Stanford University

Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

Public Goods Provision and the Efficacy of Governance

On May 18-19, the Program on Poverty and Governance will host a two-day conference on the provision of public goods and good governance throughout the world. This conference, co-sponsored by the Center for Latin American Studies, will bring together an interdisciplinary group of economists, political scientists, policymakers, and public health researchers examining these questions. Public goods—goods and services such as education, healthcare, sanitation, potable water, and other benefits provided by the government—are intrinsically tied to issues of governance, which we broadly define as the exercise of political authority and the use of institutional resources to manage society’s problems and affairs. More specifically, factors such how political leaders get elected, the way in which government projects get funded, whether the community participates in decision-making, and the extent to which the distribution of government benefits is done through clientelistic networks, among others, play an important role in the quality and coverage of public goods that governments provide. Additionally, a critical question in large parts of the developing world relates to the role of international players and foreign aid in the provision of public goods –does external provision of public goods enable or hinder governmental capacity to deliver public services in poor communities? Through two days of presentations and panel discussions, the conference will explore how various facets of governance affect the provision of public goods and services throughout the world.

The conference will be held in Encina Hall at Stanford University May 18th and 19th, 2012. Guests are encouraged to RSVP by May 16th. Any questions may be addressed to the Program on Poverty and Governance program associate Elena Cryst.

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CISAC Conference Room

Beatriz Magaloni

Dept. of Political Science
Encina Hall, Room 436
Stanford University,
Stanford, CA

(650) 724-5949
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Senior Fellow at the Freeman Spogli Institute for International Studies
Graham H. Stuart Professor of International Relations
Professor of Political Science
beatriz_magaloni_2024.jpg MA, PhD

Beatriz Magaloni Magaloni is the Graham Stuart Professor of International Relations at the Department of Political Science. Magaloni is also a Senior Fellow at the Freeman Spogli Institute, where she holds affiliations with the Center on Democracy, Development and the Rule of Law (CDDRL) and the Center for International Security and Cooperation (CISAC). She is also a Stanford’s King Center for Global Development faculty affiliate. Magaloni has taught at Stanford University for over two decades.

She leads the Poverty, Violence, and Governance Lab (Povgov). Founded by Magaloni in 2010, Povgov is one of Stanford University’s leading impact-driven knowledge production laboratories in the social sciences. Under her leadership, Povgov has innovated and advanced a host of cutting-edge research agendas to reduce violence and poverty and promote peace, security, and human rights.

Magaloni’s work has contributed to the study of authoritarian politics, poverty alleviation, indigenous governance, and, more recently, violence, crime, security institutions, and human rights. Her first book, Voting for Autocracy: Hegemonic Party Survival and its Demise in Mexico (Cambridge University Press, 2006) is widely recognized as a seminal study in the field of comparative politics. It received the 2007 Leon Epstein Award for the Best Book published in the previous two years in the area of political parties and organizations, as well as the Best Book Award from the American Political Science Association’s Comparative Democratization Section. Her second book The Politics of Poverty Relief: Strategies of Vote Buying and Social Policies in Mexico (with Alberto Diaz-Cayeros and Federico Estevez) (Cambridge University Press, 2016) explores how politics shapes poverty alleviation.

Magaloni’s work was published in leading journals, including the American Political Science Review, American Journal of Political Science, Criminology & Public Policy, World Development, Comparative Political Studies, Annual Review of Political Science, Cambridge Journal of Evidence-Based Policing, Latin American Research Review, and others.

Magaloni received wide international acclaim for identifying innovative solutions for salient societal problems through impact-driven research. In 2023, she was named winner of the world-renowned Stockholm Prize in Criminology, considered an equivalent of the Nobel Prize in the field of criminology. The award recognized her extensive research on crime, policing, and human rights in Mexico and Brazil. Magaloni’s research production in this area was also recognized by the American Political Science Association, which named her recipient of the 2021 Heinz I. Eulau Award for the best article published in the American Political Science Review, the leading journal in the discipline.

She received her Ph.D. in political science from Duke University and holds a law degree from the Instituto Tecnológico Autónomo de México.

