Political Geography: Asia / Topic: Health

1. Valuing Longer, Healthier Lives: Assessing the Productivity of Health Spending in South Korea

Author:: Karen Eggleston
Publication Date:: 03-2023
Content Type:: Special Report
Institution:: East-West Center
Abstract:: This research studies the link between medical spending and health outcomes in South Korea, providing evidence on the productivity of medical spending over recent decades. The author advocates for the Korean government to develop a “satellite account for health” to complement national income and product accounts. Current measures do not account for changing quality nor give providers any incentive for cost-effective substitution between forms of treatment for a given condition. By leveraging existing strengths of Korea’s National Health Insurance and health outcome data, Korea can develop an accurate measure of medical productivity and a more accurate measure of overall economic productivity, while becoming a global pioneer of “health satellite accounts” for overall populations. Such a productivity metric built on condition-specific net value can help Korea increase the “bang for the buck” from medical spending, mitigate wasteful spending, and promote high-value innovations for longer, healthier lives.
Topic:: Health, Public Spending, and Productivity
Political Geography:: Asia and South Korea

2. A Future Projection of Post-Covid-19 in Japan: Universal Values and International Cooperation

Author:: Yukio Sakurai
Publication Date:: 01-2023
Content Type:: Journal Article
Journal:: The Rest: Journal of Politics and Development
Institution:: Centre for Strategic Research and Analysis (CESRAN)
Abstract:: This essay aims to clarify the most popular impacts of the COVID-19 pandemic and examine a future projection of Post-COVID-19 in Japan. This is based on interdisciplinary studies, particularly the literature survey on global governance in English and Japanese. Japan has consistently lived after WWII under the principles of freedom, democracy, human rights, and the rule of law. Given the challenges caused by the pandemic, it is unpredictable how much conflict between multiple powers will hinder national security and economic globalization. The following five actions should be executed: Japan should participate in international research activities to envision a future society, Japan should adopt a unique future concept to address ageing populations and social security reform in their international cooperation, a review of neoliberalism, construction of a society that can respond to societal risks, and political leadership and freedom of speech to deal with serious social risks should be championed.
Topic:: Health, Governance, Pandemic, and COVID-19
Political Geography:: Japan and Asia

3. Moving on Up: Multilevel Monitoring and Advocacy for Health Rights

Author:: Abrehet Gebremedhin
Publication Date:: 01-2023
Content Type:: Working Paper
Institution:: Accountability Research Center (ARC), American University
Abstract:: Multilevel approaches to monitoring and advocacy are often used by international development practitioners, particularly in civil society, in efforts to hold governments—from the national to the local—to account for policy implementation. However, such approaches are not yet well understood or identified by many scholars in the social accountability field. This evidence review addresses this gap through a cross-case comparison of multilevel approaches in ten health rights programs across Africa, Asia, and Latin America. It draws on published evaluations, working papers, and peer-reviewed journal articles, as well as insights shared by implementers and researchers. Cases were selected to illustrate health rights initiatives that included monitoring or advocacy activity at a minimum of two different levels: local health facility, district, regional, provincial or national. Four significant findings emerge from this review of evidence: Vertical integration is a relatively common feature of multilevel monitoring and advocacy in these ten cases and is most likely to take place at the lower ends of the health system. However, it is largely implicit, and often not articulated in project design or theories of change. Horizontal organizing—the coordination of civil society action across districts or geographies—is a less visible feature of multilevel approaches to health rights programming than vertical integration. Despite the multilevel nature of health monitoring and advocacy in these ten cases, less than half reported working at the regional or provincial level, indicating a ‘missing middle’ between local and national activity. Escalation—the process by which citizens’ unaddressed claims move upwards to those with greater decision- making powers—is an important mechanism for accountability and one way in which vertical integration can happen. However, escalation is not clearly articulated in much of the gray literature, and therefore merits further research. The findings from this evidence review have implications for strategy, including: the importance of explicitly identifying multilevel tactics for monitoring and advocacy; theorizing the process by which unaddressed claims can be addressed, particularly moving up beyond the local level; emphasizing the importance of the ‘middle’ and ensuring regional and provincial decision-making is leveraged; and looking to link vertical integration with opportunities for horizontal organizing.
Topic:: Civil Society, Health, Accountability, Advocacy, and Monitoring
Political Geography:: Africa, Asia, and Latin America

4. Global Health Diplomacy as a Path to De-escalatory Engagement with North Korea

Author:: Andrew Ikhyun Kim
Publication Date:: 11-2022
Content Type:: Commentary and Analysis
Institution:: East Asia Institute (EAI)
Abstract:: Andrew Ikhyun Kim, White House Fellow at the Office of Management and Budget, suggests global health diplomacy as a conceptual framework to bring North Korea back to the negotiating table and de-escalate the situation. In specific, he proposes a health aid package engaging North Korea in the long term which is owned, driven, co-financed by North Korea, and coordinated with strategically lifting without precondition, the sanctions. He highlights that even if these do not come to fruition in the short term, aid efforts would still have the potential to build trust, lay the groundwork for future engagement, and alleviate the dire health needs of North Korean people.
Topic:: International Relations, Diplomacy, Health, and Engagement
Political Geography:: Asia, South Korea, and North Korea

5. Analysis of the Healthcare Sector in Africa and Its Policy Implications for Korea

Author:: Young Ho Park, Munsu Kang, Yejin Kim, Kyu Tae Park, and Young-Chool Choi
Publication Date:: 03-2022
Content Type:: Policy Brief
Institution:: Korea Institute for International Economic Policy (KIEP)
Abstract:: One of the main changes in Korea’s foreign affairs in recent years is the expansion of official development assistance (ODA), among which Africa is showing particularly rapid growth. Korea’s ODA to Africa accounted for 15% of its total ODA budget in 2010, and rose to 25% in 2019 as Korea emphasized its role in international development. Korea ranks 11th in terms of the cumulative size of ODA to the African healthcare sector between 2011–2019, totaling 674 million USD. As Korea’s expansion of ODA and solidarity in international development aid to respond to COVID-19 are related, the expansion of ODA in the African healthcare sector is anticipated to continue. This study analyzes features of the healthcare sector in Africa in an effort to suggest various plans for development cooperation, based on an evaluation of Korea’s ODA project design to enable the effective provision of ODA.
Topic:: Foreign Policy, Development, Health, Economic Growth, COVID-19, and Foreign Assistance
Political Geography:: Africa, Asia, and South Korea

6. BRICS and Global Health Diplomacy in the Covid-19 Pandemic: Situating BRICS’ diplomacy within the prevailing global health governance context

Author:: Candice Moore
Publication Date:: 10-2022
Content Type:: Journal Article
Journal:: Revista Brasileira de Política Internacional (RBPI)
Institution:: Instituto Brasileiro de Relações Internacionais (IBRI)
Abstract:: BRICS have been cast as a bloc with the potential to make significant changes in Global Health. The management of the Covid-19 pandemic has shown divisions in the bloc and the limits of its ability to formulate policies or even act upon previously agreed positions. This paper employs an examination of BRICS Health Ministerial declarations and an analysis of power in International Relations to reflect on BRICS’ Global Health diplomacy during the Covid-19 pandemic, covering the key questions of vaccine research and development, vaccine nationalism, and travel bans. It finds that multiple dimensions of power matter in Global Health leadership.
Topic:: Health, International Cooperation, Governance, Pandemic, COVID-19, and BRICS
Political Geography:: Africa, Russia, China, Europe, India, Asia, South Africa, Brazil, and South America

7. Planetary Health: Reflections from Asia

Author:: Margareth Sembiring
Publication Date:: 06-2022
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: Planetary Health is a concept that advocates the care of the planet for human own survivability. It underscores the health implications of environmental degradation brought about by human activities and development progress, and calls for a systemic approach that considers and addresses socio-environmental trade-offs of certain policy and/or economic objectives. In view of multiple crises that have been happening in recent years – from the COVID-19 pandemic to the war in Ukraine – which have further negatively affected the environment, understanding how Planetary Health can be applied to address continuing environmental decline is critical. Planetary Health is a relatively new term in Asia. Drawing from the discussions in the 6th NTS-Asia Consortium Annual Conference in April 2022, this NTS Insight maps the different ways Indonesia, India, Bangladesh, Japan, and China engage Planetary Health in their specific contexts. The interpretations of the concept are likely to influence the trajectory of its implementation.
Topic:: Health, International Cooperation, Recovery, Pandemic, and COVID-19
Political Geography:: Asia

8. Planetary health: An alternative framework for disaster governance in ASEAN?

Author:: S. Nanthini and Lina Gong
Publication Date:: 08-2022
Content Type:: Commentary and Analysis
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: The COVID-19 pandemic has accelerated the search for a better way of managing human activities and their environmental impact thereby zeroing in on the specific actions needed to maintain a balance for Planet Earth’s sustainability.
Topic:: Environment, Health, International Cooperation, Governance, Sustainability, and COVID-19
Political Geography:: Asia and ASEAN

9. Estimating Japan’s Return on Investment from an Ambitious Program to Incentivize New Antibiotics

Author:: Rachel Silverman and Adrian Towse
Publication Date:: 12-2022
Content Type:: Policy Brief
Institution:: Center for Global Development
Abstract:: Anti-microbial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure those same drugs, driving “anti-microbial resistance,” or AMR. Already, drug-resistant infections kill an estimated 23,210 Japanese citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. To address this growing crisis and solve market failures that prevent the development of new antibiotics, the government of Japan is considering a new program that would provide minimum guaranteed revenue to the successful developers of new antibiotics. In this note, we present the results of a modelling exercise to estimate the likely return on investment (ROI) from such a program, assuming it is paired with complementary and proportionate efforts from Japan’s G7 partners. The results are necessarily imprecise due to several uncertain parameters, but nevertheless provide evidence of a very high expected ROI that is robust to different inputs and assumptions.
Topic:: Health, Science and Technology, Health Care Policy, and Medicine
Political Geography:: Japan and Asia

10. North Korea’s Covid-19 Outbreak: An Opening for Engagement?

Author:: Lorenzo Mariani and Leonardo Bruni
Publication Date:: 06-2022
Content Type:: Commentary and Analysis
Institution:: Istituto Affari Internazionali
Abstract:: In January 2020, in response to the novel coronavirus, the Democratic People’s Republic of Korea (DPRK; North Korea) closed its borders and for the next two years claimed it had not experienced a single case of Covid-19. However, on 12 May 2022, North Korea disclosed a severe domestic outbreak and in the following weeks began reporting millions of cases of “fevers” and several deaths.[1] Pyongyang’s admission was initially interpreted as a veiled request for international assistance as the country is particularly vulnerable due to its zero per cent vaccination rate, inadequate healthcare system and chronic food insecurity. However, as with previous attempts during the height of the pandemic, offers of aid and vaccines from the Republic of Korea (ROK; South Korea), the US, international organisations (IOs) and multilateral initiatives like COVAX received no response; most likely due to suspicion of the aid being politicised.[2]
Topic:: Health, Foreign Aid, European Union, Economy, and COVID-19
Political Geography:: Asia and North Korea

11. Medical Security, Covid Challenge and the U.S. - Japan Alliance

Author:: Kent Calder
Publication Date:: 12-2021
Content Type:: Journal Article
Journal:: Fletcher Security Review
Institution:: The Fletcher School, Tufts University
Abstract:: National security has been classically conceived as a narrowly military and state-centric concept, especially in the Western industrial world. Security is, generations of strategists and statesmen have told us, a matter of defending core nation-state values and interests by force of arms. Two world wars across the first half of the twentieth century, and a long nuclear confrontation to follow, engrained this military and state-centric conception deeply into global consciousness and public discourse. The tragic COVID-19 crisis now confronting us suggests that this logic may be flawed, or at least oversimplified. Over 2.3 million people worldwide died in the first year of this global pandemic, with well over 100 million infected. These figures are likely understated.44 Untold millions of people continue to suffer from “long COVID” maladies around the world.
Topic:: Economics, Health, National Security, COVID-19, and Health Crisis
Political Geography:: Japan, Asia, North America, and United States of America

12. Educational Policies and Healthy Aging in China

Author:: Xi Chen and Qi Gao
Publication Date:: 03-2021
Content Type:: Video
Institution:: Weatherhead East Asian Institute, Columbia University
Abstract:: A considerable amount of attention has been paid to the relationship between education and the promotion of one’s own health. This talk presents the latest evidence and discusses both the upward and downward multigenerational impacts of educational reforms in China over the past few decades on healthy aging. Cosponsored by the Weatherhead East Asian Institute, the Columbia China Center for Social Policy, and the Columbia School of Social Work.
Topic:: Education, Health, Aging, and Domestic Policy
Political Geography:: China and Asia

13. China’s Improvised Mask Diplomacy in Chile

Author:: Urdinez. Francisco
Publication Date:: 04-2021
Content Type:: Working Paper
Institution:: Carnegie Endowment for International Peace
Abstract:: During the pandemic, Chinese medical and equipment supplies to Chile have come mostly from a diverse cast of Chinese players with local experience in Chile. They adapted to Chile’s unique system of emergency and disaster management. China has become a global power, but there is too little debate about how this has happened and what it means. Many argue that China exports its developmental model and imposes it on other countries. But Chinese players also extend their influence by working through local actors and institutions while adapting and assimilating local and traditional forms, norms, and practices. With a generous multiyear grant from the Ford Foundation, Carnegie has launched an innovative body of research on Chinese engagement strategies in seven regions of the world—Africa, Central Asia, Latin America, the Middle East and North Africa, the Pacific, South Asia, and Southeast Asia. Through a mix of research and strategic convening, this project explores these complex dynamics, including the ways Chinese firms are adapting to local labor laws in Latin America, Chinese banks and funds are exploring traditional Islamic financial and credit products in Southeast Asia and the Middle East, and Chinese actors are helping local workers upgrade their skills in Central Asia. These adaptive Chinese strategies that accommodate and work within local realities are mostly ignored by Western policymakers in particular. Ultimately, the project aims to significantly broaden understanding and debate about China’s role in the world and to generate innovative policy ideas. These could enable local players to better channel Chinese energies to support their societies and economies; provide lessons for Western engagement around the world, especially in developing countries; help China’s own policy community learn from the diversity of Chinese experience; and potentially reduce frictions.
Topic:: Diplomacy, Disaster Relief, Health, Pandemic, and COVID-19
Political Geography:: China, Asia, South America, and Chile

