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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Two political scientists comment on Thomas Ambrosio's The Geopolitics

of Demographic Decay: HIV/AIDS and Russia's Great-Power Status (Post-Soviet

Affairs, 22, 1, January-March 2006).

Ambrosio's three indicators of great-power capacity, Russia's society, military, and economy, are reviewed in terms of his argument about how the projected effects of HIV/AIDS weakens each factor.

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Journal Articles
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Post-Soviet Affairs
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Michael A. McFaul
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Analyzing a variety of cross-national and sub-national data, we argue that high adult mortality reduces economic growth by shortening time horizons. Higher adult mortality is associated with increased levels of risky behavior, higher fertility, and lower investment in physical and human capital. Furthermore, the feedback effect from economic prosperity to better health care implies that mortality could be the source of a poverty trap. In our regressions, adult mortality explains almost all of Africa's growth tragedy. Our analysis also underscores grim forecasts of the long-run economic costs of the ongoing AIDS epidemic.

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CDDRL Working Papers
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This paper presents empirical evidence on a specific mechanism through which demographic transition affects economic growth. The evidence provides support for the models of demographic transition emphasizing the demand for children. Using a panel of African countries during 1985-2000, I show that the AIDS epidemic effects the total fertility rates positively and the school enrollment rates negatively. These patterns are consistent with the theoretical models that argue the existence of a precautionary demand for children in the face of uncertainty about child survival. Parents, who are faced with a high mortality environment for young adults, choose to have more children and provide each of them with less education, leading a reversal in the fertility transition and a reduction in the aggregate amount of human capital investment. The empirical estimates show that a country that has witnessed the average increase in AIDS incidence for Africa, have 0.8 more births and 30 percentage points less primary school enrollment since 1985. The results imply lower economic growth and welfare for the current and future African generations.

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This paper examines two related questions: what effects do infectious diseases exert on growth and development, and are they quantitatively important? We present evidence on the effect of health and infectious diseases on economic development using Hansen's (2000) endogenous threshold methodology. Taking into account various proxies for infectious diseases as potential threshold variables we show that countries are clustered in regimes that obey different growth paths and thus provide direct evidence of threshold effects. Motivated by this evidence we propose an epidemiological overlapping generations model where the transmission and incidence of an infectious disease depend upon economic incentives and rational behavior. The economic cost of the disease comes from its effect on mortality (infected individuals can die prematurely) and morbidity (lower productivity and/or lower flow of utility from a given consumption bundle). Our main theoretical finding is that if infectious diseases are particularly virulent or debilitating, growth- or development-traps are possible. Numerical results from a calibrated version of the model show that threshold effects of diseases are quantitatively important and in particular, significant health interventions are required to propel disease addicted countries to a high-growth trajectory.

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Encina Basement Conference Room

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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
rsd15_081_0253a.jpg MD, MPH

Dr. Paul Wise is dedicated to bridging the fields of child health equity, public policy, and international security studies. He is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics, Division of Neonatology and Developmental Medicine, and Health Policy at Stanford University. He is also co-Director, Stanford Center for Prematurity Research and a Senior Fellow in the Center on Democracy, Development, and the Rule of Law, and the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Wise is a fellow of the American Academy of Arts and Sciences and has been working as the Juvenile Care Monitor for the U.S. Federal Court overseeing the treatment of migrant children in U.S. border detention facilities.

Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston. His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School and was the founding Director or the Center for Policy, Outcomes and Prevention, Stanford University School of Medicine. He has served in a variety of professional and consultative roles, including Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, Chair of the Strategic Planning Task Force of the Secretary’s Committee on Genetics, Health and Society, a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH, and the Health and Human Secretary’s Advisory Committee on Infant and Maternal Mortality.

Wise’s most recent U.S.-focused work has addressed disparities in birth outcomes, regionalized specialty care for children, and Medicaid. His international work has focused on women’s and child health in violent and politically complex environments, including Ukraine, Gaza, Central America, Venezuela, and children in detention on the U.S.-Mexico border.  

Core Faculty, Center on Democracy, Development and the Rule of Law
Affiliated faculty at the Center for International Security and Cooperation
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Paul H. Wise Professor of Pediatrics, Fellow CHP/PCOR Stanford University
Seminars
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Mr. Faber will speak about the legal and political issues concerned in treating HIV/AIDS in Sub Saharan Africa from ther perspective of a major pharmaceuticals company.

