Stanford University

Varun Karekurve-Ramachandra

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Gerhard Casper Postdoctoral Fellow in Rule of Law, 2022-2023
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Varun Karekurve-Ramachandra is a Ph.D candidate in political science at the University of Rochester with a broad interest in empirical political economy. His work has appeared (or is forthcoming) in the American Journal of Political Science and The Quarterly Journal of Political Science. He uses a wide range of quantitative methods to study the judiciary, women in politics, political institutions, and bureaucracies with a focus on South Asia.

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What Would a Feminist Foreign Policy for India Look Like?

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Flyer for the webinar "What Would a Feminist Foreign Policy for India Look Like?"

May 17, 5- 6 p.m. Pacific Time
May 18, 5:30 - 6:30 a.m. Indian Standard Time

India has long portrayed itself as having a foreign policy guided by principles of justice. For decades, it stood above the ruthless geopolitics of the Cold War – in word if not in deed – and instead fashioned itself as a champion of decolonization and international equality. Today, with nonalignment apparently passé, several states have begun to embrace feminism and related principles as a basis for a normative, or principled foreign policy. This webinar will examine what a feminist foreign policy would look like for India. In such a foreign policy, how would feminism intersect with other values, such as environmentalism; to what extent would it clash with or reinforce national interests; and does India have the domestic political foundations to sustain such a normative policy?


Panelists

Square photo portrait of Ambika Vishwanath
Ms Ambika Vishwanath is the Co-Founder and Director of the Kubernein Initiative, a geopolitical advisory group. Ambika is a geopolitical analyst and water security specialist with experience in the field of governance and foreign policy. She has led Track 2 diplomacy efforts and consulted with several governments and international organizations in the Middle East, Europe, and South Asia, and helped shape their policies in the field of conflict resolution, water diplomacy, and security. At Kubernein, she leads their flagship program on Gender and Indian Foreign Policy and projects on water, climate, and security. The first Indian to be invited as a member of the prestigious Munich Young Leaders Network, she is also a China-India Visiting Scholars Fellow, 2020 – 2021, Ashoka University, and a Non-Resident Fellow with the Agora Institute, Germany.

Moderator

Square photo portrait of Arzan Tarapore
Arzan Tarapore is the South Asia research scholar at the Shorenstein Asia-Pacific Research Center at Stanford University, where he leads the newly-restarted South Asia research initiative. He is also a senior non-resident fellow at the National Bureau of Asian Research. His research focuses on Indian military strategy and contemporary Indo-Pacific security issues. Prior to his scholarly career, he served as an analyst in the Australian Defense Department. Arzan holds a Ph.D. in war studies from King’s College London. 

 

Square event banner with text "What Would a Feminist Foreign Policy for India Look Like?", featuring a photograph of two Indian women conversing while looking at a tablet
This event is part of the 2022 Spring webinar series, Negotiating Women's Rights and Gender Equality in Asia, sponsored by the Walter H. Shorenstein Asia-Pacific Research Center.

Questions?

Contact Kana Igarashi Limpanukorn
Arzan Tarapore
Arzan Tarapore

Via Zoom Webinar

Ambika Vishwanath Co-Founder, Co-Director Kubernein Initiative

Explaining Indian Military Strategy in the Kargil War

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For spring quarter 2022, CISAC will be hosting hybrid events. Many events will offer limited-capacity in-person attendance for Stanford faculty, staff, fellows, visiting scholars, and students in accordance with Stanford’s health and safety guidelines, and be open to the public online via Zoom. All CISAC events are scheduled using the Pacific Time Zone. 

