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Kavita N. Ramdas
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In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the former president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

In reaction to the arrest of Dominique Strauss-Khan for allegations of rape in May, Kavita Ramdas and Christine Ahn argue in a piece for Foreign Policy in Focus that gender bias is embedded in the global policies and practices at the IMF, which unfairly target women. Kavita Ramdas is the president and CEO of the Global Fund for Women and a visiting scholar at the Center on Democracy, Development, and the Rule of Law.

As Dominique Strauss-Kahn, head of the world’s most powerful financial institution, the International Monetary Fund (IMF), spends a few nights in Rikers Island prison awaiting a hearing, the world is learning a lot about his history of treating women as expendable sex objects. Strauss-Kahn has been charged with rape and forced imprisonment of a 32-year-old Guinean hotel worker at a $3,000-a-night luxury hotel in New York.

While the media dissects the attempted rape of a young African woman and begins to dig out more information about Strauss-Kahn’s past indiscretions, we couldn’t help but see this situation through the feminist lens of the “personal is political.” 

For many in the developing world, the IMF and its draconian policies of structural adjustment have systematically “raped” the earth and the poor and violated the human rights of women. It appears that the personal disregard and disrespect for women demonstrated by the man at the highest levels of leadership within the IMF is quite consistent with the gender bias inherent in the IMF’s institutional policies and practice.

Systematic Violation of Women’s Human Rights

The IMF and the World Bank were established in the aftermath of World War II to promote international trade and monetary cooperation by giving governments loans in times of severe budget crises. Although 184 countries make up the IMF’s membership, only five countries—France, Germany, Japan, Britain, and the United States—control 50 percent of the votes, which are allocated according to each country’s contribution.

The IMF has earned its villainous reputation in the Global South because in exchange for loans, governments must accept a range of austerity measures known as structural adjustment programs (SAPs). A typical IMF package encourages export promotion over local production for local consumption. It also pushes for lower tariffs and cuts in government programs such as welfare and education. Instead of reducing poverty, the trillion dollars of loans issued by the IMF have deepened poverty, especially for women who make up 70 percent of the world’s poor.

IMF-mandated government cutbacks in social welfare spending have often been achieved by cutting public sector jobs, which disproportionately impact women. Women hold most of the lower-skilled public sector jobs, and they are often the first to be cut. Also, as social programs like caregiving are slashed, women are expected to take on additional domestic responsibilities that further limit their access to education or other jobs.

In exchange for borrowing $5.8 billion from the IMF and World Bank, Tanzania agreed to impose fees for health services, which led to fewer women seeking hospital deliveries or post-natal care and naturally, higher rates of maternal death.  In Zambia, the imposition of SAPs led to a significant drop in girls’ enrollment in schools and a spike in “survival or subsistence sex” as a way for young women to continue their educations.

But IMF’s austerity measures don’t just apply to poor African countries. In 1997, South Korea received $57 billion in loans in exchange for IMF conditionalities that forced the government to introduce “labor market flexibility,” which outlined steps for the government to compress wages, fire “surplus workers,” and cut government spending on programs and infrastructure. When the financial crisis hit, seven Korean women were laid off for every one Korean man. In a sick twist, the Korean government launched a "get your husband energized" campaign encouraging women to support depressed male partners while they cooked, cleaned, and cared for everyone.

Nearly 15 years later, the scenario is grim for South Korean workers, especially women. Of all OECD countries, Koreans work the longest hours: 90% of men and 77% of women work over 40 hours a week.  According to economist Martin Hart-Landsberg, in 2000, 40 percent of Korean workers were irregular workers; by 2008, 60 percent worked in the informal economy. The Korean Women Working Academy reports that today 70 percent of Korean women workers are temporary laborers.

Selling Mother Earth

IMF policies have also raped the earth by dictating that governments privatize the natural resources most people depend on for their survival: water, land, forests, and fisheries. SAPs have also forced developing countries to stop growing staple foods for domestic consumption and instead focus on growing cash crops, like cut flowers and coffee for export to volatile global markets. These policies have destroyed the livelihoods of small-scale subsistence farmers, the majority of whom are women.

