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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With what now seem like almost weekly product scandals, recalls, and supply chain exposes, the public increasingly wants to know more about the products they are putting in, on, and around their families. Until recently, consumers had no way to find out the full impacts of the products they consumed. However, with advances in information technologies, product assessment methodologies, and web and mobile platforms, there is now a real potential to radically increase transparency in consumer markets and global supply chains. Dara O'Rourke, Associate Professor at UC Berkeley, will discuss an experiment in providing information to the public about the environmental, social, and health impacts of products and companies: GoodGuide. GoodGuide's award-winning web and iPhone apps have been featured recently in the New York Times, Newsweek, Time, and even Oprah's Magazine! Dara will discuss GoodGuide's long-term vision, current strategies, and the information technologies they are applying to this challenge.

Dara O’Rourke is an Associate Professor at the University of California, Berkeley, and the co-founder of GoodGuide. Dara’s research focuses on systems for monitoring the environmental, labor, and health impacts of global production systems. His research has been featured in The New York Times, The International Herald Tribune, The Boston Globe, The Los Angeles Times, The Economist, Business Week, Newsweek, Time, and TechCrunch. Dara has served as a consultant to international organizations such as the World Bank, the United Nations Development Programme, the Organization for Economic Cooperation and Development, and a wide range of domestic and international non-governmental organizations. He has degrees in Mechanical Engineering, Political Science, and Energy and Resources, and he previously taught at MIT.

GoodGuide seeks to revolutionize how consumers see and interact with products and companies. GoodGuide provides a suite of tools that offer information about the environmental, social, and health performance of products and companies to consumers at the point of purchase (through web and mobile apps), and that empower people to screen and compare products based on their personal values and concerns. GoodGuide's tools seek to empower millions of consumers to buy products that better match their values, to avoid products that are detrimental to their health, the environment, or issues they care about, and to participate in a more transparent marketplace.

CISAC Conference Room

Dara O'Rourke Good Guide and Associate Professor of Environmental and Labor Policy Speaker UC Berkeley
Seminars
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The stated purpose of the Trade Act of 1974 was to promote free trade. Section 301 authorized the U.S. President to impose retaliatory trade sanctions if negotiations were unsuccessful in reducing unreasonable limits on trade. The Act was reinforced in 1984, became known as “Super 301”, and made annual assessment and retaliatory measures mandatory.

Because of trade imbalances, four emerging Asian countries gave the US firms access to cigarette markets: Japan (1987), Taiwan (1987), South Korea (1989) and Thailand (1990). These forced market opennings were called the “Second Opium War” by local protestors in these countries, challenging U.S. export of unwelcome and unhealthy products.

A sea change occurred in the decades that followed the cigarette market opening in Taiwan. Of particular interest are changes in areas marketing skills and market share; lower cigarette prices; paradoxical increased smuggling; increased youth consumption; evolution of the powerful tobacco industry lobby; and a sharp increase in tobacco-related cancer deaths. Accompanying the increased cigarette consumption, a special, unusual habit of chewing betel quid started and grew into a mainstream practice among adult males (nearly one out of four). Oral and esophageal cancer increased sharply soon after the market opened. At the same time, the patriotic protectionists, NGOs, and government galvanized an anti-smoking movement, which gradually transformed Taiwan's culture so that smoking in public is no longer socially acceptable. A new term, “de-normalization,” was coined about the favorable effect of market opening.

 The ironic outcome of Super 301 is that while the market was forced open solely by the US, in only ten years, US market share, once leading, shrunk to a distant fifth, after Japan, UK, Germany and domestic producers. The trade imbalance was little affected by the opening of the cigarette market.

Dr. Wen's colloquium continues the colloquium series on tobacco control in East Asia, sponsored by the Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center, in coordination with FSI’s Global Tobacco Prevention Research Initiative.

Philippines Conference Room

Chi Pang Wen Speaker National Health Research Institutes, Taiwan
Seminars
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Why do community-based education and social persuasion programs for promoting healthy lifestyle and preventing chronic disease sometimes fall short of our expectations? Why are population effects so difficult to engineer and why are they so ephemeral?

This research carried out at USC, the Claremont Graduate University, and collaborating institutions in China integrates across social, behavioral, and neurocognitive sciences to address those questions. We conclude tentatively that the answer to each of the questions may lie in individual and context variability relative to program response, and that in order to more fully address the question of prevention program response variability requires engagement and integration across several levels of science to consider the roles of social groupings, environmental selection and design, social influence processes, and brain biology.

What works in one social, cultural or organizational setting may not be so effective in another. What works for persons with certain genetic and experiential backgrounds may be totally ineffective for persons with different dispositional or personality characteristics. In a series of community/school based prevention trials carried out in markedly different southern California and central China settings, we have uncovered domains of consistent response, and other domains of substantial environment- and disposition-based response variability.

