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.

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About the topic: Stanford University, in collaboration with humanitarian NGOs, WHO, the Global Fund and the North Korean Ministry of Public Health have undertaken to develop that country's first National Tuberculosis Reference Laboratory. North Korea is estimated to have the highest tuberculosis rate outside sub-Saharan Africa and is believed to have a mounting epidemic of patients infected with drug-resistant strains. This presentation will focus on the nature of the TB epidemic in North Korea, the role of this laboratory in addressing this epidemic, challenges to the laboratory's development in this isolated country and possible "dual use" concerns about the importation of equipment and expertise intended for the diagnosis and treatment of TB patients.

 

About the speaker: Gary Schoolnik is Professor of Medicine, Microbiology and Immunology, Attending Physician in Internal Medicine and Infectious Diseases at Stanford Hospital, Associate Director of the Institute for Immunology, Transplantation and Infection and Associate Dean, School of Medicine. His research laboratory studies tuberculosis and cholera using molecular, genetic and genomic methods to understand how these microbes cause disease and how that understanding might lead to improved preventive, diagnostic and treatment strategies.

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Gary Schoolnik Professor, Medicine (Infectious Diseases); Professor, Microbiology and Immunology; Senior Fellow, Institute for the Environment Speaker
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President Obama and Mitt Romney meet for their third debate to discuss foreign policy on Monday, when moderator Bob Schieffer is sure to ask them about last month's terrorist attack in Libya and the nuclear capabilities of Iran.

In anticipation of the final match between the presidential candidates, researchers from five centers at Stanford’s Freeman Spogli Institute for International Studies ask the additional questions they want answered and explain what voters should keep in mind.


What can we learn from the Arab Spring about how to balance our values and our interests when people in authoritarian regimes rise up to demand freedom?  

What to listen for: First, the candidates should address whether they believe the U.S. has a moral obligation to support other peoples’ aspirations for freedom and democracy. Second, they need to say how we should respond when longtime allies like Egypt’s Hosni Mubarak confront movements for democratic change.

And that leads to more specific questions pertaining to Arab states that the candidates need to answer: What price have we paid in terms of our moral standing in the region by tacitly accepting the savage repression by the monarchy in Bahrain of that country's movement for democracy and human rights?  How much would they risk in terms of our strategic relationship with Bahrain and Saudi Arabia by denouncing and seeking to restrain this repression? What human rights and humanitarian obligations do we have in the Syrian crisis?  And do we have a national interest in taking more concrete steps to assist the Syrian resistance?  On the other hand, how can we assist the resistance in a way that does not empower Islamist extremists or draw us into another regional war?  

Look for how the candidates will wrestle with difficult trade-offs, and whether either will rise above the partisan debate to recognize the enduring bipartisan commitment in the Congress to supporting democratic development abroad.  And watch for some sign of where they stand on the spectrum between “idealism” and “realism” in American foreign policy.  Will they see that pressing Arab states to move in the direction of democracy, and supporting other efforts around the world to build and sustain democracy, is positioning the United States on “the right side of history”?

~Larry Diamond, director of the Center on Democracy, Development, and the Rule of Law


What do you consider to be the greatest threats our country faces, and how would you address them in an environment of profound partisan divisions and tightly constrained budgets? 

What to listen for: History teaches that some of the most effective presidential administrations understand America's external challenges but also recognize the interdependence between America's place in the world and its domestic situation.

Accordingly, Americans should expect their president to be deeply knowledgeable about the United States and its larger global context, but also possessed of the vision and determination to build the country's domestic strength.

The president should understand the threats posed by nuclear proliferation and terrorist organizations. The president should be ready to lead in managing the complex risks Americans face from potential pandemics, global warming, possible cyber attacks on a vulnerable infrastructure, and failing states.

Just as important, the president needs to be capable of leading an often-polarized legislative process and effectively addressing fiscal challenges such as the looming sequestration of budgets for the Department of Defense and other key agencies. The president needs to recognize that America's place in the world is at risk when the vast bulk of middle class students are performing at levels comparable to students in Estonia, Latvia and Bulgaria, and needs to be capable of engaging American citizens fully in addressing these shared domestic and international challenges.

