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11. Crisis from Kolkata to Kabul: COVID-19’s Impact on South Asia

Author:
Husain Haqqani and Aparna Pande
Publication Date:
05-2020
Content Type:
Special Report
Institution:
Hudson Institute
Abstract:
The world’s most populous region, South Asia, with almost 1.9 billion people living in eight countries, has so far had fewer reported infections and fatalities per capita from the novel coronavirus than projected in early models. However, the region is unlikely to escape the widespread disruption and damage felt across the globe, and its worst health-care crisis may be yet to come. In South Asia, as in other regions, the COVID-19 pandemic is testing the capacities of states to provide security and effective healthcare and to maintain essential services. It is also having an impact on fragile democratic institutions and societal bonds, in addition to putting considerable strains on the economy. [...] Following is a country-by-country report, with inputs from experts on the ground, on the coronavirus pandemic’s impact in South Asia and its human, economic, and political consequences.
Topic:
Economics, Health, Crisis Management, and COVID-19
Political Geography:
Pakistan, China, South Asia, India, Asia, and Sri Lanka

12. Reporting on the Spread of HIV in China

Author:
David Cowhig
Publication Date:
11-2019
Content Type:
Journal Article
Journal:
American Diplomacy
Institution:
American Diplomacy
Abstract:
Chinese physician Dr. Wang Shuping predicted the HIV epidemic among Henan peasant blood sellers and eventually raised the alarm all the way to Beijing when local and provincial authorities ignored the rapid spread of HIV among the sellers. This heroic and far-sighted woman became my most important informant on the HIV epidemic when I worked in the Environment, Science and Technology Section of U.S. Embassy Beijing 1996 – 2001.
Topic:
Diplomacy, Health, Public Policy, and Memoir
Political Geography:
China, Beijing, North America, and United States of America

13. Healing One-fifth of Humanity: Progress and Challenges for China’s Health System

Author:
Karen Eggleston
Publication Date:
10-2019
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
China’s national health reforms over the past two decades have brought the system closer to the modern, safe, reliable and accessible health system that is commensurate with China’s dramatic economic growth, improvement in living standards, and high hopes for the next generation. Celebrating a decade this year, China’s national health reforms of 2009 consolidated a system of social health insurance covering the entire population for basic health services, contributing to a surge in healthcare utilization while reducing out-of-pocket costs to patients – which declined from 56% to 28% of total health expenditures between 2003 and 2017. An expanded basic public health service package, funded by per capita government budget allocations that include a higher central government subsidy for lower income provinces, provides basic population health services to all Chinese. A higher percentage of Chinese accessed hospital admissions in 2017 than in the average high-income (OECD) country – a large increase from the turn of the 21st century.i A recent re-shuffle of the governance structure consolidates the purchaser role for social health insurance schemes under the newly created National Healthcare Security Administration, with most other health sector functions under the re-christened National Health Commission, among other changes. China’s world-leading technological prowess in multiple fields spanning digital commerce to artificial intelligence—and accompanying innovative business models such as WeDoctor that have not yet been fully integrated into the health system—hold promise for supporting higher quality and more convenient healthcare for China’s 1.4 billion.
Topic:
Health, Science and Technology, Governance, and Health Care Policy
Political Geography:
China and Asia

14. Rural-Urban Disparities in the Utilization of Mental Health Inpatient Services in China: The Role of Health Insurance

Author:
Junfang Xu, Jian Wang, Madeleine King, Ruiyun Liu, Fenghua Yu, Jinshui Xing, Lei Su, and Mingshan Lu
Publication Date:
01-2018
Content Type:
Video
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China.
Topic:
Health, Health Care Policy, Mental Health, Urban, and Rural
Political Geography:
China and Asia

15. Bird Flu — It’s What’s for Dinner: What Human Population Growth and Climate Change Mean for the Future of Avian Influenza Outbreaks

Author:
Nahid Bhadelia
Publication Date:
07-2017
Content Type:
Journal Article
Journal:
Fletcher Security Review
Institution:
The Fletcher School, Tufts University
Abstract:
China is currently experiencing its fifth epidemic of “bird flu,” or avian influenza H7N9, since 2013 when it was first noted to cause human infections. The virus, which is mainly transmitted from poultry to humans, is also prone to limited human-to-human transmission. To date, there have been 1,258 human cases, with one-third of those cases (460) occurring during this year’s epidemic alone.[1] There are many “subtypes” of avian influenza circulating in birds around the world and most of these viruses cause limited or no human infections. However, two avian influenzas subtypes causing high human mortality have jumped from birds to humans in the last decade, H5N1 and then H7N9. The significant potential of this class of viruses to cause a human pandemic is a global public health concern, particularly because the conditions leading to the rise of these infections are becoming more favorable — for the viruses.
Topic:
Climate Change, Environment, Health, and Infectious Diseases
Political Geography:
China, Asia, and Global Focus