SEMINAR RECORDING

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About the Event: What explains the consistent patterns – and exceptions – in Indian wartime strategy? In most of its wars, the Indian military has used a similar military strategy – to gain limited advantage on the battlefield as a way of consolidating the strategic status quo. The key exception was the eastern theater in the 1971 war, in which it sought – and won – battlefield decision to effect a major territorial revision. Much of contemporary international relations scholarship elides questions of strategy altogether, treating combat as an abstract contest of material power or resolve. Scholarship that does deal with strategy often seeks to explain consistency through strategic culture, or evolutions in military doctrine; but cannot explain patterns and exceptions in wartime behavior. This paper offers an explanation of military strategy as a function of the state’s geopolitical risk assessment and its military’s organizational preferences. Dr. Tarapore illustrates the argument with a detailed case study of the 1999 Kargil war, in which India was cautioned by the risk of nuclear retaliation, and the military pursued a tightly limited campaign. This research has implications not only for our understanding of Indian strategic behavior, but also theoretical debates on conventional deterrence and conflict processes.

About the Speaker: Dr. Arzan Tarapore is the South Asia research scholar at Stanford University's Asia-Pacific Research Center, and a senior nonresident fellow at the National Bureau of Asian Research. His research focuses on military strategy, Indian defense policy, and Indo-Pacific security issues. He previously held research positions at the RAND Corporation, the East-West Center in Washington, and the Observer Research Foundation in New Delhi. Prior to his scholarly career, he served for 13 years in the Australian Defence Department. Arzan holds a PhD in war studies from King's College London.

Virtual to Public. Only those with an active Stanford ID with access to William J. Perry Conference Room in Encina Hall may attend in person. 

Arzan Tarapore
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Research Seminar Series

Off the Farm and Into the Field: Master's Students Practice Hands-on Policymaking

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Melissa Morgan
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Every year, students in the Ford Dorsey Master's in International Policy (MIP) at the Freeman Spogli Institute for International Studies participate in the Policy Change Studio, a pioneering two-quarter program designed to provide our master's students with the know-how to bring about change in the world.

In 2020, many of the internships and outreach opportunities for our students were reduced or cancelled altogether because of the COVID-19 pandemic. By 2021, most of our students were able to participate in virtual programs with our policy partners. After two years of adapting, we're excited that the 2022 cohort of MIP students once again has the opportunity to work in-person with their partner organizations and meet changemakers on the ground to evaluate and fine-tune the impacts of their policy work.

Keep reading to see where our students have been working around the world.
 

Tunis, Tunisia

Emily Bauer, Soomin Jun and Kyle Thompson have been in Tunisia working with Wasabi, a communications company, working to understand the root causes of Tunisia’s large informal economy and find incentives for greater formal sector participation.

Emily Bauer, Soomin Jun and Kyle Thompson in Tunisia
Emily Bauer and Eman Thompson ride a camel in Tunisia.
Emily Bauer, Soomin Jun and Kyle Thompson meet with stakeholders in Tunisia.
Emily Bauer, Soomin Jun and Kyle Thompson arrive at the airport in Tunisia.
Emily Bauer, Soomin Jun and Kyle Thompson meet with stakeholders in Tunisia.

Pretoria, South Africa

Janani Mohan and Eli MacKinnon have been in South Africa with a local branch of the United Nations Development Programme to work on the longstanding problem of South Africa's highly skewed income distribution and vast disparities in employment access across different regions and social groups.

Eli MacKinnon and Janani Mohan with their NREL hosts in South Africa.
Eli MacKinnon and Janani Mohan with a statue of Nelson Mandela in South Africa.
Janani Mohan and Eli MacKinnon share a meal with their UNDP partners in South Africa.
Janani Mohan and Eli MacKinnon meet with stakeholders in South Africa
Eli MacKinnon and Janani Mohan pose at the Cape of Good Hope.

Jakarta, Indonesia

Sylvie Ashford, Calli Obern, Daniel Gajardo and Sarah Baran traveled to Indonesia to work with the U.S. Department of Energy's National Renewable Energy Laboratory's (NREL) local branch that is tackling policy barriers to decarbonizing industrial heat sources in the country.