A social influences based smoking prevention program framed in collectivist values and objectives worked to prevent smoking in one cultural setting but not another. And an individualist framed social influences program worked in the setting where the collectivist program did not. But the characteristics of the particular settings, which defined program success or failure, were different from what conventional (e.g., cultural psychology) wisdom would have led us to expect. Furthermore, both within and across cultural settings, the same individual dispositional characteristics moderated or determined program effectiveness, again in ways not predicted by the common cultural and behavioral science wisdom.

In recent studies carried out both in China and the U.S. we have found affective decision deficits, with known neural underpinnings, to account for rapid progression to regular smoking and binge drinking. These deficits are akin to the dispositional characteristics found earlier to moderate prevention program effects. Subsequent brain imaging studies confirm the hypothesized regions of neural involvement. Together these findings hold promise for more effective – situation and phenotype specific – approaches to engendering and sustaining more optimal individual and population health behavior.

Philippines Conference Room

Carl Anderson Johnson Dean & Professor of Community & Global Health Speaker Claremont Graduate School
Lectures
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Seema Jayachandran is an assistant professor in the Department of Economics at Stanford University. She is also a Faculty Research Fellow at the National Bureau of Economic Research (NBER), and a Research Affiliate of the Bureau for Research and Economic Analysis of Development (BREAD), Centre for Economic Policy Research (CEPR), and Stanford Center for International Development (SCID).

Her research focuses on microeconomic issues in developing countries, including health, education, labor markets, and political economy. Her work has been published in the American Economic Review ("Odious Debt," on sovereign debt incurred by dictators), Journal of Political Economy ("Selling Labor Low," on labor market risk in India), and the Quarterly Journal of Economics ("Life Expectancy and Human Capital Investments," on increased education caused by declines in maternal mortality in Sri Lanka), and other journals.

Her current projects are based in India, Nepal, and Zimbabwe. She also works on social issues in the United States. Previously she was a Robert Wood Johnson Scholar in Health Policy Research at the University of California, Berkeley. She also worked as a management consultant with McKinsey & Company in San Francisco. She earned a PhD and master's degree from Harvard University, a master's degree from the University of Oxford where she was a Marshall Scholar, and a bachelor's degree from MIT.

Seminar summary:

Seema Jayachandran's presentation focused on the problem of what to do about "odious debt" -- that is, debt lent to rogue regimes that ultimately must be borne and paid by successive (legitimate) governments. She asks to what extent the status quo can change so that lenders will not want to lend to illegitimate governments. Her solution lies in increasing the costs of lending to rogue regimes through a policy of loan sanctions. Adopting an ex ante posture, Jayachandran argues that interests rates for loans would move toward infinity if banks knew that future legitimate governments would repudiate the debts of past regimes, particularly if new governments would have the blessing of the international community to do so. The loan-sanctions solution addresses a challenge faced by the debt relief movement, which focuses on debt "overhang," which weakens a poor country's economy. Instead, loan sanctions focus on the notion that some debt is, simply, illegitimate. And while trade sanctions pose problems (Jayachandran mentions that trade sanctions are often easy to evade and hurt people more than government), loan sanctions prevent a sanctioned government from borrowing. Loan sanctions are also self- enforcing (e.g., a lender would not lend if that lender knew it was unlikely to be repaid). The author raised questions for debate about who or what international body would implement loan sanctions or policy, the problem of banks making short-term loans to dictators who pay, and defining bad behaviors narrowly (or broadly) enough so as to target rogue or illegitimate regimes.

Encina Ground Floor Conference Room

Seema Jayachandran Assistant Professor of Economics Speaker Stanford Univesity
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This paper tests the claim that a small number of distinct „welfare regimes,
combining institutional patterns and social welfare outcomes, can be identified
across the developing world. It develops a methodology for clustering a large
number of developing countries, identifying and ranking their welfare regimes,
assessing their stability over the decade 1990-2000, and relating these to important
structural variables. It identifies three meta-welfare regimes: proto-welfare state
regimes, informal security regimes and insecurity regimes (distinguishing illiterateinsecurity
and morbidity-insecurity regimes). Membership of these is „sticky over
time, but has been modified by two global trends: the HIV-AIDS pandemic in Africa
and the growing role of remittances in some countries.

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Miriam Abu Sharkh
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Secondhand smoke (SHS) is a known cause of cancer, heart disease, respiratory disease, and other ailments. However, these diseases have a multiplicity of causes. Defendants claim SHS exposures are "low" and other sources created the illness. Plaintiffs claim "high" exposures to SHS caused their disease. In the world of toxic torts litigation involving allegations of injury from secondhand smoke, how does the expert witness use multidisciplinary science and technology in the investigation and establishment of facts and evidence in a court of law? Cases have been brought on behalf of railroad conductors, casino dealers, flight attendants, laborers, nurses, barbers, bartenders, prisoners, office workers, and even condo owners. How have they fared in high stakes litigation, and what does it take to prove a case?

