Please join us in congratulating Didi Kuo, Center Fellow at the Freeman Spogli Institute for International Studies (FS), and co-author Andrew S. Kelly, Assistant Professor in the Department of Health Sciences at California State University, East Bay, on being awarded the 2023 Leonard S. Robins Award for the Best Paper on Health Politics and Policy by the American Political Science Association (APSA)!
The Robins Award is named in honor of Leonard S. Robins, who, through his presence and gentle questioning at virtually every health politics panel, graciously nurtured the scholarship of both junior and senior scholars. The award recognizes the best paper on any subject that fits under the rubric of Health Politics and Policy presented at the previous annual APSA meeting.
Kuo and Kelly's award-winning paper, "State Capacity and Public Health: California and COVID-19," investigates the comparative COVID-19 policy response across counties and regions within California. In the description of the 2022 APSA panel "The Politics of Pandemic Response and the Opportunities for Health Policy Reform," during which they presented their paper, it notes that "In moving beyond a consideration of formal state and public health capacity, Kuo and Kelly argue that the more robust policy response of the Bay Area was, in part, a product of partnerships between state and community-based actors. Drawing on the concept of 'embedded autonomy,' Kuo and Kelly reconceptualize public health capacity and consider it within broader issues of state capacity and democracy."
An abstract of the paper can be found below:
On March 17, 2020, six counties in the Bay Area jointly issued the nation’s first shelter-in-place orders in response to the COVID-19 crisis. Cities and states across the United States quickly followed suit, with varying degrees of success. Public health officials have been critical in setting policies, enforcing behavioral and non-pharmaceutical interventions, and communicating with the public. This paper explores the determinants of public health capacity, distinguishing between formal institutional capacity (ie budget, staff) and informal embedded capacity (ie community ties, insulation from political pressures). It argues that informal embedded capacity is critical to public health capacity, but difficult to measure empirically. It concludes by relating public health capacity to broader issues of state capacity and democracy.
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Didi Kuo, Expert on Comparative and American Politics, Announced as FSI’s Newest Center Fellow
As a Center Fellow, Kuo will continue to advance her research agenda at the Center on Democracy, Development and the Rule of Law, exploring both the challenges facing American democracy today and their roots.
ARD Launches Podcast on Politics of COVID-19 in the Arab World
The Program on Arab Reform and Democracy (ARD) at CDDRL, in partnership with the Arab Studies Institute, is pleased to announce the launch Mofeed-19, a 19-minute video podcast that discusses research efforts pertaining to the impact of the COVID-19 pandemic on the Arab world.
The award recognizes Kuo and Kelly's paper, “State Capacity and Public Health: California and COVID-19,” as the best paper on health politics and policy presented at the 2022 American Political Science Association (APSA) conference.
This talk is based on the co-authors' recent paper "How Much Will the Pandemic Change Egyptian Governance and for How Long?" The Egyptian regime has reacted in an unexpected way to the global pandemic—with civilian, technocratic, and expert bodies leading the way and even some (admittedly officially patrolled) political debate being allowed to emerge. This talk examines these recent developments and evaluates whether they mark a real change in Egyptian governance, and if so, why, what kind, and will it last.
Co-Authors Bios
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Amr Hamzawy is currently a senior research scholar at the Center on Democracy, Development, and the Rule of Law at Stanford University. He studied political science and developmental studies in Cairo, The Hague, and Berlin. He was previously an associate professor of political science at Cairo University and a professor of public policy at the American University in Cairo. Between 2016 and 2017, he served as a senior fellow in the Middle East program and the Democracy and Rule of Law program at the Carnegie Endowment for International Peace, Washington, DC. His research and teaching interests as well as his academic publications focus on democratization processes in Egypt, tensions between freedom and repression in the Egyptian public space, political movements and civil society in Egypt, contemporary debates in Arab political thought, and human rights and governance in the Arab world. His new book On The Habits of Neoauthoritarianism – Politics in Egypt Between 2013 and 2019appeared in Arabic in September 2019. Hamzawy is a former member of the People’s Assembly after being elected in the first Parliamentary elections in Egypt after the January 25, 2011 revolution. He is also a former member of the Egyptian National Council for Human Rights. Hamzawy contributes a weekly op-ed to the All Arab daily al-Quds al-Arabi.