Sylvie Ashford, Calli Obern, Daniel Gajardo and Sarah Baran pose with their NREL partners in Indonesia.
Sylvie Ashford, Calli Obern, Daniel Gajardo, and Sarah Baran
Sylvie Ashford, Calli Obern, Daniel Gajardo and Sarah Baran visit a textile factory in Indonesia.
Sylvie Ashford, Calli Obern, Daniel Gajardo and Sarah Baran meet with stakeholders in Indonesia.
A monkey commandeer the MIP camera in Indonesia.

Washington D.C., United States

Eyal Zilberman, Chaeri Park, Me Me Khant and Mikk Raud went from the West Coast to the East to the Washington D.C.-based Cyber Threat Alliance (CTA) to identify ways the U.S. government can reduce the prevalence of ransomware attacks against public and private entities.

Chaeri Park, Me Me Khant and Mikk Raud at the Cybersecurity and Infrastructure Security Agency in Washington D.C.
Chaeri Park, Me Me Khant and Mikk Raud at the Estonian embassy in Washington D.C.
Chaeri Park, Mikk Raud and Me Me Khant outside the United States Capitol in Washington D.C.
Chaeri Park, Me Me Khant and Mikk Raud at the National Mall.
Chaeri Park, Mikk Raud and Me Me Khant meet with stakeholders in Washington D.C.

India

Shirin Kashani, Madeleine Morlino and Amanda Leavell are working with SheThePeople, a female-first digital media website founded by Draper Hills alumna Shaili Chopra, that focuses on women-related journalism.

Shirin Kashani, Madeleine Morlino and Amanda Leavell
Shirin Kashani, Madeleine Morlino and Amanda Leavell visit with former Mayor Kishori Pednekar.
Shirin Kashani and Amanda Leavell meet with stakeholders in India.
Shirin Kashani, Madeleine Morlino and Amanda Leavell with a class of school girls in India.
Shirin Kashani, Madeleine Morlino and Amanda Leavell in India.

Tallinn, Estonia

Johannes Hui, Dave Sprague, Bradley Jackson and Arelena Shala partnered with the International Centre for Defense and Security (ICDS), a strategic policy think tank, to investigate the use of sub-threshold, grey-zone and hybrid military countermeasures to deter Russian provocations in the Baltic-Nordic region.

Johannes Hui, Dave Sprague, Bradley Jackson and Arelena Shala in downtown Tallinn.
Johannes Hui, Dave Sprague, Bradley Jackson and Arelena Shala meet with stakeholders in the ICDS.
Johannes Hui, Dave Sprague, Bradley Jackson and Arelena Shala in a forest in Estonia.
Johannes Hui, Dave Sprague, Bradley Jackson and Arelena Shala in Tallinn.
Johannes Hui, Dave Sprague, Bradley Jackson and Arelena Shala in Estonia.

The Ford Dorsey Master's in International Policy

Want to learn more? MIP holds admission events throughout the year, including graduate fairs and webinars, where you can meet our staff and ask questions about the program.

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Students from the 2022 cohort of the Ford Dorsey Master's in International Policy participate in the Policy Change Studio.
News

Where Our Master's Students are Making Policy Impacts in 2022

From women's health and reproductive rights in India to cybersecurity issues in Washington D.C., students from the 2022 cohort of the Ford Dorsey Master's in International Policy are tackling big policy projects in the Policy Change Studio.
Where Our Master's Students are Making Policy Impacts in 2022
The Ford Dorsey Master's in International Policy class of 2023
Blogs

Meet the Ford Dorsey Master’s in International Policy Class of 2023

The 2023 class of the Ford Dorsey Master’s in International Policy are finally here on campus and ready to dive into two years of learning, research and policy projects at the Freeman Spogli Institute for International Studies.
Meet the Ford Dorsey Master’s in International Policy Class of 2023
Protestors wave flags in front of San Francisco's Ferry Building against the military coup in Myanmar
Blogs

Working from Home While Worrying For Home

About the author: Me Me Khant ’22 was an FSI Global Policy Intern with the The Asia Foundation. She is currently a Ford Dorsey Master’s in International Policy student at Stanford University.
Working from Home While Worrying For Home
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The 2022 cohort of the Ford Dorsey Master's in International Policy has been busy this quarter getting out of the classroom and into hands-on policymaking with partner organizations in Tunisia, Estonia, India and beyond.

