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Beth Duff-Brown
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As global health assistance for developing countries dwindles, a Stanford student working on her PhD in health policy has developed a novel formula to help donors make more informed decisions about where their dollars should go.

Donors have typically relied predominately on gross national income (GNI) per capita to determine aid allocations. But using GNI is problematic because it effectively penalizes economic growth. It also fails to capture contextual nuances important to channeling aid effectively and efficiently.

So Tara Templin, a first-year Stanford PhD student specializing in health economics, and her Harvard colleague Annie Haakenstad, have developed a framework that estimates funding based on needed resources, expected spending and potential spending into 2030. They believe the more flexible model makes it adaptable for use by governments, donors and policymakers.

“We've observed development assistance for health growth attenuate over the last seven years,” said Templin, who was a research fellow at the Institute for Health Metrics and Evaluation before coming to Stanford. “There are difficult trade-offs, and this entails honing in on the specific challenges and countries most in need.”

Their research published in the journal Health Policy and Planning outlines how their “financing gaps framework” can be adapted to short- or long-run time frames, between or within countries.

“Depending on donor preferences, the framework can be deployed to incentivize local investments in health, ensuring the long-term sustainability of health systems in low- and middle-income countries, while also furnishing international support for progress toward global health goals,” write the authors, who also are Stephen Lim of the University of Washington, Jesse B. Bump of Harvard and Joseph Dieleman, also at the University of Washington.

The authors developed a case study of child health to test out their framework. It shows that priorities vary substantially when using their results as compared to focusing mainly on GNI per capita or child mortality.

The case study uses data from the Global Burden of Disease 2013 Study, Financing Global Health 2015, the WHO Global Health Observatory and National Health Accounts. Funding flows are anchored to progress toward the U.N. Sustainable Development Goals’ target for reductions in the death rates of children under 5. More than six million children die each year before their fifth birthday, so the United Nations set a goal to reduce under-5 mortality to at least 25 per 1,000 live births.

To build their child health case study, the authors relied on a 2015 study that estimated the average cost per child-life saved is $4,205 in low-income countries, $6,496 in lower-middle income countries and $10,016 in upper-middle countries.

The framework considers three concepts. First, expected government spending is constructed from national health accounts, which are standardized financial reports from countries around the world. Second, ability to pay is estimated by looking at countries with similar levels of economic development and looking at associations with country investment in the health sector. Lastly, needed investment considers a health target, the country’s current health burden, and average costs to save children’s lives in each country.

“Our focus is on the gap between the resources needed to reach critical health targets and domestic health spending,” the authors wrote. “We highlight two facets of domestic health resources—expected spending and potential spending—as critical. While donor preferences may vary, basing aid allocation on expected or existing spending levels incentivizes countries to spend less on health. We therefore propose the use of potential spending, which is a measure of a country’s ability to pay, as the domestic resource benchmark.”

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Instead of the gap between expected spending and need, their framework focuses on the gap between potential spending and the health resources needed to meet global health targets. In the framework, policymakers can choose which gap they want to target, since this decision can involve many factors.

“By focusing on that gap, donors can catalyze sustained domestic spending while also addressing the resource needs critical to reaching international health goals,” they wrote.

They then looked at 10 countries with the most need for additional child health resources. The gap between expected spending and potential spending was highest in Afghanistan, at 79 percent, and lowest in Cameroon, where expected spending exceeded potential spending.

“Fifty years ago, GNI was the best proxy for countries’ ability to finance their own development and health,” the authors wrote.

But today, more empirical data and technology are available, allowing donors to incorporate a broader set of health financing measures into their decision-making process.

“The flexible but targeted nature of our framework is critical in the current era of global health financing,” said Haakenstad, the lead author. “Our framework helps to ensure the poor and disadvantaged, the majority of which now reside in middle-income countries, are reached by development assistance and other public financing. This funding is critical to reducing death and disability and reaching global targets in health.”

 

The authors’ research was supported by the Welcome Trust (099114/Z/12/Z).