James Repace, MSc., is a biophysicist and an international secondhand smoke consultant who has published 83 scientific papers, 70 of which concern the hazard, exposure, dose, risk, and control of secondhand smoke. He has received numerous national honours, including the Flight Attendant Medical Research Institute Distinguished Professor Award, the Robert Wood Johnson Foundation Innovator Award, the Surgeon General's Medallion, and a Lifetime Achievement Award from the American Public Health Association. He holds an appointment as a Visiting Assistant Clinical Professor at the Tufts University School of Medicine, and is a consultant to Stanford doing research on secondhand smoke in casinos. He is a former senior policy analyst and scientist with the U.S. Environmental Protection Agency, serving on both the Air Policy and Indoor Air Staffs, Office of Air and Radiation, and in the Exposure Analysis Division, Office of Research and Development. He served as a consultant to the Occupational Safety and Health Administration, U.S. Department of Labor, on its proposed rule to regulate secondhand smoke and indoor air quality. He was also a research physicist at the Naval Research Laboratory in the Ocean Sciences and Electronics Divisions. His degrees are from the Polytechnic University of New York; he has also pursued post-masters' studies at the Catholic University of America in Washington DC.

Yang & Yamazaki Environment &
Energy Building Room 101
Stanford University
Stanford, CA 94305

James Repace Speaker Repace Associates
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Hard Choices offers a most rewarding perspective on how Southeast Asian states straddle the ongoing tensions among three rarely compatible goals—security, democracy, and regionalism. Empirically rich and topically diverse, [the book] is broad in scope and full of deep analytic insights. It will be appreciated well beyond Southeast Asia." — T. J. PEMPEL, University of California, Berkeley

Southeast Asia faces hard choices. The region’s most powerful organization, ASEAN, is being challenged to ensure security and encourage democracy while simultaneously reinventing itself as a model of Asian regionalism.

Should ASEAN’s leaders defend a member country’s citizens against state predation for the sake of justice—and risk splitting ASEAN itself? Or should regional leaders privilege state security over human security for the sake of order—and risk being known as a dictators’ club? Should ASEAN isolate or tolerate the junta in Myanmar? Is democracy a requisite to security, or is it the other way around? How can democratization become a regional project without first transforming the Association into a “people centered” organization? But how can ASEAN reinvent itself along such lines if its member states are not already democratic?

How will its new Charter affect ASEAN’s ability to make these hard choices? How is regionalism being challenged by transnational crime, infectious disease, and other border-jumping threats to human security in Southeast Asia? Why have regional leaders failed to stop the perennial regional “haze” from brush fires in democratic Indonesia? Does democracy help or hinder nuclear energy security in the region?

In this timely book—the second of a three-book series focused on Asian regionalism—ten analysts from six countries address these and other pressing questions that Southeast Asia faces in the twenty-first century.

Recent Praise for Hard Choices

“In this delightful volume, a diverse, fresh, and talented group of authors shed new light on Southeast Asia and speak engagingly to wider scholarly questions.  Emmerson's introduction sets the tone for an unusually creative edited collection.”
 —Andrew MacIntyre, Australian National University
“In Hard Choices, Donald Emmerson has brought together a remarkable group of leading young scholars to write on Southeast Asian regionalism from political-security, economic, and sociological perspectives. His introductory chapter defines the dimensions of regionalism on which the other contributors elaborate in a series of fine essays examining ASEAN’s past, present, and alternative futures. Hard Choices is a landmark study that will be consulted for years to come by scholars and practitioners. Highly recommended.”
—Sheldon Simon, Arizona State University

Examination copies: Desk, examination, or review copies can be requested through Stanford University Press.

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Security, Democracy, and Regionalism in Southeast Asia

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Donald K. Emmerson
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Stephen J. Stedman
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FSI senior fellow Stephen Stedman reviews John Bolton's book, Surrender Is not an Option, in the July/August issue of the Boston Review. "The memoir reads like an international relations primer done in the style of a modern morality tale," he writes. "Imagine Kenneth Waltz's classic Man, the State, and War as written by Ayn Rand."

One of the more remarkable underreported stories of 2008 was a speech in which the State department’s legal adviser John Bellinger admitted that there “are also realities about the International Criminal Court that the United States must accept.” He also stated that the Bush administration would work with the Court to maximize its chances of success in Darfur. Bellinger did not say that the United States might actually join the Court, but acknowledged that it enjoyed widespread international support and legitimacy, and that the United States could fruitfully cooperate with it on areas of mutual benefit.

Neither mea culpa nor volte-face, the speech nonetheless indicates the distance the administration has traveled in seven years. While Bellinger’s oratory went largely unnoticed by foreign policy wonks and the attentive public alike, it did not escape the scrutiny of John Bolton, who dismissed it as Clinton-era “pabulum” and reflective of “the yearning the Rice State Department has for acceptance” by academics and foreign intellectuals. He added ominously, “the fight resumes after Jan. 20.”