14. ASEAN Matters for America/America Matters for ASEAN

Author:: East-West Center
Publication Date:: 12-2021
Content Type:: Working Paper
Institution:: East-West Center
Abstract:: This project maps the trade, investment, employment, business, diplomacy, security, education, tourism, and people-to-people connections between the United States and the 10 member states of the Association of Southeast Asian Nations (ASEAN) at the national, state, and local levels. Part of the Asia Matters for America initiative, this publication, the one-page connections summaries for states, and the AsiaMattersforAmerica.org website are resources for understanding the robust and dynamic US-ASEAN relationship.
Topic:: Defense Policy, Agriculture, Diplomacy, Health, and Infrastructure
Political Geography:: Asia, North America, Southeast Asia, and United States of America

15. Promoting health diplomacy in the fight against COVID-19: the case of Vietnam

Author:: Le Dinh Tinh and Nguyễn Tiền Thanh
Publication Date:: 09-2021
Content Type:: Journal Article
Journal:: Revista Brasileira de Política Internacional (RBPI)
Institution:: Instituto Brasileiro de Relações Internacionais (IBRI)
Abstract:: The global but uneven course of the Covid-19 pandemic highlights the importance of international cooperation and negotiation on such matters as financial assistance, medical equipment provision, vaccine development and distribution, and other pandemic response measures. This article will present a theoretical overview of “health diplomacy” and analyze the case of Vietnam within this framework, showing how the country’s political response to the pandemic demonstrates an increasingly proactive engagement in health diplomacy. The article argues that health diplomacy will become more relevant for international relations in the time to come and that the case of Vietnam might yield valuable lessons.
Topic:: Diplomacy, Health, Pandemic, and COVID-19
Political Geography:: Asia and Vietnam

16. China’s Public Procurement Protectionism and Europe’s Response: The Case of Medical Technology

Author:: Fredrik Erixon, Anna Guildea, Oscar Guinea, and Philipp Lamprecht
Publication Date:: 09-2021
Content Type:: Policy Brief
Institution:: European Centre for International Political Economy (ECIPE)
Abstract:: This paper concerns China’s market for medical technologies and how the Chinese state is assisting its own companies to gain greater sales at the expense of producers from Europe and other advanced manufacturing economies. The medical technology sector captures a variety of products, services and solutions which are essential to the provision of healthcare to citizens. Examples range from fairly simple technologies such as sticking platers, to complex ones, such as coronary stents, orthopaedics and pacemakers. In the last decades, Europe’s exports of medical devices to China have grown robustly. On the back of vibrant innovation, firms from Europe and elsewhere have not just followed the growth of Chinese demand for medical devices – they have also increased their share of Chinese imports. Now, however, this market is at risk of being gradually closed off for European firms as China doubles down on various policies that advantage local firms, while ultimately harming innovation and Chinese patients. China has recently introduced a new element in its industrial policy for its medical technology sector – a policy that builds on its long-term ‘made-in-China’ ambition to have local firms taking up the lion’s share of the market for medical devices by 2030. Beijing and provincial governments are using many different policies to provide support to the domestic industry and are in effect pursuing a policy for import substitution. Accessing the Chinese market for medical devices has never been easy but it has become increasingly challenging in recent years. Direct financial support, tax benefits, R&D support, local content requirements, opaque approval systems and other forms of advantages to domestic MedTech producers are now becoming major sources for the behaviour and development of the Chinese medical device market. China’s Fourteenth Five-Year Plan and the country’s new economic model of ‘dual circulation’ reinforces this trend. The Chinese market is becoming less open. Added to that is centralised state procurement – a new public procurement policy in China that was launched in 2019 for medical devices which has led to a grossly distorted procurement market. While this policy has reduced the price of medical devices in a drastic way, it has also paved the way for Chinese firms to take up a larger market share. This procurement policy is gradually squeezing European firms out of the Chinese market. Competition in China is becoming less fair. These policies follow a pattern. In several sectors, Chinese firms have grown their domestic market share through industrial subsidies and policies that restrict market access for foreign firms – or make it more difficult for foreign firms to compete in China. From their domestic market, these firms have then expanded abroad and taken a more prominent role outside of China. Backed by the Chinese state, these firms can squeeze market opportunities even more for otherwise-competitive European producers. Now this development is happening in the MedTech sector. It is urgent for Europe to respond to China’s procurement protectionism. MedTech manufacturers in Europe are often small and medium-sized enterprises, and they already struggle with getting into the Chinese market. China’s new procurement policy has also had a significant impact on Chinese imports of medical devices: a 1.3 billion euro trade deficit for China in medical technology products in 2019 turned into a 5.2 billion euro surplus in 2020. In Africa, Asia and Latin America, competitive European manufacturers are now confronted with competition from Chinese MedTech companies that have the backing of the Chinese state. The competitive distortions in the Chinese market now spill over to the global market – making European MedTech manufacturers even more disadvantaged. Europe should consider a case at the World Trade Organisation (WTO) against China’s policies which reduce European market presence for medical devices. Once agreed, a new International Procurement Initiative might be a useful instrument to wield pressure against the Chinese government to agree to free and fair competition. Europe can also negotiate with China – for instance in the framework of the Comprehensive Agreement on Investment (CAI) or through the new initiative on trade and health that Europe proposed to the Ottawa Group in 2020. These responses should focus both on remedying China’s current policy for growing its domestic medical technology industry by distorting its market and setting out the core policies and rules that should guide the future market for medical technologies. Fredrik Erixon and Anna Guildea are Director and Research Associate, respectively, at ECIPE. Oscar Guinea and Philipp Lamprecht are Senior Economists at ECIPE. The authors are grateful to a number of experts in the private sector and from the European Commission, the Federal Ministry for Economic Affairs and Energy in Germany, China’s Ministry of Industry and Information Technology that have taken their time to share their knowledge with us.
Topic:: Health, Science and Technology, European Union, and Public Procurement
Political Geography:: China, Europe, and Asia

17. A Just Response to Beijing’s COVID-19 Abuses

Author:: David Asher, Miles M. Yu, David Feith, Matthew Zweig, and Thomas DiNanno
Publication Date:: 06-2021
Content Type:: Policy Brief
Institution:: Hudson Institute
Abstract:: Nearly 18 months after word of a deadly new virus began leaking out of Wuhan, China, the Chinese government’s response remains fundamentally hostile to international cooperation and transparency. Despite hundreds of offers of assistance, polite diplomatic entreaties, and demands for access to data by governments and health authorities across the globe, the world still knows far too little about COVID-19’s origin. As in a Dali painting, the clocks have melted but time has not stood still. China’s initial silencing and censoring of its doctors and scientists, followed by misinformation about COVID-19’s dangers—especially denials concerning the virus’s ability to be spread human-to-human, invisibly and asymptomatically—helped cost the world trillions of dollars and millions of lives. Whether one believes COVID-19 originated in a zoonotic host, a bat cave, a frozen food shipment, or a Wuhan lab’s dangerous “dual-use” research supporting undeclared bioweapons programs, the world needs answers from the Chinese Communist Party. These are answers Beijing won’t provide unless it faces a high price for refusing. For the good of public health and international security, the Biden administration and the Congress can unite in a coordinated, long-term response.
Topic:: Security, Health, Research, Transparency, Public Health, and COVID-19
Political Geography:: China and Asia

18. COVID‐19 Effects on US Higher Education Campuses: Academic Student Mobility to and from China

Author:: Mirka Martel
Publication Date:: 03-2020
Content Type:: Special Report
Institution:: Institute of International Education (IIE)
Abstract:: The Institute of International Education (IIE) is studying the effects of COVID‐19 (coronavirus) on global student mobility on U.S. higher education campuses. Our aim in this series is to provide more information about the effects that COVID‐19 has had on international student mobility, and the measures U.S. higher education institutions are taking regarding international students currently on campus and those abroad, international students interested in studying in the United States, and U.S. students planning to study abroad. The first survey was launched on Feb. 13, 2020, and specifically focuses on the effects of COVID‐19 with regard to academic student mobility to and from China. As the COVID‐19 outbreak evolves, IIE will administer follow‐on surveys to the U.S. higher education community to monitor the unfolding situation and to keep the international education community informed.
Topic:: Education, Health, Youth, Mobility, Higher Education, and Coronavirus
Political Geography:: China, Asia, North America, and United States of America

19. China, Italy and COVID-19: Benevolent Support or Strategic Surge?

Author:: Francesca Ghiretti
Publication Date:: 03-2020
Content Type:: Commentary and Analysis
Institution:: Istituto Affari Internazionali
Abstract:: The bilateral relationship between Italy and China is back in the spotlight one year after the signature of the Memorandum of Understanding (MoU) on China’s Belt and Road Initiative. To date, Italy is the second hardest hit country by COVID-19 pandemic after China. Despite strict measures in place to limit the crisis, numbers keep rising, placing the national health care system under severe strain.
Topic:: Health, Bilateral Relations, Foreign Aid, and Propaganda
Political Geography:: China, Europe, Asia, Italy, and European Union

20. Double-Edged Aid: China’s Strategy to Gain Influence through Regional Assistance

Author:: Liselotte Odgaard
Publication Date:: 03-2020
Content Type:: Special Report
Institution:: Hudson Institute
Abstract:: This report addresses China’s approach to development in Central Asia, Southeast Asia, East Africa, and the Arctic. China has worked through the Shanghai Cooperation Organization to meet Russian demands for continued regional primacy in Central Asia, helping Beijing foster economic and social dominance, access strategic energy resources, and treat the Uyghur minorities as a problem of terrorism rather than a development issue. In Southeast Asia, China has worked through the Association of South-East Asian Nations (ASEAN) to meet regional demands for soft and hard infrastructure to legitimize China’s growing strategic presence. China is therefore able to undermine the regional economic and security foothold of the US alliance system and challenge the interpretations of the Law of the Sea that legitimizes the military presence and activities of extra regional powers. In East Africa, China has cooperated with the African Union (AU) and the East African Intergovernmental Authority on Development (IGAD) to address regional demands for hard and soft infrastructure without political conditions, to link antipiracy problems to problems of poverty, and to mediate local civil wars. This has helped China establish an economic and strategic foothold at the intersection of the Indian Ocean and Middle East, projecting power far from its shores. In the Arctic, China has established research stations that function as both environmental research laboratories and military surveillance stations.
Topic:: International Relations, Economics, Health, Foreign Aid, Regulation, and Trade
Political Geography:: China and Asia

21. Crisis from Kolkata to Kabul: COVID-19’s Impact on South Asia

Author:: Husain Haqqani and Aparna Pande
Publication Date:: 05-2020
Content Type:: Special Report
Institution:: Hudson Institute
Abstract:: The world’s most populous region, South Asia, with almost 1.9 billion people living in eight countries, has so far had fewer reported infections and fatalities per capita from the novel coronavirus than projected in early models. However, the region is unlikely to escape the widespread disruption and damage felt across the globe, and its worst health-care crisis may be yet to come. In South Asia, as in other regions, the COVID-19 pandemic is testing the capacities of states to provide security and effective healthcare and to maintain essential services. It is also having an impact on fragile democratic institutions and societal bonds, in addition to putting considerable strains on the economy. [...] Following is a country-by-country report, with inputs from experts on the ground, on the coronavirus pandemic’s impact in South Asia and its human, economic, and political consequences.
Topic:: Economics, Health, Crisis Management, and COVID-19
Political Geography:: Pakistan, China, South Asia, India, Asia, and Sri Lanka

22. The Effects of Financial Inclusion on Development Outcomes: New Insights from ASEAN and East Asian Countries

Author:: Rajabrata Banerjee, Ronald Donato, and Admasu Afsaw Maruta
Publication Date:: 09-2020
Content Type:: Working Paper
Institution:: Economic Research Institute for ASEAN and East Asia (ERIA)
Abstract:: This study empirically examines the effects of financial inclusion on economic development, – economic growth, education, health, and income inequality – in 20 Asian countries in the period 2004-2015. The financial inclusion index at an aggregate level is constructed using a hybrid methodology (reported in the previous paper) and we empirically examine its relationship with particular development outcomes. We then disaggregate the index into the three dimensions of financial inclusions – access, usage, and quality – and further into the top two indicators from each dimension based on principal component analysis scores (reported in the previous paper), to examine whether specific dimensions or indicators are more strongly associated with particular development outcomes than with others. Our results show that aggregate financial inclusion has a strong positive effect on all development outcomes and this effect improves for countries with lower political risk. At the dimension level, while usage is the only dimension impacting on economic growth, and access is the only dimension impacting on health outcomes, both usage and access influence education and income inequality. Moreover, the top ranked indicators in each dimension exert a far greater positive influence on development outcomes than the second highest ranked indicators. Our findings show that adopting a single blanket policy may not be appropriate to realise the full potential of financial inclusion in a less developed country. Policy prescriptions should therefore target specific dimension and indicators of financial inclusion to maximise the positive effect on development outcomes.
Topic:: Development, Health, Finance, and Fiscal Policy
Political Geography:: Asia