“IMF adjustment programs forced poor countries to abandon policies that protected their farmers and their agricultural production and markets,” says Henk Hobbelink of GRAIN, an international organization that promotes sustainable agriculture and biodiversity. "As a result, many countries became dependent on food imports, as local farmers could not compete with the subsidized products from the North. This is one of the main factors in the current food crisis, for which the IMF is directly to blame."

In the Democratic Republic of Congo (DRC), IMF loans have paved the way for the privatization of the country’s mines by transnational corporations and local elites, which has forcibly displaced thousands of Congolese people in a context where women and girls experience obscenely high levels of sexual slavery and rape in the eastern provinces. According to Gender Action, the World Bank and IMF have made loans to the DRC to restructure the mining sector, which translates into laying off tens of thousands of workers, including women and girls who depend on the mining operations for their livelihoods. Furthermore, as the land becomes mined and privatized, women and girls responsible for gathering water and firewood must walk even further, making them more susceptible to violent crimes.

We Are Over It

Women’s rights activists around the globe are consistently dumbfounded by how such violations of women’s bodies are routinely dismissed as minor transgressions. Strauss-Kahn, one of the world’s most powerful politicians whose decisions affected millions across the globe, was known for being a “womanizer” who often forced himself on younger, junior women in subordinate positions where they were vulnerable to his far greater power, influence, and clout. Yet none of his colleagues or fellow Socialist Party members took these reports seriously, colluding in a consensus shared even by his wife that the violation of women’s bodily integrity is not in any sense a genuine violation of human rights.

Why else would the world tolerate the unearthly news that 48 Congolese women are raped every hour with deadening inaction? Eve Ensler speaks for us all when she writes, “I am over a world that could allow, has allowed, continues to allow 400,000 women, 2,300 women, or one woman to be raped anywhere, anytime of any day in the Congo. The women of Congo are over it too.”

We live in a world where millions of women don’t speak their truth, don’t tell their dark stories, don’t reveal their horror lived every day just because they were born women.  They don’t do it for the same reasons that the women in the Congo articulate – they are tired of not being heard. They are tired of men like Strauss-Kahn, powerful and in suits, believing that they can rape a black woman in a hotel room, just because they feel like it. They are tired of the police not believing them or arresting them for being sex workers. They are tired of hospitals not having rape kits. They are tired of reporting rape and being charged for adultery in Iran, Pakistan, and Saudi Arabia.

Fighting Back

For each one of them, and for those of us who have spent many years investing in the tenacity of women’s movements across the globe, the courage and gumption of the young Guinean immigrant shines like the torch held by Lady Liberty herself. This young woman makes you believe we can change this reality. She refused to be intimidated.  She stood up for herself. She fought to free herself—twice—from the violent grip of the man attacking her. She didn’t care who he was—she knew she was violated and she reported it straight to the hotel staff, who went straight to the New York police, who went straight to JFK to pluck Strauss-Kahn from his first-class Air France seat.

In a world where it often feels as though wealth and power can buy anything, the courage of a young woman and the people who stood by her took our breath away. These stubborn, ethical acts of working class people in New York City reminded us that women have the right to say “no.”  It reminded us that “no” does not mean “yes” as the Yale fraternities would have us believe, and, most importantly that no one, regardless of their position or their gender, should be above the law.  A wise woman judge further drove home the point about how critically important it is to value women’s bodies when she denied Strauss-Kahn bail citing his long history of abusing women.

Strauss-Kahn sits in his Rikers Island cell. It would be a great thing if his trial succeeds in ending the world’s tolerance for those who discriminate and abuse women. We cannot tolerate it one second longer.  We cannot tolerate it at the personal level, we must refuse to condone it at the professional level, and we must challenge it every time it we see it in the policies of global institutions like the International Monetary Fund.

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Background. The effect of antiretroviral therapy (ART) interruption or intensification on health-related quality of life (HRQoL) in advanced HIV patients is unknown.