Bolton has been a powerful influence on Republican foreign policy for the last twenty years. Before his appointment as ambassador to the United Nations in 2005—which was achieved without Senate confirmation—Bolton dominated arms-control policy in the first Bush term. He killed the Anti-Ballistic Missile (ABM) Treaty, negotiations with North Korea, and the Biological Weapons Convention verification protocol. During the Clinton years, he campaigned tirelessly from his Heritage Foundation perch for missile defense and against global governance, which he seems to equate with global government. In 1998, when then-Secretary-General of the United Nations Kofi Annan released a report critical of both the United Nations secretariat and member states for the failure to prevent genocide in Srebrenica, Bolton chastized Annan for having the temerity to criticize governments for what they did or did not do in the former Yugoslavia. He added menacingly: “I think if he continues down this road, ultimately it means war, at least with the Republican Party.”

Bolton came of age politically during Barry Goldwater’s presidential campaign. The future policy heavyweight was a high schooler in Baltimore at the time. He honed his conservatism at Yale College and Yale Law School, ducked Vietnam through a National Guard posting (“looking back, I am not terribly proud of this calculation”), and got his first taste of Washington as an intern to Spiro Agnew. During the Bush Sr. presidency, Bolton was Assistant Secretary for International Organization Affairs in James Baker’s State Department, and was one of the first people who Baker called when he needed a posse of chad-disputing lawyers in Florida in November 2000. Bolton’s name keeps showing up in various articles about the fight inside the Republican Party for the soul of John McCain’s foreign policy.

All of this makes it imperative to read his memoirs, which clarify the stakes in the forthcoming election. Although it is hard to imagine Bolton in a McCain administration—his memoirs offend so many within his party, across the aisle, and overseas, that Bolton could not win Senate confirmation for capitol dog-catcher—Bolton will be plotting, pressing, and pushing to force McCain’s foreign policy back to the unilateralism of George Bush’s first term, when the war on terror meant never having to say you’re sorry. And there are important national security posts that do not require Senate approval.

The memoir reads like an international relations primer done in the style of a modern morality tale—imagine Kenneth Waltz's classic Man, the State, and War as written by Ayn Rand.

To Bolton, the United Nations is a “target rich environment,” and I had a front row seat to watch his gunslinging. In 2005 I served as Special Adviser to UN Secretary-General Kofi Annan. I was responsible for developing member-state support for his efforts to overhaul the United Nations. In that capacity, I was in Brussels in March 2005 when President Bush nominated Bolton as Ambassador to the United Nations. One high-ranking EU official recoiled in horror, and, to share his agita, repeated two of Bolton’s more famous lines: that “UN headquarters could lose ten floors and no one would know the difference,” and that “there was no United Nations.” How in the world, the official asked, could such a man be Ambassador to the United Nations?

Amidst nodding heads and shared pained looks, I offered that if I could pick the ten floors, I would agree with Bolton. Moreover, I said, any sentient being who spends time in Turtle Bay—the Manhattan site of the United Nations—will at some point in frustration say to themselves that there is no United Nations. Bolton’s sin was to say it publicly. Finally, I suggested that John Bolton was irrelevant: “If the President of the United States and the Secretary of State want a strong, effective United Nations, then Bolton will have to deliver. If they don’t, you could have John Kerry as the U.S. ambassador, and nothing will happen.”

Oh well; win some, lose some. Which is what Condoleeza Rice is rumored to have told a friend who asked how John Bolton could have possibly been nominated for the position under her watch.

Or more accurately, I was half right, half wrong. Reading this book, one can almost feel sorry for how unsuited Bolton was for his new job. For four years he had been the point man for breaking American commitments abroad, insulting allies and enemies alike, ditching the ABM Treaty, and unsigning the Rome Statute, which established the International Criminal Court (“my happiest moment at State”). In the heady days of the first Bush administration, when it believed the United States was so powerful it could get anything that it wanted without friends, partners, or institutions, Bolton was the “say no” guy, a job he performed with great brio. How could he know that in 2005 his big boss, the President, and his nominal boss, the Secretary of State, would actually decide that international cooperation was necessary, and that maybe we should start worrying about America’s free fall in world opinion? A pit bull in the first term, Bolton would be a yap dog in the second, grating on the Secretary of State, the President, and most American allies.

Almost sorry, for whatever else you say about John Bolton, he is not of the “we can disagree without being disagreeable” school of American politics. This is one of the nastiest, pettiest memoirs in the annals of American diplomatic history. Among the many targets of insults and catty remarks are former and present U.K. ambassadors to the United Nations Emyr Jones Parry, Adam Thomson (“I could never look at or listen to Thomson without immediately thinking of Harry [Potter] and all his little friends”), and John Sawers; recent U.K. foreign ministers; just about every UN civil servant mentioned; indeed, just about every U.S. civil servant mentioned, along with countless journalists and politicians.