23. Intended and Unintended Consequences of a New Limit on Working Hours in South Korea: Implications for Precarious Employment

Author:: Sungchul Park and Hansoo Ko
Publication Date:: 06-2020
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Effective as of July 1, 2018, South Korea set a new cap on employees’ weekly working hours, decreasing the maximum number from 68 to 52. In this study, we comprehensively analyze the effectiveness of the law’s implementation by observing changes in work time, health status, health care utilization, health behavior, monthly expenses, and satisfaction between pre- and post-implementation periods (2014–2017 vs. 2019). We find evidence of both intended and unintended consequences—and, in this last category, some are beneficial and some not. As intended, employees eligible for the 52-hour work week saw their average working hours decrease, while their monthly spending on leisure increased substantially. A beneficial unintended consequence was that work time also decreased in firms with less than 300 employees that had not yet implemented the 52-hour work schedule (they have done so since, in January 2020). Among adverse unintended consequences, the most notable were heterogeneous effects across employment types (full-time vs. precarious employment) and, in particular, negative impacts on precarious employees (that is, those facing relatively high levels of job insecurity). Despite almost no change in their work time, precarious employees saw substantial increases in outpatient visits and monthly expenses for health care, indicating suggestive evidence of adverse health consequences. Another adverse unintended consequence was that overall job satisfaction decreased among several groups of employees. This may reflect a heavy workload among employees still expected to work overtime, especially experienced employees or those working in large firms. While employment rates increased after the new schedule’s implementation, the majority were in precarious jobs. This has negative implications because of the adverse health impacts of being in precarious employment; also, the workload of experienced employees in this field might have intensified amid all the new hiring. Our findings suggest key policy recommendations for how to leverage the benefits of the 52-hour cap on weekly working hours while addressing its negative unintended consequences.
Topic:: Health, Labor Issues, Employment, and Labor Policies
Political Geography:: Asia and South Korea

24. Coronavirus, China, and the Middle East

Author:: Mordechai Chaziza
Publication Date:: 06-2020
Content Type:: Special Report
Institution:: The Begin-Sadat Centre for Strategic Studies (BESA)
Abstract:: The Middle East was already plagued by war, famine, and wholesale death in the form of multiple civil wars when the outbreak of Covid-19, a novel coronavirus, added pestilence to the mix. The pandemic offers a unique prism through which to assess the way China interacts with Middle Eastern states in time of crisis. While many countries in the Middle East suspended bilateral air travel, repatriated their citizens from China, and prevented Chinese workers from returning to the region, the same governments also sought to maintain close relations, expressed support for Beijing, and delivered aid to China. The findings show that at least for now, the relationship between China and the Middle Eastern states remains close. However, it may take months to see the full ramifications of the pandemic in the Middle East, so it is too soon to tell how China’s interactions with the countries of the region will develop.
Topic:: International Relations, Health, Bilateral Relations, and COVID-19
Political Geography:: China, Middle East, and Asia

25. The Impact Of Covid-19 On Sino-African Trade Activities

Author:: Egoh Aziz
Publication Date:: 06-2020
Content Type:: Special Report
Institution:: The Nkafu Policy Institute
Abstract:: The recent outbreak of COVID-19 has caused waves of horror and anxiety across many nations in the world. Considering the intense unravelling of the pandemic, no exact figure as per the number of confirmed and death cases worldwide is definite because the situation changes almost every hour. However, on April 14, 2020 3:40 GMT, Worldometer reported 210 countries and territories across the globe having a total of 1,925,179 confirmed cases, and a dead toll of 119,699 deaths. The impact of the pandemic is disastrous globally affecting a variety of sectors including the service and supply chain, as well as trade, manufacturing, and tourism. This article aims to provide a synoptic assessment of the impact of COVID-19 on Sino-African trade activities. It stresses that, if African policymakers revamp their efforts to quickly address COVID-19, the human casualty will be less and African economic growth may experience lesser shock as previewed by the IMF. On the other hand, if they relent their efforts, the human casualty will soar while the growth rate may decline. The effect of COVID-19’s outbreak in China has caused a slowdown on exports and services directed towards China.According to statistics from the General Administration of Customs of China, in 2018, China’s total import and export volume with Africa was US$204.19 billion, a yearly increase of 19.7%, surpassing the total growth rate of foreign trade in the same period by 7.1 percentage points. Among these, China’s exports to Africa were US$104.91 billion, up 10.8% and China’s imports from Africa were US$99.28 billion, up 30.8%; the surplus was US$5.63 billion, down 70.0% every year. The growth rate of Sino African trade was the highest in the world in 2018. This shows that Sino-African trade has a significant contribution to the growth of African economies.
Topic:: Economics, Health, International Cooperation, International Trade and Finance, Trade, Coronavirus, Pandemic, and COVID-19
Political Geography:: Africa, China, Asia, and Cameroon

26. Toynbee Coronavirus Series: Dominic Sachsenmaier on China, geopolitics, and global history post-COVID-19

Author:: Dominic Sachsenmaier
Publication Date:: 06-2020
Content Type:: Commentary and Analysis
Institution:: The Toynbee Prize Foundation
Abstract:: Living through historically unprecedented times has strengthened the Toynbee Prize Foundation's commitment to thinking globally about history and to representing that perspective in the public sphere. In this multimedia series on the covid-19 pandemic, we will be bringing global history to bear in thinking through the raging coronavirus and the range of social, intellectual, economic, political, and scientific crises triggered and aggravated by it. Dominic Sachsenmaier, the President of the Toynbee Prize Foundation, is Chair Professor of Modern China with a Special Emphasis on Global Historical Perspectives in the Department of East Asian Studies at the University of Göttingen. His expertise centers on global and transnational Chinese history, with a focus on Chinese concepts of society and multiple modernities, among other topics. He is co-editor of the Columbia University Press book series “Columbia Studies in International and Global History“ and an elected member of the European Academy of Sciences and Arts.
Topic:: Health, International Affairs, Geopolitics, Global Focus, Coronavirus, Pandemic, and COVID-19
Political Geography:: China, Asia, and Global Focus

27. Fight the COVID-19 Pandemic and Improve Global Health Governance

Author:: Lin Ren, Aizong Xiong, Guoding Wu, Chen Shen, Xu Tian, and Bo Peng
Publication Date:: 07-2020
Content Type:: Working Paper
Abstract:: The fast spreading of the COVID-19 across the globe points to the urgency of strengthening global health governance. As the core global health governance institution, the WHO has taken a series of actions after the eruption of the epidemic and played an important role in providing guidance and coordinating global forces to combat the epidemic. The epidemic, however, has also exposed some defects of the global health governance mechanism, especially the WHO, and posed challenge to it. The international community needs to strengthen its support for the WHO to improve its role in the global health governance.
Topic:: Health, Governance, and COVID-19
Political Geography:: China, Asia, and Global Focus

28. Social Protection under Authoritarianism: Health Politics and Policy in China

Author:: Xian Huang
Publication Date:: 11-2020
Content Type:: Video
Institution:: Weatherhead East Asian Institute, Columbia University
Abstract:: On October 14, 2020, Xian Huang, Assistant Professor of Political Sciencee at Rutgers University joined Qin Gao, Professor of Social Policy and Social Work and director of the China Center for Social Policy for an event: "Social Protection under Authoritarianism: Health Politics and Policy in China." Why would an authoritarian regime expand social welfare provision in the absence of democratization? Yet China, the world's largest and most powerful authoritarian state, has expanded its social health insurance system at an unprecedented rate, increasing enrollment from 20 percent of its population in 2000 to 95 percent in 2012. Significantly, people who were uninsured, such as peasants and the urban poor, are now covered, but their insurance is less comprehensive than that of China's elite. With the wellbeing of 1.4 billion people and the stability of the regime at stake, social health insurance is now a major political issue for Chinese leadership and ordinary citizens. In this book talk, Xian Huang analyzes the transformation of China's social health insurance in the first decade of the 2000s, addressing its expansion and how it is distributed. Drawing from government documents, filed interviews, survey data, and government statistics, she reveals that Chinese leaders have a strategy of "stratified expansion," perpetuating a particularly privileged program for the elites while developing an essentially modest health provision for the masses. She contends that this strategy effectively balances between elites and masses to maximize the regime's prospects of stability.
Topic:: Democratization, Government, Health, Authoritarianism, and Political stability
Political Geography:: China and Asia

29. Social Interventions, Health and Wellbeing: The Long-Term and Intergenerational Effects of a School Construction Program

Author:: Bhashkar Mazumder, Maria Rosales-Rueda, and Margaret Triyana
Publication Date:: 12-2020
Content Type:: Working Paper
Institution:: Kellogg Institute for International Studies
Abstract:: We analyze the long-run and intergenerational effects of a large-scale school building project (INPRES) that took place in Indonesia between 1974 and 1979. Specifically, we link the geographic rollout of INPRES to longitudinal data from the Indonesian Family Life Survey covering two generations. We find that individuals exposed to the program have better health later in life along multiple measures. We also find that the children of those exposed experience improved health and educational outcomes and that these effects are generally stronger for maternal exposure than paternal exposure. We find some evidence that household resources, neighborhood quality, and assortative mating may explain a portion of our results. Our findings highlight the importance of considering the long-run and multigenerational benefits when evaluating the costs and benefits of social interventions in a middle-income country.
Topic:: Education, Health, Poverty, Inequality, Economic Growth, and Economic Development
Political Geography:: Indonesia and Asia

30. What North Korea’s Coronavirus Measures Say About Its System

Author:: Benjamin Katzeff Silberstein
Publication Date:: 02-2020
Content Type:: Commentary and Analysis
Institution:: Foreign Policy Research Institute
Abstract:: The North Korean government response to the coronavirus has been extreme, but prudent and reasonable in context. It has closed the border to China almost entirely to both goods and people though surely some transports are still getting through. No travel is allowed to or from China although there must be exceptions to this rule as well. The state (under the banner of the Red Cross, whose branch in North Korea operates as a government entity) has dispatched people around the country to inform people about the virus. No reports have been confirmed at this time of writing, but exile journalists based in South Korea have reported several deaths from the virus from North Korea. Its actions have been blunt and all-encompassing, mainly because the state lacks the necessary capacity to act differently. North Korea doesn’t have the sort of equipment required to monitor people coming from China or to test people at the pace required.
Topic:: Government, Health, Authoritarianism, Border Control, Coronavirus, and COVID-19
Political Geography:: Asia and North Korea

31. People’s Polyclinics: The Initiative of the Telugu Communist Movement.

Author:: Tricontinental: Institute for Social Research
Publication Date:: 02-2020
Content Type:: Working Paper
Institution:: Tricontinental: Institute for Social Research
Abstract:: The Indian Communist movement has experimented with various forms of people’s polyclinics, which provide free or reduced-cost health care to anyone. The epicentre of this initiative has been in the Telugu-speaking region of India, where the Nellore People’s Polyclinic alone treats 1,000 patients per day at rates 40% lower than corporate hospitals and has trained over five hundred doctors who now provide health care across the region. Our Tricontinental: Institute for Social Research Dossier no. 25 focuses on the history of the polyclinics in this region.
Topic:: Communism, Health, Community, and Medicine
Political Geography:: India and Asia

32. Modicare Post-Election: Recommendations to Enhance the Impact of Public Health Insurance on UHC Goals in India

Author:: Kalipso Chalkidou, Nishant Jain, Françoise Cluzeau, and Amanda Glassman
Publication Date:: 05-2019
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: Hailed as one of the largest publicly funded health insurance programs in the world, India’s “Modicare” has, since its launch a little more than six months ago, made universal healthcare coverage an election theme for the first time in the country’s history.[1] In this note, we describe the program, with an emphasis on its better-known secondary and tertiary care component, and offer policy recommendations to strengthen the scheme post-election to enhance its contribution to India’s vision for universal health coverage (UHC). In a country of almost 1.4 billion people that is home to one-third of global maternal deaths, where public spending for health accounts for roughly 1 percent of GDP and where 60 million people fall into poverty every year because of healthcare bills, fixing healthcare is a daunting task that will determine the world’s performance against the Sustainable Development Goals over the coming decade.
Topic:: Health, Health Care Policy, Public Health, and Health Insurance
Political Geography:: India and Asia

33. Removing Barriers and Closing Gaps: Improving Sexual and Reproductive Health and Rights for Rohingya Refugees and Host Communities

Author:: Liesl Schnabel and Cindy Huang
Publication Date:: 06-2019
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: In August 2017, widespread violence carried out with “genocidal intent” in Myanmar forced 745,000 Rohingya to flee to Bangladesh and settle in camps in Cox’s Bazar.[1] Fifty-two percent of the refugee population there are women and girls.[2] Those of reproductive age are in dire need of emergency and longer-term sexual and reproductive health and rights (SRHR)[3] services. Many have additional needs related to sexual trauma experienced in Myanmar and/or in Bangladesh.[4],[5] For many, these needs are not being fully met due to implementation and access barriers.
Topic:: Gender Issues, Health, Women, Reproductive Rights, and Sexual Health
Political Geography:: Asia and Myanmar

