Global health disparities were the topic of a special event November 11th co-sponsored by the Asia Health Policy Program of the Shorenstein Asia-Pacific Research Center and the Center for Health Policy / Primary Care and Outcomes Research.

Sir Michael Marmot, internationally renowned Principal Investigator of the Whitehall Studies of British civil servants (investigating explanations for the striking inverse social gradient in morbidity and mortality), spoke about research on the social determinants of health and taking action to promote policy change. Pointing out the extreme disparities in life expectancy for peoples in different parts of the world – including the “haves” and “have-nots” within the high-income world – he presented an overview of “Closing the gap in a generation: Health equity through action on the social determinants of health” (http://www.who.int/social_determinants/en/). That report was commissioned by the World Health Organization (WHO) and released last year; Sir Marmot served as the Chair of the Commission on Social Determinants of Health.

Criticizing those who justify initiatives in global health solely on economic grounds, Sir Marmot argued that addressing the social determinants of health is a matter of social justice.

He presented data and discussed the report’s three primary recommendations: 1. Improve daily living conditions; 2. Tackle the inequitable distribution of power, money, and resources; and 3. Measure and understand the problem and assess the impact of action.
Stating that the World Health Assembly resolution on the social determinants of health was only meaningful as a first “baby step,” Marmot urged the audience to consider how research and policy advocacy can address the social determinants of health so that all individuals can lead flourishing lives.

Examples from Asia include

• the high risk of maternal mortality (1 in 8) in Afghanistan;
• the steep gradient in under-5 mortality in India (with the rate almost three times higher for the poorest quintile than for the wealthiest quintile);
• less than half of women in Bangladesh have a say in decision-making about their own health care;
• a large share of the world’s population living on less than US$2 a day reside in Asia;
• social protection systems like pensions are possible in lower and middle-income countries, with Thailand as an example;
• more can be done to address the millions impoverished by catastrophic health expenditures, such as in southeast Asia; and
• conflict-ridden areas and internally displaced people, such as in Pakistan and Myanmar, are among the most vulnerable.

He also responded to questions about the role of freedom and liberty in social development – contrasting India and China – and commented on the peculiar contours of the US health reform debate.

Professor Marmot closed by noting that, in exhorting everyone to strive for social justice and close the gaps in health inequalities all too apparent in our 21st century world, he hoped he was not too much like Don Quixote, going around “doing good deeds but with people all laughing at him.” 
Professor Sir Michael Marmot MBBS, MPH, PhD, FRCP, FFPHM, FMedSci, is Director of the International Institute for Society and Health and MRC Research Professor of Epidemiology and Public Health at University College, London. In 2000 he was knighted by Her Majesty The Queen for services to Epidemiology and understanding health inequalities.

The Asia Society has organized a Task Force on U.S. Policy toward Burma/Myanmar, co-chaired by retired U.S. Army General Wesley Clark and Holsman International Chair (and former USAID Administrator) Henrietta H. Fore.  The panel comprises a dozen or so individuals from various occupations and backgrounds, including SEAF's director, Donald K. Emmerson.  Assisting the Task Force is an also diverse Advisory Group of some thirty experts in Southeast Asian and other countries.  The Asia Society expects to release the Task Force's final report early in 2010.  

The timing of the study is of interest in view of the Obama administration’s willingness to meet with Myanmar’s rulers. 

America’s top diplomat on Asia is Assistant Secretary of State for East Asian and Pacific Affairs Kurt Campbell.  Deputy Assistant Secretary Scot Marciel covers Southeast Asian and ASEAN affairs.  In early November 2009 the two men traveled to Myanmar.  There they met not only with the iconic opposition figure and Nobel Prize winner Daw Aung San Suu Kyi, but also with Burmese Prime Minister Thein Sein.  The latter meeting was the highest-level contact between the two governments since 1995.  An even higher-level meeting was being planned for later in November at a US-ASEAN summit in Singapore, which would bring President Obama face to face with Myanmar’s head of state, Senior General Than Shwe.

Further enhancing the timeliness of the Task Force’s work is the announced prospect of national elections in Myanmar in 2010.  No independent observers expect the exercise to bring about anything resembling liberal democracy.  But some hold out hope that the balloting could yield a marginally more representative and accountable system. 

In early November 2009 it remained to be seen whether the current shifting of American policy toward dealing directly with the Burmese junta would prove effective in nudging its leaders toward political reform, or not. 