Objective. To assess the impact of temporary treatment interruption and intensification of ART on HRQoL.

Design. A 2 x 2 factorial open label randomized controlled trial.

Setting. Hospitals in the United States, Canada, and the United Kingdom.

Patients. Multidrug resistant (MDR) HIV patients.

Intervention. Patients were randomized to receive a 12-wk interruption or not, and ART intensification or standard ART.

Measurements. The Health Utilities Index (HUI3), EQ-5D, standard gamble (SG), time tradeoff (TTO), visual analog scale (VAS), and the Medical Outcomes Study HIV Health Survey (MOS-HIV).

Results. There were no significant differences in HRQoL among the four groups during follow-up; however, there was a temporary significant decline in HRQoL on some measures within the interruption group during interruption (HUI3 −0.05, P = 0.03; VAS −5.9, P = 0.002; physical health summary −2.9, P = 0.001; mental health summary −1.9, P = 0.02). Scores declined slightly overall during follow-up. Multivariate analysis showed significantly lower HRQoL associated with some clinical events.

Limitations. The results may not apply to HIV patients who have not experienced multiple treatment failures or who have not developed MDR HIV.

Conclusions. Temporary ART interruption and ART intensification provided neither superior nor inferior HRQoL compared with no interruption and standard ART. Among surviving patients, HRQoL scores declined only slightly over years of follow-up in this advanced HIV cohort; however, approximately one-third of patients died during the trial follow up. Lower HRQoL was associated with adverse clinical events.

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Medical Decision Making
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Vilija Joyce
Paul G. Barnett
Adam Chow
Ahmed M. Bayoumi
Susan C. Griffin
Huiying Sun
Mark Holodniy
Sheldon T. Brown
Tassos C. Kyriakides
D. William Cameron
Mike Youle
Mark Sculpher
Aslam H. Anis
Douglas K. Owens
Douglas K. Owens
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Nathan Eagle, Founder and CEO of txteagle spoke at the weekly Liberation Technology Seminar Series on Dececember 2, 2010 about mobile phone usage in the developing world.

Although txteagle began in 2007 as a purely academic project, the current goal of the company and of its founder and CEO, Nathan Eagle, is to give one billion people a five percent raise. In his presentation, Eagle described the context for which txteagle was designed, how the company's focus has evolved over the past three years, and what steps the company is taking to move closer to achieving this goal in the future.

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Eagle began by offering some background information to explain the initial impetus behind txteagle. Today, about 63% of global mobile phone usage takes place in the developing world, making airtime usage in emerging markets worth about $200 billion a year. Mobile phone users at the so-called "Base of the Pyramid" typically spend 10% of their income on mobile phone airtime. Through his experience living in emerging markets and teaching mobile application development in universities across sub-Saharan Africa, Eagle began to see that a significant opportunity space existed to reduce the cost of airtime for people at the base of the pyramid, in effect giving these people a raise.

Mobile applications developed as a part of MIT's Entrepreneurial Research on Programming and Research on Mobiles (EPROM) project offered some insights into the potential of mobile-based tools. In Rwanda, where electricity is a prepaid service, one of Eagle's former students quickly cornered a significant share of the market by creating scratch cards for crediting one's electricity bill via mobile phone. In Eastern Kenya, a program called SMS Blood Bank was created to enable real time monitoring of blood supplies at local district hospitals in Eastern Kenya. Although SMS reporting of low blood levels resolved the huge amount of latency in the system of local district hospitals (where responses to dips in supply had typically taken up to 4 weeks), the price of reporting blood levels via SMS represented a pay cut for local nurses; despite nurses' initial enthusiasm, SMS reporting tapered off within weeks. When the idea of sending about 10 cents of airtime to compensate nurses for each SMS report of blood level data proved a success, the model behind txteagle was born.