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Co-sponsor: Center for African Studies

 

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Join the Center on Democracy, Development, and the Rule of Law (CDDRL) in partnership with the Center for Africa Studies for a rare opportunity to hear from one of Kenya’s leading human rights activists and the former United Nations Special Rapporteur on the Rights to Freedom of Peaceful Assembly and of Association (2011-2017) - Maina Kiai - in conversation with Larry Diamond on Kenya’s 2017 disputed presidential election. This discussion will also reflect on the growing democratic recession in Africa and how Kenya’s recent election has undermined the country's electoral democracy. Maina Kiai is a visiting practitioner at the Levin Center at Stanford Law School this quarter and was a 2007 Draper Hills Summer Fellow at CDDRL.

 

Speaker Bio:

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maina kai
Mr. Maina Kiai was the United Nations Special Rapporteur on the rights to freedom of peaceful assembly and of association from May 2011 until April 2017. A lawyer trained at Nairobi and Harvard Universities, Mr. Kiai has spent the last twenty years campaigning for human rights and constitutional reform in Kenya – notably as founder and Executive Director of the unofficial Kenya Human Rights Commission, and then as Chairman of Kenya’s National Human Rights Commission (2003-2008), where he won a national reputation for his courageous and effective advocacy against official corruption, in support of political reform, and against impunity following the violence that convulsed Kenya in 2008, causing thousands of deaths. From July 2010 to April 2011, Mr. Kiai was the Executive Director of the International Council on Human Rights Policy, a Geneva-based think-tank which used to produce research reports and briefing papers with policy recommendations. Mr. Kiai was also the Director of Amnesty International’s Africa Programme (1999-2001), and the Africa Director of the International Human Rights Law Group (now Global Rights, 2001-2003). He held research fellowships at the Danish Institute for Human Rights (Copenhagen), the Woodrow Wilson International Center for Scholars (Washington), and the TransAfrica Forum (Washington). Mr. Kiai has regularly been an advocate informing and educating Kenyans through various media about their human rights.

 

Speaker Bio:

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Larry Diamond is a senior fellow at the Hoover Institution and at the Freeman Spogli Institute for International Studies. For more than six years, he directed FSI’s Center on Democracy, Development, and the Rule of Law, and he continues to lead its programs on Arab Reform and Democracy and Democracy in Taiwan. He is the founding co-editor of the Journal of Democracy and also serves as Senior Consultant at the International Forum for Democratic Studies of the National Endowment for Democracy. His sixth and most recent book, In Search of Democracy (Routledge, 2016), explores the challenges confronting democracy and democracy promotion, gathering together three decades of his work on democratic development, particularly in Africa and Asia.  He has also edited or co-edited more than 40 books on democratic development around the world.

 

 

 

 

Maina Kiai Human Rights Activist, former United Nations Special Rapporteur on the rights to freedom of peaceful assembly and of association

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Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies
William L. Clayton Senior Fellow at the Hoover Institution
Professor, by courtesy, of Political Science and Sociology
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MA, PhD

Larry Diamond is the William L. Clayton Senior Fellow at the Hoover Institution, the Mosbacher Senior Fellow in Global Democracy at the Freeman Spogli Institute for International Studies (FSI), and a Bass University Fellow in Undergraduate Education at Stanford University. He is also professor by courtesy of Political Science and Sociology at Stanford, where he lectures and teaches courses on democracy (including an online course on EdX). At the Hoover Institution, he co-leads the Project on Taiwan in the Indo-Pacific Region and participates in the Project on the U.S., China, and the World. At FSI, he is among the core faculty of the Center on Democracy, Development and the Rule of Law, which he directed for six and a half years. He leads FSI’s Israel Studies Program and is a member of the Program on Arab Reform and Development. He also co-leads the Global Digital Policy Incubator, based at FSI’s Cyber Policy Center. He served for 32 years as founding co-editor of the Journal of Democracy.