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Nathan Brown is Professor of Political Science and International Relations at The George Washington University. He is also a non-resident Senior Fellow at The Middle East Program at the Carnegie Endowment for International Peace and serves on the board of trustees at the American University in Cairo. His contributions span a wide range of topics, including Islamist movements, Egyptian politics, Palestinian politics, and Arab law and constitutionalism. Dr. Brown served as the president of the Middle East Studies Association between 2013 and 2015. He was previously named a Guggenheim Fellow and a Carnegie Scholar by the Carnegie Corporation of New York and is a former fellow at the Woodrow Wilson International Center for Scholars. His previous research was funded by the United States Institute of Peace and two Fulbright fellowships. He received the Oscar and Shoshana Trachtenberg Award for Scholarship from George Washington University in 2015 and the Harry Harding teaching award from the Elliott School of International Affairs in 2014. His dissertation received the Malcolm Kerr award from the Middle East Studies Association in 1987. Dr. Brown is the author of six books, including Arguing Islam after the Revival of Arab Politics (Oxford: Oxford University Press, 2016), and When Victory is Not an Option: Islamist Movements in Arab Politics (Ithaca: Cornell University Press, 2012). He received his B.A. in political science from the University of Chicago and his M.A. and Ph.D. in politics and Near Eastern Studies from Princeton University.
Ukraine reclaimed independence from the Soviet Union in 1991, yet instead of implementing wide ranging institutional change to develop and prepare Ukraine for the 21st century, reform programs were burdened by legacy system support. Designing new institutions based on transparency, ecology, proportions and coverage, all architectural elements of a new social contract, only started after the 2013-2014 Revolution of Dignity. Transforming Ukraine’s healthcare system is about emancipating Ukrainian society from the Soviet sanatorium, a metaphor for ineffective administration, outdated medical standards and protocols that deny patients access to modern evidence-based healthcare solutions.
This is a unique opportunity to hear from an insider’s perspective how building a new healthcare system based on an open competitive market and universal health coverage with a single payer has changed the relationship between the government and the citizen.
Speaker Bio:
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Acting Minister of Health of Ukraine Ulana Suprun, MD
Dr. Suprun received her MD from Michigan State University College of Human Medicine. She is a Board Certified Radiologist who worked in both private and academic settings, eventually becoming the Vice Director of Medical Imaging of Manhattan in New York, NY and an Assistant Clinical Professor of Pathology at the Icahn School of Medicine at Mount Sinai, NY. During the Revolution of Dignity in Ukraine in 2013, Dr. Ulana Suprun served in the volunteer medical services. In 2014, when Russia started a war by invading and illegally annexing Crimea, and then occupying parts of Eastern Ukraine, she founded the NGO Patriot Defence, an organization that provides tactical medical training and distributed NATO Standard Improved First Aid kits to more than 36,000 soldiers and medical personnel on the battlefields. Dr. Suprun founded the School of Rehabilitation Medicine at the Ukrainian Catholic University in 2016 and served as its director until August 2016, when she was appointed Ukraine’s Minister of Health. Since then she and her team have implemented the largest healthcare transformation in Ukraine’s history.
It’s always great to see the work of one of our researchers shouted out in the New York Times. It’s even better when it becomes the scientific basis of an argument thrown into the mix of a presidential campaign.
Nicholas Kristof asserted in his column on Sunday that when women are involved in the political process and given the capacity to shape public policy, everyone benefits, particularly when it comes to health.
Kristof, who covers human rights, women’s rights, health and global affairs for the Times, wrote in his column:
Put aside your feelings about Hillary Clinton: I understand that many Americans distrust her and would welcome a woman in the White House if it were someone else. But whatever one thinks of Clinton, her nomination is a milestone, and a lesson of history is that when women advance, humanity advances.
