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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This interview was first published by the Stanford News Service.


The 2020 Summer Olympics have begun this week but public support among the Japanese public for the games has been generally low and their mood can be articulated through the succinct question: “Why are we doing this now?” says Stanford sociologist and Japan Program Director Kiyoteru Tsutsui.

 
Here, Tsutsui discusses how the various challenges posed by the COVID-19 pandemic and other national scandals related to the games have led to a general dissatisfaction among the Japanese public towards their government and the International Olympic Committee. Despite low morale, the country’s mood may change once the Summer Games commence – barring any further complications or disruptions. But given that the games are pared down this year, it still may be hard to generate the same levels of excitement as in previous years, Tsutsui said.
 
Tsutsui is the Henri H. and Tomoye Takahashi Professor and director of the Japan Program at the Walter H. Shorenstein Asia-Pacific Research Center, which is part of the Freeman Spogli Institute for International Studies. Tsutsui is also a professor of sociology and his research focuses on social movements, globalization, human rights and Japanese society. He is the author of Rights Make Might: Global Human Rights and Minority Social Movements in Japan (Oxford University Press, 2018).
 

Polls among the Japanese public show mixed support for the games and meanwhile, major advertisers in the country are pulling out. As a sociologist, how do you see this mixed public sentiment affecting overall mood and morale?

There is no question that there is a strong headwind against the Olympics in the lead-up to the opening ceremony. Opinion polls are still against the games, although the numbers improved a little in recent weeks. The general public sentiment can be summed up as “Why are we doing this now?”

The road to the Tokyo Olympics has been a long and winding one complicated by COVID-19, first and foremost, and various scandals. The Japanese public has been fed up with the COVID-19-related emergency declarations and other restrictions as well as the slower pace of vaccination compared to other developed countries. The perception, right or wrong, is that the government is making decisions based on whether they help in hosting the Olympics successfully, when the focus should be on public health and economic rescue in the COVID environment.

Morale is low, but many are hoping that things will change quickly once the games begin. Whether that happens or not depends on a whole host of factors, most importantly whether major public health incidents and other unfortunate accidents happen or not, how Japanese athletes fare, who might emerge as global stars, and so on.

To what extent has the International Olympic Committee (IOC) helped or hindered support for the games among the Japanese public?

The Japanese public sees the IOC as simply pushing its economic interest without the proper regard for their safety and health. Many people do not understand that the Japanese government does not have the authority to cancel the Olympics and could have faced a lawsuit with a huge compensation at stake if it tried to do so. The IOC looks like the IMF/World Bank during the Asian economic crisis in affected countries or the EU in some European countries – an international entity that pushes its agenda without accountability to the citizens. The frustration has nowhere to go but to the Japanese government, which combined with overall COVID-19-related dissatisfaction, has led to the most recent polls showing the lowest approval rating for the government under Prime Minister Yoshihide Suga.

For Japan, hosting the 2020 Olympic Games initially symbolized the country’s rebound from the devastating Tōhoku earthquake, tsunami and Fukushima Daiichi nuclear accident in 2011 and was poised to boost their economy. Then COVID hit, and meanwhile, Olympic expenses ballooned. Are there any opportunities for the Olympic Games to help the country bounce back? 

The 2020 Olympics was initially framed as a symbol of recovery from the triple disaster in 2011, but that slogan is no longer central. The expenses were justified as a way to develop infrastructure for foreign visitors and increase inbound tourists, and the government’s goals for the number of visitors from abroad have been met already. With no spectators allowed, Japan will lose money on hosting the Olympics, but the economic damage is not irrecoverable. Once the world gets out of COVID-19, the Japanese economy will likely rebound and tourists will come back.

It will be interesting to follow how socially, in terms of the national psyche and its unity, Japan will respond to the Tokyo Olympics. Even when the games take place in other countries, the Olympics often serve as a moment of national unity, especially in Japan. With Japan being the host, many thought that it would serve as an enormous booster towards national confidence and unity. We have yet to see how the games will turn out, but these psychological impacts will likely be lessened as the games are scaled down and may not get as much global attention as typical Olympics do.

There’s still a chance for a better outcome though if the games go smoothly and offer many compelling moments. People in many countries are still more homebound than usual and the contents that the games offer could be attractive. And the Japanese public is known to swing from one side to the other very quickly and on a massive scale, so once the games begin, TV personalities who were questioning whether the games should happen will likely quickly turn around and support Japanese athletes and tout their accomplishments. That is, if no serious outbreak incidents occur.

The Olympics are often celebrated as a nonpolitical event that can unite the world. In a globally turbulent world, what do you make of that assessment? Can the Olympics be nonpolitical?

