The Shorenstein Asia Pacific Research Center (APARC) is pleased to welcome three postdoctoral fellows for the 2018-19 academic year. The cohort includes two Shorenstein Postdoctoral Fellows and one Developing Asia Health Policy Fellow. All three will begin their year of academic study and research at Stanford this fall.

For more than a decade, Shorenstein APARC has sponsored numerous junior scholars to come to the university and work closely with Stanford faculty, develop their dissertations for publication, participate in workshops and seminars, and present their research to the broader community. APARC's Asia Health Policy Program sponsors young scholars who pursue original research on contemporary health or healthcare policy of high relevance to countries in the Asia-Pacific region, especially developing countries.

The 2018-19 fellows carry a broad range of interests including authoritarianism in Southeast Asia, the use of coercion in national security, and community health policy in developing countries. Continue reading to learn about their qualifications and research plans:

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When U.S. Vice President Michael Pence recently met with Japanese Prime Minister Shinzo Abe in Tokyo ahead of the Pyeongchang Winter Olympics, he declared that “The United States-Japan alliance is the cornerstone of peace, prosperity, and freedom in the Indo-Pacific.” Examining U.S.-Japan security relations is a priority of Stanford’s U.S.-Asia Security Initiative (USASI) at the Shorenstein Asia-Pacific Research Center. Just days prior to the Vice President’s remarks, USASI and the Sasakawa Peace Foundation (SPF) co-hosted the 2018 the U.S.-Japan Security and Defense Dialogue Series, where a key theme was coordination and cooperation in the long-standing U.S.-Japan security relationship.

Held in Tokyo from January 31 through February 2, this workshop convened senior Japanese and American policymakers, military leaders, scholars, and regional experts to discuss Japan's security strategy and the alliance between Japan and the United States. It is part of a dialogue series that deepens a discourse on contemporary Asia-Pacific security issues, while building bridges between American and Asian academics, government and military officials, and other defense and security policy specialists. Over the course of three days, core participants held frank discussions with scholars, government officials, and military leaders from both countries about the status of the U.S.-Japan security alliance given the present array of challenges in the region; met in private with key members of the Japanese government and the United States Embassy; and also engaged in candid conversations with military leaders that analyzed Japanese and American combined military planning and operations.

“This year’s workshop was the second meeting of the US-Japan Security and Defense Dialogue Series,” said USASI Director, Ambassador Karl Eikenberry. “It continues to be an excellent venue for the exchange of views between government and military officials, academics, and those with policy experience on U.S.-Japan security relations.”

Workshop Co-Host, Lieutenant General Noboru Yamaguchi, Japanese Ground Self Defense Force (Retired) and Special Advisor to the Sasakawa Peace Foundation, commented: "The issues we discussed were timely and important as the security environment surrounding the alliance is serious and cooperation among Japan, the United States, the Republic of Korea, and other partners, while improving, has a long way to go."

Solidifying the U.S. Alliance with Japan

(From left to right: General Vincent Brooks, Commander, UNC/CFC/USFK; Ambassador David Shear; Ambassador Michael Armacost; and Workshop Co-Hosts Ambassador Karl Eikenberry and Lieutenant General, (Retired) Noboru Yamaguchi)

(From left to right: General Vincent Brooks, Commander, UNC/CFC/USFK; Ambassador David Shear; Ambassador Michael Armacost; and Workshop Co-Hosts Ambassador Karl Eikenberry and Lieutenant General, (Retired) Noboru Yamaguchi)

Day One of the dialogue saw participants engage in a series of frank discussions on many of the challenges facing the U.S.-Japan security alliance, including American and Japanese assessments of security trends in East Asia; training, operations, and strategic planning between the U.S. and Japan armed forces; and security cooperation and instability on the Korean Peninsula.

“The Workshop is an unique opportunity for participants to share their views on political, economic, and security developments in the Indo-Pacific area,” reflected Ambassador Eikenberry. “It provides a way for the United States and Japan to explore ways to achieve the shared goal of maintaining peace and prosperity in the region.”

Visits with U.S. Mission and Japan Foreign Minister

Highlights for Day Two included a meeting between core dialogue participants and key officials at the U.S. Embassy in Japan, including Ambassador William Hagerty. The day ended with a consultation with Japan Foreign Minister Taro Kono. APARC faculty and affiliates at that meeting included Ambassador Eikenberry, Ambassador Michael Armacost, USASI Associate Director Dr. Belinda Yeomans, and visiting scholar Dan Sneider.