Director, Poverty, Violence, and Governance Lab
Co-director, Democracy Action Lab
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Dual Use Research of Concern: Avian H5N1 influenza adaption to a mammalian host

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The life sciences have many examples of where research results and technologies can be used for good, but also for bad purposes. Because such scenarios are so common, it is critical to identify that research which is particularly bad and would be classified as dual use research of concern (DURC). Attributes that might result in a DURC designation include how immediate a threat it represents, the magnitude of the threat, the availability of safeguards to defend against its nefarious use and its relative risk to benefits ratio. Several policy forums have studied this problem and the National Science Advisory Board for Biosecurity (NSABB) is currently the official U.S. government advisory group for DURC policy. Recently, NSABB was asked to review two manuscripts that reported adaptation of the high-path avian influenza virus H5N1 to transmission in a mammalian model. This virus rarely infects humans but when it does, it has catastrophic consequences with ~60% mortality. The board weighed the risks and the benefits of the work and recommended that the papers not be published as written, but only in a highly redacted form that would prevent the rapid and direct replication of the work. NSABB also argued for a communication pause so that the consequences of these papers and this research focus be evaluated by a broad cross section of science, public health and society. The US government accepted these recommendations and the two journals (Science and Nature) have thus far not published the papers. Multiple additional forums are planned to discuss the issues and recommendations. The future for policy development in the area of pathogen research and DURC will be shaped by these recommendations and subsequent activities.

About the speakers:

Dr. Paul Keim holds the E. Raymond and Ruth Cowden Endowed Chair in Microbiology at Northern Arizona University (NAU), where he is also a Regents Professor of Biology. In addition, he directs the Pathogen Genomics Division at The Translational Genomics Research Institute (TGen). Both institutions are based in Flagstaff, Arizona. His biological interests span many types of organisms and microbes, but revolve around genetic diversity and its organization in populations and species. This necessarily has involved systematic and phylogenetic analyses to understand how observable genetic diversity is based upon past evolutionary processes. Biodefense programs have capitalized upon his approach of using genomic analysis to understand bacterial pathogen populations for microbial forensics and molecular epidemiological analyses. His laboratory was heavily involved in analysis of evidentiary material from the 2001 anthrax-letter attacks. He has published extensively on the evolution and population genetics of Bacillus anthracis, Yersinia pestis, Francisella tularensis, Burkholderia pseudomallei, Burkholderia mallei, Brucella spp., and Coxiella burnetii. Recently, these same principles have been applied to other public health-related and clinically important pathogens such as S. aureus and E. coli. In all, he has published over 230 scientific or policy papers. Dr. Keim received his B.S. in Biology and Chemistry from Northern Arizona University in 1977 and his Ph.D. in Botany in 1981 from the University of Kansas. Dr. Keim has previously served on the editorial boards of Crop Science and Molecular Breeding; he currently serves on the editorial boards of Infection Genetics and Evolution, Investigative Genetics, and Biotechniques.

Dr. David Relman is a professor of medicine – infectious diseases, and of microbiology and immunology at Stanford. He joined CISAC as an affiliated faculty member in November 2011. He is also chief, Infectious Diseases Section, at the VA Palo Alto Health Care System. Among his other activities, Dr. Relman currently serves as Vice-President of the Infectious Diseases Society of America, Chair of the U.S. National Academies of Science Institute of Medicine's Forum on Microbial Threats, and member of the National Science Advisory Board for Biosecurity. He received a S.B. in biology from the Massachusetts Institute of Technology (1977) and an M.D. from Harvard Medical School Medicine (1982).

CISAC Conference Room

Paul Keim Acting Chair, National Science Advisory Board for Biosecurity, The Cowden Endowed Chair of Microbiology, Northern Arizona University and Director, Pathogen Genomics Division, Translational Genomics Research Institute Speaker

David Relman

CISAC
Stanford University
Encina Hall, E209
Stanford, CA 94305-6165

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Senior Fellow at the Freeman Spogli Institute for International Studies
Thomas C. and Joan M. Merigan Professor
Professor of Medicine
Professor of Microbiology and Immunology
1-RSD13_085_0052a-001.jpg MD

David A. Relman, M.D., is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University, and Chief of Infectious Diseases at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California. He is also Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford, and served as science co-director at the Center for International Security and Cooperation at Stanford from 2013-2017. He is currently director of a new Biosecurity Initiative at FSI.