The Beijing Winter Olympics in 2022 is a case in point. Boycott of the games seems unlikely, but House Speaker Nancy Pelosi has already floated an idea of diplomatic boycott. There’s a lot at stake for the host country, and the Olympics will likely be politicized when countries like China, Russia or even the U.S. host it.

Another problem is that not many democracies would be eager to host the games anymore. Public support is needed for democracies to host the Olympics, but the growing cost of the games, combined with increasingly less clear benefits of hosting, has made it difficult to find democracies that are eager to be the host country. Meanwhile, non-democracies like China and Russia, and even smaller countries like Kazakhstan or Azerbaijan campaign to become host nations. The pattern of dictatorships hosting the Olympics and the world demanding a change in their human rights practices and, threatening a boycott, might be a recurring pattern in the coming decades.

 
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Kiyoteru Tsutsui

Senior Fellow at FSI, Professor of Sociology, Director of the Japan Program
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A man cycles past a security fence outside the New National Stadium, the main stadium for the Tokyo Olympics, on June 23, 2021 in Tokyo, Japan. | Yuichi Yamazaki/ Getty Images
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While public support in Japan has been lackluster for the 2020 Tokyo Olympic Games, the mood may change once the games start – provided no major public health incidents and other unfortunate accidents occur, says Stanford sociologist Kiyoteru Tsutsui.

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Co-sponsored with the Bush China Foundation

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This event is part of Shorenstein APARC's spring webinar series "The United States in the Biden Era: Views from Asia."

The coronavirus pandemic has reinforced the importance of investing in population health domestically and globally, and of public-private collaboration in innovation for health goals--from technology for healthy aging to poverty alleviation and addressing other social determinants of health disparities. China, as the first health system to experience the devastation of COVID-19 and to rebound from pandemic control, offers lessons relevant beyond its borders. What can we draw from China's progress on healthcare development and its aims for innovation and public-private collaboration? In this webinar, Chinese practitioners and experts from academia and government will share their views on post-pandemic health policy and draw lessons for cooperation in global health. Scholars who have worked in and studied both the PRC and US health systems will discuss the challenges facing both—from strengthening risk protection and aligning incentives for quality improvement, to promoting goals articulated in the US’ 5th iteration of population health ‘ten-year plans’ (“Healthy People 2030”) and the PRC’s more recent “Healthy China 2030” and broader 14th Five Year Plan. What will it take to implement these ambitious goals? What is the linkage between health and China's foreign policy objectives and its place in the world? PRC experts share their views in this webinar co-hosted by Stanford’s Asia Health Policy Program and the George H. W. Bush Foundation for U.S.-China Relations.

Panelists:

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Cao Ying 4X4
Ying Cao is the China country director at Vital Strategies, where she leads the team to strengthen local public health systems through Vital Strategies’ Resolve to Save Lives’ global cardiovascular health initiative, tobacco control program, road safety program and evidence-based communication and policy advocacy. Dr. Cao brings over 15 years of experience in designing, leading, implementing and monitoring projects in the field of health and nutrition. She has extensive experience managing complex programs in China, with a specific focus on government and community-based programs to address unbalanced resource allocations to underprivileged areas.  Prior to joining Vital Strategies, Dr. Cao served as the director of Program Operations in Save the Children in China. Prior to Save the Children, she spent six years working in health and development within the non-profit sector and five years as a senior physician specializing in diagnostic ultrasound at Shanghai Ruijin Hospital.  Dr. Cao holds a master’s degree in public health nutrition from Wageningen University in the Netherlands and a bachelor’s degree in medicine from Shanghai Second Medical University.

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Gordon Liu 4X4
Gordon Liu is a leading expert on health and development economics, health policy reform, and pharmaceutical economics in China. He is a key figure in Chinese health care reform efforts and sits on the China State Council Health Reform Advisory Commission. Dr. Liu currently serves as an associate editor for Health Economics and China Economic Quarterly (CEQ) journals and was a coeditor of Value in Health, the official journal of ISPOR, and the editor-in-chief of the China Journal of Pharmaceutical Economics. He is president of the Chinese Society for Pharmacoeconomics and Outcomes Research and served as president of the Chinese Economists Society (CES). Prior to joining Peking University, Dr. Liu was a tenured associate professor at the University of North Carolina at Chapel Hill and an assistant professor at the University of Southern California.

