Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Life expectancy at aged 65 is remarkably similar in the three Chinese cities of Hong Kong, Shanghai, and Taipei, even though the cities differ in levels of socioeconomic development, health systems, and other factors. Edward Jow-Ching Tu will discuss research that aims to understand this phenomenon. Despite unprecedented increases in life expectancy and attainment of similar current levels of life expectancy, the cities differ in the contributions of changes in major causes of death to the improvements in life expectancy among the elderly. Tu and colleagues have explored several possible determinants of these different patterns and trends in the three cities, including socioeconomic development, health service delivery systems, cause-of-death classification systems, and competing risks from cardiovascular disease and other diseases. Their analysis suggests that the effect of equity of health service delivery has become more important over time.

Edward Jow-Ching Tu is a senior lecturer of demography in the Division of Social Science at Hong Kong University of Science and Technology. His work is focused on the impact of fertility, mortality, and migration on socio-economic changes in East Asia countries with special emphasis on nations experiencing a transition from planned economy to market economy; on causes and impacts of mortality changes and health transition on aging societies; and on the causes of lowest-low fertility in many East Asia countries. He has several active research projects ongoing in China, Japan, Taiwan, Hong Kong, and Singapore. He holds graduate degress from West Virginia University, the University of Pennsylvania, and the University of Tennessee (Knoxville). Tu has worked extensively in Asia, and has served as an adjunct professor and taught in many universities in China, including Peking University, Peoples University, Nankai Univerity, and Fudan University. He had served as a senior research scientist at the New York State Health Department and as a research fellow (full professor) at the Institute for Social Sciences and Philosophy at Academia Sinica. Tu has also taught at the State University of New York in Albany.

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Edward Jow-Ching Tu Senior Lecturer of Demography at the Division of Social Science Speaker Hong Kong University of Science and Technology
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CDDRL Postdoctoral Fellow 2012-13
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Gabriela Calderon holds a Ph.D. in Economics from Stanford University. Her research interests include policies that affect gender differences in developing countries, policy evaluation, violence in Latin America and the effect of institutions and governance on the provision of public goods and health/education outcomes. She did her master's degree in economic theory and bachelor's degree in economics at the Instituto Tecnológico Autónomo de México. Currently, in the Program on Poverty and Governance, her research analyzes the way institutions and democracy affect the provision of public goods, and the impact they have on health outcomes like infant mortality trends. She is also studying the effects of government interventions that combat  drug-trafficking organizations over violence in Mexico. 

Her research has focused on the topics of development, public finance, and the evaluation of public policy programs in Mexico. For example, during the summers of 2009/2010, she conducted a field experiment in Zacatecas, Mexico with Giacomo de Giorgi, an assistant professor from Stanford University, and Jesse Cuhna, a former Stanford student. The main task was to evaluate the impact of financial literacy classes on underprivileged women entrepreneurs in the region. To successfully complete an evaluation in an untreated region, they proposed collaborating with the Mexican NGO CREA on a joint project. They contacted local interviewers, trained them, and identified all women entrepreneurs in the 17 communities, in which we conducted the experiment.  Preliminary results suggest that the female entrepreneurs who were randomly assigned to treatment earned higher profits, had larger revenues, and served a greater number of clients. They also found that they were more likely to implement formal accounting techniques.

She has also studied  programs that are not randomly assigned as an experiment. For example, she has analyzed the effects of a national policy in Mexico of child care services, called Estancias Infantiles para apoyar a Madres Trabajadoras (EI), using administrative, census and household data.  Her empirical research strategy identifies the effects of the program on both the men and women who were eligible for the program. She used time, location and eligibility variation, and considered a major threat to identification of the actual effects: for example, a manufacturer who moves into a municipality at approximately the same time as the EI program and who happens to disproportionately demand the skills of women who were eligible to the program happened to have. To ensure that such scenarios do not affect her results, she chose not triple difference strategy, in which all ineligible people are treated as “controls” for the EI-eligible families. Instead, she employs Synthetic Control Methods, using the same methodology as Abadie and Gardeazabal (2003) and Abadie, Diamond and Hainmueller (2010) to ensure that her control group has the same mix of skills and preferences as the EI-eligible group. She adapted the Synthetic Control Method to analyze repeated cross-sectional household data, which are data that are typically available in developing countries

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Abstract:

There is a wide diversity in the provision of public services in India. In some states one can go for miles without seeing a functional school or public health centre, where roads are poorly maintained, and electricity has not yet been introduced. In other places, governments tend to function remarkably in extending basic public services to all, with tremendous consequences to human lives. In this talk, Vivek Srinivasen will explore why some parts of India have developed an impressive social commitment to such services unlike others. In this context, he will also discuss the remarkable changes in Bihar and other parts of North India in the recent years.