Grant Miller of Stanford University found that when states, one by one, gave women the right to vote at the local level in the 19th and early 20th centuries, politicians scrambled to find favor with female voters and allocated more funds to public health and child health. The upshot was that child mortality rates dropped sharply and 20,000 children’s lives were saved each year.
Many of those whose lives were saved were boys. Today, some are still alive, elderly men perhaps disgruntled by the cavalcade of women at the podium in Philadelphia. But they should remember that when women gained power at the voting booth, they used it to benefit boys as well as girls.
Miller, an associate professor of medicine and core faculty member of Stanford Health Policy, first wrote about this issue in the Quarterly Journal of Economics in 2008, arguing that women’s choices appear to emphasize child welfare more than those of men.
He presented evidence on how state-to-state suffrage rights for U.S. women from 1869 to the adoption of the 19th Amendment in 1920, which gave all women the right to vote, helped children benefit from scientific breakthroughs.
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Simple hygienic practices — including hand and food washing, boiling water and milk, refrigerating meat and the renewed emphasis on breastfeeding — were among the most important innovations in the 19th and early 20th centuries to help protect children from often-fatal diseases such typhoid fever, smallpox, measles and scarlet fever.
As women became more and more involved in state and federal politics, Miller found, child mortality declined by 8 to 15 percent, or 20,000 fewer child deaths each year.
“Public health historians clearly link the success of hygiene campaigns to the rising influence of women,” Miller wrote, citing examples with data and graphs.
That women have been — and can be — so influential seems like a no-brainer, but it’s nice to have the science to back it up.
One of the key objectives of introducing a compulsory health insurance is to provide citizens, regardless of socioeconomic status, with financial risk protection against unexpected catastrophic expenditures in the face of illness. South Korea and Taiwan achieved universal health coverage (UHC) through mandatory social insurance schemes in 1989 and 1995, respectively. Despite both countries' efforts to achieve the goal of financial risk protection for more than two decades, past research has demonstrated that household out-of-pocket (OOP) payment still accounts for more than one-third of total health expenditures in both countries. When OOP payment represents a significant share of financial sources for health care, one should be particularly concerned about the distribution of such payments, in particular, catastrophic health expenditures, across households of differing economic levels. This talk sets out to examine the change in the incidence and distribution of catastrophic health expenditures before and after the introduction of the National Health Insurance programs in South Korea and Taiwan.
Given similarity in the health and National Health Insurance (NHI) system characteristics observed in South Korea and Taiwan, substantial variation in the distribution of catastrophic payment among households was noted. The rich are more likely to incur catastrophic payment in South Korea, but the opposite trend is noted in Taiwan. Further assessment on the impact of universal health coverage (UHC) on reducing catastrophic headcount (defined as the proportion of households incurring catastrophic health payment) is observed in Taiwan, but not in South Korea. We found that when South Korea introduced the NHI program with a limited benefit package and high copayment, it produced little effect (if not none) in reducing financial burden in terms of proportion of catastrophic headcount. On the contrary, the impact of universal health coverage on catastrophic headcount ranged from -1.82% to -4.08% for Taiwan, due to the provision of a rather comprehensive benefit package with modest copayment. While UHC is a well-lauded policy goal and may be a magic word for many countries striving for the achievement, it is definitely not a panacea to resolve the incidence of catastrophic payment and potential medical impoverishment. To provide sufficient financial protection against unexpected medical expenses, the design of the benefit coverage and risk sharing mechanism is key to the success of effectively achieving UHC.