Independent Media in Modi’s India with Dr. Siddharth Varadarajan

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Siddharth Varadarajan flier

At a time when democracies face an onslaught from authoritarianism, we wonder — where on Earth is the world’s largest? Dr. Siddharth Varadarajan has raised the alarm on the decay of democratic liberties in India before many in his time. As the former editor of The Hindu, and the founding editor of The Wire, which has become one of the few fully independent media outlets operating in the ‘new India,’ he is situated at the frontlines of the largest battlefield fought by democrats today.

In conversation with Abeer Dahiya BA/BS ‘22, he shares how to hold a government accountable in an ecosystem where conventional media fails to do so, and how Stanford students can contribute to independent media in their home countries to uphold transparency.

ABOUT THE SPEAKER

Siddharth Varadarajan is a Founding Editor of The Wire and senior fellow at the Centre for Public Affairs and Critical Theory, New Delhi. Previously, he was the Editor of The Hindu. An economist by training, he studied at the London School of Economics and Columbia University and taught at New York University before returning to India to work as a journalist. He has been a visiting lecturer at the journalism school at the University of California, Berkeley and a Poynter Fellow at Yale University.

This event is co-sponsored by the Center for South Asia and the Center on Democracy, Development and the Rule of Law.

Abeer Dahiya

Online via Zoom

Siddharth Varadarajan
Lectures

Not much happened after India’s accidental cruise missile launch into Pakistan—this time.

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Debak Das
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India accidentally fired a cruise missile into Pakistan on March 9, 2022. The missile was not armed and only damaged some property. (No lives were lost.) Both sides projected calm in the incident’s aftermath. The Indian government issued a brief statement noting that the missile launch was “a technical malfunction” during routine maintenance. It also ordered “a high-level court of inquiry.” Pakistan publicly called out India’s mistake, asked for an explanation, and called for a “thorough and transparent investigation” to be conducted jointly by both countries. Cool heads prevailed.

Read the rest at the Bulletin of the Atomic Scientists

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India accidentally fired a cruise missile into Pakistan on March 9, 2022. The missile was not armed and no lives were lost. Both sides projected calm in the incident’s aftermath. Still, the incident raises questions about the safety of India’s cruise missile systems, especially given the real risk of accidental escalation between nuclear-armed adversaries.

A New Agenda for Indian Competitiveness

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Logo of APARC South Asia Initiative's May 6, 2022 conference, 'A New Agenda for Indian Competitiveness'

This Conference will be held in person on our Stanford University Campus.
Only register if you are attending the Conference in person.

About the Conference

The inaugural conference of the South Asia Initiative at Stanford University's Shorenstein Asia-Pacific Research Center (APARC) focuses on the role that critical and emerging technologies can play in India’s national security. These technologies promise to deliver enormous advantages as powers like India and China compete for security and influence. India’s ability to deploy critical and emerging technologies will shape not only its military power but also its resilience and self-sufficiency, which the Indian government sees as key national goals in a post-pandemic world. To develop these technologies, India’s national security establishment will need new policy settings – including new relationships with private industry – and new ways of cooperating with key partners, especially the United States.

Our conference will be a unique forum bringing together academic experts, senior policymakers, and leading industry representatives to develop this critical policy agenda. Keynote speeches and panel discussions will contemplate the changing character of national security, the imperatives for public-private cooperation on technology policy, and the implications for national and foreign policy. In keeping with our policy-focused mission, we look forward not only to fostering important dialogues but also to convening problem-solvers with different perspectives, to understand and act on new technologies’ role in strategic competition.