The Task Force’s report, scheduled for release early in 2010, should at least provide food for policymaking thought, as U.S. officials continue to review what has been and could be done with regard to a regime that has so far resisted both isolation and engagement.

Which facets of Cold War history do you find most compelling?

JS: A great deal of work has been done on the origins of the Cold War, but I am more interested in two other questions: Why did it last so long? and Why did it end when (and how) it did? The Cold War could have ended (along with a great deal else) if there had been a military conflict between the superpowers. And while there were some close calls, this did not happen. Instead, there were a number of proxy wars that created a great deal of damage in their immediate environments, but did not lead to a U.S.-Soviet war. Why not? In large measure, I think, because both sides created and sustained a stable order in Europe, the one part of the world where their land armies faced one another.

The Cold War ended, and ended peacefully, when Gorbachev decided to allow this European order to collapse. He based this decision on an extraordinary miscalculation: that the Soviet regime could survive in a new Europe, taking advantage of Western Europe's economic resources and dynamism without abandoning the Communist Party's leading role in the state. By the time it was clear that would not happen, it was too late to go back. The Cold War ended the way most wars end, with the defeat of one side, a largely peaceful defeat to be sure, but a defeat nonetheless.

AE: I am fascinated by those cases in which people living under totalitarian regimes in Eastern Europe stood up against their oppressors, often knowing that their own political actions were bound to fail. The cases of the 1953 uprising in the GDR, the 1956 Hungarian Revolution and the 1968 Prague Spring will always inspire us and force us to acknowledge that even in situations that seem to exclude human agency, individuals and groups can exercise their ability to act and their wish to live freely.

Why is it valuable to examine how both the rise and fall of the Wall impacted culture in Germany and even throughout Europe?

JS: Obviously the Wall shaped East German culture and, to some extent, continues to do so. I am less convinced that the Wall was of central importance for the West. Many West Germans tended to forget about the East, the possibilities of unification seemed remote, the attractions of Western Europe much more compelling. A major impact of the Wall's fall on both Germanies was to reveal how far they had grown apart.Many West Germans tended to forget about the East, the possibilities of unification seemed remote, the attractions of Western Europe much more compelling. A major impact of the Wall's fall on both Germanies was to reveal how far they had grown apart.

AE: It’s valuable because the building of the Wall was not only the result of the communist regime’s will to stop the flight of its own people to the West but also the result of the West’s inability to effectively counter what is now universally acknowledged as an unbearable crime. The Wall is a lesson in the history of tyranny but also in the inability to face up to tyrants. The mistakes of those who allowed the Wall to be built may be repeated in the future. Learning what happened before, during and after the building of the Wall in 1961 may help us avoid the emergence of similar repressive artifacts in the future.

The fall of the Wall, on the other hand, gives us many lessons regarding the ability of political actors – on both sides of the East-West divide – to overcome, by way of decisive actions, decades-long tyranny.

How do you approach such a far-reaching era of history in a research project?

JS: It is important to see the end of the Cold War in the light of long-range trends, especially changes in global economic institutions. At the same time, we should try to understand the human impact of these events. In her recent book on 1989, Mary Elise Sarotte describes how East Germans fleeing to the West in the fall of 1989 threw away their Eastern currencies as they reached the border. It seems to me that this episode captures the intersection of deep structural transformations and immediate human experience. Money, including the physical appearance of East German coins, the "welcome money" given to East German arrivals in the West, and of course, the 1-1 exchange of East for West Marks, had an extraordinary symbolic and practical significance for this story.

AE: I study the ways in which literature and the arts reflect on the past. In the case of postwar German literature, the past consists of the two totalitarian regimes that dominated Germany in the twentieth century: Nazism and Communism. It is to a significant extent by way of revisiting the past, I believe, that cultures and socio-political institutions evolve. In telling and retelling what occurred in Europe during the twentieth century, postwar German literature (one of my main subjects of interest) made a substantial contribution to the creation of the modern, progressive Germany we know today.

Could you describe examples of how the Wall, and what it represented, influenced German cultural and aesthetic works created during its existence?

JS: East Germany had a vibrant literary culture and produced a great many novels that reflect the experience of the Wall. I especially admire Christa Wolf's Divided Heaven. Her career illustrates both the accomplishments and the limitations of culture in a society like the GDR. Since 1989, there has been a great deal of work reflecting on the meaning of the Wall. I just read Uwe Tellkamp's novel, Der Turm, which is set in and around Dresden in the late 1980s. It is a remarkable book in many ways, a sprawling family saga as well as a sharp political portrait of the regime's last days.

