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.

Professor Hidehiko Ichimura of the University of Tokyo will share recent results from his research on the health of older adults and the retirement process in Japan. His research draws upon a unique data source, the Japanese Study of Aging and Retirement (JSTAR). This rich dataset provides information on how middle-aged and elderly Japanese live in terms of economic, social, and health outcomes, and how these interact with their family status. The JSTAR project aims to provide longitudinal data enabling detailed policy-relevant comparisons to other industrialized countries (e.g. the Survey on Health, Aging and Retirement in Europe, the US Health and Retirement Study, the English Longitudinal Study on Aging, and similar surveys now launched in Korea, China, and India).

Professor Ichimura received his BA in economics from Osaka University in 1981 and his Ph.D. in economics from the Massachusetts Institute of Technology (MIT) in 1988. He has taught at the University of Minnesota, the University of Pittsburgh, and University College London. He is now Professor in the Graduate School of Public Policy and Graduate School of Economics at the University of Tokyo. 

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Hidehiko Ichimura Professor in the Graduate School of Public Policy and Graduate School of Economics Speaker University of Tokyo
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Nutrition, physical activity, smoking, and alcohol consumption are major causes of morbidity and mortality related to noncommunicable diseases (NCDs). Hypertension, diabetes type II, cancer, and chronic pulmonary diseases cause 60 percent of deaths worldwide and will likely increase by 17 percent during the next 10 years. Eighty percent of deaths caused by NCDs are registered in low- and middle-income countries in the working-age population and contribute to the growth of poverty [1,2,3].

During the last 15 years in Mongolia the leading causes of mortality have been cardiovascular disease and cancer.

This qualitative survey is one part of the Facility-Based Impact Study (FBIS) and was funded by the MCA Health Project. The overall goal of the MCA Health Project is to reduce mortality and morbidity caused by NCD and traffic accidents. Over a period of five years, the project aims to provide the population with essential knowledge about health promotion, the prevention and early detection of NCDs, and the adoption of healthy lifestyles through capacity building for the health system and, more specifically, for the preventive facilities. One main activity of the project is to improve primary health services related to NCDs through interventions for capacity building on the level of health facilities. This FBIS focuses on assessing the current situation in the facilities to enable a later comparison of the results of this baseline study and a later follow-up study to evaluate the impact of the Health Project on the performance of health staff, their knowledge, attitudes, and practice in the facilities, and the preparedness of facilities in terms of equipment and staff. The survey was carried out by a joint team of local and international consultants from the MCA Health Project, EPOS Health Management and THL Finland, and researchers from the School of Public Health.  

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Asia Health Policy Program working paper # 31
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President Obama and Mitt Romney meet for their third debate to discuss foreign policy on Monday, when moderator Bob Schieffer is sure to ask them about last month's terrorist attack in Libya and the nuclear capabilities of Iran.

In anticipation of the final match between the presidential candidates, researchers from five centers at Stanford’s Freeman Spogli Institute for International Studies ask the additional questions they want answered and explain what voters should keep in mind.


What can we learn from the Arab Spring about how to balance our values and our interests when people in authoritarian regimes rise up to demand freedom?  

What to listen for: First, the candidates should address whether they believe the U.S. has a moral obligation to support other peoples’ aspirations for freedom and democracy. Second, they need to say how we should respond when longtime allies like Egypt’s Hosni Mubarak confront movements for democratic change.

And that leads to more specific questions pertaining to Arab states that the candidates need to answer: What price have we paid in terms of our moral standing in the region by tacitly accepting the savage repression by the monarchy in Bahrain of that country's movement for democracy and human rights?  How much would they risk in terms of our strategic relationship with Bahrain and Saudi Arabia by denouncing and seeking to restrain this repression? What human rights and humanitarian obligations do we have in the Syrian crisis?  And do we have a national interest in taking more concrete steps to assist the Syrian resistance?  On the other hand, how can we assist the resistance in a way that does not empower Islamist extremists or draw us into another regional war?  

Look for how the candidates will wrestle with difficult trade-offs, and whether either will rise above the partisan debate to recognize the enduring bipartisan commitment in the Congress to supporting democratic development abroad.  And watch for some sign of where they stand on the spectrum between “idealism” and “realism” in American foreign policy.  Will they see that pressing Arab states to move in the direction of democracy, and supporting other efforts around the world to build and sustain democracy, is positioning the United States on “the right side of history”?