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Liang Xiaofeng 4X4
 Dr. Xiaofeng Liang received his medical degree at Shanxi Medical University in 1984 and a Master's degree in Public Health from the College of Public Health of Peking University of Medicine in 1995. From 1996 to 1998, he worked as a visiting scholar at the Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Miami, Florida, USA.  After his return to China, he held the positions of Vice-Director of Epidemic Prevention Station of Gansu Province (1999-2000), Vice-Director of Institute of Epidemiology and Microbiology, CAPM (2000-2001), and the Director of Immunization Program (NIP) of China CDC (2001-2011), and deputy director of China CDC.  He is the winner of the 2013 Wu Jieping-Paul Janson Medicine and Pharmacy award and has been recognized as an outstanding contribution expert of the Ministry of Health China 2011-2012. He received the special allowance subsided by the State Council of China in 2010.  Since 2008, he has been a member of the Global Strategy Advisory Group of Experts (SAGE) on Immunization of the WHO. He served as the Vice Secretary-general of the Chinese Foundation of Hepatitis Prevention (2005). He was a member of the Chinese Committee Advisory of Immunization Practice, the Chinese Association of Community Health and the Branch of Biological Products, and the Chinese Association of Prevention Medicine. He was a member of the National Polio Eradication Certification Committee and a member of the National Measles Elimination Verification Committee.  His research in public health led to advances in immunization and vaccine-preventable disease control in China. As the principal investigator on the Key Programs for Science and Technology Development of China since 2004, his main scientific research has focused on the epidemiology regularity and prevention and control countermeasures of Hepatitis B. His current research is focused on non-communicable disease control and nutrition and tobacco control. He is the author of more than 30 articles in national and international journals, such as The Lancet and, The New England Journal of Medicine.

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Ying Cao China country director, Vital Strategies’ Resolve to Save Lives global health initiatives
Gordon Liu Professor, Peking University
Liang Xiaofeng Executive Vice President and Secretary General of the Chinese Preventive Medicine Association
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This event is part of the Asia Health Policy Program (AHPP) 2020-21 Colloquium series "Health, medicine, and longevity: Exploring public and private roles"

We will hear from distinguished speakers on public-private collaborations in accelerating improvements in palliative care in Singapore and parts of South Asia, as well as informal care and technology-enabled self-management of chronic illness among Asian-Americans. Joining us from Singapore is Mr. Laurence Lian, Chairman of the Lien Foundation, sharing evidence about the impact of the Foundation’s work on end of life care, collaborating with the public sector in palliative care training, improving access to pain medication, and other initiatives. Dr. Ranak Trivedi of Stanford will discuss her work to address the stress management needs of patients and their families and to improve culturally concordant care for South Asian women with breast cancer and their caregivers.

Speakers:

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Laurence Lien 4X4
Laurence Lien is Co-Chair and CEO of the Asia Philanthropy Circle (APC), a membership-based platform for Asian philanthropists to exchange, learn and collaborate.  Laurence is also the Chairman of Lien Foundation, a family foundation that has become well-regarded for its forward-thinking and radical approach in the fields of education, eldercare and the environment, as well as the Chairman of Lien AID, the foundation humanitarian arm for enabling sustainable access to clean water and sanitation for Asia’s rural poor.

Laurence was the CEO of the National Volunteer & Philanthropy Centre in Singapore from 2008-2014, and was the Chairman of the Community Foundation of Singapore from 2013-2019.  Prior to his work in the non-profit sector, Laurence served in the Singapore Government.  Laurence holds degrees from Oxford University, the National University of Singapore, and Harvard University’s Kennedy School of Government.  He was also a Nominated Member of Parliament in Singapore from 2012-2014. 

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Ranak Trivedi 4X4
Dr. Ranak Trivedi is a clinical health psychologist, assistant professor in the Dept. of Psychiatry and Behavioral Sciences, Stanford University and an investigator at the Center for Innovation to Implementation at the VA Palo Alto Health Care System. She completed her PhD in clinical health psychology at Duke University. Her NIH, VA and foundation-funded studies are focused on improving outcomes for Veterans with mental health conditions, and improving the self-management of serious illnesses by enhancing the collaboration and coping of patients and their caregivers. Her studies have provided insights into how caregivers and chronically and seriously patients collaborate around their mutual health, understanding the impact of their interpersonal relationship on chronic illness self-management, and the individual, dyadic, and systems-level barriers that they encounter. These insights have been used to develop two technology-enabled dyadic self-management programs to address the stress management needs of both patients and their framily. Dr. Trivedi is a Sojourns Scholars Leader, and she is using this platform to improving culturally concordant care for South Asian women with breast cancer and their caregivers. Dr. Trivedi was selected for the year long Leadership Institute for Women in Psychology hosted by American Psychological Association in 2020. Dr. Trivedi serves as the Director of Training and Education at the Center for Innovation to Implementation at the VA Palo Alto Health Care System, site PI and Training Director for the Elizabeth Dole National Center of Excellence for Veteran and Caregiver Research, and the Director of Caregiving and Family Systems at the Stanford Center for Asian Health Research and Education (CARE).

