The update below also appears on SPICE’s Diversity, Equity, and Inclusion page, where we post periodic updates about SPICE’s DEI-focused work.

This article was first published by the social and political economy portal IndiaSpend.

Women from poor households made about 235,000 fewer hospital visits compared to men for seven gender-neutral disease categories between January 2017 and October 2019, a new study analyzing a Rajasthan state health insurance scheme has estimated. The Bhamashah Swasthya Bima Yojana aims to provide health insurance to about 46 million persons living below the poverty line, as a step towards universal and equitable access to healthcare in the state, per the study.

Pascaline Dupas and Radhika Jain of Stanford University studied data of insurance claims from 4.2 million hospital visits under the Bhamashah scheme from its launch in December 2015 till October 2019, and the study was published as a National Bureau of Economic Research working paper. The study was conducted in partnership with the Rajasthan state government.

Women made up 45% of hospital visits under the Bhamashah scheme between January 2017 and October 2019, though their share in the population is 48%, per the study. The gender gap is starker for girls and older women. The share of girls in children aged under 10 years who visited the hospital under this insurance program was 33%, though their share of this age group's population is 47%; among those aged above 50 years, women are 51%, yet their share of hospital visits under this insurance program was 43%.

"We were struck by this discrepancy in the data. We were not expecting such a large [gender] difference," Dupas, an economist and professor at Stanford University, told IndiaSpend. In most other developed countries for which such data have been analyzed, subsidized healthcare usually caters to those who otherwise don't have access to it, added Jain, a postdoctoral fellow in Asia Health Policy at Stanford University, US.

This opinion piece was first published in the economics and policy portal Ideas for India.

Equity in healthcare is a key goal of health policy in India. Analyzing administrative data from Rajasthan, this article highlights substantial gender gaps in the utilization of subsidized hospital care under the state health insurance program. These disparities persist despite substantial program expansion and seem to be driven by households being less willing to allocate resources to female vis-à-vis male health.

Over the past 15 years, India’s central government and numerous state governments have put in place health insurance programmes that entitle low-income households to free healthcare at public and empanelled private hospitals. Health equity and universal health coverage are explicit goals of these programs. In new research, we study gender equity in the Bhamashah Swasthya Bima Yojana (BSBY)1 health insurance program, which was launched in the state of Rajasthan in 2015, and is similar in design to the national Pradhan Mantri Jan Arogya Yojana (PMJAY).

Our starting point is a dataset of insurance claims filed for all 4.2 million hospital visits between 2015 and 2019, including patient age, gender, residence address, hospital visited, dates of admission and discharge, and service(s) received. We geo-coded hospital locations and patient addresses, which allowed us to calculate proximity to hospitals and the distance traveled for every hospital visit. Finally, we linked the insurance data to the 2011 Census and data on three rounds of village-level (gram panchayat) elections. To our knowledge, the dataset we compiled from these various sources is the first dataset of its type in India and allows us to study care-seeking under insurance with unusual granularity.

In a webinar dated, February 12, 2021, a panel of Stanford University scholars shared their reflections on the legacy of the January 25, 2011 Uprising in Egypt. Marking the 10-year anniversary of the uprising and the ouster of Hosni Mubarak, the panel examined the trajectory of authoritarianism in the country over the past decade. Moderated by ARD Associate-Director Hesham Sallam, the panel included former CDDRL Visiting Scholar Nancy Okail, Stanford Professor of History Emeritus Joel Beinin, and CDDRL Senior Research Scholar Amr Hamzawy. The panelists addressed a variety questions including: How have political developments in Egypt and elsewhere in recent years informed our understanding of the January 25 Uprising and its significance? In what ways have authoritarian institutions adapted in the aftermath of the 2011 uprising and how have they shaped the prospects for political change and/or stability? Where are the sites of political contestation and resistance in today’s Egypt?

This op-ed by Kiyoteru Tsutsui originally appeared in Nikkei Asia.

