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.
Researchers call for policy, aid and innovation to help world’s poorest
Philanthropist and software giant Bill Gates spoke to a Stanford audience last week about the importance of foreign aid and product innovation in the fight against chronic hunger, poverty and disease in the developing world.
His message goes hand-in-hand with the ongoing work of researchers at Stanford’s Freeman Spogli Institute for International Studies. Much of that work is supported by FSI’s Global Underdevelopment Action Fund, which provides seed grants to help faculty members design research experiments and conduct fieldwork in some of the world’s poorest places.
Four FSI senior fellows – Larry Diamond, Jeremy Weinstein, Paul Wise and Walter Falcon – respond to some of the points made by Gates and share insight into their own research and ideas about how to advance and secure the most fragile nations.
Without first improving people’s health, Gates says it’s harder to build good governance and reliable infrastructure in a developing country. Is that the best way to prioritize when thinking about foreign aid?
Larry Diamond: I have immense admiration for what Bill Gates is doing to reduce childhood and maternal fatality and improve the quality of life in poor countries. He is literally saving millions of lives. But in two respects (at least), it's misguided to think that public health should come "before" improvements in governance.
First, there is no reason why we need to choose, or why the two types of interventions should be in conflict. People need vaccines against endemic and preventable diseases – and they need institutional reforms to strengthen societal resistance to corruption, a sociopolitical disease that drains society of the energy and resources to fight poverty, ignorance, and disease.
Second, good governance is a vital facilitator of improved public health. When corruption is controlled, public resources are used efficiently and justly to build modern sanitation and transportation systems, and to train and operate modern health care systems. With good, accountable governance, public health and life expectancy improve much more dramatically. When corruption is endemic, life-saving vaccines, drugs, and treatments too often fall beyond the reach of poor people who cannot make under-the-table payments.
Foreign aid has come under criticism for not being effective, and most countries have very small foreign aid budgets. How do you make the case that foreign aid is a worthy investment?
Jeremy M. Weinstein: While foreign aid may be a small part of most countries’ national budgets, global development assistance has increased markedly in the past 50 years. Between 2000 and 2010, global aid increased from $78 billion to nearly $130 billion – and the U.S. continues to be the world’s leading donor.
The challenge in the next decade will be to sustain high aid volumes given the economic challenges that now confront developed countries. I am confident that we can and will sustain these volumes for three reasons.
First, a strong core of leading voices in both parties recognizes that promoting development serves our national interest. In this interconnected world, our security and prosperity depend in important ways on the security and prosperity of those who live beyond our borders.
Second, providing assistance is a reflection of our values – it is these humanitarian motives that drove the unprecedented U.S. commitment to fighting HIV/AIDS during the Bush Administration.
Perhaps most importantly, especially in tight budget times, development agencies are learning a great deal about what works in foreign assistance, and are putting taxpayers’ dollars to better use to reduce poverty, fight disease, increase productivity, and strengthen governance – with increasing evidence to show for it.
Some of the most dire situations in the developing world are found in conflict zones. How can philanthropists and nongovernmental organizations best work in places with unstable governments and public health crises? Is there a role for larger groups like the Gates Foundation to play in war-torn areas?
Paul H. Wise: As a pediatrician, the central challenge is this: The majority of preventable child deaths in Sub-Saharan Africa and in much of the world occur in areas of political instability and poor governance.
This means that if we are to make real progress in improving child health we must be able to enhance the provision of critical, highly efficacious health interventions in areas that are characterized by complex political environments – often where corruption, civil conflict, and poor public management are the rule.
Currently, most of the major global health funders tend to avoid working in such areas, as they would rather invest their efforts and resources in supportive, well-functioning locations. This is understandable. However, given where the preventable deaths are occurring, it is not acceptable.
Our efforts are directed at creating new strategies capable of bringing essential services to unstable regions of the world. This will require new collaborations between health professionals, global security experts, political scientists, and management specialists in order to craft integrated child health strategies that respect both the technical requirements of critical health services and the political and management innovations that will ensure that these life-saving interventions reach all children in need.
Gates says innovation is essential to improving agricultural production for small farmers in the poorest places. What is the most-needed invention or idea that needs to be put into place to fight global hunger?
Walter P. Falcon: No single innovation will end hunger, but widespread use of cell phone technology could help.
Most poor agricultural communities receive few benefits from agricultural extension services, many of which were decimated during earlier periods of structural reform. But small farmers often have cell phones or live in villages where phones are present.
My priority innovation is for a $10 smart phone, to be complemented with a series of very specific applications designed for transferring knowledge about new agricultural technologies to particular regions. Using the wiki-like potential of these applications, it would also be possible for farmers from different villages to teach each other, share critical local knowledge, and also interact with crop and livestock specialists.
Language and visual qualities of the applications would be key, and literacy problems would be constraining. But the potential payoff seems enormous.