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Laurence Lien Co-Chair & CEO, Asia Philanthropy Circle
Ranak Trivedi Assistant Professor, Stanford University, and Director of Caregiving and Family Systems, Stanford Center for Asian Health Research and Education
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Noa Ronkin
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China and the United States are usually cast as fierce rivals, but there are broad areas of society where the two nations share profound similarities. As they confront growing demands to provide their citizens with goods and services such as healthcare, education, housing, and transportation, both the Chinese and U.S. governments engage the private sector in the pursuit of public value, although they do so in different ways.

This type of engagement, in which the government calls on the private sector to meet public goals, is known as collaborative governance and it is becoming an increasing share of the economy in both China and the United States. A new book, The Dragon, the Eagle, and the Private Sector (Cambridge University Press), analyzes the application of collaborative governance in a wide range of policy arenas in China and the United States.

The book itself is the result of collaborative research by three co-authors: APARC Deputy Director Karen Eggleston, Harvard Kennedy School Raymond Vernon Senior Lecturer in Public Policy John Donahue, and Harvard Kennedy School’s Frank P. Ramsey Professor of Political Economy Richard Zeckhauser. On March 5, 2021, the three co-authors gathered for a virtual book launch, an event co-sponsored by Shorenstein APARC and the Mossavar-Rahmani Center for Business and Government at the Harvard Kennedy School.

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Introducing the new book, Lawrence H. Summers, president emeritus of Harvard University and the Charles W. Eliot University Professor at the Kennedy School, called the co-authors’ analysis of collaborative governance “micro microeconomics” that shows how particular tasks and particular commitments of resources, once decided on, are going to be best accomplished. This work, Summers noted, sheds light on situations involving both cooperation and competition — aspects that affect almost any complex problem yet are rarely considered by economists.

A key element of collaborative governance, noted Zeckhauser, is the sharing of discretion. Rather than contracting at one pole and complete laissez-faire at the opposite pole, in a collaborative governance process, the two parties involved play a role in determining what is produced and how it is produced. It is a process that calls on the best capabilities of both the private and public sectors and that grants each of them an element of control. Sometimes that process results in triumphs, sometimes in tragedies, and other times in outcomes that are “in-between.” The book analyses cases of this entire gamut. “We hope that this volume provides guidance on how the triumphs can become more common, the tragedies more scarce, and the in-between outcomes improved,” said Zeckhauser.

This book provides a key to understanding how to achieve [...] quality-public-private collaboration, done right. Delving deep into two very different societies, the US and China, the authors provide lessons that illuminate and should inform scholars and policymakers alike.
Fareed Zakaria
Journalist and Author

Collaborative Governance in the Time of COVID-19

The unfolding of the COVID-19 pandemic provides dramatic current illustrations of collaborative governance. The urgent need for an effective vaccine created the conditions for a successful partnership between the U.S. government and the pharmaceutical sector, with the former offering both regulatory processes and significant financing, the latter its innovation. Consider the Moderna vaccine, which, based on evidence from clinical trials, is over 90% effective at preventing laboratory-confirmed COVID-19 illness. The vaccine was created within less than a year using a new approach, based on Messenger RNA technology, by a company that had never before produced a commercial product. “This is a triumph of collaborative governance,” said Zeckhauser.

The vaccine distribution process in the United States, however, has proved to be challenging and chaotic. Zeckhauser contrasted this experience with China’s activation of technology giant Tencent, which is using its ubiquitous WeChat application to allow individuals to easily find where the vaccine is distributed and sign up for vaccination appointments. “There is probably a lesson here in the way these two outcomes came about. We hope that individuals in both China and the United States will examine the lessons in this volume to see how they can achieve outcomes for their citizens that produce public benefits more effectively.”

A Spectrum of Policy Domains

The book details how China and the United States grapple with the complexity of producing the goods and services they need to meet a broad array of public goals. Eggleston surveyed the five broad policy domains she and her co-authors examine in the book through detailed historical legacies and case studies of the application of collaborative governance in both countries.

These domains include the railroads that build the nation historically in both countries and China’s high-speed rail network; real estate's intricate tangle of public and private partnerships; hosting the Olympic Games and the experience of the public and private sectors in that endeavor in both countries; education provision; and state and market in population health and health care in both countries. The book spotlights the different ways in which both countries produce public goods and services in these broad policy domains.