Room 180 Law

Gunther Faber Vice President for Sub Saharan Africa Glaxo, Smith, Kline
Lectures
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This study provides new evidence on the appropriate model of the economic and demographic transition. The episode analyzed is the eradication of hookworm disease in the American South (c. 1910). In previous work (Bleakley 2004), it was shown that the eradication of hookworm disease led to a significant increase in school attendance and literacy. The present study shows that this increase in human capital investment was accompanied by a fertility decrease that was both economically and statistically significant. A decline in the hookworm infection rate from 40 to 20% is associated with a decline in fertility that amounts to 40% of the entire fertility decline observed in the American South between 1910 and 1920. The relative change in fertility and schooling caused by hookworm eradication is approximately equal to aggregate comovements during the period considered. We argue that this evidence is consistent with models of the fertility transition emphasizing economic incentives rather than changing cultural attitudes and birth control technologies. Furthermore our data supports models emphasizing intergenerational altruism. Variables affecting childrens' economic prospects affect parental fertility decisions. A consequence of this finding is that we do not require changes in the economic opportunities faced by parents directly to explain the economic and demographic transition.

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Encina Hall, C149
616 Jane Stanford Way
Stanford, CA 94305

(650) 725-0500
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Senior Fellow, Freeman Spogli Institute for International Studies
Professor, by courtesy, of Political Science
alberto_diaz-cayeros_2024.jpg MA, PhD

Alberto Díaz-Cayeros is a Senior Fellow at Stanford University's Freeman Spogli Institute for International Studies (FSI), and co-director of the Democracy Action Lab (DAL), based at FSI's Center on Democracy, Development and Rule of Law (CDDRL). His research interests include federalism, poverty relief, indigenous governance, political economy of health, violence, and citizen security in Mexico and Latin America.

He is the author of Federalism, Fiscal Authority and Centralization in Latin America (Cambridge, reedited 2016), coauthored with Federico Estévez and Beatriz Magaloni, of The Political Logic of Poverty Relief (Cambridge, 2016), and of numerous journal articles and book chapters.

He is currently working on a project on cartography and the developmental legacies of colonial rule and governance in indigenous communities in Mexico.

From 2016 to 2023, he was the Director of the Center for Latin American Studies at Stanford University, and from 2009 to 2013, Director of the Center for US-Mexican Studies at UCSD, the University of California, San Diego.

Affiliated faculty at the Center on Democracy, Development and the Rule of Law
Co-director, Democracy Action Lab
Director of the Center for Latin American Studies (2016 - 2023)
CV
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Richard E. Behrman Professor of Child Health and Society
Senior Fellow, Freeman Spogli Institute for International Studies
rsd15_081_0253a.jpg MD, MPH

Dr. Paul Wise is dedicated to bridging the fields of child health equity, public policy, and international security studies. He is the Richard E. Behrman Professor of Child Health and Society and Professor of Pediatrics, Division of Neonatology and Developmental Medicine, and Health Policy at Stanford University. He is also co-Director, Stanford Center for Prematurity Research and a Senior Fellow in the Center on Democracy, Development, and the Rule of Law, and the Center for International Security and Cooperation, Freeman Spogli Institute for International Studies, Stanford University. Wise is a fellow of the American Academy of Arts and Sciences and has been working as the Juvenile Care Monitor for the U.S. Federal Court overseeing the treatment of migrant children in U.S. border detention facilities.

Wise received his A.B. degree summa cum laude in Latin American Studies and his M.D. degree from Cornell University, a Master of Public Health degree from the Harvard School of Public Health and did his pediatric training at the Children’s Hospital in Boston. His former positions include Director of Emergency and Primary Care Services at Boston Children’s Hospital, Director of the Harvard Institute for Reproductive and Child Health, Vice-Chief of the Division of Social Medicine and Health Inequalities at the Brigham and Women’s Hospital and Harvard Medical School and was the founding Director or the Center for Policy, Outcomes and Prevention, Stanford University School of Medicine. He has served in a variety of professional and consultative roles, including Special Assistant to the U.S. Surgeon General, Chair of the Steering Committee of the NIH Global Network for Women’s and Children’s Health Research, Chair of the Strategic Planning Task Force of the Secretary’s Committee on Genetics, Health and Society, a member of the Advisory Council of the National Institute of Child Health and Human Development, NIH, and the Health and Human Secretary’s Advisory Committee on Infant and Maternal Mortality.