Relman was an early pioneer in the modern study of the human indigenous microbiota. Most recently, his work has focused on human microbial community assembly, and community stability and resilience in the face of disturbance. Ecological theory and predictions are tested in clinical studies with multiple approaches for characterizing the human microbiome. Previous work included the development of molecular methods for identifying novel microbial pathogens, and the subsequent identification of several historically important microbial disease agents. One of his papers was selected as “one of the 50 most important publications of the past century” by the American Society for Microbiology.

Dr. Relman received an S.B. (Biology) from MIT, M.D. from Harvard Medical School, and joined the faculty at Stanford in 1994. He served as vice-chair of the NAS Committee that reviewed the science performed as part of the FBI investigation of the 2001 Anthrax Letters, as a member of the National Science Advisory Board on Biosecurity, and as President of the Infectious Diseases Society of America. He is currently a member of the Intelligence Community Studies Board and the Committee on Science, Technology and the Law, both at the National Academies of Science. He has received an NIH Pioneer Award, an NIH Transformative Research Award, and was elected a member of the National Academy of Medicine in 2011.

Stanford Health Policy Affiliate
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The Insider Threat: Preserving the Good of Powerful Science in a Dangerous World

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Recent events in the U.S. have raised concerns about the safety and security of research with hazardous microbial agents, particularly with regard to the insider threat. The anthrax letters of 2001 and several technical surprises in legitimate infectious disease research, led to a series of high-level committee recommendations on safety and security of the ongoing work. When a scientist from a U.S. military high-containment laboratory was implicated in the anthrax letters case, the president and congress called for more regulation. Subsequently, a series of steps to reduce the risk have been proposed: from armed guards, pathogen accountability and medical and psychological exams for scientists to training, ethical frameworks, codes of conduct and standards of quality research. Franz will discuss the implications of these events on both security and productive research in support of public health and the life-sciences enterprise, and the important role of leadership and culture in enhancing both safety and security.

About the speaker: Dave Franz is a Vice President and Chief Biological Scientist at MRIGlobal. He served in the U.S. Army Medical Research and Materiel Command for 23 of 27 years on active duty and retired as Colonel. He served as Commander of the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) and as Deputy Commander of the Medical Research and Materiel Command. Prior to joining the Command, he served as Group Veterinarian for the 10th Special Forces Group (Airborne). Dr. Franz was Technical Editor for the Textbook of Military Medicine on Medical Aspects of Chemical and Biological Warfare released in 1997. He serves on numerous national committees and boards. Dr. Franz holds an adjunct appointment as Professor for the Department of Diagnostic Medicine and Pathobiology at the College of Veterinary Medicine, Kansas State University. The current focus of his activities relates to the role of international engagement in the life sciences as a component of national security policy.

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Dave Franz Vice President and Chief Biological Scientist Speaker MRIGlobal
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What to Do about Flu? A Public Health Challenge

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Infectious diseases, especially those transmitted from person to person through the respiratory route, continue to pose a threat to the global community. Public health surveillance systems and the International Health Regulations are intended to facilitate the recognition of and rapid response to infectious diseases that pose the risk of developing into a pandemic, but the response to the 2009 H1N1 influenza pandemic illustrates the continuing challenges to implementing appropriate prevention and control measures. The response to the 2009 H1N1 influenza pandemic will be discussed and its implications examined.

Speaker biography:

Arthur Reingold, MD is Professor and Head of the Division of Epidemiology and Associate Dean for Research in the School of Public Health (SPH) at the University of California, Berkeley (UCB). He holds concurrent appointments in Medicine and in Epidemiology and Biostatistics at the University of California, San Francisco (UCSF). He completed his BA and MD degrees at the University of Chicago and then completed a residency in internal medicine at Mt. Auburn Hospital in Cambridge, Massachusetts. He is board certified in internal medicine and holds a current medical license in California, but has devoted the last 25 years to the study and prevention of infectious diseases in the U.S and in developing countries throughout the world.

He began his career as an infectious disease epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC), working there for eight years. While at CDC, he worked domestically on Toxic Shock Syndrome, Legionnaires’ disease, bacterial meningitis, fungal infections, and non-tuberculous mycobacterial infections and internationally on epidemic meningitis in West Africa and Nepal.