The memoir reads like an international relations primer done in the style of a modern morality tale—imagine Kenneth Waltz’s classic Man, the State, and War as written by Ayn Rand. Bolton, usually singlehandedly, takes on what he calls the High Minded, the Normers (those who create international norms of behavior or try to “[whip] the United States into line with leftist views of the way the world should look”), the EAPeasers (career State Department officials who advocate negotiations with North Korea), the Risen Bureaucracy, the Crusaders of Compromise, the Arms Control True Believers, and the EUroids.

The book has the formulaic allegories typical of the genre—the young, innocent female (Kristen Silverberg, Assistant Secretary for International Organization Affairs) driven to tears after being berated by the cold-hearted career bureaucrat (Nicholas Burns); the noble knight (Bolton himself) fighting against the political higher ups who care only about “positioning themselves” (Rice) or their legacy (Colin Powell). And of course Bolton’s plaintive cries that the 2005-06 changes in administration policy occurred against the will of the President. One sees the peasants now: ‘If only the King knew what was happening, this would never go on.’

Now add a heaping dose of xenophobia. Foreigners, appeasing foreigners, foreigners claiming to know us better than we know ourselves: all loom large in Bolton’s memoirs. He insults the former Swedish foreign minister and President of the General Assembly Jan Eliasson as not only having “an ethereal Hammarskjöldian vision problem, but also a Gunnar Myrdal problem, yet another foreigner who ‘understood’ us better than we did ourselves.” (This is the Myrdal who shared the 1974 Nobel Prize in Economics with Friedrich Hayek, and whose classic book on race, An American Dilemma: The Negro Problem and Modern Democracy, was cited in Brown v. Board of Education.) At one point in his belittlement of a Bush political appointee, a special assistant to Condoleeza Rice, no less, Bolton adds that she was “a naturalized citizen originally from Pakistan,” in case we wondered why she could not possibly understand America’s real foreign policy interests. In Bolton’s worldview Zbigniew Brzezinski is probably a naturalized American citizen originally from Poland; Henry Kissinger, a naturalized American citizen originally from Germany.

In the Bolton universe, you want Iran and North Korea to be referred to the Security Council, so that when it fails to unite behind a resolute strategy, the United States is then free to take the tough action it needs to take. And in the case of North Korea, Bolton is clear about what that would be: “unilateralist, interventionist, and preemptive.” Is it any wonder that when it came to Iran and North Korea, our allies and adversaries were loathe to refer them anywhere near Bolton?

Richard Hofstadter’s 1964 article “The Paranoid Style in American Politics” was prompted by the supporters of the Goldwater campaign. Bolton strides right off the pages of Hofstadter’s essay:

He is always manning the barricades of civilization . . . he does not see social conflict as something to be mediated and compromised, in the manner of the working politician. Since what is at stake is always a conflict between absolute good and absolute evil, what is necessary is not compromise but the will to fight things out to a finish. Since the enemy is thought of as being totally evil and totally unappeasable, he must be totally eliminated—if not from the world, at least from the theatre of operations to which the paranoid directs his attention. This demand for total triumph leads to the formulation of hopelessly unrealistic goals, and since these goals are not even remotely attainable, failure constantly heightens the paranoid’s sense of frustration. Even partial success leaves him with the same feeling of powerlessness with which he began, and this in turn only strengthens his awareness of the vast and terrifying quality of the enemy he opposes.

According to Bolton, we do not need diplomats who negotiate, seek common ground, and strive for cooperative solutions. We need litigators who will go to the wall defending American interests, who will understand that when others say no, they mean no, and that therefore compromise is illusion. But in a world where the United States needs international cooperation for its own peace and prosperity, what comes next? Bolton’s answers are laughable—we stick with our “closest friends in the United Nations”—Israel, Palau and the Marshall Islands. Or we forge a new alliance with Japan, South Korea, Australia, Canada, and New Zealand to overcome the parasitic and paralytic EU. The road to global primacy runs through . . . Wellington?

There are, of course, some glaring contradictions in the memoirs. Bolton is known as a sovereignty hawk and he spells out the content of that doctrine as “greater independence and fewer unnecessary restraints.” The job of civil servants, politically appointed or career, is “to implement the president’s policies.” So it comes as a double shock when we find Bolton handing a draft Security Council resolution to the Israeli ambassador, in case the ambassador wants to ask his Prime Minister to appeal directly to Bush or Rice to change President Bush’s policy on Lebanon.

Another example concerns Bolton’s recurring beratement of UN officials for forgetting that they work for the member states. He then describes how one Under-Secretary-General, American appointee Christopher Burnham, surreptitiously showed him budget documents that put the United States at an advantage in budget negotiations. It is hard to see how you can have it both ways. Either UN officials serve all member states equally or the organization is up for grabs to the most powerful state.