Bio
Jui-fen Rachel Lu, Sc.D., is the Fulbright Visiting Scholar at Center for East Asian Studies, Stanford University, and a Professor at Chang Gung University (CGU) in Taiwan, where she teaches comparative health systems, health economics, and health care financing and has served as department chair (2000-2004), Associate Dean (2009-2010) and Dean of College of Management (2010-2013). She earned her B.S. from National Taiwan University, and her M.S. and Sc.D. from Harvard University, and she was also a Takemi Fellow at Harvard (2004-2005). Prof. Lu is currently the President of Taiwan Society of Health Economics (TaiSHE) and an Honorary Professor at Hong Kong University (2007-2017). Dr. Lu was also the recipient of IBM Faculty Award in 2009.
Her research focuses on 1) the equity issues of the health care system; 2) impact of the NHI program on health care market and household consumption patterns; 3) comparative health systems in Asia-Pacific region. She is a long-time and active member of Equitap (Equity in Asia-Pacific Health Systems) research network and was the coordinator for the catastrophic payment component of Equitap II research project which involved 21 country teams and was jointly funded by IDRC, AusAID, and ADB. Professor Lu has also been appointed to serve as a member on various government committees dealing with health care issues in Taiwan.
Okimoto Conference Room, Encina Hall 3rd Floor, East Wing
Rachel Jui-fen Lu
Visiting Scholar, Center for East Asian Studies
Stanford University
Stanford students belong to the first generation that could witness the end of extreme global poverty — in what would be one of humankind's greatest achievements — the head of the World Bank said during a recent talk on campus.
But their generation, he said, is also likely to experience the first global pandemic since the 1918 influenza that killed more than 50 million people.
Jim Yong Kim, president of the World Bank, said innovations in health, education and finance are behind the World Bank's twin goals of ending extreme poverty and boosting shared prosperity for the bottom 40 percent of the global population.
Speaking at the inaugural conference of the Stanford Global Development and Poverty Initiative on Oct. 29, Kim lauded faculty and students for their multidisciplinary approach in tackling poverty and improving public health. He is an infectious disease physician who oversaw World Health Organization initiatives on HIV/AIDS.
"Seeking transformative solutions to challenges of development and poverty that are necessarily cross-disciplinary is exactly what a great university should be doing," Kim said in his speech at Stanford.
The World Bank announced last month that the number of people living on less than $1.90 a day is expected to drop to 9.6 percent of the global population by the end of the year. That is down from 36 percent in 1990.
The bank has pledged to cut that rate to 3 percent by 2030.
"We expect the extreme poverty rate to drop below 10 percent for the first time in human history," he said. "This is the best news in the world today. And this is the first generation in human history that has been able to see that potential outcome."
Promoting prosperity
One of the co-founders of Partners in Health, Kim was the keynote speaker at the daylong conference, "Shared Prosperity and Health," which drew together Stanford faculty and researchers, plus government and NGO officials from around the world.
Kim's talk was optimistic about the newly adopted U.N. Sustainable Development Goals, with an ambitious agenda to end poverty and hunger, ensure healthy lives, empower women and girls and attain quality education for all children by 2030.
While those goals seem lofty, Kim pointed to the accomplishment of bringing down extreme poverty to 10 percent, a figure many had once said was impossible.
Ninety-one percent of children in developing countries now attend primary school, up from 83 percent in 2000, he said. And the number of people on antiretroviral drugs for treatment of HIV in sub-Saharan Africa has increased eightfold in the last decade.
"But we're humbled by the challenges ahead," Kim said. "Rising global temperatures will have devastating impacts on poor countries and poor people – and, as we saw with Ebola, major pandemics are likely to disproportionately affect the poor."
Pandemic threats
Kim said that most virologists and infectious disease experts are certain a pandemic will sweep the world in the next 30 years. He said that would lead to more than 30 million deaths and anywhere from 5 to 10 percent of lost GDP.
He blasted the global community for taking eight months to respond to the Ebola crisis in West Africa, noting that Guinea, Sierra Leone and Liberia had among the fastest growing economies in Africa before the outbreak killed more than 11,000 people – most of whom were poor.
In an effort to speed up financial aid the next time such an outbreak occurs, the World Bank is developing the Pandemic Emergency Facility, which would disburse funding immediately to national governments and responding agencies.