A photo collage of headshot portraits of 18 guest speakers participating at the Shorenstein APARC South Asia Initiative Conference "A New Agenda for Indian Competitiveness"

Conference Agenda


8:30-8:45 a.m.
Opening and Welcome Remarks

Prof. Gi-Wook Shin, Director of Asia-Pacific Research Center and Korea Program, Stanford
Dr. Arzan Tarapore, Research Scholar, Asia-Pacific Research Center, Stanford

8:45-9:30 a.m.
Keynote address: “Technology’s Role in Managing India’s Security Challenges.”

Dr. Ajay Kumar, Defence Secretary, India
Introduction by Prof. Michael McFaul, Director of the Freeman Spogli Institute for International Studies, Stanford

9:30-10:45 a.m.
Panel 1: Redefining the Military’s Relationship with Technology

Moderated by Dr. Arzan Tarapore, Research Scholar, Asia-Pacific Research Center, Stanford

LtGen Stephen D. Sklenka, Deputy Commander, U.S. Indo-Pacific Command
LtGen (ret.) Raj Shukla, ARTRAC
Ms. Kari Bingen, Hawkeye 360
Ms. Heather Richman, BMNT

10:45-11:00 a.m.
Coffee Break

11:00 a.m. -12:15 p.m.
Panel 2: The Way Forward in Defense Innovation

Moderated by Mr. Steve Blank, Adjunct Professor, Management Science and Engineering, Stanford

Mr. Sanjay Jaju, Director iDEX (Virtual)
Mr. Mike Brown, Director DIU
Ms. Colleen Laughlin, Defense Innovation Board
Ms. Lauren Bedula, Silicon Valley Defense Group

12:15-2:00 p.m.
Lunch

Fireside chat: "Looking Forward: Critical and Emerging Technology in the U.S.-India Relationship"

Mr. Jose W. Fernandez, Under-Secretary of State for Economic Growth, Energy, and Environment (virtual)
Introduction by Amb. Scot Marciel, Visiting Practitioner Fellow on Southeast Asia, Stanford

Fireside chat: "A New Agenda for US-India Relations"

Amb. Atul Keshap, USIBC (Virtual)
Mr. Vikram Singh, USIP and USISPF

With Dr. Joe Felter, Gordian Knot Center for National Security Innovation, Stanford

2:00-2:15 p.m.
Coffee Break

2:15-3:45 p.m.
Panel 3: Start-Up Success Stories

Moderated by: Sridhar Narayanan, Professor of Marketing, Stanford Graduate School of Business
 

Mr. Vinayak Dalmia, 3rditech
Ms. Vrinda Kapoor, 114AI (Virtual)
Mr. John Martellaro, Skanda Defense
Ms. Jacqueline Tame, GameBreaker AI

3:45-4:00pm
Concluding Remarks

​Breakfast, lunch, and afternoon refreshments will be served at the conference.

Parking information can be found on our Shorenstein APARC Contact Us page.

Questions?

Contact Kana Igarashi Limpanukorn
Conferences

The Effects of India's COVID-19 Lockdown on Critical Non-COVID Health Care and Outcomes

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Radhika Jain and Pascaline Dupas with a screenshot of the cover of their Social Science & Medicine journal article

Highlights

  • India's nationwide COVID-19 lockdown severely disrupted critical chronic care.

  • Non-COVID-19 morbidity and mortality increased sharply in the subsequent months.

  • Socioeconomically disadvantaged patients were worst affected.

  • Indirect health effects increase the toll of pandemics and worsen health inequality.

  • Pandemic control policies must ensure critical health services continue.

Abstract

India's COVID-19 lockdown, one of the most severe in the world, is widely believed to have disrupted critical non-COVID health services. However, linking these disruptions to effects on health outcomes has been difficult due to the lack of reliable, up-to-date health outcomes data. The authors identified all dialysis patients under a statewide health insurance program in Rajasthan, India (N = 2110), and conducted surveys to examine the effects of the lockdown on non-COVID care access and health outcomes. Post-lockdown mortality was their primary outcome and morbidity and hospitalization were secondary outcomes.

