Hanmo's research fields include labor and health economics, development economics, and population studies, with a particular focus on China's fertility, healthcare, and elderly care systems and policies. She primarily conducts empirical research to explore the principles of how various interventions affect caregiving practices, fertility behaviors, and other health or economic outcomes by utilizing data from surveys and hospital records. In 2022, Hanmo received her Ph.D. in economics from Peking University. Building on her doctoral work on health and economic development, she broadened her research to include aging and health systems as a postdoctoral scholar at the Harvard T.H. Chan School of Public Health from 2022 to 2023.
Objective To investigate factors that differentiate elderly adults in rural China who accept free vision screening and cataract surgery from those who could benefit from vision care but refuse it when offered.
Design We conducted a population-based, cross-sectional study between October and December 2016. Logistic regression models were used to examine the predictors of accepting free vision screening and cataract surgery.
Setting Rural communities in Handan, China.
Participants Adults aged 50 years or older, with presenting visual acuity ≤6/18 in the better seeing eye, suspected by examining ophthalmologist to be due to cataract.
Results Among 613 persons with cataract identified on a population basis, 596 (97.2%) completed the household survey (mean (SD) age, 71.5 (10.0) years; 79.8% female). A total of 214 persons (35.9%) refused participation, while 382 (64.1%) took part in the vision screening. A total of 193 (50.5%) participants were found eligible for surgery, while 189 (49.5%) were not. Among 99 randomly selected participants who were offered immediate free surgery, surgery was accepted by 77 participants (77.8%) and refused by 22 (22.2%). In the multivariate model, being engaged in income-generating activities (p<0.01), self-reported better physical capacity (p<0.001) and having had a recent physical examination (p=0.01) were significantly associated with acceptance of vision screening. The only variable significantly associated with acceptance of surgery was presenting visual acuity, with better vision inversely associated with acceptance of surgery (p<0.05) models.
Conclusion Our results suggest that refusal of basic eye examinations may be at least as important a determinant of low surgical rates in rural China as lack of acceptance of surgery itself.
Breastfeeding self-efficacy (BSE), defined as a mother’s confidence in her ability to breastfeed, has been confirmed to predict the uptake of exclusive breastfeeding (EBF). Early experiences during the birth hospital stay, especially in-hospital formula feeding (IHFF), can impact both EBF and maternal breastfeeding confidence. Therefore, our objective was to examine the association between IHFF and EBF outcomes and investigate whether this association is influenced by BSE. The study included 778 infants from a larger cohort study conducted in 2021, with a one-year follow-up in rural areas of Sichuan Province, China. We used a causal mediation analysis to estimate the total effect (TE), natural direct (NDE), and nature indirect effects (NIE) using the paramed command in Stata. Causal mediation analyses revealed that IHFF was negatively associated with EBF (TE odds ratio = 0.47; 95% CI, 0.29 to 0.76); 28% of this association was mediated by BSE. In the subgroup analysis, there were no significant differences in the effects between parity subgroups, as well as between infant delivery subgroups. Our study found that IHFF hindered later EBF and that BSE mediated this association. Limiting the occurrence of in-hospital formula feeding or improving maternal breastfeeding self-efficacy is likely to improve exclusive breastfeeding outcomes.
On October 18, as part of its autumn 2023 seminar series on APEC in advance of the organization's meeting in San Francisco in November, Shorenstein APARC and its Asia Health Policy Program (AHPP) presented the series' second event, Asia-Pacific Digital Health Innovation: Technology, Trust, and the Role of APEC. The featured panelists were Kiran Gopal Vaska, Director of the National Health Authority of India, and CK Cheruvettolil, the Senior Strategy Officer, Digital Health and Artificial Intelligence, at the Bill & Melinda Gates Foundation. Siyan Yi, the Director of the Integrated Research Program at the National University of Singapore and a former AHPP fellow, moderated the conversation.