But it is the big betrayal that is at the heart of the book. Facing a quagmire in Iraq, a faltering coalition in Afghanistan, a nuclear armed North Korea, the possibility of a nuclear Iran, and a war against terror that was creating more, not fewer, terrorists, Condoleeza Rice convinced President Bush that maybe they should stop digging a bigger hole for American foreign policy. And that meant actually trying diplomacy in North Korea, Iran, and the Middle East.

The losers were John Bolton and his acolytes; the winners were the professionals like Nicholas Burns and Christopher Hill. Faced with defeat and repudiation of the failed policies he advocated, Bolton’s response is familiar and tiresome: the professionals had secretly hijacked the president’s policy; the Secretary of State cares more about appeasing foreigners than protecting American interests.

The moment of reckoning for Bolton and for the President that nominated him is not described in the book, but it took place two months after Bolton left the administration. When the United States and North Korea reached a deal in February 2007 that holds the promise of denuclearizing the country, Bolton tried to scuttle it. Asked by reporters whether he was loyal to the President, Bolton answered, “I’m loyal to the original policy.”

What did Bolton achieve at the United Nations? Very little, which was fine by him and fine by the cast of nonaligned Ambassadors who oppose a more effective international organization. I asked one of them in December 2006 if he was happy that Bolton was leaving. He said, “No, we’ve learned how to deal with Mr. Bolton.” When I sought clarification, he said, “Look, Bolton comes in and asks for the sun, the moon, and the stars, and we say ‘no.’ He then says, ‘I told you so’ and leaves. Everybody is happy.”

Which returns us to the question of why anyone would want to wade through these 500 self-serving pages. The best answer: to remind yourself of the stakes of this upcoming election and why the United States needs more old-fashioned diplomacy and less paranoia and arrogance. A McCain presidency might not eschew diplomacy, but in the political free-for-all that is the Republican party, Bolton and his minions are always there, ready to denigrate any agreement or compromise, to sabotage and subvert real diplomacy.

Asked by reporters whether he was loyal to the President, Bolton answered, "I'm loyal to the original policy."

To understand the stakes, consider the little known and even less appreciated record of American negotiations with North Korea since 1994. Between what was called the “Agreed Framework” that brought North Korea back into the Nonproliferation Treaty (NPT) in 1994 and the end of 2000, the United States and North Korea reached twenty agreements on a wide array of issues. Certain of these agreements foundered in implementation, but an objective assessment shows that some of the noncompliance stemmed from constraints placed by American domestic politics.

The Bolton strategy killed the Agreed Framework, hoping through threats, sanctions, and use of force to end the North Korean regime. Unfortunately for Bolton—fortunately for the rest of us—our ally South Korea and our necessary partner China did not want to deal with the consequences: either a war or a collapsed, deadly state on their borders. In the end, they did not have to because North Korea left the NPT, developed a nuclear bomb, and tested it, bankrupting the Bolton policy and producing the sharp change of strategy that has born fruit in recent North Korean steps to end its nuclear program.

Writing about the successes of American negotiators in bringing North Korea and the United States back together in February 2007, former State Department negotiator Robert Carlin and Stanford Professor Emeritus John Lewis have described why Bolton and his crowd loathe diplomacy is loathed by Bolton and his crowd, and why it is so necessary:

Diplomats strive to put down words all of them can swallow and hopefully their superiors in [the] capital can stomach. Written agreements are difficult to reach. The pain often comes not so much in dealing with the other side but in dealing with your own. Unless you are dictating terms to a defeated enemy, you are going to have to compromise on something, probably several somethings, that will make many people unhappy. That was done for the February 13th agreement, and there is no shame to it.

John Bolton did much damage to American interests in the first Bush administration, but he was implementing the president’s policy. President Bush deserves the blame for putting Bolton in a position to continue hardming American interests even when the overall direction of policy changed.

Given that many countries treated the United States as radioactive in 2005; given that trust and confidence in the United States were at all time lows; given that our record was one of a violator of international law and human rights; President Bush, had he truly wanted to start to move the United States out of the hole he had been so assiduously digging, would have had to send to the United Nations an ambassador with extraordinary listening skills, who could work across various international chasms, rebuild respect for American diplomacy, and, yes, advocate agreements that would make a lot of people unhappy. Someone, in fact, a lot like our present Ambassador, Zalmay Khalilzad, a naturalized citizen originally from Afghanistan. Instead he sent . . . Yosemite Sam.