Diamond’s research focuses on global trends affecting freedom and democracy and on U.S. and international policies to defend and advance democracy. His book, Ill Winds: Saving Democracy from Russian Rage, Chinese Ambition, and American Complacency, analyzes the challenges confronting liberal democracy in the United States and around the world at this potential “hinge in history,” and offers an agenda for strengthening and defending democracy at home and abroad.  A paperback edition with a new preface was released by Penguin in April 2020. His other books include: In Search of Democracy (2016), The Spirit of Democracy (2008), Developing Democracy: Toward Consolidation (1999), Promoting Democracy in the 1990s (1995), and Class, Ethnicity, and Democracy in Nigeria (1989). He has edited or coedited more than fifty books, including China’s Influence and American Interests (2019, with Orville Schell), Silicon Triangle: The United States, China, Taiwan the Global Semiconductor Security (2023, with James O. Ellis Jr. and Orville Schell), and The Troubling State of India’s Democracy (2024, with Sumit Ganguly and Dinsha Mistree).

During 2002–03, Diamond served as a consultant to the US Agency for International Development (USAID) and was a contributing author of its report, Foreign Aid in the National Interest. He has advised and lectured to universities and think tanks around the world, and to the World Bank, the United Nations, the State Department, and other organizations dealing with governance and development. During the first three months of 2004, Diamond served as a senior adviser on governance to the Coalition Provisional Authority in Baghdad. His 2005 book, Squandered Victory: The American Occupation and the Bungled Effort to Bring Democracy to Iraq, was one of the first books to critically analyze America's postwar engagement in Iraq.

Among Diamond’s other edited books are Democracy in Decline?; Democratization and Authoritarianism in the Arab WorldWill China Democratize?; and Liberation Technology: Social Media and the Struggle for Democracy, all edited with Marc F. Plattner; and Politics and Culture in Contemporary Iran, with Abbas Milani. With Juan J. Linz and Seymour Martin Lipset, he edited the series, Democracy in Developing Countries, which helped to shape a new generation of comparative study of democratic development.

Download full-resolution headshot; photo credit: Rod Searcey.

Former Director of the Center on Democracy, Development and the Rule of Law
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Part of an eighteen-month Academy project on Civil Wars, Violence, and International Responses, the essays in the Winter 2018 issue of Dædalus consider the impediments to ending civil wars and offer policy recommendations for states involved in conflict and for the international community. The companion Fall 2017 issue of Dædalus describes the causative factors of civil wars in the modern era, examines the security risks posed by intrastate violence, and explores the challenges confronting external actors.

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Stephen D. Krasner
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A critical question for agricultural production and food security is how water demand for staple crops will respond to climate and carbon dioxide (CO2) changes1, especially in light of the expected increases in extreme heat exposure2. To quantify the trade-offs between the effects of climate and CO2 on water demand, we use a ‘sink-strength’ model of demand3,4 which relies on the vapour-pressure deficit (VPD), incident radiation and the efficiencies of canopy-radiation use and canopy transpiration; the latter two are both dependent on CO2. This model is applied to a global data set of gridded monthly weather data over the cropping regions of maize, soybean, wheat and rice during the years 1948–2013. We find that this approach agrees well with Penman–Monteith potential evapotranspiration (PM) for the C3 crops of soybean, wheat and rice, where the competing CO2 effects largely cancel each other out, but that water demand in maize is significantly overstated by a demand measure that does not include CO2, such as the PM. We find the largest changes in wheat, for which water demand has increased since 1981 over 86% of the global cropping area and by 2.3–3.6 percentage points per decade in different regions.

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Nature Climate Change
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Daniel W. Urban, Justin Sheffield
David Lobell
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Andrew Myers
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Political scientist Anna Grzymala-Busse finds that authoritarians face a choice in the face of change: try to cling to power, exit governing or reinvent themselves as democrats. It’s those who reinvent themselves as newly minted democrats who fare the worst in the long run.

In the years since World War II, as the global geopolitical map was drawn and redrawn along ideological lines, the world witnessed ascension of many authoritarians. They often ruled for long stretches, but eventually most faced a political reckoning. The people they governed no longer accepted their authority and demanded change.