It is crucial for China to embrace the transparency imperative because the evil twin of collaborative governance is cronyism or corruption.
John Donahue
Harvard University

East and West

Professor Yijia Jing of Fudan University, an expert on privatization, governance, and collaborative service delivery, participated in the discussion with the book co-authors and shared insights on public-private relationships in China. Collaborative governance in the country, he said, has undergone a gradual process of institutionalization. He observed that Chinese local governments apply different strategies in collaborating with private companies. For example, local governments like Guangdong and Shanghai partner in different ways with digital giants Tencent and Alibaba to build up their digital capacities — collaborations through which they have been learning how to balance their multiple roles as partners, policymakers, and market regulators.

Jing noted that China uses collaborative governance not only in domestic arenas but also in areas of international development, through entities such as the BRICS Development Bank and the Asian Infrastructure Investment Bank. China is also promoting collaborative governance as part of its Belt and Road initiative.

A Call for Transparency

The Dragon, the Eagle, and the Private Sector helps decision-makers apply the principles of collaborative governance to effectively serve the public. The book's overarching conclusion is that transparency is the key to the legitimate growth of collaborative governance. In the United States, said Donahue, the principle of governmental transparency is widely accepted as a broad-spectrum accountability device. He recognized that he and his co-authors do not expect China to adopt the U.S. approach to transparency, but expressed their hope to see more transparency “with Chinese characteristics.” “It is crucial for China to embrace the transparency imperative because the evil twin of collaborative governance is cronyism or corruption,” Donahue argued.

In many countries and policy arenas, collaborative governance could effectively increase innovation but is not available because the populace is convinced that any interaction between the public and private sectors amounts to corruption on the part of elites against the public interest. The potential in China to create public value through interaction between its public and private sectors is enormous, concluded Donahue. ”It would be a shame to squander that.”

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Robot Adoption Brings Benefits to Japan’s Aging Society

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In their new book, APARC Deputy Director Karen Eggleston and co-authors John Donahue and Richard Zeckhauser of Harvard University seek to empower decision-makers to more wisely engage the private sector in the pursuit of public value by analyzing how China and the United States use collaborative governance strategies to meet growing demands for public services.

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Technological progress boosts productivity and has made societies wealthier, but the impact of new digital technologies could be different from anything seen before. Some experts predict a future with robots and other forms of automation increasingly replacing workers, contributing to stagnant income, and worsening inequality. Yet it is difficult to pinpoint the net impact of advanced technologies on labor. There is anecdotal evidence that robotics and automation reduce manufacturing employment and wages, but evidence from the service sector remains scant. Collaborative research by APARC experts is now starting to fill this gap.

The researchers — including Karen Eggleston, APARC deputy director and director of the Asia Health Policy Program (AHPP), Yong Suk Lee, the deputy director of the Korea Program, and University of Tokyo health economist Toshiaki Iizuka, a former AHPP visiting scholar — set out to probe the impact of robots on services provided in nursing homes in Japan. Their study, one of the first investigations of service sector robots, offers an offset to the dystopian predictions of robot job replacement.

Published by the National Bureau of Economic Research, the study suggests that robot adoption has increased employment opportunities for non-regular care workers, helped mitigate the turnover problem that plagues nursing homes, and provided greater flexibility for workers. It is also published in AHPP's working paper series and is part of a broader research project by Eggleston, Lee, and Iizuka, that explores the impact of robots on nursing home care in Japan and the implications of robotic technologies adoption in aging societies.

Since we are currently still in the early phase of robot diffusion in the service sector, researchers and policymakers need to continue to monitor and assess the extent to which robots complement or augment some types of labor while substituting for others.
Eggleston, Lee, and Iizuka

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Japan has been on the front lines of a demographic crisis, grappling with a declining overall population, increasing proportion of seniors, and aversion to large-scale immigration. It has also been an early adopter of robots to address the shortage of care workers relative to a growing demand for long-term care services. Japan’s experience is especially instructive as more countries face aging populations, helping shed light on how demographics interact with new automation technologies.

In a VoxEU.org article, Eggleston, Lee, and Iizuka describe their study, its findings, and its implications. Examining the relationship between robot adoption and nursing home staffing in Japan, they find that robot-adopting nursing homes had between 3% and 8% more staff than their non-adopting counterparts. The increases in staffing occurred entirely among the non-regular employees. Nursing homes with robots also appeared to have higher management quality and were better able to reduce the burden on care workers. The results suggest “that the wave of technologies that inspires fear in many countries could help remedy the social and economic challenges posed by population aging in others.”

The Financial Times Magazine has recently featured the study by Eggleston, Lee, and Iizuka, calling it “groundbreaking in several ways but perhaps most clearly for setting its sights not on manufacturing but on the services sector, where robots are only just beginning to make their mark.” The great value of the study, the article notes, is that it lays the foundation for an empirical debate “on a subject that will be deluged with human emotion as robots continue their march into the services sector.”