Designed as a means to monetize people's downtime, txteagle has grown rapidly through partnerships with over 220 mobile operators in about 80 countries around the world. In turn for helping these operators analyze their customer data, txteagle has gained access to about 2.1 billion mobile subscribers. Partnering with txteagle is a winning proposition for mobile operators, since the airtime compensation mobile subscribers receive from txteagle improves operators' Average Revenue per User (ARPU), a statistic that had been plummeting as more and more poor people became mobile phone users. By enabling people to carry out work via web browsers or SMS and compensating them via mobile money or airtime, txteagle has become a market leader at efficiently gathering data in the developing world.

Since txteagle was first created, the company has attempted to move from an outsourcing/back-office model to an emphasis on work that leverages a person's unique local knowledge and information. Typically outsourced tasks such as forms processing, audio transcription, inventory management, data cleaning, tagging, and internet search, tend to be less rewarding to the worker. By focusing on local data instead, txteagle enables unprecedented insight into emerging markets, all while optimizing engagement with local customers. Typical tasks include: maps and directions, local market prices and businesses, survey research and polling, and other forms of local knowledge gathering.

One of txteagle's central initiatives, GroundTruth, leverages this local knowledge-based model to carry out better market research. Today, global brands are already spending about $125 billion annually in emerging markets to engage the "next billion," but they typically carry out this research in a sub-optimal way. Through the txteagle platform, Eagle suggests, brands and organizations can use advertising money to design better products and services, conduct market research, and carry out brand engagement. Recent success cases include the use of txteagle to help a program of the United Nations to reach survey respondents directly and to enable the World Bank to obtain better local market price data at lower cost. 

Although txteagle's rapid growth and early successes have been encouraging, the company has ambitious goals for the next two years. The company began by focusing on outside sales through its GroundTruth market research program. Next year, the company  hopes to generate syndicated data and ultimately to create a self-source platform enabling anyone to conduct their own population-level surveys.  By continuing to focus on improving the quality of both their data and workers over time, txteagle aims to have an even greater positive impact on the incomes of the hundreds of millions of mobile phone users at the base of the pyramid.

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After the Sichuan 5.12 earthquake, many people in the disaster area suffered from mental health problems. To decrease morbidity from mental disease, the Sichuan authorities worked with diverse hospitals to establish a “three-level network of psychiatric prevention and treatment.” The goal was to disseminate knowledge about prevention and treatment for psychiatric conditions from doctors to recipients, especially regarding symptoms. How to disseminate such knowledge effectively and efficiently deserves study. Based on a sample of 146 doctor-recipient pairs from 52 hospitals in diverse areas of China (including Sichuan, Beijing, and Guangzhou), this study examines the impact of knowledge characteristics, the network status of the doctor, the network status of the hospital with which the doctor is affiliated, and the relationship quality between doctor and recipient on the effectiveness and efficiency of knowledge transfer from the doctor to patient. Findings indicate that high-status doctors are more effective in knowledge transfer. In addition, low-status hospitals were found to have a positive effect on knowledge transfer efficiency. In particular, results highlight the strong positive impact that the quality of the relationship between the doctor and patient has on both the efficiency and effectiveness of knowledge transfer. Finally, findings suggest that the relationship between knowledge characteristics and knowledge transfer is partially mediated by the relationship quality between the doctor and the recipient.

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Shorenstein APARC
Stanford University
Encina Hall E301
Stanford, CA 94305-6055

(650) 723-9741 (650) 723-6530
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Visiting Scholar, 2009-2011
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Zhe Zhang is an assistant professor of organization management at the School of Management, Xi'an Jiaotong University, China, where she also received her PhD. Her research focuses on public-private partnerships, corporate governance, and corporate social responsibility. She has published in the Journal of High Technology Management Research, International Journal of Health Care Finance & Economics, Management and Organization Review, and the International Journal of Networking and Virtual Organizations.

(Amy) Zhe Zhang Visiting Scholar, 2009-2011 Speaker Shorenstein APARC
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A class was given in the dSchool last spring. In this class small interdisciplinary teams focused on a term-long design project, taking advantage of the design process structures and methods that have been developed in the d.school. The course developed as a collaboration between Stanford, the University of Nairobi and Nokia Africa Research Center.  The focus area was finding ICT solutions to the healthcare needs of people living in Kibera slum outside Nairobi.