~Larry Diamond, director of the Center on Democracy, Development, and the Rule of Law


What do you consider to be the greatest threats our country faces, and how would you address them in an environment of profound partisan divisions and tightly constrained budgets? 

What to listen for: History teaches that some of the most effective presidential administrations understand America's external challenges but also recognize the interdependence between America's place in the world and its domestic situation.

Accordingly, Americans should expect their president to be deeply knowledgeable about the United States and its larger global context, but also possessed of the vision and determination to build the country's domestic strength.

The president should understand the threats posed by nuclear proliferation and terrorist organizations. The president should be ready to lead in managing the complex risks Americans face from potential pandemics, global warming, possible cyber attacks on a vulnerable infrastructure, and failing states.

Just as important, the president needs to be capable of leading an often-polarized legislative process and effectively addressing fiscal challenges such as the looming sequestration of budgets for the Department of Defense and other key agencies. The president needs to recognize that America's place in the world is at risk when the vast bulk of middle class students are performing at levels comparable to students in Estonia, Latvia and Bulgaria, and needs to be capable of engaging American citizens fully in addressing these shared domestic and international challenges.

~Mariano-Florentino Cuéllar, co-director of the Center for International Security and Cooperation


Should our government help American farmers cope with climate impacts on food production, and should this assistance be extended to other countries – particularly poor countries – whose food production is also threatened by climate variability and climate change?

What to listen for: Most representatives in Congress would like to eliminate government handouts, and many would also like to turn away from any discussion of climate change. Yet this year, U.S. taxpayers are set to pay up to $20 billion to farmers for crop insurance after extreme drought and heat conditions damaged yields in the Midwest.

With the 2012 farm bill stalled in Congress, the candidates need to be clear about whether they support government subsidized crop insurance for American farmers. They should also articulate their views on climate threats to food production in the U.S. and abroad.

Without a substantial crop insurance program, American farmers will face serious risks of income losses and loan defaults. And without foreign assistance for climate adaptation, the number of people going hungry could well exceed 15 percent of the world's population. 

~Rosamond L. Naylor, director of the Center on Food Security and the Environment


What is your vision for the United States’ future relationship with Europe? 

What to listen for: Between the end of World War II and the end of the Cold War, it was the United States and Europe that ensured world peace. But in recent years, it seems that “Europe” and “European” have become pejoratives in American political discourse. There’s been an uneasiness over whether we’re still friends and whether we still need each other. But of course we do.

Europe and the European Union share with the United States of America the most fundamental values, such as individual freedom, freedom of speech, freedom to live and work where you choose. There’s a shared respect of basic human rights. There are big differences with the Chinese, and big differences with the Russians. When you look around, it’s really the U.S. and Europe together with robust democracies such as Canada and Australia that have the strongest sense of shared values.

So the candidates should talk about what they would do as president to make sure those values are preserved and protected and how they would make the cooperation between the U.S. and Europe more effective and substantive as the world is confronting so many challenges like international terrorism, cyber security threats, human rights abuses, underdevelopment and bad governance.

~Amir Eshel, director of The Europe Center


Historical and territorial issues are bedeviling relations in East Asia, particularly among Japan, China, South Korea, and Southeast Asian countries. What should the United States do to try to reduce tensions and resolve these issues?

What to listen for: Far from easing as time passes, unresolved historical, territorial, and maritime issues in East Asia have worsened over the past few years. There have been naval clashes, major demonstrations, assaults on individuals, economic boycotts, and harsh diplomatic exchanges. If the present trend continues, military clashes – possibly involving American allies – are possible.

All of the issues are rooted in history. Many stem from Imperial Japan’s aggression a century ago, and some derive from China’s more assertive behavior toward its neighbors as it continues its dramatic economic and military growth. But almost all of problems are related in some way or another to decisions that the United States took—or did not take—in its leadership of the postwar settlement with Japan.

The United States’ response to the worsening situation so far has been to declare a strategic “rebalancing” toward East Asia, aimed largely at maintaining its military presence in the region during a time of increasing fiscal constraint at home. Meanwhile, the historic roots of the controversies go unaddressed.

The United States should no longer assume that the regional tensions will ease by themselves and rely on its military presence to manage the situation. It should conduct a major policy review, aimed at using its influence creatively and to the maximum to resolve the historical issues that threaten peace in the present day.