You can also listen to a Financial Times podcast that features the new study (the segment starts at 4:52).

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Ri-man, a Japanese robot prototype under development to help assist nurses to lift patients from their bed. As Japan's society ages and nursing shortage increases, there will be a need for a robot to do the heavy lifting, especially since nurses themselves are aging. | Karen Kasmauski via Getty Images
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In one of the first studies of service sector robotics, APARC scholars examine the impacts of robots on nursing homes in Japan. They find that robot adoption may not be detrimental to labor and may help address the challenges of rapidly aging societies.

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A quarter-century ago in a seminal paper, Hart, Shleifer, and Vishny (NBER1996, QJE1997) developed a theory of the ‘Proper Scope of Government.’ Oliver Hart, 2016 Nobel Laureate, reflects on that framework and its place in economics, as well as the inspiration for his more recent work on norms, guiding principles, and contracts as reference points. In discussion with Karen Eggleston, Hart answers questions posed by economists who have built upon Hart, Shleifer and Vishny (1997) and offers insights on how the theory applies to understanding public and private roles in healthcare, education, and other publicly-financed services.

Watch the webinar featuring Hart's keynote: https://youtu.be/sDp7ytudbsE

Oliver Hart is currently the Lewis P. and Linda L. Geyser University Professor at Harvard University, where he has taught since 1993. He is the 2016 co-recipient of the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel, a Fellow of the Econometric Society, the American Academy of Arts and Sciences, the British Academy, and the American Finance Association, a member of the National Academy of Sciences, a Distinguished Fellow of the American Economic Association, and has several honorary degrees. Hart works mainly on contract theory, the theory of the firm, corporate finance, and law and economics. His research centers on the roles that ownership structure and contractual arrangements play in the governance and boundaries of corporations. He has published a book (Firms, Contracts, and Financial Structure, Oxford University Press, 1995) and numerous journal articles. He has used his theoretical work on firms and contracts in several legal cases. He has been president of the American Law and Economics Association and a vice president of the American Economic Association.

This keynote is part of the Stanford Asia Health Policy Program colloquium series entitled Health, Medicine, and Longevity: Exploring Public and Private Roles

Oliver Hart, Andrei Shleifer, Robert W. Vishny, The Proper Scope of Government: Theory and an Application to Prisons, The Quarterly Journal of Economics, Volume 112, Issue 4, November 1997, Pages 1127–1161, https://doi.org/10.1162/003355300555448.

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Asia Health Policy Program working paper # 64

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Asia Health Policy Program working paper # 64
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Co-sponsored with the Harvard Kennedy School

This event is part of the Asia Health Policy Program (AHPP) 2020-21 Colloquium series "Health, medicine, and longevity: Exploring public and private roles"

Introduced by Lawrence H. Summers (President Emeritus, Harvard University), Richard Zeckhauser, Jack Donahue and Karen Eggleston discuss their recently published book, The Dragon, the Eagle, and the Private Sector: Public-Private Collaboration in China and the United States with Professor Yijia Jing of Fudan University, China's leading expert on public-private relationships will also participate. The governments of China and the United States - despite profound differences in history, culture, economic structure, and political ideology - both engage the private sector in the pursuit of public value. This book employs the term collaborative governance to describe relationships where neither the public nor private party is fully in control, arguing that such shared discretion is needed to deliver value to citizens. This concept is exemplified across a wide range of policy arenas, such as constructing high speed rail, hosting the Olympics, building human capital, and managing the healthcare system. This book will help decision-makers apply the principles of collaborative governance to effectively serve the public, and will enable China and the United States to learn from each other's experiences. It will empower public decision-makers to more wisely engage the private sector. The book's overarching conclusion is that transparency is the key to the legitimate growth of collaborative governance.

"It has become increasingly clear over the last few years that in tackling a country’s problems, what matters most is the quality of government rather than the quantity. This book provides a key to understanding how to achieve that quality-public-private collaboration, done right. Delving deep into two very different societies, the US and China, the authors provide lessons that illuminate and should inform scholars and policymakers alike." -- Fareed Zakaria

"This important book addresses how the two most important countries, the U.S. and China, address what may be their most important question: How can their public and private sectors cooperate most effectively with each other to create value. This is the rare book that is both analytic and a pleasure to read. It makes a lasting impression. It deserves a very wide readership among all those concerned about the future of the global economy." -- Lawrence H Summers, President Emeritus, Harvard University

"Eggleston, Donahue, and Zeckhauser offer an authoritative and intriguing account of why and how collaborative governance, a key modern instrument that engages public and private actors for comparative advantages in coping with complex public affairs, has been widely and deeply practiced in two vastly different countries, China and the US. An essential reading with profound academic inspirations and rich empirical inquiries." -- Yijia Jing, Fudan University.

