Projects
Mothers, Markets, and the Developmental State: Postpartum Care in South Korea’s Ultra-Low-Fertility Society
Donata Bessey
Associate Professor of Economics, East Asia International College, Yonsei University, South Korea
In the context of ultra-low fertility, South Korea has expanded public support for reproduction across multiple domains, including infertility treatment, medical costs related to pregnancy, and early childhood education. One notable exception is postpartum care. While the early postnatal period is widely recognized as critical for maternal and infant health, postpartum recovery in South Korea has increasingly been institutionalized through privately operated care centers (sanhujoriwon), financed largely out-of-pocket and characterized by stratified access.
This project examines the emergence of this market-based system as a political and institutional outcome rather than a purely cultural or medical development. It asks why postpartum care has been positioned outside the core framework of public health provision, how this configuration reflects the evolving priorities of the developmental state under demographic pressure, and what implications it has for inequality, maternal health, and early-life outcomes.
Drawing on public health, political economy, and social reproduction perspectives, the project conceptualizes postpartum care as a site where boundaries between family responsibility, market provision, and public health systems are negotiated. Methodologically, it combines policy analysis, descriptive mapping of the postpartum care sector, and analysis of institutional and commercial discourses surrounding maternal recovery and infant care. By situating the Korean case in comparative perspective, the project contributes to broader debates on how health systems adapt to demographic change and highlights postpartum care as a critical but understudied topic in the governance of reproduction and early-life health.
Kinship as Infrastructure: Genetic Screening and the Social Reproduction of Preventive Public Health in India
Samiksha Bhan
Contributing Editor, Committee for Anthropology of Science, Technology and Computing, PhD Researcher, Max Planck Institute for Social Anthropology, Germany
This project examines how preventive public health is assembled through kinship relations in India. Drawing on ethnographic and archival research on genetic screening programs for thalassemia and sickle cell disease, the project follows how patients and their families are mobilized to identify carriers within extended kin networks, transforming kinship into a key site of epidemiological work.
Screening programs for thalassemia and sickle cell disease are framed as efficient, cost-effective interventions and offer models for preventive public health. Their logic is straightforward: identify carriers, map genetic risk, and prevent the birth of affected children through informed reproductive decisions. Yet their implementation depends on a dispersed and largely unacknowledged infrastructure of kinship. Instead of treating public health as a bounded institutional system, I am interested in the distributed infrastructure sustained through the informational, affective, and logistical labour of kin that remains unrecognized and unremunerated. Situating these interventions within longer histories of population governance and community health, the project examines how genetic screening interventions transform families into sites of public health work, where categories such as “risk” and “carrier status” are translated into moral imperatives: to disclose, to test, to intervene in marriage decisions, and to manage reproductive futures. By tracing these dynamics, the project shifts analytical attention from institutional design to the political economy of social reproduction to capture a central dynamic in India’s public health system where the family becomes both the site as well as the medium for managing illness.
Political Systems, State Capability & Global Health Policy: A Comparative Study of China and Japan’s COVID-19 Governance and Its Implications for the Global South
Ge Cui
Professor and Director of the Center for Asia-Pacific and Global Strategies, Dalian University of Technology, China
The COVID-19 pandemic has revealed that pandemic governance is inherently a political and historically embedded process, rather than merely a technical or biomedical issue. This
project aims to explore how political systems, state capability, and social mobilization capacity shaped the COVID-19 responses of China and Japan, two Asian countries with distinct governance models, and to extract implications for the Global South.
Adopting a qualitative comparative case-study approach integrating historical institutionalism, comparative political economy, and governance theory, the study compares the two
countries’ pandemic governance strategies—including lockdown policies, public health administration, digital governance, and community-level control—and analyzes the influence
of historical experiences (such as China’s SARS epidemic and Japan’s universal healthcare tradition) on their governance choices. The research finds that China’s centralized party-state system enables strong state coordination and rapid mobilization, while Japan’s democratic and bureaucratic model relies on institutional coordination, social trust, and public compliance; both achieved relatively effective outcomes despite institutional differences. Academically, the project challenges Western-centric assumptions in global health studies
and enriches theoretical understanding of state capability and pandemic governance. Policy-wise, it provides comparative insights for Global South countries to strengthen pandemic
preparedness and public health resilience by selectively adapting the strengths of Asian governance models.
Life and Death under Mao: Exploring China’s Public Health Miracle and its Legacy
Jonathan Kennedy
Associate Professor, Politics and Global Public Health, Wolfson Institute of Population Health, Queen Mary University of London, UK
My project explores one of the most striking yet neglected episodes in modern global health history. Between 1950 and 1979, Chinese life expectancy rose sharply and mortality fell at an extraordinary pace, despite limited economic growth and repeated political upheaval.