 Speaker Bio: 

Vivek Srinivasen joined the Liberation Technology Program as the manager in February 2011 after completing his Ph.D. in Social Sciences from the Maxwell School of Syracuse University. Prior to this, Srinivasen worked with campaigns on various socio-economic rights in India, including the right to food, education and the right to information. Based on these experiences he has written (and co-authored) extensively on issues surrounding the right to food, including Notes from the right to food campaign: people's movement for the right to food (2003), Rights based approach and human development: An introduction (2008), Gender and the right to food: A critical re-examination (2006), Food Policy and Social Movements: Reflections on the Right to Food Campaign in India (2007).

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Vivek Srinivasen Program Manager Speaker Program on Liberation Technology, Stanford University
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The November 17 Liberation Technology Seminar was co-hosted by the Stanford Institute for Economic Policy Research (SIEPR), a nonpartisan economic policy research organization that unites remarkable economic talent from all parts of Stanford University. This seminar featured four student-led design projects that were created in the Designing Liberation Technologies course taught each spring at Stanford's Hasso Plattner Institute of Design (d.school) by professors' Josh Cohen and Terry Winograd. The class works in partnership with the University of Nairobi's School of Computing and Informatics to develop user-based designs that address outstanding challenges in the slums of Nairobi, Kenya. 

Josh Cohen described the three main elements of the design school class:

(1) There is a focus on user/human-centered design. Projects are designed based on a close engagement with end users: the people who will be using the solutions. (2) Courses are inter-disciplinary. The idea is to take people who are deeply embedded in a certain discipline and put them together with people from other disciplines. In order to come up with a solution to a real problem, team collaboration is necessary and (3) The approach to problem solving is about practice, not about theory. It is necessary to fail early and fail often in the process of creating workable solutions.

The panelists consisted of students who were working with partners in Kenya on how mobile technology could be used to address various social issues. A multidisciplinary team of students work in close collaboration with partners in Kenya, and some of these ideas are now being tested on the ground.

The first project that was described was M-maji (mmaji.wordpress.com). Sangick Jeon described how water in Kibera is scarce, costly and contaminated. Their aim is to use the nearly ubiquitous mobile technology to improve access to water. Vendors are able to advertise their water and then buyers can ask questions and provide feedback. This saves the time and resources that it takes to find clean water.

Nishuari, the second project, addresses the problem of inaccurate advice and rumors which lead to risky sexual behavior and often HIV and AIDS. They provide a mobile counseling service whereby individuals can submit health questions and receive responses from trained counselors using text messages. This helps to break down logistical and social barriers.

The third, Makmende considered the issue of serious crime in Kibera. Their aim is to look at how individuals can get safely from Point A to Point B. They set up walking groups so that people would not have to walk alone. Over 90% of people had a mobile phone and this was seen to be an effective way of building timely communication, so that groups of people can coordinate to walk more safely to reach their destinations.

The final project was Take Taka, which was the one project that was not focused on using computer technology. The team took up sanitation as the project and decided early on that the use of mobile phones adds no value to the issue. The focused instead of designing a special sanitary bucket that could be used instead of a toilet inside the home, and on developing a system of transmitting the deposits to a biogas unit. This project however has not been carried forward.

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The Program on Human Rights and the Center for Latin American Studies are pleased to host the Conference "Human Rights of Indigenous Peoples in Latin America".

Indigenous peoples around the world have often been dispossessed of their land, leading to ongoing conflict over control and usage of land and resources. Indigenous peoples in Latin America are no exception; they are among the most disadvantaged and vulnerable peoples in the region. Indigenous peoples in Latin America rank highest on underdevelopment indicators such as incarceration, illiteracy, unemployment, poverty and disease. They face discrimination in schools and are exploited in the workplace. Their sacred lands and artifacts are plundered from them. In many Latin American countries, indigenous peoples are not even permitted to study their own language.

The Stanford Spring conference “Human Rights of Indigenous Peoples in Latin America,” brings scholars from all disciplines to examine the common trends, actors, challenges and changes among indigenous populations in Latin America and the Caribbean.

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Alejandro Toledo President of Peru from 2001 to 2006 Keynote Speaker
Eliane Karp-Toledo Anthropologist, Economist and former First Lady of Peru (2001 to 2006) Keynote Speaker
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The Center on Democracy, Development, and the Rule of Law is pleased to announce that Nadejda Marques has joined the Program on Human Rights (PHR) to serve as the new program manager. In this capacity, Marques will coordinate a range of interdisciplinary initiatives and events, support new research projects, and spearhead PHR's outreach and fundraising efforts. Marques will work together with PHR Program Director and FSI Senior Fellow, Helen Stacy to support the conceptualization, design, and conduct of PHR's research initiatives, advancing the mission and visibility of PHR activities at Stanford University and beyond.

Marques joins the PHR from Boston where she worked as research coordinator for the Cost of Inaction Project at the François-Bagnoud Xavier Center for Health and Human Rights based at the Harvard School of Public Health. Working for the Cost of Inaction Project, Marques was responsible for researching and analyzing the cost of inaction of public programs and actions that help reduce the impact of HIV/AIDS on children in Angola.