~Mariano-Florentino Cuéllar, co-director of the Center for International Security and Cooperation


Should our government help American farmers cope with climate impacts on food production, and should this assistance be extended to other countries – particularly poor countries – whose food production is also threatened by climate variability and climate change?

What to listen for: Most representatives in Congress would like to eliminate government handouts, and many would also like to turn away from any discussion of climate change. Yet this year, U.S. taxpayers are set to pay up to $20 billion to farmers for crop insurance after extreme drought and heat conditions damaged yields in the Midwest.

With the 2012 farm bill stalled in Congress, the candidates need to be clear about whether they support government subsidized crop insurance for American farmers. They should also articulate their views on climate threats to food production in the U.S. and abroad.

Without a substantial crop insurance program, American farmers will face serious risks of income losses and loan defaults. And without foreign assistance for climate adaptation, the number of people going hungry could well exceed 15 percent of the world's population. 

~Rosamond L. Naylor, director of the Center on Food Security and the Environment


What is your vision for the United States’ future relationship with Europe? 

What to listen for: Between the end of World War II and the end of the Cold War, it was the United States and Europe that ensured world peace. But in recent years, it seems that “Europe” and “European” have become pejoratives in American political discourse. There’s been an uneasiness over whether we’re still friends and whether we still need each other. But of course we do.

Europe and the European Union share with the United States of America the most fundamental values, such as individual freedom, freedom of speech, freedom to live and work where you choose. There’s a shared respect of basic human rights. There are big differences with the Chinese, and big differences with the Russians. When you look around, it’s really the U.S. and Europe together with robust democracies such as Canada and Australia that have the strongest sense of shared values.

So the candidates should talk about what they would do as president to make sure those values are preserved and protected and how they would make the cooperation between the U.S. and Europe more effective and substantive as the world is confronting so many challenges like international terrorism, cyber security threats, human rights abuses, underdevelopment and bad governance.

~Amir Eshel, director of The Europe Center


Historical and territorial issues are bedeviling relations in East Asia, particularly among Japan, China, South Korea, and Southeast Asian countries. What should the United States do to try to reduce tensions and resolve these issues?

What to listen for: Far from easing as time passes, unresolved historical, territorial, and maritime issues in East Asia have worsened over the past few years. There have been naval clashes, major demonstrations, assaults on individuals, economic boycotts, and harsh diplomatic exchanges. If the present trend continues, military clashes – possibly involving American allies – are possible.

All of the issues are rooted in history. Many stem from Imperial Japan’s aggression a century ago, and some derive from China’s more assertive behavior toward its neighbors as it continues its dramatic economic and military growth. But almost all of problems are related in some way or another to decisions that the United States took—or did not take—in its leadership of the postwar settlement with Japan.

The United States’ response to the worsening situation so far has been to declare a strategic “rebalancing” toward East Asia, aimed largely at maintaining its military presence in the region during a time of increasing fiscal constraint at home. Meanwhile, the historic roots of the controversies go unaddressed.

The United States should no longer assume that the regional tensions will ease by themselves and rely on its military presence to manage the situation. It should conduct a major policy review, aimed at using its influence creatively and to the maximum to resolve the historical issues that threaten peace in the present day.

~David Straub, associate director of the Korea Studies Program at the Walter H. Shorentein Asia-Pacific Research Center

 

Compiled by Adam Gorlick.

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President Obama and Mitt Romney speak during the second presidential debate on Oct. 16, 2012. Their third and final debate will focus on foreign policy.
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U.N. Deputy High Commissioner for Refugees T. Alexander Aleinikoff estimates that in the last two years, the UNHCR has taken in an additional 2,000 refugees every day, making it one of the most challenging periods for the U.N. body in decades. Meanwhile, the traditional methods to shelter, protect and aid those refugees don’t always keep pace with growing demands and emerging technologies.