The fate of authoritarians in the aftermath of such crises is the subject of a new study in the journal Party Politics written by Stanford political scientist Anna Grzymala-Busse. At such inflection points, she says, authoritarians face a [[{"fid":"229407","view_mode":"crop_870xauto","fields":{"format":"crop_870xauto","field_file_image_description[und][0][value]":"Photograph of Anna Grzymala-Busse.","field_file_image_alt_text[und][0][value]":"Photograph of Anna Grzymala-Busse.","field_file_image_title_text[und][0][value]":"Photograph of Anna Grzymala-Busse.","field_credit[und][0][value]":"","field_caption[und][0][value]":"","thumbnails":"crop_870xauto","alt":"Photograph of Anna Grzymala-Busse.","title":"Photograph of Anna Grzymala-Busse."},"type":"media","field_deltas":{"1":{"format":"crop_870xauto","field_file_image_description[und][0][value]":"Photograph of Anna Grzymala-Busse.","field_file_image_alt_text[und][0][value]":"Photograph of Anna Grzymala-Busse.","field_file_image_title_text[und][0][value]":"Photograph of Anna Grzymala-Busse.","field_credit[und][0][value]":"","field_caption[und][0][value]":"","thumbnails":"crop_870xauto","alt":"Photograph of Anna Grzymala-Busse.","title":"Photograph of Anna Grzymala-Busse."}},"link_text":null,"attributes":{"alt":"Photograph of Anna Grzymala-Busse.","title":"Photograph of Anna Grzymala-Busse.","style":"float: right; height: 350px; width: 200px; margin-top: 10px; margin-left: 15px; margin-bottom: 10px;","class":"media-element file-crop-870xauto","data-delta":"1"}}]]choice:theycan cling to power, albeit by ceding a certain degree of control, or they can exit governing altogether, either by dissolving the party entirely or, more dramatically, by reinventing themselves as democrats.
 

Newly minted democrats

It was these reinventors – the newly minted democrats – that intrigued Grzymala-Busse the most. She found that while many enjoyed initial electoral success, most ended up losing power in the long run.
 
“Paradoxically,” Grzymala-Busse said, “this fate seems to flow precisely from the decision to reinvent their organizations, their political symbols and their state programs to fit the norms of free political competition.”
 
In adopting democratic rhetoric and standards of competence, it seems, the parties find initial success, but then are unable to sustain newfound democratic philosophies and programs. They hoist themselves on their own petards, as she put it in her paper, alluding to Shakespeare’s Hamlet.
 
These reinvented parties often attract new politicians who are more entrepreneurial than their predecessors. Those new faces, however, often prove to be mere opportunists. The resulting scandals destroy party credibility and contribute to an unending downward political spiral.

Ironically, Grzymala-Busse found that the best choice for authoritarians is simply to cling to power “counting on a loyal if unhappy electorate,” even if it means ceding much of their once-monopolistic grip on power to democratic reforms.

81 governments studied

For her study, Grzymala-Busse examined and quantified the resulting political denouements of 81 authoritarian governments spanning the period from 1945 to 2015. Countries studied include the former Soviet Bloc, China, Cuba, several in Southeast Asia, many African nations and Mexico. The governing systems ranged from the communism of the Soviet Bloc and socialism to secular state-building and rule for the sake of national security.

The success of the reinventors can be rapid and remarkable, but so too can be the demise. Grzymala-Busse noted that the Hungarian Socialist Party won 43 percent of the vote and 49 percent of the seats in 2006, only to succumb to allegations of deception, mismanagement and fraud soon afterward. In Poland, the Democratic and Left Alliance (SLD), which won 41 percent of the vote in 2001, watched as its power steeply declined in the subsequent decade until the party dissolved entirely in 2011.

“Those who reinvented shone more brightly for a brief time, but burned out. Those who chose orthodoxy never enjoyed the great success of the reinventors, but they survived,” she said.

And what of those authoritarians who choose neither to remain nor to reinvent? Grzymala said that they simply dissolve back into society where former members often capitalize on their connections to become captains of industry.

“Some become oligarchs,” she said, “retaining power by other means.”