AE: The Wall played a crucial role in the writing of such significant writers as Christa Wolf (of the former GDR) and Peter Schneider (of the Federal Republic of Germany). In novels such as Divided Heaven (1963), Wolf gave us a lasting image of life in the shadow of the Wall. In The Wall Jumper, Schneider made the absurdity of an edifice such as the Wall painfully tangible. Yet, a novel like Ian McEwan’s The Innocent makes it clear that the Wall and the division of Germany also left a significant mark on European literature as such. In recent years, films like "The Lives of Others" began exploring the meaning of the East-West divide and the lasting impact of European totalitarian regimes on the lives of individuals and societies.

During the course of your work what kind of evidence have you encountered that illustrates how the Wall impacted the legacy of European Jews?

JS: East and West Germany dealt with the legacy of Nazism--and the meaning of the Holocaust--in quite different ways. East and West Germany dealt with the legacy of Nazism--and the meaning of the Holocaust--in quite different ways. In the GDR, Nazism was seen as a particularly toxic form of fascism, that is, an expression of capitalism's structural crisis. From this perspective, the racial dimensions of Nazism did not seem central: there was, for instance, very little about the Holocaust in the exhibitions on Nazism in the old East German museum of German History. Like the museum itself, this view of Nazism is now largely gone.

AE: The Jewish community of both the GDR and the Federal Republic was rather small when the Wall was built. While the Federal Republic accepted early on the German responsibility for Nazism, the GDR regarded itself as representing the legacy of the ‘better Germany’ that is of the German left. This has been as many scholars have since claimed, the foundational myth of the GDR. In the decades following the building of the Wall, the issue for German-Jewish relations was less the East-West divide and more finding ways to commemorate the dead of the Holocaust, acknowledging the crimes of the Nazis and developing a German-Jewish dialogue based on mutual respect and different memories. However, one of the most significant contemporary German-Jewish authors is Barbara Honigmann, who in her writing also reflects on what it meant for her and others like her to grow up and come to age as a Jew in the GDR.

From the perspective of your research, what do you feel are the most lasting implications of the Berlin Wall today?

JS: In the euphoric days after the fall of the Wall, many people underestimated the material and spiritual difficulties of unification. It is not surprising that, after 40 years apart, the two Germanies have only slowly grown together. Like parts of the American south after the Civil War, parts of the old GDR have a nostalgic view of the "good old days" before 1989. This has an impact on German culture, especially in Berlin. A more lasting implication is the Left Party, a somewhat improbable alliance of Western German leftwing Social Democrats and the former East German Party of Democratic Socialism.

AE: The Wall will always remain a symbol of tyranny. It will also continue to remind us what fantasies about a ‘perfect’ human society such as those that guided the Soviet Union and the GDR may end up producing: endless human misery and the creation of enclosed, repressive political systems.

Do you believe there’s still more to learn from this transformative period of history?

JS: Historians always believe there is more to learn. In the case of 1989, I think one lesson is how often history surprises us. No one expected the Wall to fall so suddenly and so peacefully, just as no one expected the Soviet Union to collapse with such speed. Nor has the post-Cold War world turned out quite the way many people expected.

AE: Absolutely. The learning about the nature and the challenges of totalitarian thought and totalitarian regimes has just begun. Contemporary totalitarian regimes across the globe such as Iran, Syria, Myanmar or North Korea make the study of the Wall and how we—those living in open societies may react to them—crucial for the freedom of millions who suffer by those regimes. The study of the Wall and of such regimes may also prove crucial for our survival given the fact that these regimes strive to acquire deadly military capacities.

John D. Ciorciari was a Shorenstein Fellow at APARC in 2007-08 and an affiliate of APARC and SEAF in 2008-09 while a National Fellow at the Hoover Institution.   Upon leaving Stanford he took up a position as an assistant professor in the Gerald R. Ford School of Public Policy at the University of Michigan.

A main purpose of the Shorenstein Fellowship is to enable post-docs to revise their dissertations for publication.  John did exactly that.  In 2010 Georgetown University Press will publish The Limits of Alignment in the Global South:  Southeast Asia since 1975.  Congratulations, John!

During his association with SEAF John also finished co-editing and co-authoring a monograph on the (in)famous Khmer Rouge trials in Cambodia.  In 2009 the Documentation Center of Cambodia published the result:  On Trial: The Khmer Rouge Accountability Press.