Since joining the faculty at UCB in 1987, he has worked on a variety of emerging and re-emerging infections in the U.S.; on acute rheumatic fever in New Zealand; and on AIDS, tuberculosis, malaria, and acute respiraatory infections in Brazil, Uganda, Ivory Coast, Zimbabwe, India and Indonesia. He has directed the National Institutes of Health (NIH) Fogarty AIDS International Training and Research Program at UCB/UCSF since its inception in 1988; co-directed (with Dr. Duc Vugia of the California Department of Health Services), the CDC-funded California Emerging Infections Program since its inception in 1994; and served as the Principal Investigator of the UCB Center for Infectious Disease Preparedness (CIDP) since its inception in 2002.

He also has ongoing research projects concerning malaria in Uganda; HIV/AIDS and related conditions in Brazil; and tuberculosis in India.  He regularly teaches courses on epidemiologic methods, outbreak investigation, and the application of epidemiologic methods in developing countries, among others. He also teaches annual short courses on similar topics in Hong Kong, Brazil, Switzerland, and other countries.

He has been elected to membership in the American Epidemiological Society; fellowship in the American Association for the Advancement of Science and the Infectious Diseases Society of America; and membership in the Institute of Medicine of the National Academy of Sciences. In Hong Kong, He has a close working relationship with Chinese University, particularly with its School of Public Health and its Centre for Emerging Infectious Diseases. Dr. Reingold gives short courses at the School of Public Health each year and he serves on the Advisory Board of the Centre for Emerging Infectious diseases.

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Arthur Reingold Professor of Epidemiology and Associate Dean of Research Speaker UC Berkeley School of Public Health
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CISAC Honors graduate awarded a Rhodes Scholarship

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Congratulations to Anand Habib, selected this weekend for a Rhodes Scholarship. Habib, 22, of Houston, Texas, is a 2011 graduate of Stanford, where he earned a bachelor's degree in biology, with honors in international security studies. He plans to pursue a master's degree in public policy and in medical anthropology at Oxford.

Habib is currently working on community health programs at St. Joseph's Clinic in Thomassique, Haiti, under a one-year global health fellowship awarded by Medical Missionaries. The nonprofit organization is a volunteer group of more than 200 doctors, nurses, dentists, and others who work to improve the health of the poorest of the poor in the United States and throughout the world.

In 2011, he won a Deans' Award for Academic Accomplishment which honors extraordinary undergraduate students for "exceptional, tangible" intellectual achievements. One of the professors who nominated him for the award described him as a "superb critical thinker" whose work is characterized by "creative genius" and "mature insights," adding that he "exemplifies exactly the kind of deeply informed, pragmatic and caring leadership that the world needs and Stanford enables."

As a Stanford student, Habib worked on behalf of politically and medically disenfranchised people in India, Mexico and Guatemala. On campus, he turned the Stanford tradition of the annual Dance Marathon into a vehicle dedicated to addressing the HIV/AIDS pandemic by engaging not only Stanford students but also local communities and corporations, raising more than $100,000. His exceptional work was recognized by his participation in the Clinton Global Initiative University Conference in April, 2011.

From Haiti, Habib discussed his current position, his plans in Oxford, and how his CISAC thesis relates to his work. 

What are you currently working on? 

I am currently working on a global health fellowship with an NGO that operates a clinic in Haiti's Central Plateau. As part of the fellowship I am helping to manage a number of community and public health projects including fortified salt (to counter iodine deficiency and filariasis), a point-of-use potable water system, a malnutrition intervention program, and a small system of community health committees and community health workers. For the past two months, I've taken on a number of administrative functions along with my co-fellow, who is also a recent college graduate. I started the fellowship shortly after graduation at the end of June 2011 and I am slated to be in Haiti until the end of June 2012.

What will you do at Oxford?

I proposed two one-year Masters programs: a masters in public policy from Oxford's new Blavatnik School of Government, and an M.Sc. in medical anthropology. As of now, I'm thinking of sticking with my proposed programs -- probably pursuing the medical anthropology degree first as it is a bit more theoretical. I think it would be better to have the more "academic" experience first before gaining the practical tools that an MPP will hopefully afford me. After a short send-off in Washington, D.C., at the end of September 2012, I will fly with the other American Rhodes Scholars-elect to Oxford the first week of October with term beginning shortly thereafter.

How does your work in the CISAC Honors program relate to what you are currently doing, your plans for Oxford, or what you'll be doing afterward? 