As the summer of racial unrest forced America to confront its racist past and present yet again, a book by Heather McGhee, The Sum of Us: What Racism Costs Everyone and How We Can Prosper Together, which documents how racial division prevents Americans from uniting to lift everyone's lot, has attracted a good deal of attention.

From welfare to education to policing, Americans have generally supported policies that lifted the white middle class. But as the middle class has become more racially diverse, politics has become a divisive zero-sum game, with many whites seeing government spending as shifting money away from them toward minorities, even if whites also benefit.

This politics of racial division forecloses a social consensus that could boost the U.S. as a whole, leading to flagging social infrastructure, sputtering criminal justice system reform and challenges in offering broad economic support even to counter the pandemic.

This is not a problem unique to the United States. Social scientists have studied the relationship between racial division and low levels of public goods provision in multiple countries and established that ethno-racially heterogeneous societies tend to provide less in the way of public services.

Plagued by suspicions that some groups might benefit more than others, diverse societies tend to have greater difficulty in reaching consensus and working together on a strategy for economic and social development that would improve everyone's lives.

On this count, Japan is at the other end of the spectrum. More ethno-racially homogenous than most other advanced democracies, Japan has fared well when it comes to providing public goods such as efficient public transportation systems, low crime rates and universal health care.

Japan is often quick to reach a broad consensus about government spending on public services, since people generally feel that everyone benefits if they all support each other. Strong social cohesion, facilitated by the relative homogeneity of the population, enables this social consensus that supports spending on public goods.

The flip side of this coin is Japanese society's persistent resistance to diversity and disruption. Used to the comfort of living and working with similar people, Japan has been criticized for its reluctance to accept immigrants.

In response, the Japanese government has rather clumsily allowed immigrant workers in recent decades, first encouraging the migration of Japanese-Brazilians on the basis of shared ethnic roots that were supposed to make it easy for them to assimilate.

Learning that the reality of Japanese-Brazilians' life in Japan did not support this idea, Japan then adopted trainee programs to bring in foreign workers on a temporary basis. With the emphasis squarely on the temporary nature of their stay, those who came to Japan under this scheme could not contribute toward the country's long-term diversity.

Faced with a declining population, Japan needs immigrant labor, and its business leaders have consistently supported accepting more migrant workers. In addition to addressing the labor shortage, a more diverse workforce would likely stimulate innovation and facilitate adaptation to changing economic environments. Much social science research has demonstrated positive relationships between diversity and innovation.

Yet Japan's leaders are having a hard time pressing ahead. While it is easy for the public to come to a consensus for policies that boost all Japanese, it has proved difficult for them to support any policy that would undermine Japan's homogeneity.

Aside from ethnic diversity, Japan's consensus-oriented society is generally resistant to change. Valuing the protection of all members, companies have been slow to streamline and transform their operations to adapt to the changing economic environment, resulting in the prolonged economic decline since the 1990s.

While Brazil is home to the world's largest overseas Japanese population, many Japanese-Brazilians who moved to Japan discovered it was not easy for them to assimilate.

Urged on by American consultants, Japan imported America's neoliberal economic model to revitalize its economy through this period, and the lifetime employment and seniority-based salary system has given way to a rise in temp workers and various attempts to introduce a merit-based salary system. These efforts have not met with much success, leaving behind a questionable legacy, including the suppression of wages after the labor shortage of recent years.

In the U.S., racial division undermines the provision of public goods that would reduce economic inequality. But its acceptance of diversity contributes to innovation and economic revitalization that keeps the U.S. at the vanguard of a new economy.

In Japan, ethno-racial harmony facilitates public goods provision that prevents economic inequality from spiraling out of control. But aversion to diversity and dissent makes it difficult to accept much-needed immigrant labor and to adapt to changes in the economic environment.

In both countries, these characteristics are ingrained into their social fabric and resistant to change. However, the two largest economies with a democratic polity have much to learn from each other, and they should work together to find solutions for their problems.