On Trial is dedicated to “the victims of [Pol Pot’s grossly misnamed] Democratic Kampuchea and to promoting a legal accountability process that will honor their memories and provide their families with justice.”

Sophal Ear, an assistant professor at the US Naval Postgraduate School (Monterey) and himself a survivor of Pol Pot’s regime praised On Trial as an “excellent,” “thoughtful,” “timely,” and “essential book.”

The renowned historian of Cambodia David Chandler—a professor emeritus at Monash University (Australia) and a former SEAF speaker—also lauded the book: 

“This invaluable collection of essays, sponsored by the Cambodian NGO that has pioneered research on the Khmer Rouge era, provides a wealth of information about the so-called Khmer Rouge Tribunal.  On Trial is accessible, well researched, and passionately engaged with the innumerable tragedies of the Khmer Rouge period.  Its authors argue that the ongoing trials may possibly lead toward deeper reconciliation and certainly a deeper knowledge of what happened throughout the country in those horrific years.”

Other publications stemming from John’s time at Stanford include these three wide-ranging titles, all published in January 2009: 

“The Balance of Great-power Influence in Contemporary Southeast Asia,” International Relations of the Asia-Pacific (9: 1), pp. 157-196; International Politics and the Mess in Myanmar, JPRI Working Paper No. 114, Japan Policy Research Institute; and An Asian Monetary Fund in the Making? SCID Working Paper No. 378, Stanford Center for International Development.

While at Stanford in 2008-09 John also gave off-campus presentations on topics including Asian security, Cambodian history, and alignment politics at Columbia, Princeton, and Chicago, among other universities, and the International Studies Association, among other professional-society venues.

Future Shorenstein Fellows take note:  John Ciorciari is a tough act to follow.  SEAF wishes him the best of success in his future endeavors.

Edited by SEAF Director Don Emmerson and co-published in 2008-09 by APARC at Stanford and ISEAS in Singapore, Hard Choices: Security, Democracy, and Regionalism in Southeast Asia continues to attract attention. Excerpted below are two differing but equally thoughtful recent reviews:

Noel M. Morada is a professor of political science at the University of the Philippines-Diliman and director of the Philippines Progamme in the Asia Pacific Centre for the Responsibility to Protect (R2P) at the University Queensland in Brisbane, Australia.

Writing in Kasarinlan: Philippine Journal of Third World Studies, 23: 2 (2008), pp. 119-122, Prof. Morada found the title of Hard Choices “apt” because its authors “ask hard questions—including philosophical ones—on the merits and demerits of pushing for a more ‘people-centered’ ASEAN, the challenges and constraints in implementing Responsibility to Protect (R2P) principles in the region, as well as the possible directions that ASEAN may take in the near future.”

A “good thing” about the book, in his view, “is that the reader is left to make his or her own conclusions” about “the issues and arguments” that it presents. He notes the variety of backgrounds of the authors: from scholars based far from Southeast Asia, through local analysts on Track II, to an official from inside the ASEAN secretariat itself. Their chapters, in his judgment, contribute significantly to current debates about what balance that ASEAN should strike between “state-centered and society-centered conceptions of security,” including “the dilemmas and constraints” that state and societal actors face in pursuing a more “participatory” kind of regionalism in Southeast Asia.

Among the issues featured in Hard Choices, Morada cites “the thorny problem of intervention in the domestic affairs of [ASEAN] members,” including the challenge to regionalism posed by Myanmar’s rulers, and whether or not the ASEAN Charter can facilitate a response or may itself be an obstacle to reform. While highlighting the relative optimism of Mely Caballero-Anthony’s chapter on non-traditional security, he finds a consensus among the book’s authors that “ASEAN’s traditional norms—i.e., state sovereignty and non-interference—still rule.”

Prof. Morada ends his review thus: “This should be a required reading for graduate students specializing in Southeast Asia and a must have for ASEAN specialists and observers. More importantly, civil society groups would benefit immensely from reading this volume as part of their education about ASEAN, on which many remain uninformed. Many of my friends in the academic community in the region have in fact been quite disappointed with many civil society groups who simply want to push their agenda but have not done their homework on the workings of ASEAN. This book should help enlighten them further.”

Lee Jones is a lecturer in the Department of Politics at the College of Queen Mary, University of London.