63% of patients experienced a disruption to their care. Transport barriers, hospital service disruptions, and difficulty obtaining medicines were the most common causes. We compared monthly mortality in the four months after the lockdown with pre-lockdown mortality trends, as well as with mortality trends for a similar cohort in the previous year. Mortality in May 2020, after a month of exposure to the lockdown, was 1.70 percentage points (95% CI 0.01–0.03) or 64% higher than in March 2020 and total excess mortality between April and July was estimated to be 22%. A 1SD increase in an index of care disruptions was associated with a 0.17SD (95% CI 0.13–0.22) increase in a morbidity index, a 3.1 percentage point (95% CI 0.012–0.051) increase in hospitalization, and a 2.1 percentage point (95% CI 0.00–0.04) increase in probability of death between May and July. Females, socioeconomically disadvantaged groups, and patients living far from the health system faced worse outcomes. The results highlight the unintended consequences of the lockdown on critical, life-saving non-COVID health services that must be taken into account in the implementation of future policy efforts to control the spread of pandemics.

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Journal Articles
January 2022

Impact of the COVID-19 Pandemic on Chronic Disease Care in India, China, Hong Kong, Korea, and Vietnam

Author(s)
  • Karen Eggleston,
  • Kavita Singh,
  • Yiqian Xin,
  • Yuyin Xiao,
  • Jianchao Quan,
  • Daejung Kim,
  • Thi-Phuong-Lan Nguyen,
  • Dimple Kondal,
  • Xinyi Yan,
  • Guohong Li,
  • Carmen S. Ng,
  • Hyolim Kang,
  • Hoang Minh Nam,
  • Sailesh Mohan,
  • Lijing L. Yan,
  • Chenshu Shi,
  • Jiayin Chen,
  • Hoa Thi Hong Hanh,
  • Viswanathan Mohan,
  • Sandra Kong
Impact of the COVID-19 Pandemic on Chronic Disease Care in India, China, Hong Kong, Korea, and Vietnam
Journal Articles
November 2021

Urban-Rural Health Insurance Integration in China

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Urban-Rural Health Insurance Integration in China
Working Papers
June 2021

Women Left Behind

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Women Left Behind
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Evidence from Dialysis Patients

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Social Science & Medicine
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India’s Century? A Conversation with Indrani Bagchi

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Time:  7:30am-8:45am  California, USA 2 March 2022 
9:00pm-10:15pm New Delhi, India 2 March 2022
 

India’s international position has evolved sharply in the first two decades of the 21st century, and it is poised to become only more consequential in coming decades. Its strategic interests and influence have now stretched into the distant reaches of the Indo-Pacific, it has emerged as a central actor in managing global governance challenges like climate change, and it may have the capacity to take a commanding position in some key leading-edge technologies. In this webinar, veteran journalist Indrani Bagchi, who spent nearly two decades covering India’s foreign relations for the Times of India, will reflect on India’s recent trajectory and its prospects. Through the prism of some key episodes and issues of India in the 21st century, the webinar will examine India’s capacity and approach to manage international issues, as well as the constraints and challenges Indian policymakers must face. 

Speaker: 

Headshot photo of Indrani Bagchi
Indrani Bagchi is CEO-designate at Ananta Aspen Centre, India. She was Associate Editor with the Times of India, where she reported and analyzed foreign policy issues for the newspaper from 2004 until 2022. As Diplomatic Editor, Indrani covered the Ministry of External Affairs (MEA) on her news beat, and interpreted and analyzed global trends with an Indian perspective. Earlier, Indrani worked with India Today, the Economic Times and The Statesman, and has held fellowships at Oxford University and the Brookings Institution. She is a Fellow of the Kamalnayan Bajaj Fellowship Class 3 of the Ananta Aspen Centre and a member of Aspen Global Leadership Network. She graduated from Loreto College, Calcutta University with English honors. 