~David Straub, associate director of the Korea Studies Program at the Walter H. Shorentein Asia-Pacific Research Center

 

Compiled by Adam Gorlick.

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President Obama and Mitt Romney speak during the second presidential debate on Oct. 16, 2012. Their third and final debate will focus on foreign policy.
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China and some other Asian countries have experienced a large surplus of men of marriageable age. The existing literature studies the impact of sex imbalance using aggregate sex ratios, such as at the county, city, or province level. However, these studies may miss important impacts on health and behavior because the relevance of surplus sons to family decisions mainly stems from pressure conveyed through social interactions with the local reference group.

This paper draws from unique social network data, collected from households' long-term spontaneous gift exchange records (li dan), combined with household panel data from 18 Chinese villages to explore the prevalence of men's localized pressure to get married. The surveyed villages are home to Chinese ethnic minorities, which largely circumvents endogenous fertility decisions on the first-born child due to the implementation of One Child Policy and its associated relaxations afterwards. To identify the effect of pressure to find wives for their sons on parental risky behavior, we focus on comparing families with a first-born boy versus a first-born girl and distinguish the network spillover effect from the direct effect.

The spatial econometric decompositions suggest that the pressure mainly originates from a few friends with unmarried sons and unbalanced sex ratios in the friendship networks, though own village sex ratio and having an unmarried son also affects parental risk-taking behavior. The results are consistent across specifications allowing for long-run and short-run effects. We also find similar patterns for parental working hours, their likelihood to engage in entrepreneurial activities and decision to migrate. In contrast, parents with a daughter do not demonstrate this pattern. Since the sex ratio imbalance in China will probably worsen in the next decade, disentangling the real sources of marriage market pressure may help design policies to improve parental well-being.

Dr. Xi Chen's main research interests involve health economics and development economics in the developing contexts. He recently completed his PhD in applied economics at Cornell. His research seeks to better understand how social interactions affect health behavior and outcomes, how socioeconomic status drives social competition. Most of his current work draws on primary data from China and secondary data from India and Indonesia.

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Xi Chen Assistant Professor Speaker Department of Health Policy and Management Yale School of Public Health
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Walter H. Shorenstein
Asia-Pacific Research Center
616 Serra St C333
Stanford University
Stanford, CA 94305-6055

(650) 724-6459 (650) 723-6530
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Asia Health Policy Postdoctoral Fellow in Developing Asia
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Marjorie Pajaron joins the Walter H. Shorenstein Asia-Pacific Research Center during the 2012–13 academic year from the University of Hawai’i at Manoa Department of Economics where she served as a lecturer.

She took part for five years in the National Transfer Accounts project based in Honolulu. Her research focuses on the role of migrant remittances as a risk-coping mechanism, as well as the importance of bargaining power in the intra-household allocation of remittances in the Philippines.

Pajaron received a PhD in economics from the University of Hawai’i at Manoa.

Working Papers:

 “Remittances, Informal Loans, and Assets as Risk-Coping Mechanisms: Evidence from Agricultural Households in Rural Philippines.” October 2012. Revise and Resubmit, Journal of Development Economics.

“The Roles of Gender and Education on the Intra-household Allocations of Remittances of Filipino Migrant Workers.” June 2012.

“Are Motivations to Remit Altruism, Exchange, or Insurance? Evidence from the Philippines.” December 2011.

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This paper examines the effect of income growth induced by 1978–84 land reform on the
sex ratio imbalance in China. Using variation in reform timing by county together with the
absence of sex selection among first-born child, we compare the sex of the second child between families with a first girl and those with a first boy before and after the reform. Results show that following a first daughter, the second child is 5.5 percent more likely to be a boy after landreform. Better educated parents are substantially more likely to respond with sex selection. After assessing various potential channels, our evidence is most consistent with an effect of increased household income.
 
Shuang Zhang is a postdoctoral fellow at SIEPR. She received her PhD from Cornell University in 2012 and will start as an assistant professor at the University of Colorado Boulder after one year at SIEPR. Her primary interests are development, health and education. Her current work focuses on various reforms and health outcomes in China.
 