The Maoist “public health miracle” was widely acknowledged at the time: both the U.S. Senate Subcommittee on Health (1971) and the World Health Organization’s International Conference on Primary Health Care (1978) discussed China’s achievements in detail and sought to learn from it. Recent scholarship on Maoist China has rightly focused on the immense human costs of the Great Leap Forward and the Cultural Revolution. The period’s extraordinary achievements in public health have been largely forgotten.
My project examines how mass mobilisation, rural health campaigns, preventive medicine, and the training of barefoot doctors enabled the rapid expansion of low-cost healthcare across the Chinese countryside. It contrasts the Chinese case with India, asking what explains the divergence in health outcomes between two large, low-income Asian states after 1949. Beyond recovering a neglected historical case, the project explores the broader implications of Mao-era public health transformation for contemporary debates on the political determinants of health, primary healthcare, and community-based public health systems. At a moment of widening health inequalities and renewed questioning of technocratic global health models, the Chinese experience offers an opportunity to rethink how large-scale improvements in population health can be achieved through a political commitment to a grassroots, horizontal approach to public health rather than one focusing on biomedical innovation and economic growth.
The Single-Payer Market: Fifty Years of Korea’s National Health Insurance
Saerom Kim
Assistant Professor, Preventive Medicine, Inje University College of Medicine, Busan, South Korea
The year 2027 marks the 50th anniversary of the introduction of South Korea’s National Health Insurance (NHI). Korea achieved UHC through a single-payer institution, yet that institution has operated in ways that systematically enabled and sustained a privately-dominated, hospital-centric delivery system. This study asks how Korea’s NHI has come to simultaneously serve as a vehicle for the commercialization of its healthcare system, even as it retains its mandate for social protection—and, by extension, how medical professionalism in Korea has been configured not as a counterforce to commercialization but as an active driver of it beyond the NHI’s regulatory reach.
To address these questions, this study draws upon the theoretical framework of the productivist welfare regime and its neoliberal reconstitution. By applying interpretive policy analysis of state-produced policy documents, supplemented by quantitative secondary data, this study traces the institutional trajectory of Korea’s healthcare system across three periods: the developmental state era (1963-1987), democratic consolidation (1987-1997), and the post-1997 neoliberal reconstitution. The discursive construction of market-oriented professional identity is examined through analysis of statements and advocacy materials produced by physician organizations, complementing the macro-level policy analysis.
By providing a theoretically integrated account of the political-economic transformation of Korea’s healthcare system, this study seeks to illuminate the structural costs of building universal coverage upon a privately-dominated delivery system. Ultimately, the Korean case offers critical insights for global health policy, highlighting the limitations of financing-centric UHC reforms and warning against the unchecked marketization of healthcare provision.
Rebuilding Primary Health Care in Rural China: An Ethnographic Study in Qingtian County, Zhejiang Province
Marty Kirchner
PhD candidate, Anthropology, The Graduate Center, City University of New York, U.S.
This project examines rural primary health care (PHC) reform in Qingtian County, Zhejiang Province, China, within the context of Zhejiang’s designation as a “common prosperity” demonstration zone, a policy initiative aiming to reduce inequality and improve public well-being. By treating PHC reform as a site where health system transformation, rural governance, and economic restructuring converge, the study investigates how local officials, health providers, and populations navigate the reorganization of healthcare delivery, financing, and coordination amid rapid demographic change and shifting political-economic priorities.
Grounded in ethnographic fieldwork in Qingtian, the project links county-level PHC reforms to national health system changes and broader socio-economic policies. It examines how PHC interacts with public hospital restructuring, insurance policy changes, and pharmaceutical regulations. The study also explores how health sector policies interact with rural development practices, focusing on how local governments mobilize revenue, address workforce shortages, and coordinate administrative authority across sectors. By tracing these dynamics, the project offers insights into how structural pressures manifest and are managed within local institutional reform.
The project contributes to global health scholarship by offering a case study of how the Alma-Ata vision of PHC is reworked in practice. Contemporary reforms unfold against a layered history—from the “barefoot doctor” program to market-driven reforms. The study focuses on efforts to rebuild PHC capacity after the erosion of earlier collective supports, exploring how public health systems are assembled, contested, and revised amid marketization, uneven regional development, and fiscal constraints, and the countervailing forces that enable durable PHC systems to emerge.