While India is not an APEC member, Indian initiatives are examples of leveraging technology to better the health of the most vulnerable citizens in low- and middle-income countries (LMICs). Kiran Gopal Vaska gave an overview of the Ayushman Bharat Digital Mission (ABDM), India's latest health initiative that focuses on the interoperability of health records, services, and health claims. He stressed that ABDM was built on previous digital infrastructure, like Aadhaar, the national digital identity system, and Digilocker, a digital storage scheme for citizens' health and other records.
The approach India has taken is for the government to build the rails—the infrastructure of the system—and create a space where the private sector can develop applications integrated with that space through application programming interfaces (APIs), avoiding the siloing that can hamper the interoperability of data.
Regarding health data, privacy is a crucial concern at the patient level. ABDM addresses this concern through the use of a consent artifact. Individuals decide whether hospitals or other medical service providers have access to their data, and this access has levels of granularity: you can share specific portions of 7 different data types, like immunizations or prescriptions. You can limit that sharing to a particular period, like one day.
Also participating on the panel was CK Cheruvettolil, who discussed strategies by the Bill & Melinda Gates Foundation in leveraging the power of mobile phones to augment the work of Accredited Social Health Activists (ASHAs), the more than one million female frontline health workers in India. ASHAs can use mobile phone cameras, sensors, and streaming data to better care for low-birth-weight babies and other patients.
He explained the critical role of taking local context into account when developing software by using the example of pregnant Indian women in their third trimesters. The custom for Indian mothers, especially in rural areas, is for the child to be born in the maternal grandparents' home. If software were to store only the mother's address, healthcare workers in the grandparents' jurisdiction would not know that a pregnant woman in the critical third trimester would soon be giving birth at a local address.
Kiran Gopal Vaska noted that India had solved the technological issues, and now the task was to push for adoption. He emphasized that the technologies underlying India's digital health stack were created as public goods for the world, and for LMICs to support each other in advancing digital health technologies, the key was interoperability, "using standards that are accessible and acceptable worldwide."
Shorenstein APARC continued its APEC seminar series with the second installment, Asia-Pacific Digital Health Innovation: Technology, Trust, and the Role of APEC, a panel discussion that focused on how India’s digital health strategy has evolved and its lessons for other countries creating their own.
Objective
To test the feasibility and effectiveness of a mindfulness-based intervention in rural-to-urban migrant Chinese children using trained community volunteers.
Method
Migrant students ages 9 to 16 from 5 schools in Shanghai (N = 653) were randomly assigned to a mindfulness only group (n = 167), a mindfulness plus life skills group (n = 118), or a waitlist control group (n = 368). The first 2 groups received an 8-week mindfulness intervention delivered 1 hour weekly by trained community volunteers. The mindfulness plus life skills group received 8 additional hours of skills-based mentorship. Measurements on mindfulness, resilience, and anxiety and depression symptoms were collected before and after intervention. Multivariable regression analyses compared the intervention vs control groups.
Results
Before intervention, there were no significant demographic or outcome measure differences between groups except that students in the intervention groups were slightly older. Students had relatively low levels of mindfulness and prosociality difficulties and similar degrees of depression and anxiety symptoms compared with prior studies. After intervention, no statistically significant differences were found in mean scores for mindfulness, resilience, anxiety, or depression in the intervention vs control groups.
Conclusion
A volunteer-led mindfulness intervention did not significantly benefit migrant Chinese children after 8 weeks. More implementation research is needed for low-cost, scalable, and contextually effective mental health prevention programs.
This story was updated on September 18, 2023, to reflect the passing of Victor Fuchs.
It is hardly news that America’s health care system is complicated, expensive, and, in many ways, dysfunctional and that the nation’s health care outcomes are falling behind those of other, even sometimes poorer, countries. The problems of rising costs and disparities in access and outcomes were already well established in 1974, when Victor Fuchs, the late Henry J. Kaiser, Jr., Professor of Economics and of Health Research and Policy at Stanford, first published his seminal book Who Shall Live? Health, Economics and Social Choice. In what turned out to be the first edition of the book, Fuchs applied fundamental concepts from economic theory to health and medical care in an innovative manner that hadn't been attempted previously, presenting an economic framework for addressing health and medical care challenges and emphasizing the importance of choice at both individual and societal levels. The publication became a classic introduction to health economics and is recognized for pioneering the field.
