Former U.S. Ambassador to Afghanistan Karl Eikenberry has been awarded a William J. Perry Fellowship in International Security at Stanford’s Center for International Security and Cooperation (CISAC), where he will continue to address emerging security challenges facing the United States.

Ambassador Eikenberry has an ambitious agenda for the coming academic year, which includes teaching and mentoring students, public speaking and working closely with former Secretary of Defense William Perry. He also will take part in activities at the Walter H. Shorenstein Asia-Pacific Research Center (APARC), such as the new China and the World research initiative.

“It’s a lifetime honor to receive the Perry Fellowship,” says Eikenberry. “I can’t think of an American in modern times who has better exemplified inspirational commitment to public service than Dr. William Perry. And I can’t think of a better institute of higher learning to be associated with than Stanford University.”

Ambassador Eikenberry has been at Stanford since September 2011 as the Frank E. and Arthur W. Payne Distinguished Lecturer and is an affiliated faculty member for CISAC, APARC and the Center on Democracy, Development and the Rule of Law (CDDRL), as well as research affiliate at the Europe Center – all policy research centers within Stanford’s Freeman Spogli Institute of International Studies.

Before coming to Stanford, Ambassador Eikenberry led the civilian surge directed by President Obama from 2009 to 2011 in an effort to reverse the momentum gained by insurgents, and set the conditions for a transition to Afghanistan sovereignty. He retired from his 35-year military career in April 2009 with the rank of U.S. Army Lieutenant General after posts including commander and staff officer with mechanized, light, airborne and ranger infantry units in the United States, as well as Korea, Italy and as the Commander of the American-led Coalition Forces from 2005-2007.

"Karl Eikenberry's record of public service amply demonstrates his unique qualities, not only as a leader of the American military at a challenging time, but as a strategic thinker and an insightful diplomat,” says CISAC Co-Director Mariano-Florentino Cuéllar. “He has a rare understanding of the profound challenges facing our world, and has been a tremendous asset to CISAC and Stanford.”

Ambassador Eikenberry’s research areas include U.S. strategy in the Asia-Pacific region; China’s evolving security strategy; the United States and NATO; the future of the U.S. military; Washington’s policies in Central and South Asia; and assessing the risks of military intervention.

The fellowship was established to honor Perry, the 19^th U.S. secretary of defense and former CISAC co-director, and to recognize his leadership in the cause of peace. Perry is co-director of the Preventive Defense Project and the Nuclear Risk Reduction Initiative at CISAC and is an expert on U.S. foreign policy, national security and arms control. Perry Fellows spend a year at CISAC conducting policy-relevant research on international security issues. They join other distinguished scientists, social and political scientists and engineers who work together on problems that cannot be solved within a single field of study.

Ambassador Eikenberry is a graduate of the U.S. Military Academy, has master’s degrees from Harvard University in East Asian Studies and Stanford University in Political Science, and was a National Security Fellow at the Kennedy School of Government at Harvard. He earned an Interpreter’s Certificate in Mandarin Chinese from the British Foreign Commonwealth Office while studying at the United Kingdom Ministry of Defense Chinese Language School in Hong Kong, and has an Advanced Degree in Chinese History from Nanjing University in the People’s Republic of China.

China’s demographic landscape is rapidly changing, and the government has responded by launching ambitious social and health service reforms to meet the changing needs of the country’s 1.3 billion people. This week, officials approved a five-year plan to develop a comprehensive nationwide social security network.

Karen Eggleston, the Asia Health Policy Program (AHPP) director and a Stanford Health Policy fellow, discusses the success of China’s health care reforms—including its recently established universal health care system—and the long road still ahead.

Why is the overall health and wellbeing of China’s population important globally?

There are many reasons why the health of China’s citizens matters within a larger global context. On the most basic level, China represents almost 20 percent of humanity. But it is also a major player in the world economy and it depends on having a healthy workforce, especially now that its population is aging more. The government’s ability to meet the needs of its underserved citizens contributes to a more productive and stable China, and works towards closing the huge gaps we see in human wellbeing across the world.

China also potentially offers a model for other developing countries, such as India, that may want to figure out how to make universal health coverage work at a tenth of the income of most of the countries that have put it into place before.

What are some of the biggest changes in China’s health care system since 1949?

One of the most significant changes is that China has achieved very basic universal health insurance coverage in a relatively short period of time.  

Throughout the Mao period (1949–1978) there was a health care system linked to the centrally planned economy, which provided a basic level of coverage via government providers with a lot of regional variation. When economic reform came in 1980, large parts of the system—particularly financing for insurance—collapsed. The majority of China’s citizens were uninsured during the past few decades of very rapid social and economic development.

China’s overall population is changing quite dramatically, which means it has different health care needs, such as treating chronic disease and caring for an increasingly elderly population. The central government is trying to establish a system of accessible primary care—a concept that China’s barefoot doctors helped to pioneer but that fell into disarray—and health services that fit these new needs. 

How does China’s basic health care system work? Are there segments of the population still not receiving adequate coverage and care?

China has had a system where people can select their own doctors. Patients usually want to go to clinics attached to the highest-reputation hospitals, but of course, when you are not insured you almost always by default go to where you can afford the care. “It is difficult to see the doctor, and it is expensive” has been the lament of patients in China, so an explicit goal of the health care reforms has been to address this.

The term “universal coverage” has different definitions. China initially put in place a form of insurance that only covers 20 or 30 percent of medical costs for the previously uninsured population, especially in rural areas. Benefits have expanded, but remain limited. As with the previous system, disparities in coverage still exist across the population. China not only has a huge population with huge economic differences, but within that there is a large migrant worker population. It is a challenge to figure out how to cover these citizens and how to provide them with access to better care. The government is quite aware there are segments of the population not receiving equal coverage, and it continues to strive to resolve the issue.  

What are the greatest innovations in China’s health care system in recent years?

One of the most remarkable things China has achieved is really its new health insurance system. Even if the current coverage is not particularly generous it is nearly universal, and mechanisms are put in place each year to provide more generous coverage. China is also working on strengthening its primary care and population health services, infusing a huge sum of government money into these efforts. It is the only developing country of its per-capita income that has achieved such results so far.

Interestingly, a lot of people assume China achieved its universal coverage by mandate, while in fact the central government did so by subsidizing the cost for local governments and individuals. This reduces the burden, for example, on poorer rural governments and residents, and is one innovative way China is trying to eliminate the disparity in access to care.

Eggleston has recently published a working paper on China’s health care reforms since the Mao era on the AHPP website, as well as an article in the Milken Institute Review.

Gordon Liu, a Chinese government advisor on health care and the executive director of Peking University’s Health Economics and Management Institute, spoke at Stanford on May 29 on the future of China’s health care system.