Speakers

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Lawrence H. Summer 4X4
Lawrence H. Summers is President Emeritus of Harvard University. During the past two decades he has served in a series of senior policy positions, including Vice President of development economics and chief economist of the World Bank, Undersecretary of the Treasury for International Affairs, Director of the National Economic Council for the Obama Administration from 2009 to 2011, and Secretary of the Treasury of the United States, from 1999 to 2001. 

 

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richard_zeckhauser_4x4
Richard J. Zeckhauser is the Frank Ramsey Professor of Political Economy at the Harvard Kennedy School.  

 

 

 

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John Donahue 4X4
John D. Donahue is Faculty Chair for the Master’s in Public Policy program at the Harvard Kennedy School.

 

 

 

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Karen Eggleston 4X4
Karen Eggleston is Senior Fellow at the Freeman Spogli Institute for International Studies and Director of the Asia Health Policy Program in the Shorenstein Asia-Pacific Research Center at Stanford University.

 

 

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Yijia Jing 4X4
Yijia Jing is a Chang Jiang Scholar, Seaker Chan Chair Professor in Public Management, Dean of the Institute for Global Public Policy, and Professor of the School of International Relations and Public Affairs, Fudan University. He conducts research on privatization, governance, and collaborative service delivery. He is the founding editor-in-chief of the journal Global Public Policy and Governance.

Lawrence H. Summers President Emeritus of Harvard University
Richard J. Zeckhauser Frank P. Ramsey Professor of Political Economy, Harvard Kennedy School
John D. Donahue Raymond Vernon Senior Lecturer in Public Policy, Harvard Kennedy School

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
0
Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
karen-0320_cropprd.jpg PhD

Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director, Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
CV
Date Label
Senior Fellow, the Freeman Spogli Institute for International Studies (FSI), Stanford University
Yijia Jing Dean of the Institute for Global Public Policy, and Professor of the School of International Relations and Public Affairs, Fudan University
Seminars
Paragraphs

A wave of new technologies – such as robotics, artificial intelligence, and digital platforms – prompts both concern about automation and unemployment as well as optimism about innovation enriching longer, healthier lives. In one of the first studies of service sector robotics using establishment-level data, we study the impact of robots on staffing in Japanese nursing homes, using geographic variation in robot subsidies as an instrumental variable. We find that robot adoption decreases difficulty in staff retention, as well as increases employment of care workers and nurses on flexible employment contracts. Our findings suggest that robots may help to remedy challenges posed by rapidly aging populations and strained caregiving workforces, and that their adoption may not be detrimental to workers or quality of care, although more research would be valuable.

JEL Code: I11, J14, J23, O30,
Key words: Robots, jobs, nursing homes, automation, aging, healthcare
Last updated: May 2026

 

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Working Papers
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Asia Health Policy Program working paper # 63
Authors
Karen Eggleston
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Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management in primary health care (PHC). We provide evidence on China’s efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% fewer inpatient admissions, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.

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Publication Type
Working Papers
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Asia Health Policy Program working paper # 62
Authors
Karen Eggleston
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This event is part of Shorenstein APARC's winter webinar series "Asian Politics and Policy in a Time of Uncertainty."

Is demographics destiny as societies search for sustainable, innovation-led growth? Many analysts worry that population aging slows the socioeconomic engine of innovation. What can the older societies of East Asia do to remain innovative? Will younger South Asia inevitably eclipse East Asia as the South Asian population surges into the working ages, just as surely as India will soon overtake China as the most populous country in the world? In this webinar celebrating the publication of Demographics and Innovation in the Asia-Pacific, social scientists from across the region probe multiple aspects of these critical questions. Chinese economist and entrepreneur James Liang will offer insights regarding demography and innovation in China; economist James Feyrer probes the economics of demography and comparative productivity effects across the Asia-Pacific; sociologist Joon-Shik Park will discuss “Population Cliffs, Crisis of Local Society, and the Politics of Innovation Cities in South Korea”; and political scientist Kenji Kushida will focus on “How Japan’s Aging Demographics Have Affected Pathways of Technological Development.” Karen Eggleston, co-editor and author, will moderate the discussion.

Speakers:

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James Liang 4X4
James Liang is one of the Co-founders and Executive Chairman of the Board of Trip.com Group Ltd. He was the Chief Executive Officer from 2000 to 2006 and from 2013 to 2016. Trip.com Group has grown to become one of the world’s largest online travel agencies. Currently, James serves as Co-Chairman of Tongcheng-eLong (HKSE:7080) and on the boards of a number of other Internet companies, including Sina (NASDAQ: SINA), and MakeMyTrip (NASDAQ: MMYT). He is also Research Professor of Economics at Peking University.