Otherwise, China's nondemocratic model could become the dominant model for economic success, with its top-down forced consensus and suppression of diversity.

Democracies have long proven better at correcting their mistakes and adjusting to changes in their environment. As the two largest democratic economies in the world, the U.S. and Japan should be able to overcome the cost of racial division and the cost of homogeneity respectively even if it takes decades to achieve that.

In his March 15, 2021 lecture for SPICE’s Reischauer Scholars Program, actor George Takei—who played Hikaru Sulu, helmsman of the USS Enterprise in Star Trek—added “and Stand Back” to the iconic Star Trek words, “Live Long and Prosper,” as he was greeting students. His addition of “and Stand Back” was a message to the RSP students that it is important to continue to socially distance during the pandemic.

During his riveting lecture, Takei didn’t need to draw upon his acting skills to engage his audience of students as he recollected his family’s life after the Japanese attack on Pearl Harbor on December 7, 1941, and drew parallels between his family’s experience during World War II and anti-Asian sentiment and hate crimes (including killings and stabbings) against Asian Americans today. Takei was four years old at the time of the Pearl Harbor attack, and following the signing of Executive Order 9066 by President Franklin Roosevelt on February 19, 1942, Takei and his family along with approximately 120,000 people of Japanese descent—two thirds of whom were American citizens like Takei—were forced from their homes.

As he did with his legions of fans in Star Trek, Takei had the students glued to their screens as he recalled the day that he and his family were forced from their home in Los Angeles.

On that day that I can never forget, I had just turned five years old. It was a few weeks after my birthday, April 20. My father had gotten us dressed up hurriedly and told us to wait in the living room while my father and mother did some last-minute packing in the bedroom. Our baby sister was an infant and she was in the bedroom with them in a cradle. In the living room, my brother and I were just gazing out the front window at our neighborhood and suddenly we saw two soldiers marching up our driveway. They carried rifles with shiny bayonets on them. They stomped up the front porch and with their fists, began pounding the door. I still remember how it felt, like the walls were trembling… My father came out of the bedroom, answered the door, and literally, at gunpoint we were ordered out of our home… Shortly after and escorted by one of the soldiers, my mother came out holding our baby sister in one arm and a huge duffle bag in the other, and tears were streaming down her cheeks. The terror of that morning is still alive in me. I will never be able to forget that horrific day. It is seared into my memory.

Upon hearing this, RSP student Kogen Brown reflected, “I was deeply struck by the fact that these details remained in Mr. Takei’s mind after all these years. I remember only a few snippets of my life from that age, and the fact that he remembers so many specific aspects about the time that he was interned really goes to show the emotional and psychological impact that internment had on Japanese Americans—even those who were so young that they didn’t know what was happening or why it was happening to them.”

The War Relocation Authority (WRA) was the federal agency created in 1942 to oversee the Japanese Americans who were removed from the West Coast during World War II. The WRA built and operated a network of camps, where those removed were subjected to forced incarceration. Takei and his family were taken to the horse stables in Santa Anita Racetrack where they were assigned to a horse stall, which was still pungent with horse manure. The family stayed for four or five months in the so-called Santa Anita Assembly Center while the more permanent concentration camps were being built. From Santa Anita, Takei and his family were sent by train to the so-called Rohwer War Relocation Center in Arkansas. Takei recollected, “There, as a five-year-old child, I had an adventure. A discovery of a whole alien world. I am a southern Californian. I’m used to palm trees. In Rohwer beyond the barbed wire fence was the bayou. I have memories of camp as a fun experience, but that was a child’s experience. At the same time, parallel to my childhood experience, my parents had a grotesque experience—barbed wire fences, sentry towers, machine guns pointed at them. When we made the night run to the latrine from our barrack, searchlights followed us. My mother considered it an invasive, humiliating light but the five-year-old me thought it was nice that they lit the way for me to pee. Same experiences but two different memories.”