Now a third edition of Who Shall Live? has been released by World Scientific Publishing, co-authored by Karen Eggleston, director of Shorenstein APARC’s Asia Health Policy Program. This edition adds supplemental research and an all-new section that focuses on the decade 2012–21, specifically looking at the Affordable Care Act, the COVID-19 pandemic, the intersection of health and politics, and the state of expenditures and outcomes during that period.
Eggleston was honored to be able to work with Fuchs, who had also been a senior fellow emeritus at the Freeman Spogli Institute for International Studies and the Stanford Institute for Economic Policy Research, but noted that “it was a little depressing to hear him conclude that the pandemic would not be the 'wake-up call’ for systemic reforms that he has spent a lifetime showing the United States needs.” Fuchs passed away peacefully in his longtime home on Stanford’s campus on September 16, 2023. He was 99.
Part of the story of U.S. health care is its poor showing compared to other, often less-affluent nations. Japan is one of the comparison countries in the updated section on the last decade; in one example, Eggleston describes, “between 2012 and 2019 (pre-pandemic), life expectancy at birth did not increase at all in the United States, while it increased 0.18 years per annum in Japan, and 0.16 years per annum across 10 other high-spending OECD countries.” This is despite the fact that “in 2019, Japan spent only 63% of what the United States spends on healthcare (as a share of GDP)… Why can’t we do better for Americans?”
This question is precisely the one that Who Shall Live? aims to answer—that the state of any health care system is a result of “the necessity of choice at both the individual and social levels.” To shrink the costs of health care in the United States and improve outcomes, different choices have to be made—by patients (in their personal lifestyles and behavior), by physicians, by hospitals, and by the U.S. government.
Asia Health Policy Program Director Karen Eggleston has coauthored the new third edition of Victor Fuch's 'Who Shall Live: Health, Economics, and Social Choice,' an authoritative book considering the great health challenges of our time.
Friday, November 17, 2023 | 12:00 pm -1:20 pm Pacific Time
Goldman Room E409, Encina Hall, 616 Jane Stanford Way
China’s draconian response to COVID-19 drew considerable criticism, with many suggesting that intense digital surveillance and harsh lockdowns triggered the unusual public dissent seen in China in late 2022. However, we argue that rather than backfiring, digital surveillance may have legitimized the government’s overreaction by making uncertain threats appear certain. We collected data on daily counts of lockdown communities and COVID cases from 2020 to 2023. Using a difference-in-differences approach with World Value Surveys (China 2012, 2018) and a nationwide online survey in 2023, we show that real-world lockdowns significantly reduced public perception of respect for human rights and trust in the government; however, these effects are moderated by the pervasiveness of COVID surveillance, proxied by cellphone usage. To establish causality, we use a survey experiment to show that digital surveillance indeed increases support for COVID lockdowns by making citizens more likely to believe they are close contacts. In contrast, surveillance cannot justify protest crackdowns. Our findings suggest that uncertainty in threats to public safety may foster support for state surveillance and coercion.
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Xu Xu is Assistant Professor of Politics and International Affairs at Princeton University. Xu studies digital authoritarianism, political repression, and the political economy of development, with a regional focus on China. He is currently working on a book entitled Authoritarian Control in the Age of Digital Surveillance. His other ongoing projects examine the political aspects of artificial intelligence, social media propaganda, public opinion on state repression, and state-society relations in China. His work has appeared in the American Journal of Political Science, the Journal of Politics, and the Journal of Law, Economics, and Organization, among other peer-reviewed journals.
He received his Ph.D. in political science from Pennsylvania State University in 2019, and was a postdoctoral fellow at Stanford University from 2020 to 2021.
A NOTE ON LOCATION
Please join us in-person in the Goldman Conference Room located within Encina Hall on the 4th floor of the East wing.