In addition to his expertise in the travel industry, James is also a leading scholar of demographics and social studies. He has played an important role in shaping China’s population policies in recent years and in generating public interest in issues such as education and urban planning. As a co-author of the book Too Many People in China?, James analyzed the impact of the one-child policy and the adverse effects of demographic changes on China’s economy. He is also the author of multiple other publications, including The Rise of the Network Society, and his latest book published in 2018, The Demographics of Innovation.

James received his Ph.D. degree from Stanford University and his master’s and bachelor’s degrees from Georgia Institute of Technology.

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Feyrer, James 4X4
James Feyrer is an Associate Professor of Economics at Dartmouth College.  He received his Ph.D. from Brown University and his B.S. from Stanford University.  His work is primarily in applied macroeconomics. His work on the impacts of demographics and trade on growth have been influential in policy circles.  In particular his work on the impact of globalization on output has informed the Brexit debate. He has published articles in the Quarterly Journal of Economics, the American Economic Review, the Review of Economics and Statistics, the Journal of the European Economic Association, among other journals.

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Park Joon Shik 4X4
Joon-Shik Park is Professor in the Department of Sociology at Hallym University, Chuncheon, Korea. He got his Ph.D. degree at Yonsei University in Korea. His research focuses on employment and regional studies. Prof. Park began his academic career as a researcher on labor and employment issues in Korean society. Recently, Prof. Park has been interested in comparing social economy and local regeneration in the context of global social and economic crisis. He recently published several books, articles, and project reports on such issues as the impact of globalization on employment regimes and local societies; social dialogue and integration; creative innovations for sustainable local development. Prof. Park has served as President of the Korean Regional Sociological Association, Dean of the Social Science School at Hallym University. He is now a member of the Presidential Commission on Policy Planning of the Korean Government. He is leading the Inclusive Society Division in the Presidential Commission as the chair person. He is also serving as Vice President of Vision and Cooperation of Hallym University.

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Kenji Kushida 4X4
Kenji E. Kushida is a Research Scholar at the Shorenstein Asia-Pacific Research Center Japan Program at Stanford University. Kushida’s research streams include 1) Information Technology innovation, 2) Silicon Valley’s economic ecosystem, 3) Japan’s political economic transformation since the 1990s, and 4) the Fukushima nuclear disaster. He has published several books and numerous articles in each of these streams, including “The Politics of Commoditization in Global ICT Industries,” “Japan’s Startup Ecosystem,” “Diffusing the cloud: Cloud computing and implications for public policy,” “Leading without followers: how politics and market dynamics trapped innovations in Japan's domestic ‘Galapagos’ telecommunications sector” and others. He holds a PhD in political science from the University of California, Berkeley, an MA in East Asian studies and BAs in economics and East Asian studies, all from Stanford University.

Moderator:

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Karen Eggleston 4X4
Karen Eggleston is Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University, and Director of the Stanford Asia Health Policy Program and Deputy Director of the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies, and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Via Zoom Webinar.
Register https://bit.ly/2YD0Rvk

James Liang Research Professor of Economics, Peking University.
James Feyrer Department of Economics, Dartmouth College.
Joon-Shik Park Department of Sociology, Hallym University.
Kenji Kushida Shorenstein APARC, Stanford University.

Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9072 (650) 723-6530
0
Senior Fellow at the Freeman Spogli Institute for International Studies
Center Fellow at the Center for Health Policy and the Center for Primary Care and Outcomes Research
Faculty Research Fellow of the National Bureau of Economic Research
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
karen-0320_cropprd.jpg PhD

Karen Eggleston is a Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford University and Director of the Stanford Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center at FSI. She is also a Fellow with the Center for Innovation in Global Health at Stanford University School of Medicine, and a Faculty Research Fellow of the National Bureau of Economic Research (NBER). Her research focuses on government and market roles in the health sector and Asia health policy, especially in China, India, Japan, and Korea; healthcare productivity; and the economics of the demographic transition.

Eggleston earned her PhD in public policy from Harvard University and has MA degrees in economics and Asian studies from the University of Hawaii and a BA in Asian studies summa cum laude (valedictorian) from Dartmouth College. Eggleston studied in China for two years and was a Fulbright scholar in Korea. She served on the Strategic Technical Advisory Committee for the Asia Pacific Observatory on Health Systems and Policies and has been a consultant to the World Bank, the Asian Development Bank, and the WHO regarding health system reforms in the PRC.

Director, Asia Health Policy Program at the Walter H. Shorenstein Asia-Pacific Research Center
Stanford Health Policy Associate
CV
Date Label
Shorenstein APARC, Stanford University.
Seminars
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