16. Happiness and health in China: The paradox of progress

Author:
Carol Graham, Shaojie Zhou, and Junyi Zhang
Publication Date:
06-2015
Content Type:
Working Paper
Institution:
The Brookings Institution
Abstract:
The past two decades in China brought unprecedented rates of economic growth, development, and poverty reduction. Indeed, much of the reduction in the world’s extreme poverty rates during that time can be explained by the millions of people in China who exited poverty. GDP per capita and household consumption increased fourfold between the years 1990 and 2005.1 China jumped 10 places forward on the Human Development Index from 2008 until 2013, moving up to 93 of 187 countries, and life expectancy climbed to 75.3 years, compared to 67 years in 1980.
Topic:
Development, Economics, Health, and Human Welfare
Political Geography:
China

17. Antimicrobial Resistance as an Emerging Threat to National Security

Author:
Maxine Builder
Publication Date:
01-2015
Content Type:
Working Paper
Institution:
Atlantic Council
Abstract:
Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
Topic:
Health, National Security, Infectious Diseases, and Health Care Policy
Political Geography:
United States, China, United Kingdom, America, and Europe

18. The Global Fund's China Legacy

Author:
Yanzhong Huang
Publication Date:
03-2014
Content Type:
Working Paper
Institution:
Council on Foreign Relations
Abstract:
The Global Fund to Fight AIDS, Tuberculosis and Malaria (hereafter "the Global Fund" or "the Fund") is the world's main multilateral funder in global health and the largest financier of anti-AIDS, anti-tuberculosis (TB), and anti-malaria programs. Since its inception in 2002, the Global Fund has disbursed $23.2 billion to more than 140 countries; today, it accounts for 21 percent of the international funding for the prevention and treatment of HIV/AIDS, 82 percent of that for TB, and 50 per cent of that for malaria. Until recently, it awarded grants based on the need of individual countries and the quality of each proposal. As a performance-based initiative, it closely tracks the results flowing from each grant disbursement. As a value-oriented organization, it requires recipients to have transparent, accountable, and inclusive governance mechanisms. Indeed, in terms of multisectoralism and civil society participation, the Fund is considered the most progressive global health institution. But unlike many other health-related multilateral organizations, it is not an implementing agency and lacks in-country presence. Instead, as a funding mechanism, it has grant applications and project/program implementation in each country overseen by a "country coordinating mechanism" (CCM), which draws representatives from government, UN and donor agencies, nongovernmental organizations (NGOs), the private sector, and people living with the diseases.
Topic:
Civil Society, Economics, Health, and Governance
Political Geography:
China and East Asia

19. Patient Copayments, Provider Incentives and Income Effects: Theory and Evidence from China's Essential Medications List Policy

Author:
Brian K. Chen
Publication Date:
09-2013
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
How do demand - and supply - side incentives interact, when there are potentially large provider income effects? We develop a simple model and empirically test it with data from China's Essential Medications List (EML) policy, which reduced patient copayments and changed provider incentives by removing a large source of revenue from primary care providers: drug dispensing revenues. Using a panel of patient - level spending and clinical data for Chinese patients with diabetes or hypertension over two and a half years, we find evidence of strategic provider response that dampened the impact of patient copayment reductions. Resource use and patient out - of - pocket spending did not change, when taking account of patient utilization outs ide primary care.
Topic:
Communism, Health, and Governance
Political Geography:
China and Israel

20. Journal of Public and International Affairs 2013

Author:
Greg Rosalsky, Sarah Schleck, Nathaniel D. F. Allen, Ezra Levin, Alex Penwill, Farzan Sabet, Daniel Tam-Claiborne, Albert Trithart, Mark Walker, Ben Grubb, and Gloria Twesigye
Publication Date:
05-2013
Content Type:
Journal Article
Journal:
Woodrow Wilson School Journal of Public and International Affairs
Institution:
Woodrow Wilson School of Public and International Affairs, Princeton University
Abstract:
The nine articles in this volume were chosen from over 150 submissions through a blind-selection process in Princeton. After individually reading a large number of submissions, attending editors first voted for their favorite papers via secret ballot, and we then facilitated an open debate to winnow down these choices to the cream of the crop. In the intervening months before publication, editors in Princeton from relevant policy areas worked with the authors to fact-check their work and fine-tune their arguments. While their geographic foci and policy subjects are multifarious, all the authors in this edition share a passion for changing the world through better policy. Whether it is women’s health issues in Tanzania, banking regulation in the European Union, diplomacy with Iran over its nuclear ambitions, or immigration policy in the United States, the authors implore global policymakers to change course in order to remedy contemporary problems in public affairs. This dedication to making the world a better place through public policy, in addition to demonstrating first-rate scholarship, make us proud to showcase these articles.
Topic:
Health, Nuclear Weapons, Politics, Foreign Aid, Governance, Nuclear Power, Democracy, Economy, Arms Trade, and Microcredit
Political Geography:
Africa, China, Iran, Tanzania, Honduras, Mali, Niger, and United States of America