During his recollection of his life during World War II, Takei noted, “There are relevant lessons that apply to what’s happening today. We talk about Asian hate, hate of Asian people, and horrific things are being done to elderly Asians because of the pandemic we are going through. This kind of hate is what Japanese Americans were subjected to more than 80 years ago… back then, graffiti was painted on some of our homes, on our cars… like what’s happening today.”

Takei underscored the ironies of being detained behind barbed wire. He noted,

“I still can’t wrap my head around how horribly the U.S. government failed Japanese Americans,” reflected RSP student Kalia Lai, “Hearing from Mr. Takei that he and the other Japanese American students still had to say the Pledge of Allegiance at the start of school made me realize how empty those words, ‘with liberty and justice for all,’ turned out to be for Japanese Americans, and how inhumane the incarceration camps were.”

Takei also shared that in 1943, the War Department and WRA established a “loyalty questionnaire” as a means to assess the loyalty of all adults in the WRA camps. Takei spoke specifically about the final two questions, questions 27 and 28, which created confusion and resentment.

Question number 27 asked if Japanese Americans were willing to serve in the armed forces of the United States on combat duty wherever ordered. Question number 28 asked if individuals would swear unqualified allegiance to the United States and faithfully defend the United States from any or all attack by foreign or domestic forces, and forswear any form of allegiance or obedience to the Japanese Emperor, or any other foreign government, power, or organization. U.S. citizens resented being asked to renounce loyalty to the Emperor of Japan when they had never held a loyalty to the Emperor. At the time, Japanese immigrants were barred from becoming U.S. citizens, so they wondered if renouncing their only citizenship would leave them stateless.

Despite the confusion, thousands from Hawaii and the concentration camps served in the U.S. Army. The 442nd Regimental Combat Team was organized on March 23, 1943, after more than a year during which Americans of Japanese descent were declared enemy aliens by the U.S. War Department. Takei emphatically noted, “We weren’t the enemy, we were Americans.” The 442nd RCT became the most decorated unit for its size and length of service in U.S. military history. Following the end of the war, President Truman honored them and said, “You fought not only the enemy, but you fought prejudice—and you have won.”

Takei noted the importance for students to study about history as it teaches us important lessons and stated that he has made it his life’s mission to talk about the incarceration of Japanese Americans. “As a matter of fact, today we are living through a time that will be studied as a very important part of history by future generations,” expressed Takei. Recalling his years behind barbed wire, he emphasized that he and his family were viewed with suspicion and hate simply because of the way they looked. “There were no charges, no trial, no due process… Terror made toxic by racism started to affect the so-called leaders of our country, the politicians, but instead of leading, these politicians got swept up by the hysteria and became part of that hysteria… We have so much to learn from history because we are repeating the same kind of mentality that put us in these barbed wire prison camps.”

These words resonated in RSP student Noah Kurima, whose paternal grandparents were among the 120,000 who were incarcerated. Kurima commented, “What surprised me the most upon hearing Mr. Takei speak about his wartime experiences are the parallels that I see in our country eight decades later. As a 16-year-old, I would have hoped that more progress had been made in the area of cross-cultural understanding. The hysteria, racism, and failure of political leadership that Mr. Takei described from his childhood seem eerily similar to what I have seen in the media recently. I hope that the RSP students in the year 2100 will not be witnessing the same parallels that I am today.”

In a strongly emphasized message to the students, Takei said that the ideals of the United States “are noble but they become real and true only when the people infuse those ideals with truth with backing. At times of panic and hysteria, we start behaving irrationally.”

RSP Instructor Naomi Funahashi reflected, “I hope that my students especially take this message to heart. I honestly hesitated to close the session because of the clear impact that Mr. Takei was having on my students.” Funahashi gratefully acknowledged Takei and noted, “Sharing your recollections—particularly those of you as a five-year-old boy—we could feel your very palpable sense of terror and fear, and through your voice, you helped students to understand why it’s such an important issue to study today.”