Rajiv Shah, the administrator for the U.S. Agency for International Development from 2010-2015, spoke earlier at the conference about his work leading the U.S. efforts to contain Ebola.
"Three small countries with total population of maybe 30 million people had such weak health systems with so little domestic investment – in one country $6 per capita health investment per year – that when Ebola became a crisis there was no first-line of defense," he said.
By October 2014, the U.S. was pouring hundreds of millions of dollars into containment efforts, including the establishment of a 2,500-personnel military deployment to hit Ebola on the ground. Shah said President Obama "stayed extraordinarily true to the science" of containment at the source.
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Stunted children
Moving beyond containment of epidemics, Kim said the most important investment developing countries could make in their people starts when a woman becomes pregnant. Using a combination of health, nutrition and education will have lifelong benefits for each child, as well as for the country in which each prospers.
The World Bank estimates that 26 percent of all children under age 5 in developing countries are stunted, which means they are malnourished and under-stimulated, risking a loss of cognitive abilities that lasts a lifetime. The number climbs to 36 percent in sub-Saharan Africa, giving those children limited prospects in life."This is a disgrace, a global scandal and, in my view, akin to a medical emergency," Kim said. "Children who are stunted by age 5 will not have an equal opportunity in life. If your brain won't let you learn and adapt in a fast-changing world, you won't prosper and, neither will society. All of us lose."
From 2001 to 2013, the World Bank invested $3.3 billion in early childhood development programs in poor countries. Kim said innovative policymaking and financial tools allowed the bank to help Peru cut its rate of child stunting in half to 14 percent in just eight years.
"Progress is possible – and it can happen quickly. But we must do even more,"he said.
Kim said the world set a target in 2012 to reduce stunting in children by 40 percent. But that would still leave 100 million children malnourished and undereducated. The bank and world leaders should pledge to end stunting for all children by 2030, he said.
"With partners like the Global Development and Poverty Initiative and the entire Stanford community, I'm full of hope that we can indeed be the first generation in human history to end extreme poverty and create a more just and prosperous world for everyone on the planet."
The United States spends over 17 percent of GDP on health care; the next six highest countries spend over 11 percent. This six percent differential indicates an excess spending of approximately one trillion dollars per year. Depending on the benefit from the extra spending, this suggests the possibility of a huge misallocation of resources. Also, because the federal government funds almost half of total health care spending, there are significant effects on the deficit and the debt. The main reasons for the excess are (1) the U.S. pays higher prices for drugs, devices, and equipment and higher fees to specialists and sub-specialists; (2) higher administrative costs; and (3) a more expensive mix of medical care. The seminar will focus on institutional and political explanations for the three proximate reasons.
Speaker Bio:
Victor R. Fuchs is the Henry J. Kaiser Jr Professor Emeritus at Stanford University, in the Departments of Economics and Health Research and Policy. He is also a Research Associate of the National Bureau of Economic Research and a Senior Fellow at SIEPR. He applies economic analysis to social problems of national concern, with special emphasis on health and medical care. He is author of nine books, the editor of six others, and has published over two hundred papers and shorter pieces. His current research focuses on male-female differences in mortality, reform of medical education, and the future of U.S. health care.
His best known work, Who Shall Live? Health, Economics, and Social Choice (1974; expanded edition 1998, 2nd expanded edition 2011), helps health professionals and policy makers to understand the economic and policy problems in health that have emerged in recent decades. Other books include The Service Economy (1968), How We Live (1983), The Health Economy (1986), Women’s Quest For Economic Equality (1988), and The Future of Health Policy (1993). He is the editor of Individual and Social Responsibility: Child Care, Education, Medical Care, and Long-term Care in America (1996).