34. Healing One-fifth of Humanity: Progress and Challenges for China’s Health System

Author:: Karen Eggleston
Publication Date:: 10-2019
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: China’s national health reforms over the past two decades have brought the system closer to the modern, safe, reliable and accessible health system that is commensurate with China’s dramatic economic growth, improvement in living standards, and high hopes for the next generation. Celebrating a decade this year, China’s national health reforms of 2009 consolidated a system of social health insurance covering the entire population for basic health services, contributing to a surge in healthcare utilization while reducing out-of-pocket costs to patients – which declined from 56% to 28% of total health expenditures between 2003 and 2017. An expanded basic public health service package, funded by per capita government budget allocations that include a higher central government subsidy for lower income provinces, provides basic population health services to all Chinese. A higher percentage of Chinese accessed hospital admissions in 2017 than in the average high-income (OECD) country – a large increase from the turn of the 21st century.i A recent re-shuffle of the governance structure consolidates the purchaser role for social health insurance schemes under the newly created National Healthcare Security Administration, with most other health sector functions under the re-christened National Health Commission, among other changes. China’s world-leading technological prowess in multiple fields spanning digital commerce to artificial intelligence—and accompanying innovative business models such as WeDoctor that have not yet been fully integrated into the health system—hold promise for supporting higher quality and more convenient healthcare for China’s 1.4 billion.
Topic:: Health, Science and Technology, Governance, and Health Care Policy
Political Geography:: China and Asia

35. Integrated Child Development Services (ICDS)By AVANI KAPUR and RITWIK SHUKLA

Author:: Avani Kapur and Ritwik Shukla
Publication Date:: 07-2019
Content Type:: Policy Brief
Institution:: Centre for Policy Research, India
Abstract:: The Integrated Child Development Services is the Government of India’s (GoI’s) flagship programme aimed at providing basic education, health, and nutrition services for early childhood development. This brief uses government data to analyse ICDS performance along the following parameters: Allocations, releases, and expenditures; Component-wise trends; Human and physical resources; Coverage, and Outcome.
Topic:: Development, Education, Government, Health, Budget, and Children
Political Geography:: South Asia, India, and Asia

36. How can the NHS recruit and retain migrant nurses after Brexit?

Author:: Georgia Spiliopoulos and Stephen Timmons
Publication Date:: 06-2019
Content Type:: Policy Brief
Institution:: Asia Research Institute, University of Nottingham
Abstract:: Non-British nurses working for the National Health Service (NHS) face a number of challenges, which must be addressed in the context of ongoing Brexit negotiations. Since the 2016 Referendum result to leave the European Union (EU), the number of EU nurses registering with the Nursing and Midwifery Council (NMC) plummeted in 2017 by 96% – from 1,304 EU nurses registering with the NMC in July 2016 to just 46 in April 2017 (Siddique, 2017). This drop in numbers is also linked with the number of EU nurses leaving the UK (Matthews-King, 2017). A recent NMC report (2019) published a 1% increase, for the first time in three years, in the number of new nurse registrants, for the period between April 2018 and March 2019. This increase translates into 6,000 nurses from the UK, EU and overseas. These numbers, while encouraging, reflect the changes in international recruitment from EU and non-EU countries, and importantly the impact of Brexit on the retention of both EU and non-EU nurses. This paper recommends measures to support the retention of these nurses.
Topic:: Health, Health Care Policy, Brexit, and Public Health
Political Geography:: Britain, United Kingdom, and Asia

37. How can the NHS recruit and retain migrant nurses after Brexit?: Background Report

Author:: Georgia Spiliopoulos and Stephen Timmons
Publication Date:: 06-2019
Content Type:: Special Report
Institution:: Asia Research Institute, University of Nottingham
Abstract:: The UK Referendum decision to leave the European Union in June 2016 exacerbated some of the long-standing challenges the National Health Service (NHS) has been facing in recruiting and retaining nursing staff. In 2018, it was estimated that one in eight posts was vacant, which translates into 36,000 nursing vacancies (King’s Fund, 2018). Arguably, these challenges have been present since the founding of the NHS in 1948. Pre-established initiatives recruiting overseas nurses to deal with acute staffing shortages during the war effort, mainly from the Commonwealth, were also adopted by the NHS. Hence, the Nurses’ Act of 1949 relaxed the criteria for the registration of overseas nurses set up by the General Nursing Council (Solano and Rafferty, 2007). Therefore, we can trace historical developments in recruiting non-UK nurses, which reflect changing state regulations over time, connected to particular political and financial factors, xenophobic rhetoric and also problems in retaining British nursing staff (Bach, 2007; Ball, 2004; Cangiano et al, 2009; Simpkin and Mossialos, 2017; Solano and Rafferty, 2007). In the 1950s, for example, significant numbers of overseas nurses entered the UK as trainees, while an even higher number of British nurses emigrated abroad, fuelling concerns over training of overseas nurses but also bringing to the forefront anxieties over race (Solano and Rafferty, 2007). An illustrative example of political will influencing recruitment of overseas nurses was seen in New Labour’s push for a ‘modernization agenda’ in the late 1990s and subsequently, a push for international recruitment (Deeming, 2004). However, aggressive recruitment initiatives targeting nursing staff from developing countries such as Zimbabwe, Kenya and Zambia, led to the introduction of the NHS ‘Code of Practice’ on ethical recruitment in 2001 (Deeming, 2004), with calls for overseas recruitment to focus mainly on pre-existing agreements with countries such as the Philippines and India (Buchan, 2006).
Topic:: Health, Health Care Policy, Brexit, and Public Policy
Political Geography:: Britain, United Kingdom, and Asia

38. Engaging India: Guide to Developing Health Care Partnerships with States

Author:: Nicole Davis, Christa Twyford Gibson, and Jonathan Gonzalez-Smith
Publication Date:: 08-2019
Content Type:: Working Paper
Institution:: Center for Strategic and International Studies
Abstract:: Indian states control most facets of healthcare delivery. Every state has a different set of healthcare delivery gaps and priorities. Understanding these gaps can help foreign institutions target cooperation more effectively- going to the right place with the right type of cooperation. But having a base for cooperation must be paired with an effective strategy to engage India's states. Issues such as states' political timelines, shifts in key bureaucrats, and other issues can have a major impact on potential projects. In this report, Innovations in Healthcare and CSIS lay out strategies employed by a range of international institutions with current subnational partnerships in India.
Topic:: Health, Governance, Health Care Policy, and Innovation
Political Geography:: India and Asia

39. More Is Possible Now to Address North Korea’s Health and Humanitarian Needs

Author:: J. Stephen Morrison
Publication Date:: 02-2019
Content Type:: Working Paper
Institution:: Center for Strategic and International Studies
Abstract:: As President Trump and Kim Jong-un meet for their second summit in Hanoi, will there be serious consideration given to what concrete actions can be taken to protect and advance a health and humanitarian agenda that can directly benefit North Korea’s impoverished majority and reduce the threat of a runaway tuberculosis (TB) outbreak? Perhaps. Certainly, let’s hope so. There is much that can be done.
Topic:: Foreign Policy, Health, Poverty, and Humanitarian Crisis
Political Geography:: Asia, North Korea, North America, and United States of America

40. Indian State Priorities for Health Innovation Partnerships

Author:: Nicole Davis, Christa Twyford Gibson, and Jonathan Gonzalez-Smith
Publication Date:: 03-2019
Content Type:: Working Paper
Institution:: Center for Strategic and International Studies
Abstract:: Many international institutions—universities, foundations, companies, NGOs, and governments—would like to engage more deeply with the government of India to improve health outcomes. However, a lack of transparency, changing state-level priorities, and the absence of a single venue to learn about engagement opportunities holds back many potential partnerships. The Center for Strategic and International Studies (CSIS) Wadhwani Chair in U.S.-India Policy Studies and Duke University’s Innovations in Healthcare have launched the “Indian States Health Innovation Partnership” to address this information gap and encourage subnational health care cooperation between Indian government entities and external partners. The primary goal of this project is to strengthen health outcomes in India by methodically identifying which Indian states are ripe for innovative partnerships with international institutions and broadcasting these opportunities publicly to spur future partnerships. In the first phase of this project, the team developed a clearer picture of India’s state-level health care reform priorities and identified specific areas for potential partnership across four categories: capacity building, organizational delivery, financing, and specific health conditions.
Topic:: Health, Governance, Health Care Policy, Innovation, and Public Health
Political Geography:: India and Asia

41. Rural-Urban Disparities in the Utilization of Mental Health Inpatient Services in China: The Role of Health Insurance

Author:: Junfang Xu, Jian Wang, Madeleine King, Ruiyun Liu, Fenghua Yu, Jinshui Xing, Lei Su, and Mingshan Lu
Publication Date:: 01-2018
Content Type:: Commentary and Analysis
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China.
Topic:: Health, Health Care Policy, Mental Health, Urban, and Rural
Political Geography:: China and Asia

42. Substance Abuse Policy in Thailand: Current Challenges and Future Strategies

Author:: Darika Saingam
Publication Date:: 01-2018
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Substance abuse has been an important social and public health problem in Thailand for decades. The National Household Survey on Substance and Alcohol Use in Thailand, which has been conducted six times, shows that substance abuse has steadily increased. Extrapolated country-wide in recent data, the estimated number of people who have used at least one addictive substance at some time in their lives was 2,964,444 or 5.8% of the total population aged 12 - 65 years. Kratom, Methamphetamine, methamphetamine hydrochloride crystal (ice), and cannabis were the most prevalent substances of abuse. Historical documentation and policy reports were used in this study. The objectives of this study were to complete a document review, determine the effectiveness of previous measures to control illegal substance abuse in Thailand, and consider options for the future. Controlling illegal substance abuse in the future and minimizing total harm requires a delicate balance of efforts to reduce the prevalence, quantity, and harmful effects of substances. Drug policy interventions should be continually evaluated for their effectiveness. The strategies relevant to drug policy, apart from primary prevention, are health services for chronic drug users, reform of criminal sanctions against drug addicts, and legalization of kratom.
Topic:: Health, Drugs, and Substance Abuse
Political Geography:: Asia and Thailand

43. Dual Practice of Public Hospital Physicians in Vietnam

Author:: Ngan Do and Young Kyung Do
Publication Date:: 04-2018
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon of so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam. Nearly half of the participants in the study sample reported themselves as dual practitioners. Various types of private practice were mentioned. Private practice at health facilities owned by the private sector was the most prevalent, followed by private practice delivered at health facilities owned by the dual practitioners themselves. Private practice inside public hospitals was also noted. Dual practitioners were likely to be senior and hold management positions inside their public hospitals. Substantial income differences were found between dual practitioners and those physicians practicing in only the public sector. The majority of dual practitioners, however, reported the willingness to give up private practice if certain conditions were met, such as a basic salary increase or non-pecuniary benefits. The main reasons dual practitioners gave for not leaving the public sector included a sense of public responsibility and opportunities to gain a broader professional network and more training. This study reiterates the significant challenges associated with dual practice, including its financial implications and possible effects on health care quality and access. The need for a high-quality workforce committed to the public sector is particularly critical, given the possibility of universal insurance coverage. Future research should address the need to improve data collection on physicians’ dual practice and incorporate the topic in policy debates on health reform.
Topic:: Health, Health Care Policy, Reform, and Hospitals
Political Geography:: Asia and Vietnam

44. Economic Dimensions of Personalized and Precision Medicine in Asia: Evidence from Breast Cancer Treatment in Taiwan

Author:: Jui-fen Rachel Lu and Karen Eggleston
Publication Date:: 04-2018
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: High costs of precision medicine raise concerns about exacerbating income-related disparities in healthcare utilization and health outcomes. One approach to expanding coverage in Asia has been to cover the precision therapy but require the pharmaceutical firm to cover the costs of the companion diagnostic test. Taiwan’s National Health Insurance (NHI) adopted this approach for lung cancer, colorectal cancer and leukemia, but not for the first target therapy covered by NHI, trastuzumab for the treatment of HER2-positive breast cancer. Analyzing a unique dataset linking medical claims, cancer registry data and proxies for income between 2004 and 2015, we find that lower-income patients are more likely to be diagnosed with later stages of breast cancer, and this pattern renders NHI coverage of anti-HER2 therapy pro-poor even before full coverage of the diagnostic tests. Moreover, the expansion of NHI coverage—including the FISH diagnostic test and trastuzumab for early-stage breast cancer—strengthened the pro-poor distribution of genetic testing and target treatment, albeit only marginally. The extent of pharmaceutical company coverage of testing and its impact on patient access are topics of our ongoing research, contrasting breast cancer with colorectal cancer.
Topic:: Health, Health Care Policy, Economic Inequality, and Medicine
Political Geography:: Taiwan and Asia

45. Building Regulations For Faecal Sludge Management: Review of Building Regulations From Indian States

Author:: Arkaja Singh
Publication Date:: 12-2018
Content Type:: Special Report
Institution:: Centre for Policy Research, India
Abstract:: Getting approvals under the various building regulations applicable to any particular jurisdiction is often the first step in construction and development. The Report ‘Building Regulations for Faecal Sludge Management: Review of Building Regulations from Indian States’ seeks to understand how these building regulations address on-site sanitation, what kind of standards do they impose on developers, and how well do they incorporate mechanisms to enforce these standards. In this report, we look at six states: Andhra Pradesh, Odisha, Rajasthan, Tamil Nadu, Maharashtra, and Uttar Pradesh. We also look at other standards that are applicable to on-site containment of Faecal sludge, and the manner in which these standards get incorporated into the building regulations. We find that context-specific attention to On-Site Containment of Faecal Sludge is only given in very few states, at least within our sample size. Usually, Building Regulations seem to rely on already existing standards such as the National Building Code, 2016. Additionally, the inconsistencies within the bye-laws exhibit a lack of understanding on the issue of FSM, amongst the policy-makers. As Faecal Sludge Management is an issue at the interface of environment, sanitation, and public health, a lack of convergence between various departments of the government is also noticed.
Topic:: Environment, Government, Health, Regulation, and Sanitation
Political Geography:: South Asia, India, and Asia

46. Unpacking the Processes of Open Defecation Free Status in Udaipur: A case study of Udaipur, Rajasthan

Author:: Devashish Deshpande and Avani Kapur
Publication Date:: 08-2018
Content Type:: Case Study
Institution:: Centre for Policy Research, India
Abstract:: This report is the culmination of a study conducted by the Accountability Initiative (AI) on Swachh Bharat Mission-Gramin in 2017 on the request of the Udaipur district administration. The study understands the outcomes, and the processes, which led to Open Defecation Free status in selected Gram Panchayats.
Topic:: Development, Health, Social Policy, Sanitation, and Services
Political Geography:: South Asia, India, and Asia

47. ACKNOWLEDGING THE FLEXIBILITIES OF THE TRIPS AGREEMENT: ENSURING THE RIGHT TO ACCESS TO MEDICINES OR A STRATEGY OF PASSIVE REVOLUTION?