“The diversity of the participants made the dialogue especially interesting,” said Ambassador Armacost. “The presentations and comments were both thoughtful and practical.” The frank and open dialogue about the operation of the U.S.-Japan security alliance, noted Sneider, covered topics ranging “from the broad strategic level to the nitty gritty issues of alliance coordination and cooperation. Both Japanese and American participants have found this to be refreshing and revealing.”

Fleet Activities Yokosuka

(Meeting with Commander of the Japanese Self-Defense Fleet, Vice Admiral Kazuki Yamashita)

(Meeting with Commander of the Japanese Self-Defense Fleet, Vice Admiral Kazuki Yamashita)

The 2018 U.S.-Japan Security and Defense Dialogue Series closed with a group of the U.S. and Japanese participants visiting United States Fleet Activities Yokosuka. There, they met with the Commander of the U.S. 7th Fleet, Vice Admiral Phil Sawyer, and had a working lunch aboard USS Chancellorsville. They subsequently toured the Memorial Ship Mikasa (famous for serving as Admiral Togo’s flagship during the Russo-Japanese War) and met with the Commander of the Self-Defense Fleet, Vice Admiral Suzuki Yamashita at his headquarters. The conversations throughout the day focused on the importance of the alliance and the challenges of conducting combined U.S.-Japanese naval and joint operations.

Chatham House Rule applied to the dialogue, but a workshop report with no direct attribution or remarks will soon be made available to the public.

June 2018 Update: the 2018 workshop report is now published. Read it now.

A Japanese version of the workshop report is also available.

The report from the inaugural U.S.-Japan Security workshop of May 2016 is also available. 

The U.S.-Asia Security Initiative is part of Stanford University’s Walter H. Shorenstein Asia-Pacific Research Center (APARC). Led by former U.S. Ambassador and Lieutenant General (Retired) Karl Eikenberry, USASI seeks to further research, education, and policy relevant dialogues at Stanford University on contemporary Asia-Pacific security issues.

The Shorenstein Asia-Pacific Research Center (APARC) at Stanford is now accepting applications for the Shorenstein Postdoctoral Fellowship in Contemporary Asia, an opportunity made available to two junior scholars for research and writing on Asia.

Fellows conduct research on contemporary political, economic or social change in the Asia-Pacific region, and contribute to Shorenstein APARC’s publications, conferences and related activities. To read about this year’s fellows, please click here.

The fellowship is a 10-mo. appointment during the 2018-19 academic year, and carries a salary rate of $52,000 plus $2,000 for research expenses.

For further information and to apply, please click here. The application deadline is Dec. 20, 2017.

Sophia Hu, a Stanford student and prospective anthropology major, writes a summary of an annual forum that examines China’s health policy in comparative perspective

The Asia Health Policy Program held its Third Annual Forum on China’s Community Health Services and Primary Health Care Reform on June 22 in Beijing. The forum featured a diverse panel of speakers who addressed how to improve China’s primary care and community health care services. From discussing insurance plans to evaluating national policies and encouraging students to consider working as rural doctors, the speakers presented a wide array of research and experience. A brief summary of each presentation is detailed below.

Weichang Wang, director of the Ningxia Health Care Reform, discussed his experiences implementing a reformed health insurance payment system, originally developed by a team of researchers at Harvard and executed in Ningxia, China. Through this plan, his team created a medical insurance fund for the town that prioritized reimbursement for lower-level institutions, i.e. primary care centers. The plan resulted in increased accessibility, frequency of visits and patient satisfaction at primary care centers. It also saved money; however, some issues did arise such as how to develop accurate projections for the medical fund.

Quilin Chen of the Chinese Academy of Social Sciences, informed by his experience in Inner Mongolia, examined the disparity of hospitalization rates among different regions. He analyzed several factors, including financial incentives for patients and hospitals, regional differences in culture, and technological changes among primary care centers.

Jiaying Zhao of Australia National University and Shanghai University proposed using artificial intelligence (AI) to support primary care centers. She highlighted the benefits of AI, including how it can help inform physician decisions and bolster patient trust in primary care centers. Zhao, whose presentation motivated a spirited debate, shared important insights on the growing role of technology/CS in the health care field.

Jeroen Struijs of the Netherlands National Institute of Public Health and the Environment gave an overview of the primary care system in the Netherlands. With one of the most highly regarded systems in the world, the Netherlands prioritizes primary care-centric health care. He described how Dutch citizens seek care with their primary care physicians first – or face a penalty – before going on to specialists or hospitals. He also explained their bundled payment system. This system pays health services providers for a “bundle” of treatment for certain diseases, helping to align provider incentives with efficient convenient care, rather than fee-for-service which financially rewards quantity of services.