Under the guidance of Jussi Impiö at Nokia and the Computer Science faculty, 27 students from the University of Nairobi Computer Science department conducted need finding studies at a number of health-related sites, including clinics, hospitals, community health workers, community leaders, and government offices. They read background materials, made observations, and talked with a wide variety of stakeholders. Their reports became the basis of the Stanford teams' initial understanding of users and needs. Communication with the group in Nairobi was also maintained throughout the course, using a Facebook group to facilitate discussions, as well as several teleconference sessions.

Working in small teams, 20 Stanford students from a wide range of disciplines worked over 10 weeks to develop initial design concepts to respond to some of the needs that had been identified. Click on the title of each project to view their final presentations:

  • mNote: an online archive for community health worker notes. This application empowers community health workers by preserving the flexibility and control they appreciate in their current paper notebooks, but adding digital knowledge management capabilities.
  • M-MAJI ("mobile water"): an electronic information system that allows people to use their mobile phones to identify clean water sources in their community. The application seeks to decrease the time and money spent searching for water, improve water quality, and foster vendor accountability by providing a mechanism for user feedback.
  • Babybank: a dedicated savings plan designed specifically for pregnant women in the slums of Nairobi. By leveraging a popular cell phone payment system, M-Pesa, the application aims to make savings easier, so that expecting mothers can afford the services that will keep themselves and their babies healthy.
  • Mazanick: an application to provide support and advice to pregnant women via SMS, with the aim of helping motivate them to attend prenatal appointments.
  • PillCheck (Kifaa cha Tenbe): a mobile application to help people in Kibera find information on the availability and pricing of malaria drugs quickly.
  • PatientMap :a system to make the waiting process in clinics more transparent, and to increase patient trust in the medical system.

This summer, two follow up trips are planned, with Nairobi students due to spend several weeks at Stanford, while a number of students from the Stanford group will visit Nairobi to explore possibilities for developing their projects further. Building on the success and lessons learnt so far, the Designing Liberation Technologies course will be open to a new set of students next academic year. 

Wallenberg Theater

Program on Global Justice
Encina Hall West, Room 404
Stanford University
Stanford, CA 94305

(650) 723-0256
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Marta Sutton Weeks Professor of Ethics in Society, and Professor of Political Science, Philosophy, and Law
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MA, PhD

Joshua Cohen is a professor of law, political science, and philosophy at Stanford University, where he also teaches at the d.school and helps to coordinate the Program on Liberation Technology. A political theorist trained in philosophy, Cohen has written extensively on issues of democratic theory—particularly deliberative democracy and the implications for personal liberty, freedom of expression, and campaign finance—and global justice. Cohen is author of On Democracy (1983, with Joel Rogers); Associations and Democracy (1995, with Joel Rogers); Philosophy, Politics, Democracy (2010); The Arc of the Moral Universe and Other Essays (2011); and Rousseau: A Free Community of Equals (2011). Since 1991, he has been editor of Boston Review, a bi-monthly magazine of political, cultural, and literary ideas. Cohen is currently a member of the faculty of Apple University.

CDDRL Affiliated Faculty
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Joshua Cohen Speaker

Gates Computer Science 3B
Room 388
Stanford, CA 94305-9035

(650) 723-2780
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Professor of Computer Science
founding faculty member at Hasso Plattner Institute of Design at Stanford
and CDDRL Affiliated Faculty
winograd.jpg
PhD

Terry Winograd is a co-leader of the Liberation Technology program at CDDRL and Professor of Computer Science in the Computer Science Department at Stanford University. His research focus is on human-computer interaction design, especially theoretical background and conceptual models. He directs the teaching programs and HCI research in the Stanford Human-Computer Interaction Group, and is also a founding faculty member of the Hasso Plattner Institute of Design at Stanford.

Prof. Winograd was a founding member and former president of Computer Professionals for Social Responsibility. He is on a number of journal editorial boards, including Human Computer Interaction, ACM Transactions on Computer Human Interaction, and Informatica. Some of his publications includes Understanding Computers and Cognition: A New Foundation for Design (Addison-Wesley, 1987) and Usability: Turning Technologies into Tools (Oxford, 1992). 