Author:: Sevgi BALKAN-ŞAHİN
Publication Date:: 10-2018
Content Type:: Journal Article
Journal:: Alternative Politics
Institution:: Department of International Relations, Abant Izzet Baysal University, Turkey
Abstract:: The Doha Ministerial Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health adopted in November 2001 clarified the right to use the TRIPS flexibilities to promote public health. Examining the hegemonic struggle of opposing social forces from a neo-Gramscian perspective, the paper attributes this outcome to the strategy of trasformismo used by market-oriented social forces to legitimize the policies of the World Trade Organization (WTO) and prevent resistance against the market-driven TRIPS Agreement. It argues that although non-governmental organizations (NGOs) such as Medecins Sans Frontieres, Third World Network, and Oxfam worked as a counter-hegemonic force to ensure the access of least developed countries to generic versions of patented drugs, flexibilities confirmed by the Doha Declaration can be seen more as a strategy of trasformismo to absorb counter-hegemonic ideas than the counter-hegemonic groups’ successful incorporation of the right to ensure public health into the TRIPS Agreement.
Topic:: Health, World Trade Organization, Hegemony, Health Care Policy, NGOs, and Public Health
Political Geography:: United States, Europe, Asia, and North America

48. Infrastructure, Gender and Violence: Women and Slum Sanitation Inequalities in Delhi

Author:: Susan Esme Chaplin and Reetika Kalita
Publication Date:: 10-2017
Content Type:: Special Report
Institution:: Centre for Policy Research, India
Abstract:: In Delhi, as in many other Indian cities, millions of men, women and children who live in slums and informal settlements haveto daily confront the lack of adequate sanitation facilities. These sanitation inequalities have a greater impact on the health and socioeconomic status of women and girls because of their greater social vulnerability to sexual violence; there is also the role played by biology in their need for privacy, safety and cleanliness. Men and boys, on the other hand, tend to use public urinals and open defecation (OD) sites generally more frequently, because their need for privacy during these sanitation activities is not such a cause for concern. In addition, women and girls are forced every day to risk using precarious spaces for their sanitation activities that may expose them to gender-based violence and harassment and not satisfy their biological and socio-cultural needs. These urban sanitation inequalities also negatively impact the time women have available for paid employment as well as their daily domestic responsibilities, as they have to spend each morning queuing for toilets or getting up earlier to go with other women to OD sites. For adolescent girls this can often mean being late for school, which threatens their education and future life choices. India failed to meet Millennium Development Goal No. 7 (adopted by the United Nations in 2000) relating to halving the proportion of people without access to basic sanitation. In terms of toilet usage across India, the Census 2011 found that 81 percent of urban households had a private toilet or latrine. But when it came to slum households, only 66 percent had a toilet, meaning that 34 percent had to either use a community or public toilet or resort to OD (Ministry of Housing and Urban Poverty Alleviation & National Buildings Organisations 2013, p. 60). In reality, there are an estimated 41 million urban dwellers still practising OD because of a lack of access to improved sanitation (WaterAid 2016). OD is a compulsion, not a choice, and creates particular risks and imposes a variety of harms upon women and children that men and boys do not suffer. Who or what is responsible for such socioeconomic consequences of the lack of adequate sanitation infrastructure in Indian cities which perpetuate gender inequalities? How do harms like gender-based violence impact the everyday lives of women and girls living in slums in particular? This project report examines these issues using the notion of infrastructural violence and then examines the harms and suffering caused by a lack of sanitation infrastructure in two long-established localities in Delhi: Mangolpuri and Kusumpur Pahari. Mangolpuri is a resettlement colony in the northwest region of Delhi with an estimated population of more than 350,000. It is interspersed with eight JJCs clusters of varying sizes. Kusumpur Pahari is located in the heart of south Delhi, near Jawaharlal Nehru University, and now has five blocks of JJCs and an estimated population of nearly 50,000.
Topic:: Development, Gender Issues, Health, Children, Women, Income Inequality, and Sanitation
Political Geography:: South Asia, India, and Asia

49. Bird Flu — It’s What’s for Dinner: What Human Population Growth and Climate Change Mean for the Future of Avian Influenza Outbreaks

Author:: Nahid Bhadelia
Publication Date:: 07-2017
Content Type:: Journal Article
Journal:: Fletcher Security Review
Institution:: The Fletcher School, Tufts University
Abstract:: China is currently experiencing its fifth epidemic of “bird flu,” or avian influenza H7N9, since 2013 when it was first noted to cause human infections. The virus, which is mainly transmitted from poultry to humans, is also prone to limited human-to-human transmission. To date, there have been 1,258 human cases, with one-third of those cases (460) occurring during this year’s epidemic alone.[1] There are many “subtypes” of avian influenza circulating in birds around the world and most of these viruses cause limited or no human infections. However, two avian influenzas subtypes causing high human mortality have jumped from birds to humans in the last decade, H5N1 and then H7N9. The significant potential of this class of viruses to cause a human pandemic is a global public health concern, particularly because the conditions leading to the rise of these infections are becoming more favorable — for the viruses.
Topic:: Climate Change, Environment, Health, and Infectious Diseases
Political Geography:: China, Asia, and Global Focus

50. Does Unplanned Urbanization Pose a Disease Risk in Asia? The Case of Avian Influenza in Vietnam

Author:: Sumeet Saksena
Publication Date:: 01-2017
Content Type:: Special Report
Institution:: East-West Center
Abstract:: Cities are expanding very rapidly in Asia, often without adequate housing, transportation, water, or sanitation. ese new “peri-urban” areas may be hot spots for disease, both in humans and domestic animals. Research into the possible link between unplanned urban expansion and disease outbreaks compared patterns of land-use change with two major outbreaks in Vietnam of highly pathogenic avian in uenza (HPAI, subtype H5N1) that killed millions of chickens between 2003 and 2005. Work began by classifying communes into land-use categories: rural, peri-urban, urban, and urban core. e study found that peri-urban communes had at least a 150 percent higher risk of experiencing an H5N1 outbreak than did other types of commune, and that urbanization entails a spatial convergence of several key risk factors for H5N1 transmission. By focusing prevention programs on communes with these factors, the Vietnamese government can potentially improve disease prevention at lower cost. is research may also help explain the epidemi- ology of other infectious diseases, both in humans and livestock.
Topic:: Health, Urbanization, and International Development
Political Geography:: Asia

51. Odisha Urban Sanitation Policy and Strategy 2017

Author:: Centre for Policy Research
Publication Date:: 12-2016
Content Type:: Special Report
Institution:: Centre for Policy Research, India
Abstract:: Over the past four years, the national policy environment and institutional response to sanitation have undergone a substantial change. The launch of the Swachh Bharat Mission (Urban) and Atal Mission for Rejuvenation and Urban Transformation (AMRUT) have catapulted sanitation into the league of priority sectors. In the backdrop of such developments, Housing and Urban Development Department under the Government of Odisha sought to revise the Urban Sanitation Strategy 2011 with the able support from the Centre for Policy Research (CPR) supported by the Bill and Melinda Gates Foundation. The revised Odisha Urban Sanitation Strategy 2017 and Odisha Urban Sanitation Policy 2017 make crucial strides towards the achievement of a Clean Odisha. The purview of the strategy has been expanded to address gaps in the entire sanitation value chain for the management of not only solid waste, but also liquid waste including faecal sludge/septage and menstrual hygiene. The revised strategy is grounded in the principles that have underpinned the Odisha government's efforts so far to provide the people with equitable and safe access to sanitation, along with establishing the most advanced sanitation infrastructure. Over the next ten years, concerned departments will work towards six objectives: (a) achieving open defecation free and (b) open discharge free urban areas; (c) effectively managing and treating solid waste; (d) ensuring that sewage, (e) septage/faecal sludge and liquid waste are safely treated and disposed; and (f) ensuring safety guidelines are followed in physical handling and management of waste. In addition, providing women and girls with safe access to menstrual hygiene has also been included as an objective in the revised strategy.
Topic:: Development, Health, Infrastructure, Governance, Public Policy, and Sanitation
Political Geography:: South Asia, India, and Asia

52. Reforming the Liability Regime for Air Pollution in India

Author:: Shibani Ghosh
Publication Date:: 12-2015
Content Type:: Working Paper
Institution:: Centre for Policy Research, India
Abstract:: The recent uproar about the toxic levels of pollution in the country’s national capital region has once again brought to fore the failure of the regulatory and legal mechanisms in India to control air pollution. Despite an early legislative acknowledgment of the issues relating to air pollution, and regulatory mechanisms set up consequently, India has not been able to restrict the sharp upward trajectory of air pollution. While several issues with regard to the legal and regulatory regime governing air quality in the country deserve serious and urgent consideration, this paper focuses on one issue in particular – the liability regime for violation of air quality standards. The paper is divided into three parts. The first part discusses the relevant provisions of the law pertaining to liability - civil and criminal - for causing air pollution. The second part identifies three critical issues that have emerged in the current liability regime: (1) the Pollution Control Boards do not have the power to levy penalties; (2) criminal prosecution is not an effective solution; and (3) the National Green Tribunal Act does not provide complete relief. The third and final part of the essay proposes a way forward. It is suggested that the Pollution Control Boards need to be granted additional enforcement powers, and administrative fines for violations should be introduced, albeit with certain conditions.
Topic:: Environment, Health, Governance, Law Enforcement, Law, Reform, and Pollution
Political Geography:: South Asia, India, and Asia

53. Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India

Author:: Jishnu Das, Alaka Holla, Aakash Mohpal, and Karthik Muralidharan
Publication Date:: 02-2015
Content Type:: Working Paper
Institution:: Centre for Policy Research, India
Abstract:: We present among the first direct evidence on the quality of healthcare in low-income settings using a unique and original set of audit studies, where standardized patients were presented to a nearly-representative sample of rural public and private primary care providers in the Indian state of Madhya Pradesh. We report three main findings. First, private providers are mostly unqualified but spent more time with patients, and completed more items on a checklist of essential history and examination items than public providers, while being no different in their diagnostic and treatment accuracy. Second, we identify the private practices of qualified public sector doctors, and show that the same doctors exert higher effort and are more likely to provide correct treatment in their private practices. Third, we find a strong positive correlation between provider effort and prices charged in the private sector, whereas we find no correlation between effort and wages in the public sector. Our results suggest that market-based accountability in the unregulated private sector may be providing better incentives for provider effort than administrative accountability in the public sector in this setting. While the overall quality of care is low in both the public and private sectors, these differences in provider effort may partly explain the dominant market share of fee-charging private providers even in the presence of a system of free public healthcare.
Topic:: Government, Health, Privatization, Health Care Policy, Social Policy, and Rural
Political Geography:: South Asia, India, and Asia

54. East-West Center Working Papers, Environmental Change, Vulnerability, and Governance Series

Author:: Alex S. Forster
Publication Date:: 03-2014
Content Type:: Working Paper
Institution:: East-West Center
Abstract:: North Korea is an extremely isolated and impoverished nation. While its political elites are able to enjoy some degree of luxury in spite of UN sanctions, the lower classes suffer from shortages of food, electricity, healthcare, and other basic needs. Many of the lower class and fringe populations reside in rural areas with limited infrastructure, and rely on black markets to survive. Their situation could be dramatically improved if electricity could be provided to their communities to power heating, health clinics, manufacturing facilities, fertilizer plants, and water pumps for agricultural irrigation.
Topic:: Health, Food, and Sanctions
Political Geography:: Asia and United Nations

55. Perceived Risk of Avian Influenza in Poultry Varies with Urbanization in Vietnam

Author:: Jefferson Fox, Melissa L. Finucane, Sumeet Saksena, Nghiem Tuyen, James H. Spencer, Nguyen Lam, Trinh Dinh Thau, Tran Duc Vien, and Nancy D. Lewis
Publication Date:: 10-2014
Content Type:: Working Paper
Institution:: East-West Center
Abstract:: Highly pathogenic avian influenza (HPAI) is an important public health concern because of its potential to cause widespread morbidity and mortality in humans and poultry and associated devastating economic losses. In this study we examined how perceptions of and response to the risk of HPAI in poultry vary across communes/wards in the north of Vietnam at different levels of urbanization (rural, transitional, urban). We conducted a quantitative household survey with 1073 respondents. Results suggested that the perceived risk of HPAI in poultry was highest in transitional and rural settings. Respondents in these settings were more likely than respondents in urban settings to agree that the process of change (in urbanization, agricultural practices, or natural habitat) increased the likelihood of an outbreak of HPAI in poultry. Compared with others, respondents in transitional areas reported that they do less planning and perceive vaccines to be more effective, while respondents in rural areas reported less perceived ability to separate infected poultry from others. We also found that the inability to respond is not necessarily because of an inability to perceive change but because, rapid and extensive change poses different challenges for poultry management as communes move from rural to transitional to urban settings. Our results suggest that public and animal health campaigns could be tailored in a way that recognizes the needs of poultry raisers in different settings.
Topic:: Health, Infectious Diseases, and Urbanization
Political Geography:: Asia and Vietnam