Goldman Room E409, Encina Hall
Please join us in congratulating Didi Kuo, Center Fellow at the Freeman Spogli Institute for International Studies (FS), and co-author Andrew S. Kelly, Assistant Professor in the Department of Health Sciences at California State University, East Bay, on being awarded the 2023 Leonard S. Robins Award for the Best Paper on Health Politics and Policy by the American Political Science Association (APSA)!
The Robins Award is named in honor of Leonard S. Robins, who, through his presence and gentle questioning at virtually every health politics panel, graciously nurtured the scholarship of both junior and senior scholars. The award recognizes the best paper on any subject that fits under the rubric of Health Politics and Policy presented at the previous annual APSA meeting.
Kuo and Kelly's award-winning paper, "State Capacity and Public Health: California and COVID-19," investigates the comparative COVID-19 policy response across counties and regions within California. In the description of the 2022 APSA panel "The Politics of Pandemic Response and the Opportunities for Health Policy Reform," during which they presented their paper, it notes that "In moving beyond a consideration of formal state and public health capacity, Kuo and Kelly argue that the more robust policy response of the Bay Area was, in part, a product of partnerships between state and community-based actors. Drawing on the concept of 'embedded autonomy,' Kuo and Kelly reconceptualize public health capacity and consider it within broader issues of state capacity and democracy."
An abstract of the paper can be found below:
On March 17, 2020, six counties in the Bay Area jointly issued the nation’s first shelter-in-place orders in response to the COVID-19 crisis. Cities and states across the United States quickly followed suit, with varying degrees of success. Public health officials have been critical in setting policies, enforcing behavioral and non-pharmaceutical interventions, and communicating with the public. This paper explores the determinants of public health capacity, distinguishing between formal institutional capacity (ie budget, staff) and informal embedded capacity (ie community ties, insulation from political pressures). It argues that informal embedded capacity is critical to public health capacity, but difficult to measure empirically. It concludes by relating public health capacity to broader issues of state capacity and democracy.
The award recognizes Kuo and Kelly's paper, “State Capacity and Public Health: California and COVID-19,” as the best paper on health politics and policy presented at the 2022 American Political Science Association (APSA) conference.
Background
Mothers’ perception of infant hunger cues is a critical content of responsive feeding, which is central to the promotion of early childhood development. However, only a few studies have examined responsive feeding in China, especially lacking the studies on perceptions of infant hunger cues. Consider the cultural differences, the aim of this study was to describe the perceptions of infant hunger cues of Chinese mothers for infants aged 3 months, and explore the relationship between maternal perceptions of infant hunger cues and different feeding methods.
Methods
A cross-sectional study was conducted with a sample of 326 mothers of healthy 3-month-old infants, including 188 exclusive breastfeeding (EBF) mothers and 138 formula feeding (FF) mothers. It was implemented in four provincial and municipal maternal and child health hospitals. The mothers’ perceptions of infant hunger cues were surveyed by self-reporting questionnaires. Chi-square tests and logistic analysis were applied to analyze the differences in maternal perceptions of infant hunger cues, including the number of hunger cues and the specific cues, between EBF group and FF group by controlling sociodemographic variables and the daily nursing indicators.
Results
We found that a higher proportion of EBF mothers could perceive multiple hunger cues (≥ 2) than FF mothers (66.5% vs.55.1%). For specific cues, the EBF mothers had higher perceptions of infant’s “hand sucking” (67.6% vs. 53.6%) and “moving head frantically from side to side” (34.6% vs. 23.9%), all p < 0.05. Regression analysis revealed that EBF might support mothers to perceive infant hunger cues than FF mothers, with the number of infant hunger cues (OR = 1.70, 95% CI: 1.01–2.85), “hand sucking” (OR = 1.72, 95% CI: 1.04–2.87), “moving head frantically from side to side” (OR = 2.07, 95% CI: 1.19–3.62). The number of infant hunger cues perceived by mothers was also associated with their educational level and family structure.
Conclusion
EBF mothers of 3-month-old infants may be more likely to perceive infant hunger cues than FF mothers in China. It is necessary to increase the health education about infant hunger and satiety cues to caregivers in China, especially among mothers with lower education levels, mothers living in nuclear families, and FF mothers.