"Nadejda Marques' training as an economist, her 15 years of work in human rights, including her work in the field in Angola and in founding the Brazilian human rights NGO Justiça Global bring valuable experience and expertise to the Program on Human Rights at the Center on Democracy, Development, and the Rule of Law," said PHR director Helen Stacy. "Even more importantly, Nadejda's commitment to bottom-up human rights reform means that she is acutely aware of human rights practice as a multi-faceted and inter-disciplinary activity. I am thrilled to welcome Nadejda to the Program on Human Rights as a thought partner to expand the reach and scope of our programming."

Marques holds degrees in economics (UNA, Brazil) and international finance (FGV, Brazil). She has worked as a special correspondent for the Washington Post in Latin America, and has taught languages and Latin American culture at Harvard, Bentley College, and the University of Massachusetts in Boston. For the past decade, Marques has worked in the field of human rights, most notably with Human Rights Watch in Brazil and Angola. Marques is fluent in English, Spanish, and Portuguese. She serves as a consultant and board member for leading human rights NGOs in Brazil and Angola.

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We sat down with recipient of the FSI Global Underdevelopment Action Fund, Professor Beatriz Magaloni to learn more about her research plans and how her work will address the larger issues of poverty and governance in Latin America and beyond.

Beatriz Magaloni, associate professor of political science at Stanford, senior fellow at the Freeman Spogli Institute (FSI), and director of the Program on Poverty and Governance (PovGov) at the Center on Democracy, Development, and the Rule of Law, was recently awarded a grant through FSI's Global Underdevelopment Action Fund. Over the past ten years, Professor Magaloni has pioneered cross-national comparative research focused primarily on Latin America and Mexico. Leading the PovGov program, Professor Magaloni launched research projects examining political incentives for heath improvements, the role of women and family-planning decisions, public goods provisions in indigenous communities, and drug-related violence in Mexico.

We sat down with Professor Magaloni to learn more about her research plans and how her work will address the larger issues of poverty and governance in Latin America and beyond.

Professor Magaloni, tell us more about the work you are conducting with the support of the FSI Global Underdevelopment Action Fund?

We are using the support of the FSI Action Fund to expand a governance project that we started in Oaxaca, Mexico in 2009 to the Chiapas region. The Oaxaca research project focused on examining the effects of political institutions on public goods provision. In 1995, the state of Oaxaca allowed indigenous communities to decide if they wanted a form of traditional indigenous governance called “Usos y Costumbres,” or party governance. Our team studied the variations in these two forms of municipal governance and how they shape the provision of welfare-enhancing public goods, such as clean water, sanitation and sewage, and roads. The findings in Oaxaca showed that traditional governance leads to higher levels of civic engagement in collective decision-making and better provision of public goods. However, one key finding revealed that women enjoyed significantly lower levels of participation in civic life and governance overall. 

Why might this be?

More traditional structures of governance in indigenous communities were disempowering for women but the research carried out in Oaxaca revealed a positive effect on social and political participation among recipients of conditional cash transfers through Oportunidades.

For those of us unfamiliar with the Oportunidades program, please tell us more.

Oportunidades is a social program funded by the Mexican federal government that provides conditional cash transfers to poor women in exchange for their direct engagement in activities related to child nutrition, health, and education.

Why are you expanding the study to Chiapas?

A policy prescription that emerged from our results in Oaxaca led us to re-evaluate the possibility of establishing “Usos y Costumbres” beyond Oaxaca, and this grant will allow us to study the state of Chiapas. The state of Chiapas is traditionally party dominated but has a strong blend of traditional forms of governance. The baseline survey will be designed in Chiapas to understand how traditional governance practices are integrated into the party governance. We will ask if poor indigenous communities are better or worse off by choosing to govern themselves through customary law and participatory democracy, versus delegating decisions concerning the provision of public goods to political parties. This will allow us to identify how governance and patterns of civic engagement differ in both of these states and the effect on provision of local goods.

Stanford graduate students and post-doctoral scholars will be integral to our efforts to administer the survey and perform subsequent analysis.

How will women be central to your study in Chiapas?

The main addition to the survey will be a substantial segment devoted to the role of women in civil society with the goal of answering a number of questions regarding civic and political participation. Conducted at the household level, it is designed to gain a fuller picture of how women in Chiapas are influenced and shaped by the Oportunidades program.

In addition, our study in Chiapas will examine the following factors pertaining to women and governance:

1. The dynamics of governance in Mexico's indigenous regions and the ways in which women participate in collective decision-making and influence the distribution and access to public goods and services in the community.

2.  The relationship between Oportunidades and women's decision-making role in the provision of public goods.

3. The effects on health and educational outcomes that may be associated both with conditional cash transfer programs and women's participation in collective decision-making.

4. The policy implications for economic development and promoting human capital.

Who are you collaborating with on this project?