56. Role of Urbanization, Land-Use Diversity, and Livestock Intensification in Zoonotic Emerging Infectious Diseases

Author:: Jefferson Fox, Duong Nong, Miguel Castrence, James Spencer, Sumeet Saksena, Nguyen Lam, Tran Duc Vien, Michael Epprecht, Chinh Tran, Melissa Finucane, and Bruce Wilco
Publication Date:: 10-2014
Content Type:: Working Paper
Institution:: East-West Center
Abstract:: Emerging infectious diseases (EIDs) continue to significantly threaten human and animal health. While there has been some progress in identifying underlying proximal driving forces and causal mechanisms of disease emergence, the role of distal factors is most poorly understood. This article focuses on analyzing the statistical association between highly pathogenic avian influenza (HPAI) H5N1 and urbanization, land-use diversity and poultry intensification. A special form of the urban transition—peri-urbanization—was hypothesized as being associated with 'hot-spots' of disease emergence. Novel metrics were used to characterize these distal risk factors. Our models, which combined these newly proposed risk factors with previously known natural and human risk factors, had a far higher predictive performance compared to published models for the first two epidemiological waves in Viet Nam. We found that when relevant risk factors are taken into account, urbanization is generally not a significant independent risk factor. However, urbanization spatially combines other risk factors leading to peri-urban places being the most likely 'hot-spots'. The work highlights that peri-urban areas have highest levels of chicken density, duck and geese flock size diversity, fraction of land under rice, fraction of land under aquaculture compared to rural and urban areas. Land-use diversity, which has previously never been studied in the context of HPAI H5N1, was found to be a significant risk factor. Places where intensive and extensive forms of poultry production are collocated were found to be at greater risk
Topic:: Health, Infectious Diseases, and Urbanization
Political Geography:: United States and Asia

57. Insecticide Resistance and Malaria A Threat Decades in the Making

Author:: William G. Brogdon, Anthony Fiore, S.P. Kachur, Laurence Slutsker, and Robert A. Wirtz
Publication Date:: 12-2014
Content Type:: Working Paper
Institution:: Center for Strategic and International Studies
Abstract:: Insecticide (DDT) use to control malaria was first employed successfully in the antimalaria program in Greece in 1947. By 1951, DDT success in controlling malaria was reported in 22 countries. However, that year also saw the first report of DDT resistance, in Anopheles sacharovi in Greece. By 1954, resistance to DDT among mosquitos was known to be a global problem, documented in Europe, the Americas, Africa, and Asia. The World Health Organization–led Global Malaria Eradication Program (GMEP) began in 1955, when resistance was already pronounced worldwide. Scientists did not identify the underlying biochemical mechanism contributing to insecticide resistance until 1958. By then, insecticide resistance was recognized by many to be a major contributor to the ultimate dismantling of GMEP, given the limited capabilities and knowledge of the time. Consequently, the global focus shifted from malaria “eradication” to malaria “control” in the late 1960s.
Topic:: Environment, Health, and Infectious Diseases
Political Geography:: Africa, Greece, and Asia

58. U.S. Support Essential to Ambitious Global Introduction of Inactivated Polio Vaccine

Author:: Nellie Bristol
Publication Date:: 12-2014
Content Type:: Working Paper
Institution:: Center for Strategic and International Studies
Abstract:: Earlier this fall, Nepal became the first low - income country to introduce the inactivated polio vaccine (IPV) into its immunization system. Many more countries will have to follow suit to meet the ambitious deadlines laid out in the Global Polio Eradication Initiative's (GPEI) Polio Eradication Endgame Strategic Plan 2013 – 2018. The plan calls for global introduction of at least one dose of IPV into routine childhood immunization schedules followed by eventual withdrawal of the widely used oral polio vaccine (OPV). Currently, 75 mostly high - and middle - income countries use the injectable IPV in their immunization systems, leaving 119 that need to do so by the end of 2015 to keep with the plan's schedule.
Topic:: Health and Health Care Policy
Political Geography:: Asia and Nepal

59. People with Disabilities in a Changing North Korea

Author:: Katharina Zellweger
Publication Date:: 01-2014
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: "People with Disabilities in a Changing North Korea" details the situation that people with disabilities face in the Democratic People's Republic of North Korea (DPRK). Despite its reputation as a repressive, closed society where human rights are routinely abused, there are in fact institutions in the DPRK that work to address the needs of the disabled, and a number of non-governmental organizations providing aid to disabled people are active in the country. In this paper, Katharina Zellweger attempts to provide "an informed and balanced view of what it means to live with disabilities in North Korea and current work to assist the disabled."
Topic:: Health, Human Welfare, and Governance
Political Geography:: Asia and North Korea

60. Empirical Investigation of Declining Childbirth: Psychosocial and Economic Conditions in Japan

Author:: Tetsuji Yamada, Chia-Ching Chen, Chie Hanaoka, and Seiritsu Ogura
Publication Date:: 08-2013
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Background: For the past two decades, more and more women in certain European countries, Japan, and the United States are giving birth to their first child at a considerably later age than ever before. It remains unclear as to what extent this age-related general fertility decline is affected by changing social and cultural norms. Method: The Global Centers of Excellence Survey was conducted by Osaka University in Japan (n=5313) in 2009. Multivariate regression analyses were conducted to examine the impact of psychosocial norms, cultural differences, and economic conditions on the perception of childbearing. Results: The findings suggest that a subjective measure of happiness has a significant influence on childbearing. A society with income inequalities between classes discourages childbearing. It is observed that women's higher labor force participation generates a negative impact on motherchild relations which causes discouragement of childbearing. A higher female labor force participation stemmed from a transition of a traditional society into a modern and marketoriented society discourages childbearing. Conclusions/implications: A woman's decision to delay childbearing is based on her perception of psychosocial norms with surrounding economic environment and her own value of opportunity in the market oriented society. Childbearing also imposes psycho-economic burdens on the working population under mix of a traditional, patriarchal society, and a modern market oriented framework. Childbearing incentives could be a strategic policy to encourage positive attitudes of childbearing in general and proper welfare policy, labor law(s), employment conditions, and social security system for a working mother with a child or children.
Topic:: Economics, Gender Issues, Health, Poverty, Social Stratification, and Labor Issues
Political Geography:: United States, Japan, Europe, Israel, and Asia

61. State Health Insurance and Out-of-Pocket Health Expenditures in Andhra Pradesh, India

Author:: Victoria Fan, Anup Karan, and Ajay Mahal
Publication Date:: 06-2012
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: In 2007, the state of Andhra Pradesh in southern India began rolling out the Aarogyasri health insurance to reduce catastrophic health expenditures in households “below the poverty line.” We exploit variation in program roll-out over time and districts to evaluate the impacts of the scheme using difference-in-differences. Our results suggest that, within the first year of implementation, Phase I of Aarogyasri significantly reduced out-of-pocket inpatient expenditures and, to a lesser extent, outpatient expenditures. These results are robust to checks using quantile regression and matching methods. No clear effects on catastrophic health expenditures or medical impoverishment are seen. Aarogyasri is not benefiting scheduled caste and scheduled tribe households as much as the rest of the population.
Topic:: Health, Poverty, and Health Care Policy
Political Geography:: India, Asia, and Andhra Pradesh

62. Travelling for health: The potential for medical tourism

Author:: Ana Nicholls
Publication Date:: 10-2011
Content Type:: Working Paper
Institution:: Economist Intelligence Unit
Abstract:: Market size: Medical tourism is not new, but it is growing. Global shift: The flow of travel from developed to developing world. Marketing: How developing countries are targeting the industry. EIU ranking: Why some countries are better placed to benefit than others. US, Europe and Asia trends: The effect of healthcare reforms, budget cuts, and growing wealth. The barriers: The need to harmonise standards and regulations.
Topic:: Globalization, Health, and Health Care Policy
Political Geography:: Europe and Asia

63. Pigs, People and a Pandemic: Communicating Risk in a City-state

Author:: K. U. Menon
Publication Date:: 03-2011
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: The 2009 H1N1 influenza pandemic, also known as the swine flu pandemic, was a test of risk communications methodology and processes. Governments were called upon to make tough decisions in the absence of substantive epidemiological data and baffling case fatality rates (CFRs). While New York adopted mitigation measures, Hong Kong and Singapore followed aggressive containment protocols. Recent studies however suggest that the benefits of such measures – achieved at great cost and allocation of resources – are minimal. This review looks primarily at the experience of a small city-state, Singapore, and compares it with two other equally densely populated cities – New York and Hong Kong – and how all three confronted the challenge and the lessons to be drawn from their experience in risk communications. Communicating risk required deft handling by political leaders and officials to persuade people to adopt strict measures. In the wake of the 2003 severe acute respiratory syndrome (SARS) epidemic, there were high expectations in Hong Kong and Singapore for visible containment measures to continue in the event of future pandemics even when benefits were known to be minimal. Cultural differences may explain the receptivity of the populace in these countries to the stiff measures put in place to contain the disease. However, this requires further study.
Topic:: Health
Political Geography:: Israel, Asia, and Southeast Asia

64. Revitalising Papua New Guinea's health system: the need for creative approaches

Author:: Katherine Lepani and Julienne McKay
Publication Date:: 11-2010
Content Type:: Policy Brief
Institution:: Lowy Institute for International Policy
Abstract:: There is significant potential for the PNG government to deliver better health services for all Papuan New Guineans. Major health problems are now preventable. Cost-effective options are available to Papua New Guineans to treat malaria, pneumonia, tuberculosis and HIV as well as to reduce infant and maternal mortality. In this Policy Brief Julienne McKay and Dr Katherine Lepani explore how demand-responsive mechanisms (vouchers, micro-health insurance, social franchises and social businesses) can be a compelling addition to strengthening health systems in PNG. The research looks at the potential use of these instruments with a focus on HIV, maternal health, tuberculosis and malaria, and contains policy recommendations for government, the private sector and donors.
Topic:: Health and Foreign Aid
Political Geography:: Asia, Australia/Pacific, and Guinea

65. Prevention and Control of Chronic Non-communicable Disease in Nine Pacific Rim Cities

Author:: Karen Eggleston, Meng Kin Lin, Kun Chen, Yunxian Yu, Sung-Il Cho, Sian Griffiths, EK Yeoh, Jamal Hisham Hashim, Masamine Jimba, Carl Anderson Johnson, Paula Palmer, Vu-Anh Le, Huu-Bich Tran, Ngoc-Quang La, and Bambang Wispriyono
Publication Date:: 12-2010
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Populous, economically dynamic, and rapidly urbanizing, the Asia Pacific both reflects and strongly shapes trends in global public health. A comparative assessment of chronic disease prevalence, risk factors, and policy responses in nine Pacific Rim cities shows that chronic diseases are rapidly becoming the leading cause of morbidity and mortality even in the lower income cities of the Pacific Rim. Policy responses are heterogeneous, with few sufficiently funded or adequately informed by evidence. Much could be learned from comparative research and rigorous evaluation of prevention and control initiatives in this region.
Topic:: Globalization and Health
Political Geography:: Asia and Australia/Pacific

66. Very Low Fertility in Asia: Is There a Problem? Can It Be Solved?

Author:: Sidney B. Westley, Robert D. Retherford, and Minja Kim Choe
Publication Date:: 05-2010
Content Type:: Policy Brief
Institution:: East-West Center
Abstract:: Fifty years ago, women in Asia were having, on average, more than five children each, and there was widespread fear of a “population explosion” in the region. Then birth rates began to fall—in several countries more steeply than anyone had anticipated. This unexpected trend has now raised concerns about the social and economic impact of extremely low fertility. Today, four of Asia's most prosperous economies—Japan, Singapore, South Korea, and Taiwan—have among the lowest birth rates in the world. With women having, on average, only one child each, these societies have expanding elderly populations and a shrinking workforce to pay for social services and drive economic growth. And in Japan, overall population numbers are already going down. Why are women choosing to have so few children? How are policy- makers responding to these trends? Government leaders have initiated a variety of policies and programs designed to encourage marriage and childbearing, but to what effect? Given current social and economic trends, it is unlikely that Asia' s steep fertility decline will be reversed, at least not in the for eseeable future.
Topic:: Demographics, Health, and Population
Political Geography:: Japan, Taiwan, Asia, South Korea, and Singapore

67. The Role of NGOs in Combating Avian Influenza in Indonesia: A Muhammadiyah Case Study

Author:: Siti Masyitah Rahma
Publication Date:: 10-2010
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: Avian influenza, or 'bird flu', has been detected in Indonesia since 2003 but it was not until 2005 that the first human cases were discovered. It is estimated that economic losses caused by this virus in Indonesia have reached US$470 million, and disrupted the livelihoods of over 10 million people dependent on the poultry industry. The Government of Indonesia has coordinated government and non-government programmes in efforts to control avian influenza in Indonesia. However, it has encountered certain constraints which resulted in a gap between policy and implementation. This allowed non-governmental organisations (NGOs) to play significant roles in terms of providing financial resources and social capital.
Topic:: Health, Islam, Non-Governmental Organization, and Health Care Policy
Political Geography:: Indonesia and Asia

68. Examining Pandemic Responses in Asia

Author:: Li Hongyan and Ong Suan Ee
Publication Date:: 10-2010
Content Type:: Policy Brief
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: The recent pandemic disease outbreaks which affected many Asian countries underscore the need for appropriate pandemic responses to be developed in order to contain and mitigate the spread of pandemics that emerge in the future. Through an examination of the different responses to SARS and H1N1 in the region, and the effects of those efforts, this NTS Insight seeks to highlight issues which should be considered when developing pandemic response programmes.
Topic:: Health, Human Welfare, and Humanitarian Aid
Political Geography:: Asia