Connecting the Dots: The water, food, energy and climate nexus
Connecting the Dots conference website
Stanford experts from a range of disciplines discuss the interconnections and interactions among humanity's needs for and use of water, food, energy, and environment. Drawing on their own research, the speakers illustrate and evaluate some of the ways in which decisions in one resource area can lead to trade-offs or co-benefits in others. Participants examine sustainable freshwater resources and uses in Africa, Asia, and the arid West.
Panel: Africa - Water, Nutrition, Health and Poverty
China: Water, Food, Climate, and Policy
Frances C. Arrillaga Alumni Center
As Stanford center opens in China, faculty showcase research
Along with the speeches and ceremonies to mark the opening of the Stanford Center at Peking University, Stanford scholars from the Freeman Spogli Institute for International Studies are showcasing their work examining China’s promises, challenges and increasingly important role in the world.
The Shorenstein Asia-Pacific Research Center held a two-day workshop examining China’s relationships with its neighbors. The event draws on work being done by Thomas Fingar, FSI’s Oksenberg-Rohlen Distinguished Fellow, who is leading a new initiative to explore the nuances and complexity of China’s foreign relations and domestic issues.
Scott Rozelle, co-director of the Rural Education Action Project, planned a conference on Thursday exploring the impacts of technology on China’s health and education systems. For years, Rozelle has studied how basic medicine and better meals improve children’s performance in school. He’s lately been evaluating the best and most affordable ways to use new technology in rural Chinese schools.
On March 26 and 27, the Asia Health Policy Program will focus on the challenges China’s growing tobacco-control movement faces against a multibillion-dollar government-run industry. Anthropologist Matthew Kohrman, a specialist on tobacco in China, will lead the workshop examining the connections woven over the past 60 years between marketing and cigarette gifting, production and consumer demand, government policy and economic profit, and the other forces behind China’s smoking culture.
In sub-Saharan Africa, a shorter walk to water saves lives
Redefining Security Along the Food-Health Nexus: report of a conference and center launch held at Stanford University on November 10, 2011
For most scholars the concept of security encompasses issues of state legitimacy, economic and political sovereignty, and protection from military, nuclear, or terrorist assault. Yet billions of people, particularly in the developing world, face more severe, individual security threats on a daily basis, such as inadequate nutrition, disease burdens, lack of potable water, and risks of sexual assault or human trafficking. Such human security concerns can become national security issues when citizens rise up against their governments or threaten to rebel. Human security issues can also emerge as international security threats—those that create conflict or galvanize cooperation among governments—with escalating income and resource inequities between countries. Stanford University has a strong tradition of scholarship in conventional areas of national and international security, as well as in the areas of global food security and health policy. On November 10, 2011, Stanford’s Freeman Spogli Institute for International Studies (FSI) held a major conference to integrate these areas of scholarship, and to launch the Center on Food Security and the Environment (FSE) as a major thrust of its international research and teaching agenda.
Structural Change and the Future of Indian Agriculture
Binswanger-Mkhize's talk will look at past and likely future agricultural growth and rural poverty reduction in the context of the overall economy of India, in which growth has accelerated sharply since the 1980s, but agriculture still has not followed suit. Despite slow growth, urban-rural consumption, income and poverty differentials have not risen. This is because urban-rural spillovers have led to a sharp acceleration of rural non-farm growth and income. Binswanger-Mkhize proposes an optimistic vision can be realized if agricultural growth accelerates, high and widely shared economic growth leads to strong spillovers to the rural economy, and the rural non-farm sector continues to flourish. This would enable the rural sector to keep up with income growth in the urban economy and rural poverty would rapidly decline. However, if agricultural growth fails to accelerate, and overall economic growth falters, a more pessimistic vision is also possible. Binswanger-Mkhize will also discuss the role of prices and wages in determining agricultural growth, rural poverty and nutrition, and the two interlinked income parity issues: rural-urban and agricultural-non-agricultural incomes parity.
Marianne Banziger, Deputy Director, Research & Partnership at International Maize and Wheat Improvement Center (CIMMYT) will provide commentary.
Bechtel Conference Center
FSE overview video: A brighter future through food security
Stanford University's Center on Food Security and the Environment (FSE) takes a global and multifaceted approach to issues of food security by tackling both the supply and demand side of the equation. By recognizing that food security issues in the 21st century are intimately tied to climate change, FSE looks at the root causes of our problems and helps to create sustainable solutions to feed those in need around the world.
NCSE conference links environment and security, new strategies needed
While many of us here in the US wake up concerned about political, economic, and military unrest at home and abroad, billions still wake up with more basic, human security concerns, opened FSE director Rosamond L. Naylor in a plenary connecting climate, energy, food, water, and health.
Are we going to have enough to eat today? How am I going to feed my family or care for family members struggling with HIV/AIDS and other infectious diesease? Is there enough water to drink, bathe, and still water my crops?