Ewen Wang is the co-investigator on this project. She is an associate professor of Surgery/Emergency Medicine at the Stanford School of Medicine and will be instrumental in collecting new data on health and education for children who are recipients of the Oportunidades program. We also are engaging inter-institutional collaborators from our partner universities, including; Alberto Díaz-Cayeros, Associate Professor of International Studies at the Center for U.S.-Mexican Studies, University of California, San Diego; and Vidal Romero, Assistant Professor of Political Science at Instituto Tecnológico Autónomo de México (ITAM).

What are the expected results or outcomes of this study?

The outcomes of this work have both theoretical and policy-relevant implications. The data we collect on the effect of participatory governance in indigenous regions in Mexico and how conditional cash transfer programs enable civic participation of women will have much broader application beyond Mexico's borders. A lot of other governments are experimenting with the use of conditional cash transfer programs and the result of this study should help inform public policy.

In Mexico, a policy brief highlighting the results of the survey will be prepared and presented to policymakers to describe the effects of local governance, civic engagement, and their impact on economic development. Policy recommendations will be presented to advise Chiapas (as well as other states in southern Mexico with a high prevalence of indigenous populations) on constitutional reform that gives autonomy to indigenous communities with respect to municipal collective decision-making.

Finally, a book-length project will be under development that describes how traditional governance in indigenous regions of Mexico shapes civic engagement, participation of women, and impacts the provision of public goods and services. The new data generated by this study will present new findings on how governance shapes the status of maternal and child health services in Chiapas, having much broader implications in the field of health policy.

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Oaxaca Magaloni
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Beatriz Magaloni
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With a sharp divergence between justifications for global health funding and the countries and diseases to which funding is disbursed, this study conducts a quantitative analysis of the determinants of U.S. financing for the 171 countries receiving development assistance for health in 2009. The project seeks to identify the key drivers for U.S. global health financing by country and facilitate research on how to make global health financing work better.

Walter P. Falcon Lounge

Eran Bendavid assistant professor of medicine; faculty affiliate in FSI/Center for Health Policy/Primary Care Outcomes Research Speaker

300 Pasteur Drive
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CDDRL Affiliated Scholar 2011-2012
Resident Physician in Internal Medicine, Stanford Medical Center
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Rajaie Batniji is a resident physician in internal medicine at Stanford and a CDDRL affiliate. His research examines the selection of priority diseases and countries in global health, and he is interested in global health financing and the priority-setting process of international institutions.  His work has also examined social determinants of health in the Middle East.  At FSI, Dr. Batniji is co-investigator on Global Underdevelopment Action Fund projects explaining U.S. global health financing and political causes of public health crisis.

Dr. Batniji received his doctorate in international relations (D.Phil) from Oxford University where he studied as a Marshall Scholar. He also earned a M.D. from the University of California, San Francisco School of Medicine and M.A. and B.A. (with distinction) degrees in History from Stanford University.   Dr. Batniji was previously based at Oxford's Global Economic Governance Program, and he has worked as a consultant to the World Health Organization. 

Publications

Protecting Health: Thinking Small. Sidhartha Sinha and Rajaie Batniji. Bulletin of the World Health Organization 2010; BLT.09.071530  http://www.ncbi.nlm.nih.gov/pubmed/20865078

Health as human security in the occupied Palestinian territory. Rajaie Batniji, Yoke Rabai’a, Viet Nguyen-Gillham, Rita Giacaman, Eyad Sarraj, Raija Leena Punamaki, Hana Saab, and Will Boyce. Lancet 2009 373:1133-43  http://www.ncbi.nlm.nih.gov/pubmed/19268352

Misfinancing global health: the case for transparency in disbursements and decision making. Devi Sridhar and Rajaie Batniji. Lancet 2008; 372: 1185-91  http://www.ncbi.nlm.nih.gov/pubmed/18926279

Coordination and accountability in the World Health Assembly. Rajaie Batniji. Lancet 2008; 372: 805 http://www.ncbi.nlm.nih.gov/pubmed/18774416

Barriers to improvement of mental health services in low-income and middle-income countries.  Benedetto Saraceno, Mark van Ommeren, Rajaie Batniji, Alex Cohen, Oye Gureje, John Mahoney, Devi Sridhar and Chris Underhill. Lancet 2007; 370:1164-74     http://www.ncbi.nlm.nih.gov/pubmed/17804061

An Evaluation of the International Monetary Fund's Claims about Public Health. David Stuckler, Sanjay Basu, Rajaie Batniji, Anna Gilmore, Gorik Ooms, Akanksha A. Marphatia, Rachel Hammonds, and Martin McKee. International Journal of Health Services 2010; 40:327-32  http://www.ncbi.nlm.nih.gov/pubmed/20440976

Reviving the International Monetary Fund: concerns for the health of the poor. Rajaie Batniji. International Journal of Health Services 2009; 39: 783-787    http://www.ncbi.nlm.nih.gov/pubmed/19927415

Mental and social aspects of health in disasters: relating qualitative social science research and the sphere standard. R Batniji, M van Ommeren, B Saraceno. Social Science & Medicine 2006; 62:1853–1864  http://www.ncbi.nlm.nih.gov/pubmed/16202495

Averting a crisis in global health: 3 actions for the G20. Rajaie Batniji & Ngaire Woods, 2009. Global Economic Governance Programme, http://www.globaleconomicgovernance.org/wp-content/uploads/averting-a-crisis-in-global-health.pdf.