"Many of us work in ways we have worked for many years, where things that have worked in the past continue to work in the present. But, meanwhile, the world has moved on," Aleinikoff recently told a gathering of nongovernment organizations from around the world. The UNHCR, he said, is looking at mobile phone technology, solar power and lighting, fuel-efficient stoves, microcredit loans and stimulating refugee livelihoods.

The agency needed an incubator to test out some of these innovative ideas. So Aleinikoff turned to CISAC, calling on its security experts to collaborate with the UNHCR on a handful of prototypes that would better protect and support the more than 42 million refugees, internally displaced and stateless people worldwide.

The request has led to a multidisciplinary partnership between the UNHCR and CISAC, with students from across the Stanford campus, professors and NGOs, as well as physicians, architects and other professionals eager to volunteer their time and expertise.

“This really matters; it’s about real people,” said Mariano-Florentino Cuéllar, CISAC’s co-director and a Stanford Law School professor teaching a class to coincide with the project. “I like to think we are creating a network of people who will stay engaged. I’m looking for people who say: This is exciting, this is doable, this is important, and I want to be a part of this.”

Cuellar has found dozens. Students, professors at the Hassno-Platner Institute of Design – better known as the d.school – as well as Bay Area NGOs and Silicon Valley designers have signed on, attending workshops and brainstorming sessions with UNHCR officials and Stanford students from around the world.

Some of the Stanford professors include Paul H. Wise, a professor of pediatrics at the Stanford Medical School and a CISAC affiliated faculty member; Francis Fukuyama, a senior fellow at the Freeman Spogli Institute for International Studies and a specialist in international political economy; and Bernard Roth, a professor of mechanical engineering and one of the founders of the d.school.

“I’m curious to see how it’s all going to play out,” Paul Spiegel, deputy director of the Division of Program Support at the UNHCR and a senior fellow at the Harvard Humanitarian Initiative, recently told the Stanford Law School class during a Skype chat from Geneva. “For us at the UNHCR, the most interesting thing is the multidisciplinary nature of this project. This is something we’ve never done before. So this is very innovative and different.”

Two dozens students with majors ranging from engineering to computer science, international policy studies, law and public health are taking Cuéllar’s class, Rethinking Refugee Communities, co-taught by Leslie Witt of the global design consultancy, IDEO.

“I got involved in the project out of intellectual curiosity and because of the prospect of seeing our ideas applied in the field,” said Danny Buerkli, a second year master’s student in international policy studies. “While most of us are not experts in humanitarian policy, we have the luxury of time to reflect and rethink how UNHCR deals with refugee situations. The project is a great way of exploring design thinking, humanitarian policies and working with a large institutional client all at the same time.”

Some of the students are preparing for a visit to a UNHCR refugee camp in Jordan for Syrians fleeing the violence in their homeland. They want to see operations firsthand to better visualize what’s needed on the ground.

You can follow the project at CISAC’s Storify.com page.

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Mariano-Florentino Cuéllar is a professor and Deane F. Johnson faculty scholar at Stanford Law School, the co-director of CISAC, professor (by courtesy) of political science, a faculty affiliate of CDDRL, and a senior fellow at FSI. A member of the Stanford faculty since 2001, he has served in the Obama and Clinton Administrations, testified before lawmakers, and has an extensive record of involvement in public service. His research and teaching focus on administrative law, executive power, and how organizations implement critical regulatory, public safety, migration, and international security responsibilities in a changing world. In July 2010, the President appointed him to the Council of the Administrative Conference of the United States, an independent agency charged with recommending improvements in the efficiency and fairness of federal regulatory programs.  He also serves on the Department of Education’s National Commission on Educational Equity and Excellence, and the Department of State’s Advisory Sub-Committee on Economic Sanctions. 