Wise’s most recent U.S.-focused work has addressed disparities in birth outcomes, regionalized specialty care for children, and Medicaid. His international work has focused on women’s and child health in violent and politically complex environments, including Ukraine, Gaza, Central America, Venezuela, and children in detention on the U.S.-Mexico border.  

Core Faculty, Center on Democracy, Development and the Rule of Law
Affiliated faculty at the Center for International Security and Cooperation
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In a May 14 lecture hosted by the Center on Democracy, Development and the Rule of Law, Francis Fukuyama, PhD -- professor of international political economy at Johns Hopkins University and renowned author of The End of History and the Last Man -- discussed the problem of weak, underdeveloped nation-states; the effectiveness of various approaches to strengthening such states; and the importance of culture, context and history in the task of state-building. His lecture, titled "State-building: A Framework for Thinking about the Transfer of Institutions to Developing Countries," drew a full room of attendees to the Bechtel Conference Center in Encina Hall

A former member of the RAND Corp. and the U.S. Department of State who has written widely on issues of democratization and international political economy, Fukuyama first presented a framework with which nation-states can be evaluated according to two key criteria: the strength of the state, and the scope of its functions. The first refers to a state's ability to enforce its own laws and policies; the second refers to how involved the state becomes in carrying out various societal functions, ranging from basic functions such as maintaining law and order and protecting public health, to more "activist" functions such as running industries and redistributing wealth.

Fukuyama asserted that from a development standpoint, nation-states should be strong but should carry out only the minimum necessary functions. He said that only one country he has studied -- New Zealand -- has effectively moved toward this ideal in recent years. He noted that many struggling, developing nations, such as Brazil, Mexico, Pakistan and Turkey, are overly ambitious in their scope -- attempting to run vast industries, for example -- but are weak and unable to carry out their policies because of factors like corruption. Other states that Fukuyama identified as "failed states," such as Haiti and Sierra Leone, are both limited in scope and weak, attempting to carry out only the most basic governmental functions and not doing it very well.

Fukuyama then discussed and evaluated various approaches to strengthening developing nations. He noted that in recent years much emphasis has been placed on encouraging such nations to reduce the scope of their functions, through deregulation and privatization, but said the effectiveness of this approach is now in question. A more effective approach, he said, is helping weak nation-states build their own strong institutions, such as political parties, public health networks and central banking.

Unfortunately, Fukuyama said, sometimes the efforts of outside organizations to strengthen a country's institutions only make things worse, because solutions are imposed from outside rather than developed from within. "Ideally, we would want a country's own public health system to handle that country's problems with AIDS or malaria," he said. "But when you flood the country with your organization's own doctors and nurses and infrastructure, what do the local doctors do? They quit their government posts to get on the payroll of your NGO." In a few months or years, when the organization withdraws its support, Fukuyama noted, the system collapses, because it was not built to be self-sustaining.

At the end of his talk, Fukuyama emphasized the importance of understanding local culture, context and history in the task of state building. For example, he said, those who run programs aiming to reduce the spread of HIV/AIDS in Africa should consider working with traditional faith healers, as they are an important part of the healthcare system in Africa.

Francis Fukuyama is dean of faculty and the Bernard L. Schwartz Professor of International Political Economy at the Paul H. Nitze School of Advanced International Studies of Johns Hopkins University. His book The End of History and the Last Man was published in 1992 and has appeared in more than 20 foreign editions. It made the bestseller lists in the United States, France, Japan and Chile, and has been awarded the Los Angeles Times' Book Critics Award.

Fukuyama received a BA in classics from Cornell University and a PhD in political science from Harvard University. He was a member of the Political Science Department of the RAND Corporation from 1979-1980, then again from 1983-89, and from 1995-96. In 1981-82 and in 1989 he was a member of the policy planning staff of the U.S. Department of State. In the early 1980s he was also a member of the U.S. delegation to the Egyptian-Israeli talks on Palestinian autonomy. He is a member of the President's Council on Bioethics, the American Political Science Association, the Council on Foreign Relations, the Pacific Council on International Policy, and the Global Business Network.

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