Professor Fuchs was elected president of the American Economic Association in 1995. He has also been elected to the American Philosophical Society, the American Academy of Arts and Sciences, the Institute of Medicine of the National Academy of Sciences, and is an Honorary Member of Alpha Omega Alpha. He has received the John R. Commons Award, Emily Mumford Medal for Distinguished Contributions to Social Science in Medicine, Distinguished Investigator Award (Association for Health Services Research), Baxter Foundation Health Services Research Prize, and Madden Distinguished Alumni Award (New York University). ASHE’s (American Society of Health Economists) Career Award for Lifetime Contributions to the Field of Health Economics and the RAND Corporation prize for the Best Paper published in the Forum for Health Economics and Policy are named and awarded in honor of Professor Fuchs.
This event is sponsored by the Stanford Center on Democracy, Development and the Rule of Law and the Center for Health Policy/Center for Primary Care and Outcomes Research.
CISAC Conference Room
Victor Fuchs
the Henry J. Kaiser Jr Professor Emeritus
Speaker
Stanford University
For nearly 70 years, CARE has been serving individuals and families in the world's poorest communities. Today, they work in 84 countries around the world, with projects addressing issues from education and healthcare to agriculture and climate change to education and women's empowerment. Helene Gayle, president and CEO of CARE USA, will discuss her work with CARE and her experiences in the field of international development. Dr. Gayle will discuss how access to global health is integral to CARE's effort in addressing the underlying causes of extreme global poverty.
Dr. Michele Barry, director of the Center for Innovation in Global Health, will moderate a conversation between CARE President and CEO, Dr. Helene Gayle and former Prime Minister of Norway and United Nations Special Envoy, Dr. Gro Brundtland.
This event is sponsoredy by CARE USA, the Center on Democracy, Development and the Rule of Law and the Haas Center for Public Service.
A reception will follow the event.
Dr. Gro Brundtland Bio:
Dr. Gro Harlem Brundtland is the former prime minister of Norway and the current deputy chair of The Elders, a group of world leaders convened by Nelson Mandela and others to tackle the world’s toughest issues. She was recently appointed as the Mimi and Peter E. Haas Distinguished Visitor for spring 2014 at the Haas Center for Public Service at Stanford University. Dr. Brundtland has dedicated over 40 years to public service as a doctor, policymaker and international leader. She was the first woman and youngest person to serve as Norway’s prime minister, and has also served as the former director-general of the World Health Organization and a UN special envoy on climate change.
Her special interest is in promoting health as a basic human right, and her background as a stateswoman as well as a physician and scientist gives her a unique perspective on the impact of economic development, global interdependence, environmental issues and medicine on public health.
Dr. Helene Gayle Bio:
Helene D. Gayle joined CARE USA as president and CEO in 2006. Born and raised in Buffalo, New York, she received her B.A. from Barnard College of Columbia University, her M.D. from the University of Pennsylvania and her M.P.H. from Johns Hopkins University. After completing her residency in pediatric medicine at the Children's Hospital National Medical Center in Washington, D.C., she entered the Epidemic Intelligence Service at the Centers for Disease Control and Prevention, followed by a residency in preventive medicine, and then remained at CDC as a staff epidemiologist.
At CDC, she studied problems of malnutrition in children in the United States and abroad, evaluating and implementing child survival programs in Africa and working on HIV/AIDS research, programs and policy. Dr. Gayle also served as the AIDS coordinator and chief of the HIV/AIDS division for the U.S. Agency for International Development; director for the National Center for HIV, STD, and TB Prevention, CDC; director of CDC's Washington office; and health consultant to international agencies including the World Health Organization, UNICEF, the World Bank and UNAIDS. Prior to her current position, she was the director of the HIV, TB and reproductive health program for the Bill and Melinda Gates Foundation.
Hewlett 201
Hewlett Teaching Center
370 Serra Mall
Stanford, CA 94305
Dr. Gro Brundtland
Mimi and Peter E. Haas Distinguished Visitor
Panelist
Haas Center for Public Service, Stanford University
Dr. Helene Gayle
President and CEO
Panelist
CARE USA
Michele Barry
Director
Moderator
Center for Innovation in Global Health
