenges remain in the form of large and in some cases growing inequalities in health and healthcare – across regions, urban-rural areas, or involving migrants and other vulnerable groups– as well as in improving the quality of healthcare, reforming public hospitals, and making expenditure growth sustainable through payment reforms and improved strategic purchasing.

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meng qing yue
Professor Meng Qingyue (MD, PhD), is Professor in Health Economics and Policy, Dean of Peking University School of Public Health, and Executive Director of Peking University China Center for Health Development Studies.

He obtained his Bachelor degree in medicine from Shandong Medical University (now Shandong University), Masters in public health from Shanghai Medical University (now Fudan University), Masters in economics from University of the Philippines, and PhD in health economics and policy from Karolinska Institutet in Sweden.

Before taking the current position, he was the Dean of Shandong University School of Public Health and Director of Shandong University Center for Health Management and Policy. His research interests include health financing policy and health provider payment systems.

He has led a team doing dozens of research projects supported by both domestic and international funding sources. He has been Member of the Expert Committee on Health Policy and Management to China Ministry of Health over the past decade. He is the Board Member of Health Systems Global elected from the Asia and Pacific Region.

 

China's health system
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Meng Qingyue Professor in Health Economics and Policy, Dean of Peking University School of Public Health, and Executive Director of Peking University China Center for Health Development Studies
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This event has moved from the 4:30pm talk to a noon talk.

Nonprofit organizations are engaged in public sector management as service deliverers, and more recently, as governance partners. Such a role shift of nonprofits can be explained by a couple of spontaneous mechanisms that link service contracting to collaborative governance. The evolving elderly service contracting in Shanghai discloses that contracting may induce power sharing, consolidate mutual trust, reshape community governance networks, and spur nonprofit development. Contracting nonprofits thus may make decisions, enforce regulatory functions, set rules, and influence community governance. An evolutionary perspective provides a new angle on the changing government-nonprofit relations in China.

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Dr. Yijia Jing is a professor in Public Administration and associate director of foreign affairs at Fudan University. He is the editor-in-chief of Fudan Public Administration Review, and serves as the vice president of International Research Society for Public Management. He is associate editor of Public Administration Review and Co-editor of International Public Management Journal. He is also the founding co-editor of a Palgrave book series---Governing China in the 21 Century.

Yijia Jing Professor in Public Administration and Associate Director of Foreign Affairs, Fudan University
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Stanford health policy expert Karen Eggleston has been appointed as a senior fellow at the Freeman Spogli Institute for International Studies (FSI), effective Sept. 1, 2015, on a continuing term.

Eggleston, who leads the Asia Health Policy Program at Stanford’s Walter H. Shorenstein Asia Pacific Research Center (APARC), is a recognized authority on comparative health policy and the economics of the demographic transition in Asia, especially China.

“FSI is delighted that Karen’s impressive scholarship and strong program leadership has earned her a promotion to the position of senior fellow,” FSI director Michael McFaul said. “It’s a well-deserved honor and the institute looks forward to working with her for many years to come.”

Trained as an economist, Eggleston first came to Stanford as a center fellow in 2007 to lead a program on Asian health policy in comparative perspective. Since then, the program has grown into an innovative hub of research, training and policy outreach.

Eggleston’s new appointment also carries membership in the University’s Academic Council and status as a principal investigator for research projects. Her research areas include population aging, healthcare productivity (“value for money”), insurance and payment incentives, and health system governance. Currently, she is leading a comparative study of “value for money” in diabetes care, with patient-level data from Japan, Hong Kong, Taiwan and China.

“Karen has been a pioneering force at our center, and in the area of Asia health policy,” said Gi-Wook Shin, director of Shorenstein APARC. “Her strong record of scholarly accomplishment has enriched the intellectual life at Stanford, and we look forward to continuing to support her research and teaching endeavors.”

Eggleston has led many crosscutting initiatives at Stanford including the organization of multiple international conferences in the United States and abroad. This past year, she co-organized a conference on China’s health reforms and primary care, held at the Stanford Center at Peking University.

She has testified on China’s health system before a U.S. congressional commission, and in 2014, spoke at the Jackson Hole Symposium of the Federal Reserve Bank.

Eggleston teaches students through Stanford’s East Asian Studies program and is an active author/editor of books and publications, including a special issue of the Journal of the Economics of Ageing (2014) focused on the economic implications of population aging in China and India. She expects to release two edited volumes through Shorenstein APARC’s publishing program shortly.

Eggleston is also a faculty research fellow at the National Bureau of Economic Research as well as affiliated with Stanford’s Center for Health Policy / Center for Primary Care and Outcomes Research.

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Rod Searcey
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