From early 2009 through the summer of 2010, he was on leave from Stanford serving as Special Assistant to the President for Justice and Regulatory Policy at the White House. In this capacity, he led the Domestic Policy Council’s work on criminal justice and drug policy, public health and food safety, regulatory reform, borders and immigration, civil rights, and rural and agricultural policy. Among other issues, Cuéllar worked on stricter food safety standards, the FDA’s regulatory science initiative, expanding support for local law enforcement and community-based crime prevention, enhancing regulatory transparency, and strengthening border coordination and immigrant integration. He negotiated provisions of the Family Smoking Prevention and Tobacco Control Act and the Food Safety Modernization Act, and represented the Domestic Policy Council in the development of the first-ever Quadrennial Homeland Security Review.

Before working at the White House, he co-chaired the Obama-Biden Transition’s Immigration Policy Working Group. During the second term of the Clinton Administration, he worked at the U.S. Department of the Treasury as Senior Advisor to the Under Secretary for Enforcement, where he focused on countering financial crime, improving border coordination, and enhancing anti-corruption measures.

He has collaborated with or served on the board of several civil society organizations, including the Haas Center for Public Service, the Constitution Project, and the American Constitution Society. He has co-chaired the Regulatory Policy Committee of the American Bar Association’s Section of Administrative Law and Regulatory Practice, and served on the Silicon Valley Blue Ribbon Task Force on Aviation Security. He is a member of the American Law Institute and the Council on Foreign Relations.

After graduating from Calexico High School in California’s Imperial Valley, he received an A.B. magna cum laude from Harvard, a J.D. from Yale Law School, and a Ph.D. in political science from Stanford. He clerked for Chief Judge Mary M. Schroeder of the U.S. Court of Appeals for the Ninth Circuit.

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Mariano-Florentino Cuéllar Co-Director Speaker CISAC
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Shiri Krebs is a Professor of Law at Deakin University and Director of the Centre for Law as Protection. She is also the Chair of the Lieber Society on the Law of Armed Conflict, an affiliate scholar at Stanford University Center for International Security and Cooperation (CISAC), and co-lead of the Australian Government Cyber Security Cooperative Research Centre (CSCRC) Law and Policy Theme. In 2024, she was appointed as a Visiting Legal Fellow at the Australian Government Department of Foreign Affairs and Trade (DFAT). Her research on drone warfare and predictive technologies in counterterrorism and armed conflict is currently funded by a 3-year Australian Research Council (ARC) DECRA fellowship and an Alexander von Humboldt Experienced Researcher Fellowship at the University of Hamburg.

Prof Krebs’ research projects on international fact-finding, biases in counterterrorism decision-making, and human-machine interaction in drone warfare, have influenced decision-making processes through invitations to brief high-level decision-makers, including at the United Nations (CTED, Office of the Secretary-General), the United States Department of Defense, and the Australian Defence Force.

Her recent research awards include the David Caron Prize (American Society of International Law, 2021), the ‘Researcher of the Year’ Award (Australian Women in Law Awards, 2022), the Australian Legal Research Awards (finalist, Article/Chapter (ECR), 2022), and the Vice-Chancellor’s Researcher Award for Career Excellence (Deakin, 2022).

Before joining Deakin University, Prof Krebs has taught in several law schools, including at Stanford University, University of Santa Clara, and the Hebrew University of Jerusalem, where she won the Dean’s award recognizing exceptional junior faculty members.

She earned her Doctorate and Master Degrees from Stanford Law School, as well as LL.B. and M.A., both magna cum laude, from the Hebrew University of Jerusalem.

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Dr. David Relman investigates the secrets of the life sciences to help build a safer world.

The Stanford microbiologist and professor of infectious diseases has been named the next co-director of the university’s Center for International Security and Cooperation (CISAC). An adviser to the federal government on emerging biological threats, Relman believes his new role at CISAC will strengthen its core mission of making the world a safer place.

“There is a strong link between microbiology, infectious diseases and international security,” Relman said. “It is increasingly clear that the destabilizing effects of human population growth and displacement, environmental degradation and climate change are all mediated in part through the emergence and spread of infectious diseases. In addition, rapidly evolving capabilities of individuals in the life sciences around the globe make it increasingly likely that this science will be used to cause harm.”