Hyuncheol Kim, an assistant professor at Cornell University, examined trends in long-term care insurance and public cancer screening programs in South Korea with a regression discontinuity design. His analyses helped to explain the relative success and failure of those programs. For example, his analysis was consistent with a theory that an intervention has a higher likelihood of failing if those receiving the intervention have other channels to receive benefits, i.e. patients are able to seek private as opposed to public insurance. His presentation also inspired discussion about primary care in Korea and the challenges Korea faces – similar to those in China – in trying to move away from a hospital-centric delivery system.

Lingui Li, director of Ningxia Medical University’s Public Sector Management Centre, delivered an overview of strategies to recruit health care workers in rural areas. He emphasized the need to balance primary public health service with primary clinical service and highlighted the dearth of doctors in villages.

Jinglin Yue, deputy dean of the Zhongshan University’s Institute of Public Administration, presented about his experiences establishing a hierarchical treatment system that aims to bring more people to primary care before pursuing treatment at hospitals. He explained the various incentives of the diverse interest groups involved, and emphasized the need for future government policies that support a 2-way referral system.

Xiaoguang Yang of Fudan University’s School of Public Health also described efforts to create a two-way referral system, based on his research of an integrated health system in Shenzhen. This initiative, using a people-centered reform paradigm, introduced the concept of “community of common destiny” to Luohu, China. The reformers tried to manage supply and demand using financial incentives to help providers including hospital groups coordinate in promoting a more integrated system.

Xiaoyun Liu of Peking University examined the efficacy of a new national program that contracts with students to commit to practicing medicine in rural areas in exchange for free medical school tuition. Using surveys, he gathered data on why students chose the program and where they chose to become rural doctors, among other factors. He then used this data to propose changes to enhance the effectiveness of the program.

Guanyang Zou, a researcher at Queen Margaret University, presented an overview of international experiences or “models” of health and social care that catered specifically to aging populations. These models included the integration of ambulatory medical care and aspects of social care and long-term care services.

Bei Lu of the University of New South Wales took an economic approach toward addressing the issue of long-term care for elderly populations. In her research, she worked closely with policymakers in Qingdao, China, and used a model to estimate how long-term care insurance could be structured so that the elderly could get optimal care without imposing a disproportionate financial burden on young taxpayers and fairly compensate providers.

Each presentation contributed important knowledge toward understanding primary care in China and elicited substantial discussion. This forum would not have been possible without the participation of the numerous speakers and the generous support of the Asia Health Policy Program and Chinese affiliates.

The latest American assertion of freedom-of-navigation rights in the South China Sea may have reassured some that new bonhomie between presidents Donald Trump and Xi Jinping won’t lead to abandonment of the region. But questions remain.

On 24 May, the guided missile destroyer USS Dewey transited within 12 nautical miles of Mischief Reef, a land feature occupied by China in the South China Sea. Analysts who had followed and criticized China’s campaign to control the sea, upon learning of this Freedom of Navigation Operation may have shared the same thought: Finally! Not since mid-October 2016 had the US been reported to have conducted such operations in the South China Sea. Since Trump’s inauguration in January, the Pacific Command had repeatedly been denied permission to conduct such a transit. 

Speculation abounds. Was the Dewey’s sail-by a one-off? Or did it augur a resumption of US efforts to forestall Chinese maritime dominion? Defense Secretary James Mattis will speak at the Shangri-La Dialogue in Singapore this week, and perhaps the Dewey’s route is meant to reinforce a message of reassurance for Asian leaders, that the United States is not resigned to Chinese primacy in the South China Sea. News of the Dewey’s trip was not formally announced. Nor was it accompanied by an official promise to follow up with further freedom-of-navigation operations. Any assuaging message, if intended, was thereby undercut, all the more so by Trump’s reputation for unpredictability and impulsiveness. 

Uncertainty abounds, too, as the region is left to wonder whether the Trump administration will make an ongoing commitment or will it offer, by implication, a transaction in the shorter run: suspension of US willingness to check China in the South China Sea, in return for Chinese willingness to check North Korea.

China’s behavior may have made these questions academic. For several years, Washington has watched Beijing turn the South China Sea into a Chinese lake. Impunity has benefited the pace of appropriation, and already some analysts have concluded the game is over. The stronger, less reversible, China’s maritime position becomes, the less valuable – bargainable – an American offer to accommodate it will be. American indifference has facilitated, or at least not impeded, China’s efforts eventually to establish full-spectrum sway over one of the economically and strategically most crucial waterways in the world. A million square kilometers larger than the Mediterranean, the South China Sea is vital for the many countries that border or use it – including China, Japan, India, South Korea, Australia, members of the Association of Southeast Asian Nations and, not least, the United States.