My honors thesis has allowed me to contextualize my experiences in Haiti in some fairly amazing ways. Two very persistent issues in Haiti are that of poor governance -- e.g. lack of strong regulatory structures, lack of government effectiveness, etc. -- and ineffective aid modalities, or the ways in which aid is delivered. My thesis was situated exactly at this nexus: how to deliver aid more effectively in order to improve governance. Ninety-nine percent of relief aid after the 2010 earthquake in Haiti was funneled to non-state organizations and only 12 percent of recovery aid went toward supporting government activities. In Haiti, I've witnessed how detrimental a patchwork system of NGO activity can be with little coordination between NGOs and little harmonization of NGO activities with government objectives. It becomes very frustrating at times, because, if my thesis is any indication, things need not be this way if both NGOs and states were engaged in collaborative partnerships -- along the lines of what Dr. Paul Farmer, deputy U.N. special envoy to Haiti, calls "accompaniment."

My initial interest in the topic of global health financing was spurred by work out of Oxford's Global Economic Governance Project. The director of the project, Dr. Ngaire Woods, was actually named the Dean of the Blavatnik School of Government through which the MPP is offered. I'd love to continue exploring the issues broached in my thesis at Oxford -- especially issues of aid effectiveness and sustainable systems of delivering development aid for health. In the future, I hope to become a physician-policymaker, helping to not only deliver care to individuals in difficult conditions around the world, but also in fostering more robust global health governance.

- Interview by Michael Freedman

 

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David Relman

CISAC
Stanford University
Encina Hall, E209
Stanford, CA 94305-6165

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Senior Fellow at the Freeman Spogli Institute for International Studies
Thomas C. and Joan M. Merigan Professor
Professor of Medicine
Professor of Microbiology and Immunology
1-RSD13_085_0052a-001.jpg MD

David A. Relman, M.D., is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University, and Chief of Infectious Diseases at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California. He is also Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford, and served as science co-director at the Center for International Security and Cooperation at Stanford from 2013-2017. He is currently director of a new Biosecurity Initiative at FSI.

Relman was an early pioneer in the modern study of the human indigenous microbiota. Most recently, his work has focused on human microbial community assembly, and community stability and resilience in the face of disturbance. Ecological theory and predictions are tested in clinical studies with multiple approaches for characterizing the human microbiome. Previous work included the development of molecular methods for identifying novel microbial pathogens, and the subsequent identification of several historically important microbial disease agents. One of his papers was selected as “one of the 50 most important publications of the past century” by the American Society for Microbiology.

Dr. Relman received an S.B. (Biology) from MIT, M.D. from Harvard Medical School, and joined the faculty at Stanford in 1994. He served as vice-chair of the NAS Committee that reviewed the science performed as part of the FBI investigation of the 2001 Anthrax Letters, as a member of the National Science Advisory Board on Biosecurity, and as President of the Infectious Diseases Society of America. He is currently a member of the Intelligence Community Studies Board and the Committee on Science, Technology and the Law, both at the National Academies of Science. He has received an NIH Pioneer Award, an NIH Transformative Research Award, and was elected a member of the National Academy of Medicine in 2011.

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Sociotechnical Challenges of Developing an Interoperable Personal Health Record

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Objectives

To analyze sociotechnical issues involved in the process of developing an interoperable commercial Personal Health Record (PHR) in a hospital setting, and to create guidelines for future PHR implementations.

Methods

This qualitative study utilized observational research and semi-structured interviews with 8 members of the hospital team, as gathered over a 28 week period of developing and adapting a vendor-based PHR at Lucile Packard Children’s Hospital at Stanford University. A grounded theory approach was utilized to code and analyze over 100 pages of typewritten field notes and interview transcripts. This grounded analysis allowed themes to surface during the data collection process which were subsequently explored in greater detail in the observations and interviews.

Results

Four major themes emerged: (1) Multidisciplinary teamwork helped team members identify crucial features of the PHR; (2) Divergent goals for the PHR existed even within the hospital team; (3) Differing organizational conceptions of the end-user between the hospital and software company differentially shaped expectations for the final product; (4) Difficulties with coordination and accountability between the hospital and software company caused major delays and expenses and strained the relationship between hospital and software vendor.

Conclusions

Though commercial interoperable PHRs have great potential to improve healthcare, the process of designing and developing such systems is an inherently sociotechnical process with many complex issues and barriers. This paper offers recommendations based on the lessons learned to guide future development of such PHRs.