Relman, the Thomas C. and Joan M. Merigan Professor at Stanford and chief of infectious diseases at the VA Palo Alto Healthcare System, has advised the U.S. government about pathogen diversity, biosecurity and the future of the life sciences landscape. He is a member of the National Science Advisory Board for Biosecurity (NSABB), chairs the Forum on Microbial Threats at the Institute of Medicine in Washington, D.C. and has participated in a number of studies for the National Academies of Science.

"David Relman is one of the nation’s top scientists exploring the mysteries of infectious disease, a thoughtful adviser to policymakers, and an extraordinary colleague,” said Tino Cuéllar, a Stanford Law School professor and the center’s co-director. “He will make tremendous contributions to CISAC's leadership as we expand our activities on public health and biosecurity while continuing our work on arms control and nuclear security."

Founded nearly three decades ago, CISAC’s mission is to produce cutting-edge research and spread knowledge to build a safer world. Now a part of the Freeman Spogli Institute for International Studies (FSI), the center has a tradition of appointing co-directors – one from the social sciences and the other from the natural sciences – to advance the center’s interdisciplinary mission.

Relman will take up the post in January, when Siegfried Hecker’s term concludes after having served as co-director since 2007. Hecker, a nuclear scientist and director emeritus of the Los Alamos National Laboratory, is one of the world’s foremost experts on plutonium, nuclear weapons and nonproliferation. He will remain at CISAC and continue to teach in the department of Management Science and Engineering.

“It has been a personal pleasure to work with Sig,” said Cuéllar. “He has been an enormous asset to CISAC.  He will continue to be a visionary leader on nuclear security and arms control issues throughout the world.”

Relman joined Paul Keim, acting chair of the NSABB, to address a CISAC seminar in March about their work in advising the government on the potential dangers of laboratory-engineered H5N1 avian influenza.

The advisory board had been asked to review two manuscripts that described the deliberate modification of the H5N1 avian influenza virus so as to be transmissible for the first time from mammal to mammal via a respiratory route. This provoked a debate in the scientific community about the risks of such work and whether the details of these experiments should be published – details that would enable anyone skilled in the art of virology and molecular biology to recreate these highly virulent and transmissible viruses. Some argued that the research could end up in the wrong hands. The board eventually recommended in a split decision that this research should be published.

“Life scientists need to be involved in discussions about the oversight of risky science and the responsible conduct of science, so that the potential benefits can be realized while the risks are minimized,” Relman said.

Relman will continue to run his research lab at the Stanford University School of Medicine and the VA Hospital in Palo Alto, where his focus is on the beneficial communities of microbes in the human body. He is president-elect of the Infectious Diseases Society of America and a member of the Institute of Medicine at the National Academies of Science. He received his S.B. in biology from MIT in 1977 and an M.D. from Harvard Medical School in 1982. He completed his clinical training in internal medicine and infectious diseases at Massachusetts General Hospital in Boston.

“The appointment of a life scientist who focuses on infectious diseases and biosecurity is an innovative step for our work in international security and cooperation,” said Gerhard Casper, president emeritus of Stanford University and director of the Freeman Spogli Institute for International Studies.

Relman tells a story that illustrates his passion for scientific discovery. On a routine visit to his dentist about 15 years ago, he brought along his own test tube. He asked the dentist to give him some plaque that he had scraped off Relman’s teeth. He wanted to study his own bacteria.

“As a clinician, I can tell you my colleagues were not looking for new microbes to worry about,” Relman said. “Some of them believed there might well be some really weird new microbes in soil or in the ocean, but that the human microbial ecosystem was something that we understood quite well. Of course – that was wrong.”

Using DNA sequencing technology, he has since discovered hundreds of new bacteria in the human body.

“Our ability to predict the next important technical or conceptual advance in the life sciences is miserable, as is our ability to anticipate how these advances will be used,” Relman said. “But we can at least hope to engage the scientific community and the general public in discussions about our goals and our understanding of risks – and how best to mitigate them.”