So back to January 20. A new American president will take office with grinding wars in Iraq and Afghanistan, a nuclear-armed North Korea, an Iran headed that way, and crises in Sudan, Israel and Palestine, Lebanon, and Pakistan. Our foreign policy is anathema; our reputation in tatters. Throw in big issues like global warming, non-proliferation, catastrophic terrorism, and a potential pandemic of a deadly new influenza. It is hard to see how any of these crises or issues can be solved without sustained international cooperation and strong international institutions. Take global warming: protecting Americans from its ravages will depend on exercising sovereignty to strike deals with other countries whose domestic behavior threatens us and whose security our domestic behavior threatens. A narrow view of sovereignty as the ability to do as we damned well please will be—quite literally—the death of us all.

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surrender is not an option
Surrender Is not an Option: Defending America at the United Nations and Abroad
by John Bolton. Threshold Editions, $27.00 (hardcover)

 

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“Should the United States promote democracy around the world?” Stanford alumna Kathleen Brown, a former FSI advisory board member, former Treasurer of the State of California, and current head of public finance (Western region) Goldman Sachs

How are democracy, development, and the rule of law in transitioning societies related? How can they be promoted in the world’s most troubled regions? These were among the provocative issues addressed by faculty from the Freeman Spogli Institute’s Center on Democracy, Development, and the Rule of Law, as part of Stanford Day in Los Angeles on January 21, 2006. Panelists included Michael A. McFaul, CDDRL director, associate professor of political science, and senior fellow, the Hoover Institution; Kathryn Stoner, associate director for research and senior research associate at CDDRL; and Larry Diamond, coordinator of CDDRL’s Democracy Program, a Hoover Institution senior fellow, and founding co-editor of the Journal of Democracy.

The capstone of a day devoted to “Addressing Global Issues and Sharing Ideas,” the CDDRL panel was attended by more than 850 alumni, Stanford trustees, and supporters as part of the nationwide “Stanford Matters” series. Moderated by Stanford alumna Kathleen Brown, a former FSI Advisory Board member, former treasurer of the State of California, and current head of public finance (western region) Goldman Sachs, the panel looked at some of the toughest trouble spots in the world, including Iraq, Russia, and other parts of the former Soviet Union.

“Should the United States promote democracy around the world?” Brown began by asking Center Director Michael McFaul. “The President of the United States has said that the United States should put the promotion of liberty and freedom around the world as a fundamental policy proposition,” McFaul responded, noting “it is the central policy question in Washington, D.C., today.” It is not a debate between Democrats and Republicans, he continued, but rather between traditional realists, who look at the balance of power, and Wilsonian liberals, who argue that a country’s conduct of global affairs is profoundly affected by whether or not it is a democracy. The American people, McFaul noted, are divided on the issue. In opinion polls, 55 percent of Republicans say we should promote democracy, while 33 percent say no. Among Democrats, only 13 percent answer unequivocally that the United States should promote democracy.

“The President of the United States has said that the United States should put the promotion of liberty and freedom around the world as a fundamental policy proposition, and it is the central policy question in Washington, D.C., today.” CDDRL Director Michael McFaulAsserting that the United States should promote democracy, McFaul offered three major arguments. First is the moral issue—democracies are demonstrably better at constraining the power of the state and providing better lives for their people. Democracies do not commit genocide, nor do they starve their people. Moreover, most people want democracy, opinion polls show. Second are the economic considerations—we benefit from open societies and an open, liberal world trade system, which allows the free flow of goods and capital. Third is the security dimension. Every country that has attacked the United States has been an autocracy; conversely, no democracy has ever attacked us. The transformation of autocracies, including Japan, Germany, Italy, and the Soviet Union, has made us safer.

It is plausible to believe that the benefits of transformation in the Middle East will make us more secure, McFaul argued. “It would decrease the threats these states pose for each other, their need for weapons, and the need for U.S. intervention in the region,” he stated. Democratic transformation would also address a root cause of terrorism, as the vast majority of terrorists come from autocratic societies. There are, however, short-term problems, McFaul pointed out. Free elections could lead to radical regimes less friendly to the United States, as they have in Egypt, Iran, Iraq, and now in Palestine. U.S. efforts to promote democracy, he noted, can actually produce resistance.

Having advanced a positive case, McFaul asked FSI colleague Stoner-Weiss, “So, how do we promote democracy?” Stoner-Weiss, also an expert on Russia, said it is instructive to see how Russia has fallen off the path to democracy. In 1991, when the Soviet Union collapsed, it seemed to be an exciting time, rife with opportunity. “Here was an enemy, a major nuclear superpower, turning to democracy,” she stated. Despite initial U.S. enthusiasm, the outcome has not been a consolidated democracy. Russia, under Vladimir Putin, is becoming a more authoritarian state, a cause for concern because it is a nuclear state and a broken state—with rising rates of HIV and unable to secure its borders or control the flow of illegal drugs.

“So can we promote democracy?” Stoner-Weiss asked. The answer is a qualified yes, from Serbia to Georgia, and the Ukraine to Kyrgyzstan. But Russia has 89 divisions, 130 ethnicities, 11 time zones, and is the largest landmass in the world, she noted. Moving from a totalitarian state to a democracy and an open economy is enormously complicated. As Boris Yeltsin said in retiring as president on December 31, 1999, “What we thought would be easy turned out to be very difficult.”