Moderator:

Photo Portrait of Arzan Tarapore
Arzan Tarapore is the South Asia research scholar at the Shorenstein Asia-Pacific Research Center at Stanford University, where he leads the newly-restarted South Asia research initiative. He is also a senior nonresident fellow at the National Bureau of Asian Research. His research focuses on Indian military strategy and contemporary Indo-Pacific security issues. Prior to his scholarly career, he served as an analyst in the Australian Defense Department. Arzan holds a PhD in war studies from King’s College London. 

 

This event is co-sponsored by Center for South Asia

Via Zoom  Register at:
https://bit.ly/3HXiwTy

Indrani Bagchi, CEO-designate, Ananta Aspen Centre, India<br> Panelist

Arzan Tarapore

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Research Scholar at CISAC
Arzan Tarapore Headshot CISAC
PhD

Arzan Tarapore is a Research Scholar whose research focuses on Indian military strategy and regional security issues in the Indo-Pacific. In academic year 2024-25, he is also a part-time Visiting Research Professor at the China Landpower Studies Center, at the U.S. Army War College. Prior to his scholarly career, he served for 13 years in the Australian Defence Department in various analytic, management, and liaison positions, including operational deployments and a diplomatic posting to the Australian Embassy in Washington, DC.

His academic work has been published in the Journal of Strategic Studies, International Affairs, The Washington Quarterly, Asia Policy, and Joint Force Quarterly, among others, and his policy commentary frequently appears on platforms such as Foreign Affairs, the Hindu, the Indian Express, The National Interest, the Lowy Institute's Interpreter, the Brookings Institution’s Lawfare, and War on the Rocks.

He previously held research and teaching positions at Georgetown University, the East-West Center in Washington, the Observer Research Foundation in New Delhi, and the RAND Corporation.

He earned a PhD in war studies from King's College London, an MSc from the London School of Economics, and a BA (Hons) from the University of New South Wales. Follow his commentary on Twitter @arzandc and his website at arzantarapore.com.

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COVID-19 Disproportionately Affected Marginalized and Rural Populations in Asia, New Study Shows

Authors
Noa Ronkin
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As the COVID-19 pandemic remains a crucial global public health threat, pandemic control measures such as lockdowns and mobility restrictions continue to disrupt the provision of health services, leading to reduced healthcare use. Indeed, evidence shows the pandemic has emerged as a particular challenge for people with chronic conditions such as diabetes and hypertension. Yet there is limited data comparing the pandemic’s impact on access to care and the severity of chronic disease symptoms at the population level across Asia.

Now a new collaborative study, published by the Asia Pacific Journal of Public Health, addresses this limitation. The study co-authors, including APARC’s Asia Health Policy Program Director and FSI Senior Fellow Karen Eggleston, offer the first report comparing the impacts of the COVID-19 pandemic and its associated mobility restrictions on people with chronic conditions at different stages of socio-demographic and economic transitions in five Asian regions — India, China, Hong Kong, Korea, and Vietnam.

The findings show that the pandemic has disproportionately disrupted healthcare access and worsened diabetes symptoms among marginalized and rural populations in Asia. Moreover, the pandemic’s broad social and economic impact has adversely affected population health well beyond those directly suffering from COVID-19, with the resulting delayed and foregone care leading to uncertain longer-term effects.

 [Sign up for APARC newsletters to receive the latest research by our scholars]

Unintended Adverse Consequences

Routine screening, risk factor control, and continuity of care for non-communicable diseases are a global challenge. The COVID-19 pandemic has exacerbated the challenge even further. Existing reports show the pandemic has particularly adverse impacts on essential prevention and treatment services for people with chronic conditions. These reductions in health services arose from pandemic-associated factors such as mobility restrictions, lack of public transport, and lack of health workforce.