Terry Winograd received a B.A. in Mathematics from The Colorado College in 1966 and Ph.D. in Applied Mathematics from M.I.T in 1970.

Terry Winograd Speaker
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This Spring quarter, while our seminar series took a break, Terry Winograd and Joshua Cohen taught a new course at the Hasso Plattner Institute of Design (the d.school): Designing Liberation Technologies.

During this class, small interdisciplinary teams focus on a term-long design project, taking advantage of the design process structures and methods that have been developed in the d.school. This year's course developed as a collaboration between Stanford, the University of Nairobi and Nokia Africa Research Center.  The focus area was finding ICT solutions to the healthcare needs of people living in Kibera slum outside Nairobi.

Under the guidance of Jussi Impiö at Nokia and the Computer Science faculty, 27 students from the University of Nairobi Computer Science department conducted need finding studies at a number of health-related sites, including clinics, hospitals, community health workers, community leaders, and government offices. They read background materials, made observations, and talked with a wide variety of stakeholders. Their reports became the basis of the Stanford teams' initial understanding of users and needs. Communication with the group in Nairobi was also maintained throughout the course, using a Facebook group to facilitate discussions, as well as several teleconference sessions.

Working in small teams, 20 Stanford students from a wide range of disciplines worked over 10 weeks to develop initial design concepts to respond to some of the needs that had been identified. Click on the title of each project to view their final presentations:

  • mNote: an online archive for community health worker notes. This application empowers community health workers by preserving the flexibility and control they appreciate in their current paper notebooks, but adding digital knowledge management capabilities.
  • M-MAJI ("mobile water"): an electronic information system that allows people to use their mobile phones to identify clean water sources in their community. The application seeks to decrease the time and money spent searching for water, improve water quality, and foster vendor accountability by providing a mechanism for user feedback.
  • Babybank: a dedicated savings plan designed specifically for pregnant women in the slums of Nairobi. By leveraging a popular cell phone payment system, M-Pesa, the application aims to make savings easier, so that expecting mothers can afford the services that will keep themselves and their babies healthy.
  • Mazanick: an application to provide support and advice to pregnant women via SMS, with the aim of helping motivate them to attend prenatal appointments.
  • PillCheck (Kifaa cha Tenbe): a mobile application to help people in Kibera find information on the availability and pricing of malaria drugs quickly.
  • PatientMap :a system to make the waiting process in clinics more transparent, and to increase patient trust in the medical system.

This summer, two follow up trips are planned, with Nairobi students due to spend several weeks at Stanford, while a number of students from the Stanford group will visit Nairobi to explore possibilities for developing their projects further. Building on the success and lessons learnt so far, the Designing Liberation Technologies course will be open to a new set of students next academic year. 

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The Chinese health care system has experienced profound changes like retrenchment of state financial support in the past decades. These changes have prompted the Chinese media and some academics to suggest that patients have a relatively low level of trust in physicians in today's China. In this colloquium, Dr. Tam reports the results of his survey of patient trust in physicians in Beijing's public hospitals. The survey was conducted by Horizon Research Group between November 2009 and January 2010, and 434 patients were interviewed.
 
The survey asked the respondents their degree of trust regarding the following three dimensions: physician agency, competence, and information provision. The survey finds a relatively high level of patient trust in physicians in Beijing public hospitals. Additionally, the survey data highlight three major determinants of patient trust in physicians, namely exposure to negative media reports about physicians and hospitals; the patient's self-assessed health status; and the patient’s level of education and income.
 
Waikeung Tam received his Ph.D. in political science at the University of Chicago in 2009. He is currently a Research Fellow at the LKY School of Public Policy at the National University of Singapore. His research focuses on public policy, political development, law and society, with special reference to China and Hong Kong. His research has been published in China Review, Asian Perspective, Journal of Contemporary Asia, and Law & Social Inquiry.

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Waikeung Tam Speaker National University of Singapore
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