Report of a High-Level Working Group, 11-13 May 2008. Rajaie Batniji, Devi Sridhar and Ngaire Woods, Global Economic Governance Programme, 2008, http://www.globaleconomicgovernance.org/project-health

Rajaie S. Batniji Rajaie Batniji, postdoctoral fellow, department of medicine Speaker
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In spite of the economic advances and increases in GDP since the collapse of communism, Russia suffers from a range of dismal public health outcomes reminiscent of a much poorer country. This study seeks to understand what role political factors play in the country's high adult mortality rate and declining life expectancy by mining World Bank and World Health Organization data and examining how Russians access healthcare services and information.

Walter P. Falcon Lounge

FSI
Stanford University
Encina Hall C140
Stanford, CA 94305-6055

(650) 736-1820 (650) 724-2996
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Satre Family Senior Fellow, Freeman Spogli Institute for International Studies
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Kathryn Stoner is the Mosbacher Director of the Center on Democracy, Development, and the Rule of Law (CDDRL), and a Senior Fellow at CDDRL and the Center on International Security and Cooperation at FSI. From 2017 to 2021, she served as FSI's Deputy Director. She is Professor of Political Science (by courtesy) at Stanford and she teaches in the Department of Political Science, and in the Program on International Relations, as well as in the Ford Dorsey Master's in International Policy Program. She is also a Senior Fellow (by courtesy) at the Hoover Institution.

Prior to coming to Stanford in 2004, she was on the faculty at Princeton University for nine years, jointly appointed to the Department of Politics and the Princeton School for International and Public Affairs (formerly the Woodrow Wilson School). At Princeton she received the Ralph O. Glendinning Preceptorship awarded to outstanding junior faculty. She also served as a Visiting Associate Professor of Political Science at Columbia University, and an Assistant Professor of Political Science at McGill University. She has held fellowships at Harvard University as well as the Woodrow Wilson Center in Washington, DC. 

In addition to many articles and book chapters on contemporary Russia, she is the author or co-editor of six books: "Transitions to Democracy: A Comparative Perspective," written and edited with Michael A. McFaul (Johns Hopkins 2013);  "Autocracy and Democracy in the Post-Communist World," co-edited with Valerie Bunce and Michael A. McFaul (Cambridge, 2010);  "Resisting the State: Reform and Retrenchment in Post-Soviet Russia" (Cambridge, 2006); "After the Collapse of Communism: Comparative Lessons of Transitions" (Cambridge, 2004), coedited with Michael McFaul; and "Local Heroes: The Political Economy of Russian Regional" Governance (Princeton, 1997); and "Russia Resurrected: Its Power and Purpose in a New Global Order" (Oxford University Press, 2021).

She received a BA (1988) and MA (1989) in Political Science from the University of Toronto, and a PhD in Government from Harvard University (1995). In 2016 she was awarded an honorary doctorate from Iliad State University, Tbilisi, Republic of Georgia.

Download full-resolution headshot; photo credit: Rod Searcey.

Mosbacher Director, Center on Democracy, Development and the Rule of Law
Professor of Political Science (by courtesy), Stanford University
Senior Fellow (by courtesy), Hoover Institution
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Kathryn Stoner-Weiss FSI senior fellow Speaker
Rajaie Batniji Postdoctoral fellow, department of medicine, Stanford University Speaker
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Francis Fukuyama
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In the May-June edition of The American Interest, Francis Fukuyama traces the contemporary history of U.S. development policy and its failure to incorporate Huntingtonian-style theory, which emphasizes the interconnectedness of economy, politics, and society. Using Egypt as an example, Fukuyama calls for policymakers to break down their silos to more holistically examine and support democratic transitions.

While academic political science has not had much to tell policymakers of late, there is one book that stands out as being singularly relevant to the events currently unfolding in Tunisia, Egypt and other Middle Eastern countries: Samuel Huntington’s Political Order in Changing Societies, first published over forty years ago.1 Huntington was one of the last social scientists to try to understand the linkages between political, economic and social change in a comprehensive way, and the weakness of subsequent efforts to maintain this kind of large perspective is one reason we have such difficulties, intellectually and in policy terms, in keeping up with our contemporary world.