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Shuang Zhang Postdoctoral Fellow, SIEPR Speaker Stanford University
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The lost decades for China in the 1950s, 1960s and 1970s look remarkably like the lost decades of Africa in the 1980s and 1990s. Poor land rights, weak incentives, incomplete markets and inappropriate investment portfolios. However, China burst out of its stagnation in the 1980s and has enjoyed three decades of remarkable growth. In this talk Rozelle examines the record of the development of China’s food economy and identifies the policies that helped generate the growth and transformation of agriculture. Incentives, markets and strategic investments by the state were key. Equally important, however, is what the state did not do. Policies that worked and those that failed (or those that were ignored) are addressed. Most importantly, Rozelle tries to take an objective, nuanced look at the lessons that might be learned and those that are not relevant for Africa. Many parts of Africa have experienced positive growth during the past decade. Rozelle examines if there are any lessons that might be helpful in turning ten positive years into several more decades of transformation.

Scott Rozelle (main speaker). Scott Rozelle is the Helen F. Farnsworth Senior Fellow and the co-director of the Rural Education Action Program in the Freeman Spogli Institute for International Studies at Stanford University. His research focuses almost exclusively on China and is concerned with: agricultural policy, including the supply, demand, and trade in agricultural projects; the emergence and evolution of markets and other economic institutions in the transition process and their implications for equity and efficiency; and the economics of poverty and inequality, with an emphasis on rural education, health and nutrition.

Alain de Janvry (commentator). Alain de Janvry is an economist working on international economic development, with expertise principally in Latin America, Sub-Saharan Africa, the Middle-East, and the Indian subcontinent. Fields of work include poverty analysis, rural development, quantitative analysis of development policies, impact analysis of social programs, technological innovations in agriculture, and the management of common property resources. He has worked with many international development agencies, including FAO, IFAD, the World Bank, UNDP, ILO, the CGIAR, and the Inter-American Development Bank as well as foundations such as Ford, Rockefeller and Kellogg. His main objective in teaching, research, and work with development agencies is the promotion of human welfare, including understanding the determinants of poverty and analyzing successful approach to improve well-being and promote sustainability in resource use.

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Encina Hall East, E404
Stanford, CA 94305-6055

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Faculty Co-director of the Stanford Center on China's Economy and Institutions
Helen F. Farnsworth Endowed Professorship
Senior Fellow at the Freeman Spogli Institute for International Studies
Senior Fellow at the Stanford Institute for Economic Policy Research
scott_rozelle_new_headshot.jpeg PhD

Scott Rozelle is the Helen F. Farnsworth Senior Fellow and the co-director of Stanford Center on China's Economy and Institutions in the Freeman Spogli Institute for International Studies and Stanford Institute for Economic Policy Research at Stanford University. He received his BS from the University of California, Berkeley, and his MS and PhD from Cornell University. Previously, Rozelle was a professor at the University of California, Davis and an assistant professor in Stanford’s Food Research Institute and department of economics. He currently is a member of several organizations, including the American Economics Association, the International Association for Agricultural Economists, and the Association for Asian Studies. Rozelle also serves on the editorial boards of Economic Development and Cultural Change, Agricultural Economics, the Australian Journal of Agricultural and Resource Economics, and the China Economic Review.

His research focuses almost exclusively on China and is concerned with: agricultural policy, including the supply, demand, and trade in agricultural projects; the emergence and evolution of markets and other economic institutions in the transition process and their implications for equity and efficiency; and the economics of poverty and inequality, with an emphasis on rural education, health and nutrition.

Rozelle's papers have been published in top academic journals, including Science, Nature, American Economic Review, and the Journal of Economic Literature. His book, Invisible China: How the Urban-Rural Divide Threatens China’s Rise, was published in 2020 by The University of Chicago Press. He is fluent in Chinese and has established a research program in which he has close working ties with several Chinese collaborators and policymakers. For the past 20 years, Rozelle has been the chair of the International Advisory Board of the Center for Chinese Agricultural Policy; a co-director of the University of California's Agricultural Issues Center; and a member of Stanford's Walter H. Shorenstein Asia-Pacific Research Center and the Center on Food Security and the Environment.

In recognition of his outstanding achievements, Rozelle has received numerous honors and awards, including the Friendship Award in 2008, the highest award given to a non-Chinese by the Premier; and the National Science and Technology Collaboration Award in 2009 for scientific achievement in collaborative research.

Faculty affiliate at the Center on Democracy, Development, and the Rule of Law
Faculty Affiliate at the Walter H. Shorenstein Asia-Pacific Research Center
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Scott Rozelle Speaker
Alain de Janvry Professor of Agricultural and Resource Economics, Goldman School of Public Policy, UC-Berkeley Speaker
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