Where is Russia today? It ranks below Cuba on the human development index; it is moving backward on corruption; and its economic development is poor, with 30 percent of the public living on subsistence income. Under Putin’s regime, private media have come under pressure, television is totally stated controlled, elections for regional leaders have been canceled, troops have remained in Chechnya, and Putin has supported controversial new legislation to curb civil liberties and NGO’s operating in Russia.

“How did Russia come to this?” she asked. In retrospect, the power of the president has been too strong. Initial “irrational exuberance” in the United States and Europe about what we could do has given way to apathy. Under Yeltsin, rule was oligarchical and democracy disorganized. Putin came to office promising a “dictatorship of law” to rid the country of corruption. Yet Russia under Putin, who rose through the KGB and never held elective office, has become far less democratic. He has severely curtailed civil liberties. The economy, dependent on oil and natural gas, is not on a path of sustainable growth.

“What can the United States do?” Stoner-Weiss asked. We have emphasized security over democracy, she pointed out, and invested in personal relations with Russia’s leaders, as opposed to investing in political process and institutions. We do have important opportunities, she noted. Russia chairs the G-8 group of major industrial nations this year, providing major opportunities for consultation, and wants to join the World Trade Organization. The United States should advance an institutional framework to help put Russia back on a path to democracy, a rule of law, and more sustainable growth, she argued.

Diamond, an expert on democratic development and regime change, examined U.S. involvement in the Middle East, noting that it is difficult to be optimistic at present. “Democracy is absolutely vital in the battle against terrorism,” he stated. The United States has to drain the swamp of rotten governments, lack of opportunity for participation and the pervasive indignity of human life. “The dilemma we face,” he pointed out, “is getting from here to there in the intractable Middle East.” There is not a single democracy in the Arab Middle East. This is not because of Islam, but rather the authoritarian nature of regimes in the region and the problem of oil.

“Can we promote democracy under these conditions?” Diamond asked. We need to get smart about it, he urged, noting that success depends on the particular context of each country. “If we want to promote democracy, the first rule is to know the country, its language, culture, history, and divisions,” he stated. We need to know, he continued, “who stands to benefit from a democratic transformation and, conversely, who stands to lose?” Rulers of these countries need to allow the space for freedom, for civic and intellectual pluralism, for open societies and meaningful participation. The danger is that there could be one person, one vote, one time. A second rule is that “academic knowledge and political practice must not be compartmentalized.” “To succeed,” Diamond stated, “we need to marry academic theories with concrete knowledge of these countries’ traditions, cultures, practices, and proclivities.”

In the lively question-and-answer session, panelists were asked, “Under what conditions is it appropriate to use force to promote democracy?” McFaul answered that we cannot invade in the name of democracy—we rebuilt Japan in that name but we did not invade that nation. We invaded Iraq in the name of national security. We know how to invade militarily, but still must learn how to build democracy. Effectiveness in the promotion of democracy, Diamond pointed out, requires the exercise of “soft” power—engagement with other societies, linkages with their schools and associations, and offering aid to democratic organizations around the world. Stoner-Weiss concurred, noting that we have used soft power effectively in some parts of the former Soviet Union, notably the Ukraine. People-to-people exchanges definitely help, she added.

To combat Osama bin Laden and the threat of future attacks in the United States, Diamond stated, we must halt the proliferation of nuclear weapons. North Korea and Iran are two of the most important issues on the global agenda. And we have got to improve governance in the Middle East in order to reduce the chances that the states of the region will breed and harbor stateless terrorists. A democratic Iran is in our interest, McFaul emphasized. Saudi Arabia must change as well—the only issue is whether change occurs with evolution or revolution. Democracy, economic development, and the rule of law, McFaul concluded, are inextricably intertwined.

Asked by alumnus and former Stanford trustee Brad Freeman what needs to happen to re-democratize Russia, McFaul pointed out that inequality has been a major issue in Russia—a small portion of the population controls its wealth and resources and, therefore, the political agenda and the use of law. Russia has been ruled by men and needs the rule of institutions, said Stoner-Weiss. We should insist that Putin allow free and fair elections, freedom of the press, and freedom of political expression, and re-focus efforts on developing the institutions of civil society, she stated.

Reform is a generational issue, McFaul emphasized. We need to educate and motivate the young so they can change their country from within. The Stanford Summer Fellows Program, which brought emerging leaders from 28 transitioning countries to Stanford in the program’s inaugural year of 2005, provides an important venue for upcoming generations to meet experienced U.S. leaders and others fighting to build democracies in their own countries. Such exchanges help secure recognition that building support for democracy, sustainable development, and the rule of law is a transnational issue.

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