Huntington, observing the high levels of political instability plaguing countries in the developing world during the 1950s and 1960s, noted that increasing levels of economic and social development often led to coups, revolutions and military takeovers rather than a smooth transition to modern liberal democracy. The reason, he pointed out, was the gap that appeared between the hopes and expectations of newly mobilized, educated and economically empowered people on the one hand, and the existing political system, which did not offer them an institutionalized mechanism for political participation, on the other. He might have added that such poorly institutionalized regimes are also often subject to crony capitalism, which fails to provide jobs and incomes to the newly educated middle class. Attacks against the existing political order, he noted, are seldom driven by the poorest of the poor; they instead tend to be led by rising middle classes who are frustrated by the lack of political and economic opportunity—a phenomenon noted by Alexis de Tocqueville in his masterful analysis of the origins of the French Revolution and raised again in the early 1960s by James Davies’s well known “J-curve” theory of revolution.2

Something like this Huntingtonian process has unfolded in recent months in both Tunisia and Egypt. In both cases, anti-government protests were led not by the urban poor or by an Islamist underground, but by relatively well-educated middle-class young people used to communicating with each other via Facebook and Twitter. It is no accident that Wael Ghonim, Google’s regional head of marketing, emerged as a symbol and leader of the new Egypt. The protesters’ grievances centered around the fact that the authoritarian regimes of Ben Ali and Mubarak offered them no meaningful pathway to political participation, as well as failing to provide jobs befitting their social status. The protests were then joined by other groups in both societies—trade unionists, Islamists, peasants and virtually everyone else unhappy with the old regimes—but the driving force remained the more modern segments of Tunisian and Egyptian society.

Societies lacking institutions that could accommodate new social actors produced a condition Huntington labeled praetorianism, in which political participation took the form of strikes, demonstrations, protests and violence. The military often seized power in such circumstances because it was the only organized actor in society capable of running a government. The Egyptian Republic’s first autocrat, Gamal Abdel Nasser, came to power in precisely this manner back in July 1952, when his Free Officers movement represented the rising Egyptian middle class. The tragedy of modern Egypt is that there has been scarcely any meaningful political development in the more than half-century since then—meaning, in Huntington’s terms, the rise of modern institutions that could peacefully channel citizen participation.

Socioeconomic development, meanwhile, has proceeded apace: Between 1990–2010 Tunisia’s Human Development Index (a composite measure of health, education and income compiled by the UN) rose 30 percent, while Egypt’s rose 28 percent. Both countries produced tens of thousands of college graduates with no discernable future and a lopsided income distribution in which a disproportionate share of the gains from growth went to a small group of politically connected insiders. Huntington’s analysis of Egypt in the 1950s and 1960s thus remains eerily relevant today.

In Political Order Huntington was also making a broader point about the process of development itself. The significance of his book needs to be seen against the backdrop of post-World War II modernization theory, which in turn drew on classic 19th-century European social theory articulated by academics like Edward Shils, Talcott Parsons and Walt W. Rostow. American modernization theory argued that development was a single, seamless process. Economic development, changing social relationships like the breakdown of extended kinship groups and the growth of individualism, higher and more inclusive levels of education, normative shifts toward values like “achievement” and rationality, secularization and the growth of democratic political institutions, were all seen as an interdependent whole.

By pointing out that the good things of modernity did not necessarily go together, Huntington played a key role in killing off modernization theory. Political development was a separate process from socioeconomic development, he argued, and needed to be understood in its own terms. The conclusion that flowed from this point of view seemed at the time counterintuitive to the point of stunning: Without political development, the other aspects of modernization could lead to bad results—to tyranny, civil war and mass violence.

There were other reasons why Western modernization theory fell into disrepute by the 1970s: It came to be regarded as too Eurocentric—indeed, as too Americentric insofar as it seemed to posit American society as the pinnacle of modernization. It failed to recognize the possibility that countries like Japan and China might take roads to modernity that would look very different from the ones pioneered by Britain and the United States. But even if one agreed that the end point of development should be some form of industrialized liberal democracy, Huntington made it clear that arriving at the desired destination was far more elusive and complicated than modernization theorists believed.

The central piece of policy advice that emerged out of Huntington’s work was the concept of the “authoritarian transition.” If political systems opened up to democratic contestation too early, before the development of political parties, labor unions, professional associations and other organizations that could structure participation, the result could be chaotic. Authoritarian regimes that could maintain order and promote economic growth, Huntington argued, might oversee a more gradual institutionalization of society, and make a transition to democracy only when broad participation could be peacefully accommodated. This form of sequencing, in which economic development was promoted before a democratic opening, was the path followed by Asian countries like South Korea and Taiwan, which made democratic transitions in the late 1980s only after they had succeeded in turning themselves into industrialized powerhouses. It was also the development strategy recommended by Huntington’s former student Fareed Zakaria, as well as by the leaders of many authoritarian governments, who liked the idea of economic growth better than the idea of democratic participation.3 We will return to the question of how well that strategy worked in the Middle East later.

Development in Silos 

As interesting and important as Huntington’s work was, it lay outside of mainstream thinking about development, which from the start was a highly Balkanized academic field that was dominated by economists. Few scholars have sought to understand development as an inter-connected process with political, economic and social parts. Few scholars have sought to understand development as an inter-connected process with political, economic and social parts.Development economists looked primarily at economic factors like capital, labor and technology as sources of economic growth, and thought neither about the consequences of growth for politics nor the relationship of political institutions to growth. The Harrod-Domar growth model that was dominant in the 1950s suggested that less-developed countries were poor primarily because they lacked capital, which then led development agencies like the World Bank to try to kick start growth with generous infusions of capital for physical infrastructure. It was only when steel plants and shoe factories in sub-Saharan Africa went idle due to corruption or lack of organizational capacity that they were forced to go back to the drawing board.