Eggleston and a group of colleagues set out to provide evidence on how the pandemic has impacted chronic disease care in diverse settings across Asia during COVID-19-related lockdowns. Using standardized questionnaires, the researchers surveyed 5672 participants aged 55.9 to 69.3 years with chronic conditions in India, China, Hong Kong, Korea, and Vietnam. The researchers collected data on participants’ demographic and socio-economic status, comorbidities, access to healthcare, employment status, difficulty in accessing medicines due to financial and nonfinancial (COVID-19 related) reasons, treatment satisfaction, and severity of their chronic condition symptoms.

If no immediate actions are taken to mitigate pandemic impacts, the Asia-Pacific region will struggle to achieve the 2030 Sustainable Development Goal target 3.4 to reduce premature mortality from non-communicable diseases […] and to promote mental health and wellbeing.
Karen Eggleston et al.

The results show that the pandemic’s broad social and economic impact has adversely affected population health well beyond those directly suffering from COVID-19. Study participants with chronic conditions faced significant challenges in managing their symptoms during the pandemic. They experienced a loss of income and difficulties in accessing healthcare or medications, with the resulting delayed and foregone care leading to uncertain longer-term effects. For a nontrivial portion of participants, these factors are associated with the worsening of diabetes symptoms. The threat is twofold among people living in rural populations with limited access, availability, and affordability of healthcare services.

A Global Health Priority

The unintended adverse consequences of the COVID-19 pandemic on chronic disease care may also further aggravate inequality in health outcomes. “If the trend continues and no immediate actions are taken to mitigate pandemic impacts,” Eggleston and her colleagues caution, then “the Asia-Pacific region will struggle to achieve the 2030 Sustainable Development Goal (SDG) target 3.4 to reduce premature mortality from non-communicable diseases by a third relative to 2015 levels and to promote mental health and wellbeing.”

Addressing the pandemic’s unintended negative social and economic impacts on chronic disease care is a global health priority, determine the researchers. They propose several measures to help provide timely care for people with chronic conditions in resource-constrained settings. These include implementing innovations in healthcare delivery models to improve the adoption of healthy lifestyle changes and self-management of chronic disease and mild COVID-19 symptoms, increasing investment in interventions to provide social and economic support to disadvantaged populations, and strengthening primary healthcare infrastructure and support of healthcare providers.

The study was supported in part by funding from Shorenstein APARC’s faculty research award, Stanford King Center for Global Development, and a seed grant from the Stanford Center for Asian Health Research and Education.

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A woman at a desk in a village medical clinic in China.
News

Strengthening the Frontline: How Primary Health Care Improves Net Value in Chronic Disease Management

Empirical evidence by Karen Eggleston and colleagues suggests that better primary health care management of chronic disease in rural China can reduce spending while contributing to better health.
Strengthening the Frontline: How Primary Health Care Improves Net Value in Chronic Disease Management
Closeup on hands holding a glucometer
News

A New Validated Tool Helps Predict Lifetime Health Outcomes for Prediabetes and Type 2 Diabetes in Chinese Populations

A research team including APARC's Karen Eggleston developed a new simulation model that supports the economic evaluation of policy guidelines and clinical treatment pathways to tackle diabetes and prediabetes among Chinese and East Asian populations, for whom existing models may not be applicable.
A New Validated Tool Helps Predict Lifetime Health Outcomes for Prediabetes and Type 2 Diabetes in Chinese Populations
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Bargaining Behind Closed Doors: Why China’s Local Government Debt Is Not a Local Problem

New research in 'The China Journal' by APARC’s Jean Oi and colleagues suggests that the roots of China’s massive local government debt problem lie in secretive financing institutions offered as quid pro quo to localities to sustain their incentive for local state-led growth after 1994
Bargaining Behind Closed Doors: Why China’s Local Government Debt Is Not a Local Problem
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In the first report of its kind comparing the impacts of the pandemic on people with chronic conditions in five Asian regions, researchers including APARC’s Karen Eggleston document how the pandemic’s broad social and economic consequences negatively affected population health well beyond those directly suffering from COVID-19.

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