Writing for a future issue of the ASEASUK Newsletter, a publication of the Association of Southeast Asian Studies in the United Kingdom, Dr. Jones, unlike Prof. Morada, misses a firmer editorial hand. “Theoretical engagement is relatively sparse,” writes Jones, “and the book would have benefited from an overarching framework to help structure and guide the contributions. Particularly given many contributors’ focus on Myanmar, ASEAN’s policies towards it, and ASEAN’s recent institutional evolution, an early chapter agreeing [to] a collective account of these matters would have left more space for analysis and argumentation.”

Jones singles out the chapter by “veteran official Termsak Chalermpalanupap” as “a highly informative overview of ASEAN’s institutional development which will be useful for all students of ASEAN.” Chapters by Simon Tay (on air pollution) and Michael Malley (on nuclear energy) are also praised by Jones as demonstrating that “democratisation does not (as other contributors imply) automatically produce either more liberal policies or enhanced regional cooperation.” On the contrary, writes Jones, “democratisation can give vent to illiberal, nationalist and uncooperative sentiments, particularly when dominated (as ASEAN polities are) by cynical oligarchs. It is disappointing, therefore, that none of the chapters engages in systematic analysis of the domestic social forces at work in ASEAN states.”

“On balance,” for Jones, “the evidence in Hard Choices seems to favour the pessimist viewpoint. The basis for concluding that civil society has shattered elites’ monopoly on policymaking is rather weak. None of the pro-intervention authors sufficiently counter[s] the pragmatist challenge that ASEAN coherence could not withstand the adoption of a more liberal-interventionist posture. However, this is a contingent judgment which should not lead us simply to endorse the status quo. … [T] he fate of individual countries and the overall direction and content of ASEAN regionalism depends ultimately on the struggles of ASEAN’s own citizens.

Concludes Jones: “A clear-sighted analysis of the respective strengths and weaknesses of the force of movement and reaction, without succumbing to the defeatism of endorsing authoritarianism or the romanticism of believing that democratic institutions alone imply the victory of civil society (or that ASEAN can do much to create such institutions), is therefore vital for understanding the region’s prospects.”

It is widely acknowledged that Southeast Asia stands at a fork in the road. The ratification and adoption of the Association of Southeast Asian Nations (ASEAN) Charter in 2008 has given the regional body new found legal status, and the proposed establishment of an ASEAN Political-Security Community, Economic Community, Socio-Cultural Community and human rights body raises the potential for the rise of a strengthened form of regionalism in Southeast Asia, where ASEAN becomes not merely a forum for communication between Member States but an actor in its own right. However, working against this momentum has been a discernible stalling of democratisation and continuing commitment to traditional principles such as non-interference and consensus decision-making, which, in the eyes of some critics, produced a lowest common denominator approach to drafting the Charter. Both of these positions are canvassed and reviewed in this excellent collection, which offers sober and well-informed analysis of the predicaments that the region now confronts. Combining broad assessments of the relationship between security, democracy and regionalism with detailed analysis of the Charter and reform process, and telling insights into major controversies, such as the question of human rights in Myanmar, the problem of the haze in Indonesia, and the question of nuclear security, this is a model of balanced and sensible analysis.
 
The book is organised into four main sections, the first being a deeply insightful introduction by the editor. Too often, editorial introductions do little other than summarise the preceding chapters, but in this volume, Emmerson carefully places the key concepts in their proper context, neatly sets out the nature of the dilemmas currently confronting the region and provides insight into some of the most important contemporary crises – especially that relating to Myanmar. Subsequent sections focus on: ‘Assessments’ – of ASEAN and its reform process; ‘Issues’ – spanning democratisations, Myanmar, non-traditional security, the haze and nuclear security; Sukma’s discussion of democratisation and Caballero-Anthony’s account of non-traditional security stand out here; and ‘Arguments’ – namely, David Martin Jones’ calling for the privileging of prudence and decency over idealism and hasty democratisation, and Erik Martinez Kuhonta’s setting out the pros and cons of non-interference and intervention for human rights.
 
Overall, this book is very hard to fault. It combines a range of perspectives, including academic and policy perspectives, canvasses a number of relevant issues and provides the reader with a very good sense of the critical concerns. In short, those interested in understanding Southeast Asia’s contemporary fork in the road should start by reading this excellent volume.
 
Reviewer: Alex Bellamy, Asia-Pacific Centre for the Responsibility to Protect, School of Political Science and International Studies, The University of Queensland, Brisbane, Queensland, Australia.  This review is reproduced with the permission of Asia Pacific Viewpoint.