The political scientists, for their part, scaled back their ambitions from large Huntingtonian-style theory and focused primarily on political phenomena. Beginning in the 1980s, there was increasing interest in the problem of transitions into and out of democracy; with democratic transitions in Spain, Portugal and nearly all of Latin America, this became a particularly pressing issue. There was some revival of interest in the democracy-development linkage, but it never led to a clear consensus on the causal links connecting the two phenomena.

The academic interest in transitions corresponded to the burgeoning of democracy promotion as a distinct field of international practice, both on the part of the United States and of other democracies around the world. The idea was planted during the 1970s, when the institutes linked with the German political parties played a key role in beating back an attempted Communist takeover in Portugal and facilitating that country’s transition to democracy. The 1980s saw the establishment of the National Endowment for Democracy (NED), a taxpayer-funded but quasi-independent organization devoted to support of pro-democracy groups around the world. One of the NED’s early successes was its funding of the Solidarity trade union in Poland before the collapse of communism. The 1990s saw the growth of a host of international organizations capable of monitoring elections and the funding of the Democracy and Governance branch of the U.S. Agency for International Development to the tune of almost $1.5 billion annually.

By the late 1990s, there was some degree of convergence in the agendas of economists and political scientists. By that point Douglass North and the school of “New Institutional Economics” he founded made economists aware of the importance of political institutions—particularly property rights—for economic growth. Economists increasingly sought to fold political variables like legal systems and checks on executive power into their models. Political science had itself been colonized at this point by economic methodology, and it was natural for such rational-choice political scientists to start looking at the economic impact of political institutions.

The return to a more interdisciplinary approach to development was marked as well by the tenure of James Wolfenson as President of the World Bank from 1995 to 2005.4 Wolfenson early on gave a speech on the “cancer of corruption” and signaled to the institution that, henceforth, political issues like corruption and good governance would be taken seriously. The publication of the 1997 World Development Report, The State in a Changing World, marked an intellectual break with the Washington Consensus focus on economic policy and state downsizing, and the Bank created a new branch devoted to reform of developing country public sectors. These changes constituted an open admission that politics was a critical component of development, and that the state was not simply an obstacle to growth but often a necessary underpinning for it. Increasingly, donor agencies have seen the promotion of democratic accountability as one tool in the fight against corruption.

This modest degree of convergence should not, however, obscure the continuing degree of compartmentalization that exists in the field of development. While paying lip service to the importance of institutions, most economists and field practitioners still see politics as at best an obstacle to the real work of development, which is improvement in incomes, health, education and the like, and not as an independent objective of development strategy. (Amartya Sen is an important exception to this generalization.) The democracy promotion agencies, for their part, spend relatively little time worrying about economic growth, social policy or public health, which in their view are goods often used by authoritarian regimes to buy off populations and prevent democratization.

The intellectual confusion surrounding development has led to severely Balkanized policies both in the United States and in the international community that often work at cross purposes from one another.The intellectual confusion surrounding development has led to severely Balkanized policies both in the United States and in the international community that often work at cross purposes from one another. For example, the authoritarian or semi-authoritarian regimes of Meles Zenawi in Ethiopia, Paul Kagame in Rwanda and Yoweri Museveni in Uganda have been aid darlings over the past decade because of their track records in promoting economic, health and social goals. At the same time, democracy promotion groups have been highly critical of them and have supported opposition groups and civil society organizations seeking accountability and limits on executive power. To be sure, aid agencies don’t object to greater government accountability on the part of these regimes, while the democracy promotion community wouldn’t stand in the way of progress on HIV/AIDS or malaria. Yet no one takes a larger view and asks, for example, whether existing aid programs are helping to keep the regime in power or, conversely, are destabilizing it.

Egypt itself presents a good case of this particular form of policy incoherence. Despite the fact that Egypt ranks as one of the top American aid recipients, it is hard to say that Washington was pursuing development goals of any sort there. The United States was primarily interested in stability. Despite brave speeches on democracy by both Condeleezza Rice and Barack Obama in Cairo, the United States actually pulled its punches in pushing serious democratic reform on Egypt, particularly after the Hamas electoral victory in Gaza in 2006. Nonetheless, U.S. economic aid programs were still pushing education and economic policy reform programs in the country. Had American aid administrators taken the Huntingtonian view that their assistance was covertly designed to promote an expectations gap and delegitimate Hosni Mubarak, this might have been a clever strategy. But no such cleverness existed. Instead, it was simply an example of compartmentalized aid programs doing their thing in ignorance of the interdependent effects of politics and economics.

What Is to Be Done?