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This study quantifies worldwide health effects of the Fukushima Daiichi nuclear accident on 11 March 2011. Effects are quantified with a 3-D global atmospheric model driven by emission estimates and evaluated against daily worldwide Comprehensive Nuclear-Test-Ban Treaty Organization (CTBTO) measurements and observed deposition rates. Inhalation exposure, ground-level external exposure, and atmospheric external exposure pathways of radioactive iodine-131, cesium-137, and cesium-134 released from Fukushima are accounted for using a linear no-threshold (LNT) model of human exposure. Exposure due to ingestion of contaminated food and water is estimated by extrapolation. We estimate an additional 130 (15–1100) cancer-related mortalities and 180 (24–1800) cancer-related morbidities incorporating uncertainties associated with the exposure–dose and dose–response models used in the study. Sensitivities to emission rates, gas to particulate I-131 partitioning, and the mandatory evacuation radius around the plant may increase upper bound mortalities and morbidities to 1300 and 2500, respectively. Radiation exposure to workers at the plant is projected to result in 2 to 12 morbidities. An additional 600 mortalities have been reported due to mandatory evacuations. A hypothetical accident at the Diablo Canyon Power Plant in California, USA with identical emissions to Fukushima may cause 25% more mortalities than Fukushima despite California having one fourth the local population density, due to differing meteorological conditions.


Mark Z. Jacobson is Director of the Atmosphere/Energy Program and Professor of Civil and Environmental Engineering at Stanford University. He is also a Senior Fellow of the Woods Institute for the Environment and Senior Fellow of the Precourt Institute for Energy. He received a B.S. in Civil Engineering with distinction, an A.B. in Economics with distinction, and an M.S. in Environmental Engineering from Stanford University, in 1988. He received an M.S. in Atmospheric Sciences in 1991 and a PhD in Atmospheric Sciences in 1994 from UCLA. He has been on the faculty at Stanford since 1994. His work relates to the development and application of numerical models to understand better the effects of energy systems and vehicles on climate and air pollution and the analysis of renewable energy resources. He has published two textbooks of two editions each and ~130 peer-reviewed scientific journal articles. He received the 2005 American Meteorological Society Henry G. Houghton Award for “significant contributions to modeling aerosol chemistry and to understanding the role of soot and other carbon particles on climate.” He has served on the Energy Efficiency and Renewables Advisory Committee to the U.S. Secretary of Energy.

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Mark Jacobson Professor of Civil and Environmental Engineering Speaker Stanford University
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The human-microbial ecosystem plays a variety of important roles in human health and disease. Each person can be viewed as an island-like “patch” of habitat occupied by microbial assemblages formed by the fundamental processes of community ecology: dispersal, local diversification, environmental selection, and ecological drift. Community assembly theory, and metacommunity theory in particular, provides a framework for understanding the ecological dynamics of the human microbiome, such as compositional variability within and between hosts. We explore three core scenarios of human microbiome assembly: development in infants, representing assembly in previously unoccupied habitats; recovery from antibiotics, representing assembly after disturbance; and invasion by pathogens, representing assembly in the context of invasive species. Judicious application of ecological theory may lead to improved strategies for restoring and maintaining the microbiota and the crucial health-associated ecosystem services that it provides.

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The tools of molecular biology have augmented forensic biological analyses and contributed to solving crimes, developing investigative leads, and exonerating the innocent. The methods are exquisitely sensitive and highly resolving. Success stories abound and are reported almost daily in the media. Indeed, forensic DNA typing is the gold standard of the forensic science disciplines. Although the methods and interpretations generally are reliable, there are some limitations that scientists, stakeholders, decision makers, and the public may not appreciate. This presentation will provide insight into the applications extolling their value and discussing the problems that need to be overcome or avoided.