Lessons on change

The takeaway of her study for at-risk authoritarians, Grzymala-Busse said, is that reinvention alone is not enough to carry the party. New parties cannot survive as the remnants of their former selves. They must become entirely new organizations with viable programmatic approaches. Likewise, she said, when newly minted democrats hail competence as a competitive advantage, they must make good on the promise. If they fall short, they face exceptionally harsh outcomes at the polls.

“The irony is, without real change, the parties that built democracy by supporting free elections fall victim to those same democratic forces they championed.”

Anna Grzymala-Busse is the Kevin and Michelle Douglas Professor of International Studies and a senior fellow at the Freeman Spogli Institute for International Studies at Stanford University.

The study was made possible by financial support from the Carnegie Foundation.

 

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Beth Duff-Brown
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Family planning programs in developing countries that offer contraceptives and reproductive health advice apparently do more than prevent pregnancies — they can keep girls in primary school for up to a year longer, even before the youngsters start to think about marriage and babies.

New research by Stanford Health Policy’s Grant Miller and Kim Singer Babiarz indicates that the availability of modern contraceptives alone can keep young girls in the classroom longer, likely because their parents develop greater expectations for their daughters’ long-term health outcomes and economic opportunities.

“What we find is that family planning exposure at a young age is linked to greater opportunities later in life – including economic empowerment,” said Babiarz, an SHP research scholar with a PhD in agricultural economics who focuses on women and children in development. “The fertility effects were modest; the most striking findings were the incentives created to keep girls in school and improvements in the types of jobs women have later in life.”

Babiarz and Miller, a senior fellow at the Freeman Spogli Institute for International Studies and director of the Stanford Center on Global Poverty and Development, unveiled their study at the annual meeting of the Center for Global Development in Washington, D.C. on Dec. 7.

They conducted research with Christine Valente, an associate professor in the department of economics at the University of Bristol and Tey Nai Peng, the principal investigator for the Malaysia Family Life Survey. The Southeast Asia nation was one of the first low-income countries to provide modern contraceptives on a large scale, first in 1954 and then establishing a National Family Planning Board in 1966.

The government then scaled up its national program between 1966 and 1974 and conducted robust surveys with retrospective life histories and detailed community-level information about the timing of family planning availability. The use of contraceptives such as the pill, condoms and IUDs, went from 3 percent in 1961 to 39 percent in 1975. The country also experienced a decrease in the fertility rate of 6.2 children to 4.3 during the same period.

The researchers were able to compare what happened to Malaysian girls who were very young when contraceptives became available in their communities to those who were adolescents when they first gained access to modern contraception. They were not surprised by the effects on fertility; that has generally been the case in countries that adopt large-scale family planning programs.

But they also found unintended incentives: that girls in communities with family planning clinics stayed in school six months longer, increasing to more than an additional year for the girls who were born after the family planning programs began. And it didn’t matter if the girls had fewer younger siblings at home.

Other benefits later in life included better jobs when they became adults. When the Malaysian girls were grown, they were more likely to take in their own elderly parents (relative to their husbands’ parents), a signal of increased status in their households. In fact, they found that the incentives for investing in girls created by family planning may actually outweigh its direct effects, which work through reductions in fertility and changes in birth timing.

“The existence of family planning and contraceptives may lead parents to believe their daughters can participate in the labor force and that more schooling will therefore benefit them,” Miller said. “In other words, it can change their expectations about the world their daughter will live in one day.”

Few studies explicitly distinguish the incentive effects of family planning on women’s education from its direct effects on fertility. Miller said he hoped the new findings might lead policymakers to consider the broader beneficial consequences of family planning beyond those that work directly through changes in pregnancy and fertility.

“A central contribution of this working paper is that it studies the possible incentive effects of family planning programs for human capital investment in girls,” the authors wrote,” which could then translate into improvements in women’s economic status throughout their lives.”

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Food security experts identify government support, policy implementation, private sector engagement and investment in smallholder farmers as keys to Africa’s agricultural future.