Ideas precede action. Before we can hope to generate a coherent set of policies for Egypt, or anywhere else for that matter, we need a better understanding of development—that is, how changes in economy, politics and society over time constitute a set of discrete yet interlinked processes. Whatever the shortcomings of classic modernization theory, it at least began from the insight that the phenomenon under study required development of a master social science that transcended existing disciplinary boundaries. This objective is as far away as ever in academia, where the traditional disciplines keep a chokehold on how younger academics think and do research. Today, the single most popular form of development dissertation in both economics and political science is a randomized micro-experiment in which the graduate student goes out into the field and studies, at a local level, the impact of some intervention like the introduction of co-payments for malaria mosquito netting or changes in electoral rules on ethnic voting. These studies can be technically well designed, and they certainly have their place in evaluating projects at a micro level. But they do not aggregate upwards into anything that can tell us when a regime crosses the line into illegitimacy, or how economic growth is changing the class structure of a society. We are not, in other words, producing new Samuel Huntingtons, with the latter’s simultaneous breadth and depth of knowledge.

On a policy level, we need far more mutual understanding between those who promote socioeconomic development and those who work on democracy promotion and governance.On a policy level, we need far more mutual understanding between those who promote socioeconomic development and those who work on democracy promotion and governance. Traditional development agencies like USAID already think politically to the extent that their aid projects are designed to support U.S. foreign policy. But they, like their counterparts in multilateral organizations like the World Bank, are not trained to do political economy analysis; they do not seek an understanding of the political context within which aid is used and abused, and what is not sought is very rarely found. We call for the liberalization of ports in Haiti, for example, without trying to understand which particular politicians are benefiting from existing arrangements that keep them closed. For their part, democracy promoters focus on democratic transitions, providing help to opposition parties and civil society organizations in authoritarian countries. But once a transition occurs, as it did after the Orange and Rose revolutions in Ukraine and Georgia, they have relatively little to offer new democratic governments in terms of policy agendas, anti-corruption strategies or help in improving the delivery of services that citizens want.

Beyond these relatively minor adjustments, a more robust theory of social change might tell us that, in certain circumstances, the best way to destabilize an authoritarian society would be not the funding of civil society groups seeking short-term regime change, but rather the promotion of rapid economic growth and the expansion of educational access.5 Conversely, there are many societies we know will simply waste development assistance dollars because they are ruled by unaccountable authoritarian regimes. In such circumstances, it might be a more efficient use of aid resources to cut development aid entirely and to work only for political change. This is, in effect, what has happened to Zimbabwe under Robert Mugabe, but the country had to sink very far before anyone considered pulling the aid plug.

Huntington got a number of things wrong. The authoritarian transition was not a universally applicable formula for development. It worked reasonably well in East Asia, where there were a number of figures like Lee Kwan Yew, Park Chung-hee or the Chinese Communist Party leadership, who used their autocratic powers to promote rapid development and social change. Arab authoritarians were cut from a different cloth, content to preside over economically stagnant societies. The result was not a coherent development strategy but a wasted generation.

The aspiration of social science to replicate the predictability and formality of certain natural sciences is, in the end, a hopeless endeavor. Human societies, as Friedrich Hayek, Karl Popper and others understood, are far too complex to model at an aggregate level. Contemporary macroeconomics, despite dealing with social phenomena that are inherently quantified, is today in crisis due to its utter failure to anticipate the recent financial crisis.

The part of social change that is the hardest to understand in a positivistic way is the moral dimension—that is, the ideas that people carry around in their heads regarding legitimacy, justice, dignity and community. The current Arab uprising was triggered by the self-immolation of an overeducated 26-year-old Tunisian vegetable seller whose cart was repeatedly confiscated by the authorities. After Mohamed Bouazizi was slapped by a policewoman when he tried to complain, he reached the end of his tether. Bouazizi’s public suicide turned into a social movement because contemporary communications technologies facilitated the growth of a new social space where middle-class people could recognize and organize around their common interests. We will probably never understand, even in retrospect, why the dry tinder of outraged dignity suddenly ignited in this fashion in December 2010 as opposed to 2009, or ten years before that, and why the conflagration spread to some Arab countries but not to others. But we can certainly do a better job in putting together the few pieces we do understand, in a way that would be useful to policymakers coping with the reality of social change.

1Huntington, Political Order in Changing Societies: With a New Forward by Francis Fukuyama (Yale University Press, 2006).

2Davies, “Towards a Theory of Revolution”, American Sociological Review, Vol. 27 (1962).

3Zakaria, The Future of Freedom: Illiberal Democracy at Home and Abroad (W. W. Norton, 2003); see also Zakaria, “A Conversation with Lee Kuan Yew”, Foreign Affairs (March/April 1994).

4For a description of the Wolfenson presidency, see Sebastian Mallaby, The World’s Banker: A Story of Failed States, Financial Crises, and the Wealth and Poverty of Nations (Penguin Press, 2004).

5See Harold James’s retroview, entitled “Growing Pains”, of a classic December 1963 essay by Mancur Olson (“Rapid Growth as a Destabilizing Force”) in The American Interest (September/October 2006).

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