Naylor emphasized the need to bring these human security issues back into the forefront of our global conscious. While these are 'humanitarian needs at the core', they are also related to national and international security.
"When people are desperate enough, and we've seen this particularly with the food price spike in recent years, they take to the streets, and sometimes when they take to the streets they realize they are disgruntled about a number of things in addition to food prices," said Naylor.
The Arab Spring and wave of rebellions throughout the Middle East last year demonstrate the connections between food security, unmet basic needs, and national security. It has been a chaotic time for world food markets, said Naylor.
Naylor's global statistics are discouraging. Over a billion people still suffer from chronic hunger and malnutrition, 1/5 don't have physical access to water, and roughly 1.6 billion are facing economic water constraints (do not have the economic resources to access available water). Food and water insecurity are exacerbating the incidence and transmission of infectious disease.
At a time when investment is sorely needed, the Hill has been making dramatic cutbacks in foreign assistance and foreign investment is falling short. Efforts made by the private sector, philanthropy, and civil society, while valuable, remain siloed. Opportunties are being missed by not addressing the interrelated nature of food and health issues.
Despite this dire outlook, Naylor offered solutions to help us rethink our development strategy.
- Invest in more diversified and nutritious crops that have more climate adaptation potential.
- Consider new irrigation strategies, particularly in areas like Africa where 96% of the continent is still not irrigated. Not large dams, but small, distributed irrigation systems that rely on solar and wind.
- Integrate food and health programs and the way we think about domestic and productive water uses.
Naylor was joined on the panel by Jeff Seabright (Vice President, The Coca-Cola Company), Daniel Gerstein (Deputy Under Secretary for Science and Technology, U.S. Department of Homeland Security), and Geoff Dabelko (Woodrow Wilson International Center for Scholars). The panel was moderated by Frank Sesno (George Washington University and Planet Forward). Video of the plenary can be found below:
Stanford research on nutrition influences policy change in China
As markets around the world slump, sputter and slump again, China maintains the fastest-growing economy. But despite the country’s boom, it has fallen behind in making sure its children will be healthy, strong and smart enough to cash in on it.
About 30 percent of children living in China’s rural areas are anemic – sick with an iron deficiency that Stanford researcher Scott Rozelle and his colleagues with the Rural Education Action Project have proven leads to bad school performance. And a poor education coupled with anemia’s physical blow puts those kids at risk for lives of poverty and missed opportunities.
But things are changing. Influenced in part by the research Rozelle has conducted and presented to Chinese officials, the government recently launched a policy to improve school lunches for about 20 million children across the country.
The plan invests $2.5 billion a year during the next nine years to ensure the meals are more nutritious for elementary and middle school students. That doubles the amount spent on lunches for China’s neediest children.
“For 5,000 years it was OK to be anemic if you're never going to leave the farm," said Rozelle, an economist and senior fellow at Stanford’s Freeman Spogli Institute for International Studies who is still experimenting with ways to improve children's health in rural China and get the government to adopt the most effective methods.
"But we're looking 20 years into the future where there are much fewer farms and you need at least a high school education to make a living in the city,” Rozelle said. “If you are sick with anemia, it is going to affect your cognitive ability, educational performance and ultimately your chances of going on in school."
Rozelle began studying anemia and its links to school performance in 2008.
After conducting an initial study of about 4,000 primary school students in Shaanxi province, he found that nearly 40 percent of the children were anemic – the result of diets that consisted mostly of rice and noodles in regions where meat, fruit and fresh vegetables are expensive and often hard to come by.
Those survey results were presented to the government in a 2009 policy brief written by Rozelle and his collaborators. Officials adopted the brief, making rural primary school nutrition part of China’s official policy discussion.
A second study conducted between 2008 and 2009 found that anemia rates dropped when schoolchildren were given vitamins fortified with iron. And as their iron levels rose, so did their test scores.
An experiment followed to back up those findings, while another set of large-scale surveys across four provinces reinforced that childhood anemia was indeed a widespread problem.
The findings from those surveys and tests were packaged in another policy brief that was accepted by the government earlier this year, prompting a government directive urging more concrete action in the area of student nutrition.
Those documents, along with several presentations Rozelle has made to government officials and commissions, have culminated in a move to pour $22.5 billion into more nutritious school lunches between now and 2020. It will likely be up to local government and school officials to decide exactly what those meals will include, but Rozelle is hopeful they’ll lead to diets with more meat, vegetables and iron supplements.
“Research-based results are an important avenue for affecting policy in China,” said Chen Zhili, vice chair of the Standing Committee of the National People’s Congress and a former minister of education. “The new programs for child nutrition were only made possible by the work of groups (like the Rural Education Action Project).”
And a national policy aimed at improving nutrition and curbing anemia helps ensure that China maintains its foothold in the world’s economy and grow in a more stable, equitable way, Rozelle said.
“The social return is huge,” Rozelle said. “These kids will be able to do better in school, work harder and sustain China’s growth.”