69. Pandemic Influenza A/H1N1 (pH1N1) in Hong Kong: Anatomy of a Response

Author:: Richard Fielding
Publication Date:: 12-2010
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: Pandemic influenza A/H1N1 (pH1N1) spread rapidly from its origins in Mexico to affect Hong Kong as its first point of entry into Asia. In this paper, the different stages of government response from prevention to mitigation to vaccination and stand down are described and discussed from the perspectives of feasibility, pragmatism, effectiveness and population responses to offer insights into future influenza pandemic preparedness.
Topic:: Globalization, Government, and Health
Political Geography:: Israel, Asia, Mexico, and Hong Kong

70. H1N1 Outbreak in Pakistan: Lessons Learnt

Author:: Sania Nishtar
Publication Date:: 12-2010
Content Type:: Working Paper
Institution:: Centre for Non-Traditional Security Studies, S. Rajaratnam School of International Studies
Abstract:: Compared to many other countries in Asia, the outbreak of pandemic influenza H1N1 appeared to be of minor concern to Pakistan. This paper analyses, using qualitative research methods, the extent to which such a notion was justified and the response of Pakistan's health system to the outbreak, exploring the degree to which it is responsive to problems posed by an emerging infection. It looks at the health system measures introduced prior to the H1N1 outbreak (after the implementation of the International Health Regulations 2005) as these came into play during this episode, as well as specific measures introduced subsequent to the H1N1 outbreak.
Topic:: Conflict Resolution, Globalization, Health, and International Affairs
Political Geography:: Pakistan and Asia

71. Aging Risk and Health Care Cost in Korea

Author:: Byong Ho Tchoe and Sang-Ho Nam
Publication Date:: 02-2009
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: It is generally perceived that health care cost is increasing because of population aging. In Korea, the number of people over 65 years of age was 3.1 percent of the population in 1970, 5.1 percent in 1990, 7.2 percent in 2000, and 9.1 percent in 2005. These figures show that the period of time in which an aging population increases by 2 percent is getting shorter; thus aging has been accelerating.
Topic:: Demographics and Health
Political Geography:: Israel, Asia, and Korea

72. The healer or the druggist: Effects of two health care policies in Taiwan on elderly patients' choice between physician and pharmacist services

Author:: Kang-Hung Chang
Publication Date:: 03-2009
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: When both physicians and pharmacists in Taiwan prescribed and dispensed drugs, many elderly people considered the two types of health care providers more or less synonymous (i.e., close substitutes). Two policies mandated in the 1990s changed this perception: National Health Insurance (NHI), which provides insurance coverage to all citizens, and a separation policy (SP) that forbids physicians from dispensing and pharmacists from prescribing drugs. The author finds that by providing an economic incentive to the previously uninsured elderly, NHI raised the probability that they would visit physicians, relative to their continuously insured counterparts. In particular, some previously uninsured elderly who once only visited pharmacists were more likely to also visit physicians after NHI was implemented. Following this, the SP made it more likely that all elderly patients would only visit physicians and buy drugs from on-site pharmacists hired by physicians—a result different than its policy goal.
Topic:: Demographics, Health, and Human Welfare
Political Geography:: Israel, Taiwan, and Asia

73. Allocation of control rights and cooperation efficiency in public-private partnerships: Theory and evidence from the Chinese pharmaceutical industry

Author:: Zhe Zhang, Ming Jia, and Difang Wan
Publication Date:: 03-2009
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: This article uses incomplete contract theory to study the allocation of control rights in public-private partnerships (PPPs) between pharmaceutical enterprises and nonprofit organizations; it also investigates how this allocation influences cooperation efficiency. We first develop a mathematic model for the allocation of control rights and its influence on cooperation efficiency, and then derive some basic hypotheses from the model. The results of an empirical test show that the allocation of control rights influences how enterprises invest in PPPs. A proper allocation provides incentives for firms to make fewer self-interested and more public-interested investments. Such an allocation also improves the cooperation efficiency of PPPs.
Topic:: Demographics, Health, and Human Welfare
Political Geography:: China, Israel, and Asia

74. AIDS Treatment in South Asia: Equity and Efficiency Arguments for Shouldering the Fiscal Burden When Prevalence Rates Are Low

Author:: Mead Over
Publication Date:: 02-2009
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: The slower spread of AIDS in South Asian countries, combined with the fact that most South Asian countries have higher per capita incomes than the most severely affected countries of other regions imply that the various impacts of the disease will be smaller in South Asia than in the worst affected countries in other regions. While justified with respect to the impact of the disease on economic output, on poverty, or on orphanhood, this conclusion does not follow with respect to the health sector, where the relatively minor public role in health care delivery and the entrepreneurial and heterogeneous private health and pharmaceutical sectors combine to magnify the potential impact of the epidemic.
Topic:: Health and Humanitarian Aid
Political Geography:: South Asia and Asia

75. Rice Crisis Forensics: How Asian Governments Carelessly Set the World Rice Market on Fire

Author:: Tom Slayton
Publication Date:: 03-2009
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: The world rice market was aflame last spring and for several months it looked as if the trading edifice that had exhibited such resilience over the last two decades was going to burn to the ground. World prices trebled within less than four months and reached a 30- year inflation-adjusted high. Many market observers thought the previous record set in 1974 would soon be toast. The fire was man-made, not the result of natural developments. While the governments in India, Vietnam, and the Philippines did not to set the world market on fire, that was the unintended result of their actions which threatened both innocent bystanders (low-income rice importers as far away as Africa and Latin America) and, ultimately, poor rice consumers at home. This paper describes what sparked the fire and the accelerants that made a bad situation nearly catastrophic. Fortuitously, when the flames were raging at peak intensity, rain clouds appeared, the winds [market psychology] shifted, and conditions on the ground improved, allowing the fire to die down. It remains to be seen, however, if the trading edifice has been seriously undermined by the actions of decision makers in several key Asian rice exporting and importing countries. In describing the cascading negative effects of these seemingly rational domestic policies, this paper aims to help policy makers in the rice exporting and importing nations to avoid a repeat of the disastrous price spike of 2008.
Topic:: Agriculture, Economics, Health, Humanitarian Aid, Markets, and Political Economy
Political Geography:: Africa, India, Asia, and Latin America

76. Health-Care Reform in Georgia: A Civil-Society Perspective

Author:: Tobias Hauschild and Esmé Berkhout
Publication Date:: 06-2009
Content Type:: Policy Brief
Institution:: Oxfam Publishing
Abstract:: This report aims to identify key challenges arising from reform of the health-care system in Georgia, especially in primary health care, and to present some possible strategies to address them. It will be a useful reference document for Oxfam, our partners, and all those concerned with improving the provision of health care in Georgia.
Topic:: Civil Society, Health, and Reform
Political Geography:: Eastern Europe, Asia, and Georgia

77. Principal-Agent Problems in Health Care: Evidence from Prescribing Patterns of Private Providers in Vietnam

Publication Date:: 12-2009
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: The principal-agent problem in health care asserts that providers, being imperfect agents for patients, will act to maximize their profits at the expense of the patients' interests. This problem applies especially where professional regulations are lacking and incentives exist to directly link providers' actions to their profits, such as a fee-for-service payment system. The current analysis tests for the existence of the principal-agent problem in the private health market in Vietnam by examining the prescribing patterns of the private providers. We show that (1) private providers were able to induce demand by prescribing more drugs than public providers for a similar illness and patient profile; (2) private providers were significantly more likely to prescribe injection drugs to gain trust among the patients; and (3) patients' education as a source of information and empowerment has enabled them to mitigate the demand inducement by the providers. Our hypotheses were supported with evidence from Vietnam National Health Survey 2001 and 2002, the first and, so far, only comprehensive health survey in the country.
Topic:: Health and Human Welfare
Political Geography:: Asia, Australia/Pacific, and Southeast Asia

78. Soft budget constraints in China: Evidence from the Guangdong hospital industry

Author:: Karen Eggleston, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, Jing Zhang, and Yu-Chu Shen
Publication Date:: 03-2009
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Using data from 276 general acute hospitals in the Pearl River Delta region of Guangdong Province from 2002 and 2004, we construct a preliminary metric of budget constraint softness. We find that, controlling for hospital size, ownership, and other factors, a Chinese hospital's probability of receiving government financial support is inversely associated with the hospital's previous net revenue, an association consistent with soft budget constraints.
Topic:: Government, Health, and Financial Crisis
Political Geography:: China and Asia

79. Out-of-pocket household health expenditures and their use in National Health Accounts: Evidence from Pakistan

Author:: Christian Lorenz
Publication Date:: 08-2009
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Out-of-pocket (OoP) household health expenditures are among the most difficult factors to measure in the context of National Health Accounts (NHA). Yet their measurement is important: OoP household expendi-tures are typically the first or second largest source of health care financing in developing countries. Their incorrect measurement can undermine the credibility of total health spending estimates and thus NHA statistics, which are an otherwise important resource for policy makers. In most countries, private expenditures account for the biggest margin of error in national health spending estimates and represent the most substantial barrier to reliable international comparisons. Differences in accounting methods explain much of the discrepancy across nations. To further the academic investigation of this important issue, this paper focuses on OoP household health expenditures in Pakistan's NHA and suggests steps toward estimating such expenditures more effectively.
Topic:: Health
Political Geography:: Pakistan, South Asia, and Asia

80. The Emerging Role of Private Health Care Provision in China

Author:: Cunrui Huang, Haocai Liang, Cordia Chu, Shannon Rutherford, and Qingshan Geng
Publication Date:: 09-2009
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: China continues to face great challenges in meeting the health needs of its large population. The challenges are not just lack of resources, but also how to use existing resources more efficiently, more effectively, and more equitably. Now a major unaddressed challenge facing China is how to reform an inefficient, poorly organized health care delivery system. The objective of this study is to analyze the role of private health care provision in China and discuss the implications of increasing private-sector development for improving health system performance.
Topic:: Government and Health
Political Geography:: China and Asia

81. OEF Commentary on Avian Flu

Publication Date:: 01-2009
Content Type:: Working Paper
Institution:: Oxford Economics
Abstract:: OEF has regularly provided scenario assessments of the economic impact of a wide range of risks to the global outlook from financial market volatility to banking crises to country studies to threats arising from less economy-based disturbances such as earthquake damage and the impact of health scares like the UK's foot and mouth outbreak and Asia's SARS attack of 2003.
Topic:: Economics, Globalization, Health, and Infectious Diseases
Political Geography:: Europe and Asia

82. The Role of Women's Empowerment and Domestic Violence in Child Growth and Undernutrition in a Tribal and Rural Community in South India

Author:: Kavita Sethuraman
Publication Date:: 02-2008
Content Type:: Working Paper
Institution:: United Nations University
Abstract:: Moderate undernutrition continues to affect 46 per cent of children under 5 years of age and 47 per cent of rural women in India. Women's lack of empowerment is believed to be an important factor in the persistent prevalence of undernutrition. In India, women's empowerment often varies by community, with tribes sometimes being the most progressive. This paper explores the relationship between women's empowerment, domestic violence, maternal nutritional status, and the nutritional status and growth over six months in children aged 6 to 24 months in a rural and tribal community. This longitudinal observational study undertaken in rural Karnataka, India included tribal and rural subjects. Structured interviews with mothers were conducted and anthropometric measurements were obtained for 820 mother-child pairs, the follow-up rate after 6 months was 82 per cent. The data were analyzed by multivariate regression. Some degree of undernutrition was seen in 83.5 per cent of children and 72.4 per cent of mothers in the sample, moreover the prevalence of undernutrition increased among children at follow up. Domestic violence was experienced by 34 per cent of mothers in the sample. In multivariate analysis, biological variables explained most of the variance in nutritional status and child growth, followed by health-care seeking and women's empowerment variables; socio-economic variables explained the least variance. Women's empowerment variables were significantly associated with child nutrition on enrolment and child growth at follow-up. At follow-up, mother's prior lifetime experience of physical violence significantly undermined child growth in terms of weight-for-age, and older age at marriage and high mobility of mothers predicted less stunting in their children. In addition to the known investments needed to reduce undernutrition, improving women's nutrition, promoting gender equality, empowering women, and ending violence against women could further reduce the prevalence of undernutrition in this segment of the Indian population.
Topic:: Gender Issues and Health
Political Geography:: India and Asia

83. Global Panic, Local Repercussions: Exploring the Impact of Avian Influenza in Vietnam

Author:: Stacy Lockerbie
Publication Date:: 09-2008
Content Type:: Working Paper
Institution:: Institute on Globalization and the Human Condition, McMaster University
Abstract:: Despite deliberately marked and guarded political and cultural boundaries, the current global state is one where epidemic is the norm and disease travels across the globe through the transnational movement of people and international trade. While developing countries or countries receiving foreign aid are at the centre of disease fatality and transmission, the rhetoric of blame serves to strengthen socio-economic divisions that divide East from West and North from South with adjectives like “modern” and “primitive,” “hygienic” and “unhygienic.” Using chicken as a metaphor, this paper draws attention to the paradoxes and misconceptions of avian influenza in Vietnam and through the exploration of local voices, comes to a better understanding of how the disease rhetoric has affected the social and cultural landscape. This research is situated in the discipline somewhere between the anthropology of infectious disease and the anthropology of food, while also incorporating themes from anthropological theory pertaining to borders, hegemonies and race. Moving beyond the epidemiological study of avian flu, I draw attention to the phenomenology or lived experience in a state of disease as residents voluntarily omit chicken, a valuable source of protein, from their diet in order to stay healthy.
Topic:: Globalization and Health
Political Geography:: Asia and Vietnam