About the speaker: Bruce Budowle, PhD, director of the UNT Health Science Center's Institute of Investigative Genetics and vice chair of the Department of Forensic and Investigative Genetics, has been named a Health Care Hero by Dallas Business Journal. He joined the Health Science Center in 2009, bringing renowned expertise in the areas of counterterrorism, primarily in identification of victims from mass disasters and microbial forensics.

Prior to joining the Health Science Center, Budowle spent 40 years as a senior scientist for the Federal Bureau of Investigation (FBI) in Washington, D.C. He was a principal advisor in efforts to identify victims from the World Trade Center attack in 2001 and helped establish a mitochondrial DNA sequencing program to enable high-throughput sequencing of human remains.

Budowle's commitment to helping families resolve missing persons cases led him to Fort Worth after a lifetime in the Virginia/Washington, D.C., area in order to collaborate with Health Science Center researchers and advance the knowledge and use of forensics and DNA to improve health and safety of the world's population. Budowle has also been instrumental in establishing the DNA-ProKids initiative to identify missing children on an international scale.

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Bruce Budowle Director Speaker University of North Texas Health Science Center Institute of Investigative Genetics
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Philanthropist and software giant Bill Gates spoke to a Stanford audience last week about the importance of foreign aid and product innovation in the fight against chronic hunger, poverty and disease in the developing world.

His message goes hand-in-hand with the ongoing work of researchers at Stanford’s Freeman Spogli Institute for International Studies. Much of that work is supported by FSI’s Global Underdevelopment Action Fund, which provides seed grants to help faculty members design research experiments and conduct fieldwork in some of the world’s poorest places.

Four FSI senior fellows – Larry Diamond, Jeremy Weinstein, Paul Wise and Walter Falcon – respond to some of the points made by Gates and share insight into their own research and ideas about how to advance and secure the most fragile nations.

Without first improving people’s health, Gates says it’s harder to build good governance and reliable infrastructure in a developing country. Is that the best way to prioritize when thinking about foreign aid?

Larry Diamond: I have immense admiration for what Bill Gates is doing to reduce childhood and maternal fatality and improve the quality of life in poor countries.  He is literally saving millions of lives.  But in two respects (at least), it's misguided to think that public health should come "before" improvements in governance.  

First, there is no reason why we need to choose, or why the two types of interventions should be in conflict.  People need vaccines against endemic and preventable diseases – and they need institutional reforms to strengthen societal resistance to corruption, a sociopolitical disease that drains society of the energy and resources to fight poverty, ignorance, and disease.  

Second, good governance is a vital facilitator of improved public health.  When corruption is controlled, public resources are used efficiently and justly to build modern sanitation and transportation systems, and to train and operate modern health care systems.  With good, accountable governance, public health and life expectancy improve much more dramatically.  When corruption is endemic, life-saving vaccines, drugs, and treatments too often fall beyond the reach of poor people who cannot make under-the-table payments. 

Foreign aid has come under criticism for not being effective, and most countries have very small foreign aid budgets. How do you make the case that foreign aid is a worthy investment?

Jeremy M. Weinstein: While foreign aid may be a small part of most countries’ national budgets, global development assistance has increased markedly in the past 50 years. Between 2000 and 2010, global aid increased from $78 billion to nearly $130 billion – and the U.S. continues to be the world’s leading donor.

The challenge in the next decade will be to sustain high aid volumes given the economic challenges that now confront developed countries. I am confident that we can and will sustain these volumes for three reasons.

First, a strong core of leading voices in both parties recognizes that promoting development serves our national interest. In this interconnected world, our security and prosperity depend in important ways on the security and prosperity of those who live beyond our borders.

Second, providing assistance is a reflection of our values – it is these humanitarian motives that drove the unprecedented U.S. commitment to fighting HIV/AIDS during the Bush Administration.

Perhaps most importantly, especially in tight budget times, development agencies are learning a great deal about what works in foreign assistance, and are putting taxpayers’ dollars to better use to reduce poverty, fight disease, increase productivity, and strengthen governance – with increasing evidence to show for it.