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Applied Clinical Informatics
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Rebecca Slayton
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No Need to Reset the Reset

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Russia watchers in the West cannot be surprised that Vladimir Putin is on his way back to the Russian presidency. Dmitri Medvedev was always his protégé, and there was no doubt that major decisions could not be made without his approval. This includes signing the New START arms control treaty, cooperating with NATO in Afghanistan and supporting U.N. sanctions on Iran — all of which should provide reassurance that Putin’s return won’t undo the most important accomplishments of the U.S.-Russia “reset.”

Yet the relationship with the West will inevitably change. For one thing, Putin can have nothing like the rapport his protégé developed with President Obama, which was built upon the two leaders’ shared backgrounds as lawyers, their easy adoption of new technologies, and their fundamentally modern worldviews.

The Bilateral Presidential Commission which Obama and Medvedev created and charged with advancing U.S.-Russia cooperation on everything from counterterrorism to health care may suffer. The relationship as a whole is not adequately institutionalized, and depends on the personal attention of Russian officials who will likely avoid taking action without clear direction from Putin, or who may be removed altogether during the transition.

Putin’s return to the presidency will also provide fodder for Western critics bent on portraying Obama and the reset as a failure, or dismissing Putin’s Russia as merely a retread of the Soviet Union.

These critics are wrong — today’s Russia bears little resemblance to what Ronald Reagan dubbed an “evil empire” — but Putin has been far more tolerant of Soviet nostalgia than his junior partner, and his next term will surely bring a new litany of quotations about Soviet accomplishments and Russia’s glorious destiny that will turn stomachs in the West.

Although he has spent his entire career within the apparatus of state power, including two decades in the state security services, Putin is at heart a C.E.O., with a businessman’s appreciation for the bottom line. Western companies already doing business in Russia can expect continuity in their dealings with the state, and it will remain in Russia’s interest to open doors to new business with Europe and the United States. The next key milestone for expanding commercial ties will be Russia’s planned accession to the World Trade Organization, which could come as soon as December.

At home, Putin faces a looming budget crisis. As the population ages and oil and gas output plateaus the government will be unable to continue paying pensions, meeting the growing demand for medical care, or investing in dilapidated infrastructure throughout the country’s increasingly depopulated regions.

This means that while Putin will seek to preserve Russia’s current economic model, which is based on resource extraction and export, he will be forced to assimilate many of his protégé’s ideas for modernizing Russia’s research and manufacturing sectors. Medvedev’s signature initiative, the Skolkovo “city of innovation,” will likely receive continuing support from the Kremlin, although it will have little long-term impact without a thorough nationwide crackdown on corruption and red tape.

Putin’s restored power will be strongly felt in Russia’s immediate neighborhood, which he has called Moscow’s “sphere of privileged interests.” Even though Kiev has renewed Russia’s lease on the Black Sea Fleet’s Sevastopol base through 2042 and reversed nearly all of the previous government’s anti-Russian language and culture policies, Ukraine is unlikely to win a reprieve from high Russian gas prices. Putin will also continue to press Ukraine to join the Russia-dominated customs union in which Kazakhstan and Belarus already participate. He may also take advantage of Belarus’s deepening economic isolation and unrest to oust President Aleksandr Lukashenko in favor of a more reliable Kremlin ally.

Putin and Medvedev have been equally uncompromising toward Georgia. Both are openly contemptuous of Georgian President Mikheil Saakashvili, and it is unlikely that any progress on relations can occur until Georgia’s presidential transition in 2013.

Putin has good reason to continue backing NATO operations in Afghanistan to help stem the flow of drugs, weapons and Islamism into Tajikistan, Uzbekistan and Russia itself. Moreover, as China extends its economic hegemony into Central Asia, he may find America to be a welcome ally.

Putin appreciates the advantages of pragmatic partnerships and will seek to preserve the influence of traditional groupings like the U.N. Security Council and the G-8 while at the same time promoting alternatives like the Shanghai Cooperation Organization and the Brics.

The succession from Putin to Medvedev and back again was decided behind closed doors, and the formal transition of power is likely to take place with similar discipline. This should offer the West and the wider world some reassurance. Putin’s return to the presidency is far from the democratic ideal, but it is not the end of “reset.” Many ordinary Russians support him because he represents stability and continuity of the status quo and, for now, that is mostly good for Russia’s relations with the West.

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