George Takei is a social justice activist, social media superstar, Grammy-nominated recording artist, New York Times bestselling author, and pioneering actor whose career has spanned six decades. He has appeared in more than 40 feature films and hundreds of television roles, and he has used his success as a platform to fight for social justice, LGBTQ+ rights, and marriage equality. For the full story of George Takei’s childhood imprisoned within American concentration camps during World War II, see his graphic memoir, They Called Us Enemy. Naomi Funahashi and I are grateful to Brad Takei for his support of George’s lecture and this article, and also to Michael Kurima for his support as a liaison between SPICE and George Takei.

This interview with APARC and Korea Program Director Gi-Wook Shin was originally published in Asia Experts Forum, a student-curated journal from the Keck Center for International and Strategic Studies at Claremont McKenna College. Ava Liao, a student journalist pursuing a dual major in International Relations and Media Studies, reported this story.

While Korean national identity was historically defined against Japanese imperialism, in more recent times Korean identity is responding to new influences related to globalization. How has Korean national identity been shaped by the distinctly Korean policy of segyehwa in the face of globalization?

Japanese colonialism was instrumental to the formation of Korean national identity. The Korean peninsula is surrounded by big powers such as China, Japan, and Russia. Even today, these influences are still very strong. A sense of threat is still there. Furthermore, although Korea is divided into North and South, Koreans share a strong sense of ethnic unity. Both North and South Koreans believe that they belong to a single nation, ethnicity, and race. For Koreans, this conflation of nation, ethnicity and race emphasizes the idea that there is a single bloodline going back to Dangun, a common ancestor and the mythic founder of the Korean nation. Even though they are divided, both sides believe that it is unnatural and only temporary and that they will eventually be reunified. 

Korea is very homogeneous; only about five percent of the population is non-ethnic Korean. The issue of maintaining social cohesion in the face of a growing power of globalization ironically strengthens ethnic identity. South Korea is trying to promote Korean culture on the world stage. Look at BTS, for example, and Parasite. Korean culture becoming popular around the world is fairly new and Koreans are really proud of that. The economy has grown greatly, it is a G20 country, and South Korea is proud of exporting its culture so successfully. With globalization, there have also been further efforts to absorb the overseas Korean population into the Korean identity and to utilize them as representatives in their host or resident countries. All these interrelated factors shape Korean national identity.

Your 2012 article “Racist South Korea? Diverse but Not Tolerant of Diversity,” concludes that although South Korea has become multi-ethnic, it has yet to become multicultural. It also outlines how foreigners, migrant workers of Korean ethnicity, and those with darker skin color often face discrimination in South Korea. Have these dynamics changed significantly since 2012?

Not so much. South Korea has been promoting multiculturalism as a policy initiative since 2006, so it is a fairly new phenomenon in Korean society. Foreign brides—from China, Vietnam, and other countries—marry Korean men and move to South Korea. They make contributions to the reproduction of the nation, which has an aging population and a low birth rate. It becomes a question of how to assimilate, and how these foreign brides can be integrated into Korean society. Even though the rhetoric is inclusive, in reality it is not very much so. Foreign brides are taught to assimilate into Korean culture and society, for example, by learning the Korean language, how to make kimchi, and how to respect the elderly. Another respect is in migrant labor, especially unskilled workers from developing countries. They are basically on a temporary visa, have little legal protection, and face a great deal of discrimination. Lower-class ethnic Koreans from China and North Korean defectors are also looked down upon, even if they belong to the same Korean nation. There is a gap between perception and reality. While they are told that they belong to the same nation and ethnicity, in reality, what really matters is class. Class matters much more than ethnicity, nationality, or even citizenship in practice. Foreign brides, migrant workers, and North Korean defectors are treated much poorly in South Korea than say, middle-class Korean-Americans or professionals from developed countries.

Your article also features Park No-Ja’s argument that colorism and white supremacy are inextricably linked in South Korean society. Why is this phenomenon prevalent across East Asia and Southeast Asia?