Some of the most dire situations in the developing world are found in conflict zones. How can philanthropists and nongovernmental organizations best work in places with unstable governments and public health crises? Is there a role for larger groups like the Gates Foundation to play in war-torn areas?

Paul H. Wise: As a pediatrician, the central challenge is this: The majority of preventable child deaths in Sub-Saharan Africa and in much of the world occur in areas of political instability and poor governance. 

This means that if we are to make real progress in improving child health we must be able to enhance the provision of critical, highly efficacious health interventions in areas that are characterized by complex political environments – often where corruption, civil conflict, and poor public management are the rule. 

Currently, most of the major global health funders tend to avoid working in such areas, as they would rather invest their efforts and resources in supportive, well-functioning locations.  This is understandable. However, given where the preventable deaths are occurring, it is not acceptable. 

Our efforts are directed at creating new strategies capable of bringing essential services to unstable regions of the world.  This will require new collaborations between health professionals, global security experts, political scientists, and management specialists in order to craft integrated child health strategies that respect both the technical requirements of critical health services and the political and management innovations that will ensure that these life-saving interventions reach all children in need.

Gates says innovation is essential to improving agricultural production for small farmers in the poorest places. What is the most-needed invention or idea that needs to be put into place to fight global hunger?

Walter P. Falcon: No single innovation will end hunger, but widespread use of cell phone technology could help.

Most poor agricultural communities receive few benefits from agricultural extension services, many of which were decimated during earlier periods of structural reform. But small farmers often have cell phones or live in villages where phones are present.

My priority innovation is for a  $10 smart phone, to be complemented with a series of very specific applications designed for transferring knowledge about new agricultural technologies to particular regions.  Using the wiki-like potential of these applications, it would also be possible for farmers from different villages to teach each other, share critical local knowledge, and also interact with crop and livestock specialists.

Language and visual qualities of the applications would be key, and literacy problems would be constraining.  But the potential payoff seems enormous.

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Children play near a punctured water pipe in Nairobi's Kibera slums.
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About the topic: What could queueing theory, the science of customer flows and delays in service systems, possibly offer towards understanding and countering terrorism? In terror queue models, newly hatched terror plots correspond to newly arriving customers, the number of ongoing terror plots corresponds to the queue of customers waiting to receive service, undercover agents or informants correspond to service providers, customer service is initiated when a terror plot is detected, and service is completed when the plot is interdicted. Not all plots are interdicted; successful terror attacks correspond to customers who abandon the queue without receiving service! Building upon these ideas, we will focus our attention upon a simple observation: other things being equal, the number of ongoing terror plots increases with the duration of time from plot initiation until execution or interdiction (whichever comes first), yet no estimate of the probability distribution governing terror plot duration has appeared in the open literature. Starting with a review of US terrorism-related indictments, lower and upper bounds for the initiation date of 30 distinct Jihadi plots were identified in addition to the date of arrest or an attempted/actual terror act. Accounting for the censoring and truncation effects inherent with these data; the estimated mean duration equals 9 months, while 95% of all plots are estimated to fall between 1 and 25 months. These estimates suggest that in the United States, on average approximately three ongoing Jihadi terror plots have been active at any point in time since 9/11/2001.

About the Speaker: Edward H. Kaplan is the William N. and Marie A. Beach Professor of Management Sciences, Professor of Public Health, and Professor of Engineering at Yale University’s School of Management who is currently on sabbatical as Distinguished Visiting Professor at Stanford’s Graduate School of Business. The author of more than 125 research articles, Kaplan received both the Lanchester Prize and the Edelman Award, two top honors in the operations research field, among many other awards. An elected member of the National Academy of Engineering and the Institute of Medicine of the US National Academies, Kaplan’s current research focuses on the application of operations research to problems in counterterrorism and homeland security. 

CISAC Conference Room

Edward H. Kaplan Professor of Management Sciences, Professor of Public Health, and Professor of Engineering, Yale; Distinguished Visiting Professor, Graduate School of Business, Stanford Speaker
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