84. The Determinants of Child Weight and Height in Sri Lanka: A Quantile Regression Approach

Author:: Harsha Aturupane, Anil B. Deolalikar, and Dileni Gunewardena
Publication Date:: 05-2008
Content Type:: Working Paper
Institution:: United Nations University
Abstract:: Reducing child malnutrition is a key goal of most developing countries. To combat child malnutrition with the right set of interventions, policymakers need to have a better understanding of its economic, social and policy determinants. While there is a large literature that investigates the determinants of child malnutrition, it focuses almost exclusively on mean effects of these determinants. However, socioeconomic background variables and policy interventions may affect child nutrition differently at different points of the conditional nutritional distribution. Using quantile regressions, this paper explores the effect s of variables such as a child's age, sex and birth order; household expenditure per capita; parental schooling; and infrastructure on child weight and height at different points of the conditional distributions of weight and height using data from Sri Lanka's Demographic and Health Survey. Results indicate that OLS estimates can be misleading in predicting the effects of determinants at the lower end of the distributions of weight and height. For example, even though on average Sri Lankan girls are not nutritionally-disadvantaged relative to boys, among children at the highest risk of malnutrition girls are disadvantaged relative to boys. Likewise, although expenditure per capita is associated with strong nutritional improvement on average, it is not a significant determinant of child height or weight at the lower end of the distribution. Similarly, parental education, electricity access, and the availability of piped water have larger effect son child weight and height at the upper quantiles than at the lower quantiles. The policy implication is that general interventions—parental schooling, infrastructure and income growth—are not as effective for children in the lower tail of the conditional weight and height distributions. These children, who are at the highest risk of malnutrition, are likely to need specialized nutritional interventions.
Topic:: Development, Education, and Health
Political Geography:: Asia and Sri Lanka

85. The sting of climate change

Author:: Sarah Potter
Publication Date:: 11-2008
Content Type:: Policy Brief
Institution:: Lowy Institute for International Policy
Abstract:: Global climate change will intensify the already significant malaria and dengue problems in maritime Southeast Asia and the Pacific Islands. Those countries with the fewest resources and poor public health infrastructure are likely to feel the impact of increasing disease the most acutely. Australia itself is a 'fringe country' to the expanding endemic zone of mosquito-borne diseases to its north. Climate change may well make more of northern Australia more vulnerable to malaria and dengue outbreaks.
Topic:: Climate Change, Environment, and Health
Political Geography:: Asia and Australia/Pacific

86. No Way Out: An Assessment of the Romani Community in Georgia

Author:: David Szakonyi
Publication Date:: 02-2008
Content Type:: Working Paper
Institution:: European Centre for Minority Issues
Abstract:: The Romani community is the most marginalized and disadvantaged ethnic community in Georgia. Although accurate estimates are hard to establish, the population is thought to number up to 1,500 persons, living in multiple small settlements across Georgia. Extreme poverty, unemployment, lack of education and health care, and isolation from larger society comprise several of the major problems the community as a whole is facing. The overall situation for the Roms in Georgia has significantly deteriorated since the Soviet period, leaving the population practically devoid of any means to lift themselves out of their often devastating circumstances.
Topic:: Education, Ethnic Conflict, Health, and Poverty
Political Geography:: Europe, Asia, Soviet Union, and Georgia

87. Incentives in China's Healthcare Delivery System

Author:: Karen Eggleston
Publication Date:: 10-2008
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: The economic approach of comparative and historical institutional analysis (Aoki 2001, Greif 2006) has virtually never been used in theoretical studies of healthcare incentives. This paper seeks to help fill this gap by exploring the explanatory power of such an approach for understanding incentives in China's healthcare delivery system. It focuses on positive analysis of why China's health system incentives evolved the way they did. The first section analyzes the institution of physician dispensing (MDD) and reforms toward separation of prescribing from dispensing (SPD), in historical and comparative perspective. It shows, for example, how MDD was a self-reinforcing institution; the longer a society remains under MDD, the higher the associated costs of supplier-induced demand can be before implementing SPD becomes the efficient self-enforcing social institution. Rapid technological change and adoption of universal coverage are likely to trigger SPD reforms. The second section seeks to explain the pattern and impact of price regulation and hospital payment reforms in contemporary China, which also reflect the legacy of MDD.
Topic:: Government, Health, and Human Welfare
Political Geography:: China, Israel, and Asia

88. The Effect of Informal Caregiving on Labor Market Outcomes in South Korea

Author:: Young Kyung Do
Publication Date:: 12-2008
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Embedded in traditional culture perpetuating family-centered elderly care, informal care is still viewed as a family or moral issue rather than a social and policy issue in South Korea. Using newly available micro data from the Korean Longitudinal Study of Aging, this study investigates the effect of informal caregiving on labor market outcomes in South Korea. By doing so, this study provides evidence to inform elderly long-term care policy in South Korea, and also fills a gap in the international literature by providing results from an Asian country. Empirical analyses address various methodological issues by investigating gender differences, by examining both extensive and intensive labor market adjustments with two definitions of labor force participation, by employing different functional forms of care intensity, and by accounting for the potential endogeneity of informal care as well as intergenerational co-residence. Robust findings suggest negative effects of informal caregiving on labor market outcomes among women, but not among men. Compared with otherwise similar non-caregivers, female intensive caregivers who provide at least more than 10 hours of care per week are at an increased risk of being out of the labor force by 15.2 percentage points. When examining the probability of employment in the formal sector only, the effect magnitude is smaller. Among employed women, more intensive caregivers receive lower hourly wages by 1.65K Korean Won than otherwise similar non-caregivers. Informal care is already an important economic issue in South Korea even though aging is still at an early stage.
Topic:: Demographics, Health, and Markets
Political Geography:: Israel, Asia, and South Korea

89. The World is Still Waiting: Broken G8 promises are costing millions of lives

Publication Date:: 05-2007
Content Type:: Policy Brief
Institution:: Oxfam Publishing
Abstract:: Poverty and suffering could be ended in our lifetime, and our leaders must do everything in their power to make this happen. This was the clear demand of the 40 million people in 36 countries who took part in the Global Call to Action Against Poverty in 2005. A year later, in the space of just one day, 24 million people across the world stood up against poverty as part of World Poverty Day.
Topic:: Education, Health, and Poverty
Political Geography:: Russia, United States, Japan, United Kingdom, Europe, Canada, Asia, France, Germany, and Italy

90. HIV/AIDS: The looming Asia Pacific pandemic

Author:: Bill Bowtell
Publication Date:: 03-2007
Content Type:: Policy Brief
Institution:: Lowy Institute for International Policy
Abstract:: The international effort to control the spread of the HIV pandemic is failing: new HIV caseloads are rising alarmingly in many parts of the Asia Pacific. For over 20 years we have known how to prevent the transmission of the HIV virus by persuading young people to make simple and sustainable changes in sexual practices and other risky behaviours. Yet despite the scientific evidence, many national governments are unable or unwilling to act in time to avert the problem.
Topic:: HIV/AIDS and Health
Political Geography:: Asia and Australia/Pacific

91. Public Health and Conflict Series: Rebuilding a Nation's Health in Afghanistan

Author:: Sarah Dye
Publication Date:: 05-2007
Content Type:: Policy Brief
Institution:: United States Institute of Peace
Abstract:: Since the Soviet invasion of 1979, Afghanistan's health system has been decimated by over 27 years of near constant conflict. The ensuing civil war between warlords and rebel groups, including the Taliban, led many Afghan doctors and other intellectuals to flee to Pakistan, Iran, and elsewhere. Under Taliban rule in the 1990s, women were forbidden to attend school, and university teaching hospitals had no equipment, no training materials, and few books. While there have been advances over the past five years through the assistance of United Nations organizations and the international NGO community, Afghanistan's health indicators remain among the lowest in the world.
Topic:: Conflict Resolution and Health
Political Geography:: Afghanistan and Asia

92. Performance-Based Incentives for Health: A Way to Improve Tuberculosis Detection and Treatment Completion?

Author:: Rena Eichler, Diana Weil, and Alexandra Beith
Publication Date:: 04-2007
Content Type:: Working Paper
Institution:: Center for Global Development
Abstract:: Tuberculosis is a public health emergency in Africa, Eastern Europe, and Central Asia. Of the estimated 1.7 million deaths from TB, 98 percent are in the developing world, the majority being among the poor. In order to reach the MDG and the Stop TB partnership targets for 2015, TB detection rates need to double, treatment success rates must increase to more than 7075 percent, and strategies to address HIV-associated TB and multi-drug resistant TB must be aggressively expanded. DOTS, the internationally-recommended TB control strategy is the foundation of TB control efforts worldwide. A standard recording and monitoring system built on routine service-based data allows nearly all countries in the world to track progress in case detection and treatment completion through routine monitoring. This provides a good base for measuring the impact of different strategies for improving TB control outcomes.
Topic:: Health, International Organization, and Poverty
Political Geography:: Africa, Europe, and Asia

93. National Food Policies Impacting on Food Security: The Experience of India, a Large Populated Country

Author:: S.S. Acharya
Publication Date:: 07-2006
Content Type:: Working Paper
Institution:: United Nations University
Abstract:: India accounts for 16.7 per cent of the world's food consumers. With the exception of China, India's size in terms of food consumers is many times larger than the average size of the rest of the countries. At the time of independence in 1947, India was in the grip of a serious food crisis, which was accentuated by the partition of the country. The demand for food far exceeded supply, food prices were high and more than half of the population living below the poverty line with inadequate purchasing power. With high rates of population growth, the dependence on imported food increased further. However, the situation improved considerably after the mid-1960s, when new agricultural development strategy and food policies were adopted. The production of staple cereals increased substantially, mainly contributed by productivity improvements. The dependence on food imports decreased and the country became a marginal net exporter of cereals. There was also an improvement in physical and economic access of households to cereals and other nutritive food products. The proportion of households reporting hunger went down and the incidence of economic poverty reduced. This paper reviews the Indian approach to tackling the severe problem of food insecurity, which India faced immediately after independence. It reviews the evolution of food policy, the major policy instruments deployed, intervention in food marketing system, and the current status of food security/insecurity. The paper also identifies the lessons emerging from the experience of India. In developing countries characterized by large segments of the rural population dependent on food production for livelihood and by the high incidence of poverty, food insecurity and malnutrition, the strategy to improve food security must encompass programmes to increase food production that combine improved technology transfer, price support to food producers and supply of inputs at reasonable prices to farmers, improvements in food marketing system, employment generation, direct food assistance programmes, and improvement in the access to education and primary health care.
Topic:: Health and Human Welfare
Political Geography:: China, India, and Asia

94. Food Security in North Korea: Designing Realistic Possibilities

Author:: Randall Ireson
Publication Date:: 02-2006
Content Type:: Working Paper
Institution:: Walter H. Shorenstein Asia-Pacific Research Center
Abstract:: Between about 1990 and 1996, North Korea experienced what can only be described as a catastrophic economic collapse, which included a 70 percent reduction in food production compared to the late 1980s. The Democratic People's Republic of Korea (DPRK) initially insisted that the agriculture collapse was a consequence of natural disasters. However, it is clear that the seeds of this catastrophe had been planted decades earlier, the result of ill-advised and ultimately unsustainable national agricultural policies. Yet difficult as the situation is, it is not without options for significant improvement. This paper outlines a strategy for agricultural revitalization in North Korea, which could, in the foreseeable future, enable the DPRK to produce—domestically and in a sustainable manner—nearly all the food needed to supply a basic balanced diet for its population. Whether this strategy can be implemented, or indeed whether it is the best strategy for the DPRK in the longer term, depends on many factors outside the farm sector, including world and regional international political issues, and DPRK policy choices regarding participation in world trade and commerce.
Topic:: International Relations, Government, Health, and Human Welfare
Political Geography:: Asia, North Korea, and Korea

95. Myanmar: New Threats to Humanitarian Aid

Publication Date:: 12-2006
Content Type:: Policy Brief
Institution:: International Crisis Group
Abstract:: The delivery of humanitarian assistance in Burma/Myanmar is facing new threats. After a period in which humanitarian space expanded, aid agencies have come under renewed pressure, most seriously from the military government but also from prodemocracy activists overseas who seek to curtail or control assistance programs. Restrictions imposed by the military regime have worsened in parallel with its continued refusal to permit meaningful opposition political activity and its crackdown on the Karen. The decision of the Global Fund for AIDS, Tuberculosis and Malaria to withdraw from the country in 2005 was a serious setback, which put thousands of lives in jeopardy, although it has been partly reversed by the new Three Diseases Fund (3D Fund). There is a need to get beyond debates over the country's highly repressive political system; failure to halt the slide towards a humanitarian crisis could shatter social stability and put solutions beyond the reach of whatever government is in power.
Topic:: Government, Health, and Humanitarian Aid
Political Geography:: Asia and Myanmar

96. Russian Health and Social Welfare: Limited Progress

Author:: Judyth L. Twigg
Publication Date:: 08-2002
Content Type:: Working Paper
Institution:: Aspen Institute
Abstract:: It has become routine for Russian policy makers to characterize their various health and social problems—rising male mortality, HIV/AIDS, illegal drug use, even pension system reform—as threats to the stability and national security of their country. Russia's importance to American national interests was thrown in sharp relief by the events of September 11 and their aftermath. A stable, prosperous Russia is a crucial partner in the war on terrorism. The fact that so many of Russia's health and social indicators remain stagnant or in decline, despite limited improvement along some dimensions, should therefore be troubling to the United States.
Topic:: Government, Health, Human Welfare, Science and Technology, and Terrorism
Political Geography:: Russia, United States, Europe, and Asia

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COLUMBIA UNIVERSITY PRESS