It reflects the reality of who has power in the world. If you refer back to history, this is very Orientalist thinking. Orientalism is the understanding of the East from the Western perspective, and Asians have not been able to overcome Orientalism. Even in Korea as I mentioned earlier, there is much higher regard for white people coming from developed countries, in comparison to Asians from developing parts of Asia, or Africans. They are not shown much respect. Even with Japan challenging the United States as a competing power in the 1980s and now China, Asians are generally not respected on the international stage as much as Americans, for example. Ironically, that is quite true, or even worse in Asia. 

The Black Lives Matter protest movement that began in the United States has greatly expanded in its global reach, although less so in East Asia. Why has the BLM movement against racism found so little resonance or support in East Asian countries?

If you compare the Black Lives Matter movement to the #MeToo movement, the #MeToo movement had much greater impact in South Korea. BLM has not had very much impact so far in South Korea, Japan, or China for different reasons. Korea had a very strong feminist movement already. #MeToo was immediately embraced by feminists and developed very quickly, but BLM has hardly found any resonance or community in East Asia. 

For Japan and South Korea, ethnic homogeneity is still very strong. There are ethnic minorities, but the population is very small. There have been some movements from ethnic minorities in Japan, but they have very little voice and are not as well-organized as BLM here. In the case of Korea, once again, most ethnic minorities are foreigners and often temporary residents, whereas black people have a much longer history in the U.S. In Korea, the majority came as adults, rather than being born and growing up there. There are some NGOs advocating for the rights of those migrants, but their impact is still limited. China is a different case. The Chinese government officially recognizes 56 different ethnic groups, with Han Chinese being the majority. China is very nervous about the breakup of the national minority structure, which is why they are repressing Xinjiang and Tibet. China suppresses any movements advocating for independence of national minorities. Japan, Korea, and China have not been much receptive to the BLM movement, for these different reasons. 

We can learn a lot from the BLM movement in studying racism in Asia but there exists a separation between Asian Studies and ethnic studies. While race and ethnicity are popular topics of discussion in the U.S., they are not much talked about in Japan or South Korea, which may also explain why there is so little resonance in East Asian countries. We, Asian experts, need to learn from the insights of ethnic studies in addressing racism in Asia.

South Korea notably has no legal protections against racial discrimination. Is this likely to change in the future, given the changing values of the younger generation?

Overall, Korea is improving protection against discrimination, especially with regards to gender and sexual minorities. They are moving in the right direction. In contrast, racial discrimination does not get much attention from the public, the media, or the government because the ethnic minority population is so small. The same goes to religious minority. For example, there are more than 100,000 Muslims in Korea right now, but there are very few Koreans who even know that there are so many Muslims. Most of them do not really understand Muslim culture, and may mainly associate them with terrorists. It is a lack of understanding and ignorance, and even though they exist, Koreans just ignore them. The Black community in Korea is even smaller, so they do not see it affecting Korean society that much. They understand that it is a global issue, but do not see it as their issue yet. 

How has the outbreak of COVID-19 exacerbated racial inequalities in South Korea?

COVID-19 certainly made the situation much more difficult for the foreign unskilled workers in Korea. The majority of them are physical workers in non-office jobs, which means they cannot work remotely. Many of them have been forced out of jobs, so they either have to go back to their country of origin or stay in Korea without stimulus funds or medical and other financial assistance that are available to Korean citizens. Many of them are also illegal or unregistered workers, so they have to hide from the government even if they do have symptoms or come into contact with the virus. Recently, there has been a number of unassisted COVID-19 deaths of unregistered foreign workers in Korea because they avoided seeking medical treatment out of a fear that they might be deported. The pandemic has also increased inequalities for society as a whole, so those already suffering from racial inequality experience it even more. Even here in the U.S., it is one story if a white male spreads COVID-19, but it is another if a Chinese one spreads it. There are similar aspects of racial discrimination in Korea. It makes bigger news if a foreign worker spreads the virus, and feeds into the same kind of prejudice.