Food security experts from the Alliance for a Green Revolution in Africa (AGRA) gathered to discuss transforming food production in Africa at Stanford on Nov. 29. The symposium, hosted by the Center on Food Security and the Environment (FSE) examined the challenges, strategies, and possible solutions for catalyzing and sustaining an inclusive agriculture transformation in Africa. 

Moderator Ertharin Cousin, FSE visiting fellow and previous World Food Programme director with more than 25 years of experience on hunger, food, and resilience strategies, launched the panel by outlining Africa’s plight. “Today some 100 million of the farmers across Sub-Saharan Africa farm less than 2 hectares of land. Some 80 percent of those living in rural areas are poor. More than 30 percent of the rural population is chronically hungry and 35 percent of the under-five-year-olds are stunted. By 2050, the bulk of the world's population growth will take place on the continent. In fact, some project that 1.3 billion will be added to the continent, and Nigeria’s [population] will grow larger than the size of the United States between now and 2050,” Cousin said

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While Africa continues to experience the highest occurrence of food insecurity worldwide, the continent also contains over 60 percent of the worlds uncultivated but fertile land. AGRA formed in 2006 to fulfill the vision that Africa can feed itself and the world. Panelists included Agnes Kalibata, AGRA President and former Minister of Agriculture and Animal Resources of Rwanda; Kanayo F. Nwanze, AGRA board member and immediate past president of the International Fund for Agricultural Development; Usha Barwale Zehr, AGRA board member and Director and Chief Technology Officer of Maharashtra Hybrid Seeds Company Private Limited; and Rajiv Shah, AGRA board member, Rockefeller Foundation President and former Administer of USAID.

Kanayo F. Nwanze stressed the importance of agricultural transformation for Africa’s future. “No country in the world ever transformed itself without going through an agrarian change. No country. Europe, 17th; Japan, 18th century; 19th century was the US, your country; China, 20th century. Why should they be different from Africa? So, first and foremost, we have to have total agricultural transformation,” Nwanze said.

AGRA president, Agnes Kalibata, also spoke to the need for policy implementation and government support in helping drive change. “AGRA as an institution can only do so much. But these governments have the potential and the capacity to reach every corner of their countries. The problem is they are challenged by capacity to do that, by capacity to design proper programs, and by capacity to implement these programs,” Kalibata said.

Expanding on governments' ability to impact and drive change, Usha Barwale Zehr highlighted Asia’s success, specifically with strategic partnerships. “…we've done a lot of talking about public/private partnership. Not so much on the ground on implementing it in a manner, which happened in Asia, for instance, where there was policy, and, most importantly, government will. The government was willing to do whatever it took to make sure that agriculture was transformed at the end of it,” Zehr said.

Beyond government and policy support the panelists also addressed the need for innovation and access to seed technologies. “Why is it that the African farmer and the Indian farmer should not have access to what the American farmer has access to today and reaps benefit from it? …So it's the hybrids, the varieties, the GM technology. Tomorrow it'll be the gene-edited products. And after that we will talk about the satellite-based imaging data that we will use for developing drought-tolerant crops for that very, very small micro environment that existed in the one district in Nigeria,” Zehr said.

"By 2050, who is going to feed Africa? … It's the youth of today. But they're not going to be using the same technologies that exist today. Just think of what IT can do, aggregation, organization of farmer's groups. So, the elements are there. I see the agriculture of tomorrow meeting the challenge – for Africa meeting that challenge is Africa being at the forefront of feeding the world. Africa has to be able to feed itself first. And we have all the opportunities there,” Nwanze said.

This is the first installment of the Global Food Security Symposium series hosted by Stanford University's Center on Food Security and the Environment and generously supported by Zach Nelson and Elizabeth Horn. FSE is a joint initiative of the Stanford Woods Institute for the Environment and the Freeman Spogli Institute for International Studies.

 

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There is plenty of research on how the rapid warming of the planet is going to have growing adverse impacts on global economies, health, food supplies and natural disasters.

A new study now suggests that as temperatures continue to rise — particularly with more and more 90-plus-degree days — more fetuses and infants will experience economic loss by age 30.