Obama-style “strategic patience” not only failed to lessen the missile-tossing truculence of Pyongyang. It failed to slow Beijing’s drive to dominate the South China Sea. Washington warned Beijing not to build up the land features it controlled; China did so anyway.  Washington warned Beijing not to militarize those properties; China did so anyway despite Xi’s public pledge to the contrary. Freedom-of-navigation operations were few, intermittent and increasingly far between, despite a promise to conduct them twice every three months. 

Meanwhile, ASEAN’s leaders were the objects of vigorous yuan diplomacy by China – attractive gifts and loans repayable in silence and deference. The Obama administration offered principles instead: good governance and navigational freedom. The Trans-Pacific Partnership promoted the first; freedom-of-navigation operations in the South China Sea defended the second.

In San Francisco in February 2016, an astute Malaysian asked his American audience to put themselves in Southeast Asian shoes: The Chinese offer you a stack of cash to spend.  The Americans offer you a stack of principles to follow. Which offer do you accept? It was a rhetorical question.

Trump may have abandoned the Trans-Pacific Partnership’s provisions for reasons of good economic governance. But why was the principle of navigational freedom neglected?  Why were the freedom-of-navigation operations performed less often under Obama and stopped altogether under Trump? 

A one-word answer could be linkage. Obama’s White House, including the National Security Council, viewed US relations with China as multi-stranded. Provoking Beijing with such operations risked losing cooperation on other issues that mattered to Washington: economic discrimination, cybersecurity, global warming, North Korea. As for Trump, initially, discontinuance of the operations could have been due to the new administration’s internal disarray and lack of staff. By May, however, it appeared that Washington might not be restarting them for a different reason: to incentivize Beijing to alleviate American economic concerns and restrain Pyongyang. 

It’s become conventional to distinguish Obama’s “strategic patience” from Trump’s “transactional dealing,” but linkage is present in both approaches. Both subordinate America’s interest in restraining Chinese maritime assertions in East Asia to America’s interest in gaining Chinese cooperation on other matters. In effect, Obama and Trump alike had bigger fish to fry. China’s salami-slicing tactic also made its incremental advances too insignificant to pick a fight over.

The Dewey’s voyage past Mischief Reef has broken a string of seven months without freedom-of-navigation operations, raising more policy questions. If operations do resume, does that mean Washington has also broken the linkage to other issues on which China could be helpful?  Is that freedom were worth defending in its own right? And what if no further operations ensue or follow a haphazard pattern?

Reassurances matter. In May, during his first trip to Europe, president Trump could have recommitted his country to defense of NATO partners by endorsing Article 5. He did not. Europeans now have reason to doubt America’s willingness to defend them against Russia President Vladimir Putin’s desire to destabilize or even retake Russia’s former satellite states. If the Dewey’s journey was not a resumption, but merely a one-time blip, will ASEAN’s leaders echo Germany Chancellor Angela Merkel in doubting America’s willingness to restrain Xi’s maritime ambitions in its own “near abroad”?

Southeast Asian policy elites may already assume that the Trump administration doesn’t care about their region. The gap between what these elites want from the US and what they expect to get emerges clearly in an April survey of more than 300 influential officials, businesspeople, scholars, journalists and activists across the 10 ASEAN countries on “How do Southeast Asians View the Trump Administration,” conducted by ISEAS Yusof Ishak Institute.

Of these respondents, an impressive 70 percent agreed that “Southeast Asia is more stable and secure with active US engagement.” But 56 percent expected the US to become less engaged in Southeast Asia in future, while 52 percent felt that the Trump administration was “not interested” in the region or considered it “irrelevant.”  As to which country or regional organization was the “most influential” in Southeast Asia, a mere 4 percent of the respondents chose the United States, compared to the 18 percent who cited ASEAN and the whopping 74 percent who chose China. An even higher proportion, 80 percent, expected China to fill any “strategic vacuum” in the region that American “indifference” might create.

There is one supportive result for Washington in the April survey: 68 percent of the respondents agreed that “the US will uphold freedom of navigation in the South China Sea.” The Trump administration should live up to that expectation. The Dewey’s sail-by should be followed by additional trips, performed regularly, publicly acknowledged, and justified by stating and restating strategic conviction: that no one country – not the United States, China, Japan nor any other state – should exercise exclusive control over the South China Sea. Such commitment, far from a chip to bargain with, is a key interest of the United States itself.

This piece was originally carried by YaleGlobal Online on June 1, 2017, and reposted with permission.