“There is a growing body of evidence that finds that shocks to the fetus and young child — whether nutritional, environmental, economic or stress-related — have long-term consequences on health, education and economic outcomes throughout the life cycle,” said Maya Rossin-Slater, an assistant professor of health research and policy at Stanford Medicine and a faculty fellow at the Stanford Institute for Economic Policy Research.

Rossin-Slater published her study Dec. 4 in the Proceedings of the National Academy of Sciences, indicating early-life exposure to extreme temperatures is linked to potential losses in human capital. Her co-authors are Adam Isen, an economist with the U.S. Department of Treasury, and Reed Walker, an assistant professor at University of California, Berkeley.

The researchers used data from the U.S. Census Bureau’s Longitudinal Employer Household Dynamic Files, which contain information on adult labor market outcomes linked to county and exact date of birth. They looked at weather in counties in 24 states on any given day, and then measured how many days with average temperatures above 90 degrees a child born on that day in that county would have experienced during gestation and during the first year of life. They then compared the earnings of individuals who were exposed to different numbers of such hot days, but who were of the same race and gender, and born in the same county and on the same day of the year (but in different years).

Each day a fetus or infant experiences 90-plus-degree temperatures, Rossin-Slater and her co-authors found that he made $30 less a year on average, or $430 over the course of his lifetime. While that may not seem like a huge loss of income, the authors point out that their study is best understood from a population-level perspective rather than from an individual one.

“There is a lot of research already showing that extreme heat has immediate effects on labor market productivity and GDP,” she said. “What we are saying is that there is another wrinkle to this — that there can be consequences many years later, on cohorts who are still in the womb.”

Most Americans today only experience one day a year that is 90 degrees or hotter. But the Climate Impact Lab has indicated that if countries continue to take only moderate action on climate change, by the end of this century there will be about 43 such days a year.

So, if you multiple a $30 annual loss a day by 43 days, you come up with an average $1,290 a year — and compounded in large populations of pregnant women in hot climates.

“Prior research shows that exposure to extreme heat in utero leads to lower birth weight and increases infant mortality,” said Rossin-Slater, who is also a core faculty member at Stanford Health Policy. She said poor fetal and infant health could impact adult earnings in three ways: cognitive impairment, poor health that causes people to miss school or work, and less non-cognitive skill development such as self-control.

“With regard to exposure to heat specifically, fetuses and infants are especially sensitive because their thermoregulatory systems are not fully developed and they have less capacity to self-regulate when their bodies are exposed to extreme temperatures,” Rossin-Slater said.

Hot Zones and Air Conditioners

The obvious questions that arise from such research: What happens to the babies of women who already live in very high temperatures? And why not just ensure that all pregnant women have air conditioners, at least in the developed world where it would be more affordable?

Women in warm zones such as parts of Africa and South Asia, as well as U.S. cities like Phoenix and Washington, D.C., shouldn’t worry too much. The loss of income is relatively little and people living in hot climates may actually adapt over time to exposure to extreme heat.

“Our study is not saying that individual people should be doing something differently to avoid exposure to extreme heat,” Rossin-Slater said. “Instead, we think we are providing additional evidence for the possible population-level consequences of climate change and the projected increase in the number of days with extreme temperatures.”

And what about those air conditioners? The cohorts in the study are actually born in the 1970s, during a period of rapid expansion in air conditioning across American households. The researchers found the earning losses went away in areas where most people got air conditioners installed.

“If we think that there is something biological going on as a result of the fetus being overheated, then it makes sense that AC, which prevents the overheating, can mitigate this negative effect,” Rossin-Slater said.

But it’s important to recognize, she said, that air conditioners come with costs, both financial from the perspective of individuals and households who can and can’t afford such systems, and environmental from the perspective of the country or planet as a whole.

“So this is not a `free’ solution and any cost-benefit calculations related to climate change should take into account this adaption response,” Rossin-Slater said. “But we ought to think about what these results imply at the global level — in many countries that are much hotter than the United States and still don’t have AC. So if we are trying to understand global inequality and the impacts of climate change on developing countries, our results suggest that climate change could play a role in perpetuating global inequality across generations.”

 

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