Medical education and the pursuit of equity in health systems: A comparative study of Nepal and Sri Lanka
Ramya Kumar
Senior Lecturer, Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Sri Lanka
Confronted with mounting economic pressures, governments across South Asia are privatising key social sectors, including health and education. Within this context, medical education has emerged as a lucrative area for commercialisation, driven by high demand, limited public sector capacity, and business imperatives.
It is believed that increasing the number of private medical schools could address doctor shortages; save foreign exchange expenses on medical school fees abroad; and increase foreign revenue by attracting international students. In this study, we explore the implications of commercialising medical education by studying the systems of Sri Lanka and Nepal, two countries that have taken very different medical education reform pathways: Sri Lanka’s state-led approach versus Nepal’s private-sector dominant model. Locating these two systems within the trajectories of neo-colonial and neoliberal forms of governance, we consider the political and economic pressures driving commercialisation, the latter’s impact on health systems, particularly the availability of doctors, where they work, and also who benefits and is excluded from medical education as a result. We hope to contribute a counter-hegemonic narrative on medical education reform, challenging long-accepted views promulgated by a range of dominant actors on the economic advantages of commercialising medical education in lower-resource settings. We also hope to shed light on questions of equity and quality of public and private medical education that have been under debate for decades across South Asia.
Nutritional Governance and the Care-Labor Crisis: A Historical Comparison of Japan and China
Lei Lei
Researcher, Institute of Developing Economies, Japan
Why did Japan and China enter the COVID-19 pandemic with comparatively resilient public health systems — and why does that resilience now face a structural threat? This project argues that the answer to both questions lies in the same place: the institutional arrangements through which each state has historically governed the relationship between food, bodies, and public health.
Drawing on a decade-long longitudinal dataset of food safety port rejection records, this research reconstructs two divergent nutritional governance regimes — Japan’s community-integrated model, anchored in public health centers and food education legislation, and China’s state-directed biosecurity model, consolidated through centralized standardization and border health enforcement. Through comparative analysis of policy documents, trade records, and Japanese- and Chinese-language academic literature, the project demonstrates that these regimes functioned as structural buffers well before the pandemic began — not as emergency responses, but as products of decades of institutional consolidation.
The second strand of the research traces how these same embedded institutional logics now shape each country’s response to an acute care-labor crisis produced by rapid demographic aging. Japan’s contested and politically uncertain turn toward international labor migration, and China’s bet on AI-driven technological substitution, reveal not simply different policy choices, but different state traditions for defining the meaning of care itself.
The findings carry direct relevance for societies across Asia and beyond — including India, South Korea, Germany, and Southeast Asia — as the human labor of care becomes an increasingly scarce resource worldwide.
Contested Pathways: State, Society, and the Politics of Universal Health Coverage in China, India and Thailand
Madhurima Nundy
Research Fellow, Global Business School for Health, University College London, UK
Universal Health Coverage (UHC) has emerged as a dominant global health objective, embedded within the Sustainable Development Goals and widely promoted through cross-national policy learning. However, prevailing approaches often privilege technical and financing solutions while overlooking the historical, political, and institutional processes that shape health system trajectories. This study critically examines the limits of such technocratic framings by analysing the contested pathways to UHC in China, India, and Thailand.
Adopting a comparative historical and political economy perspective, the research explores why countries facing similar global pressures and sharing aspirations toward UHC have followed divergent trajectories. It focuses on three key analytical dimensions: (i) political coalitions and social movements that mobilised health reform; (ii) the role of professional associations and the politics of medical knowledge; and (iii) the interplay between state formation, ideology, and political economy in shaping health system development.
China’s trajectory reflects shifts from socialist collectivism to market-oriented reforms and subsequent state-led rebuilding; Thailand demonstrates the role of a developmental state supported by strong primary health care and professional mobilisation; while India illustrates the challenges of a fragmented, federal system with a reliance on private provision.
Drawing on secondary literature and selected key informant insights, the study conceptualises health systems as arenas of contestation between state, market, and society. It foregrounds historical agency and path dependency in explaining contemporary outcomes. By situating UHC within broader socio-political contexts, the research contributes to a more grounded understanding of health system reform and challenges dominant global health narratives.
Moral Vaccination: States, Societies and Contagion in China and India
Prerna Singh
Mahatma Gandhi Associate Professor of Political Science and International Studies, Brown University, U.S.
Why have some states been more effective than others at controlling infectious disease, even under broadly similar epidemiological and material conditions? By dominant rationalist accounts, states are expected to invest in disease control when political or economic incentives align, while citizens are modeled as strategic actors who comply with public-health measures when benefits outweigh costs.
This project advances a different argument. It develops a novel “moral relationality” framework, arguing that the control of contagion is fundamentally shaped by the moral relationship between states and societies, specifically the mutual perceptions of obligation, and authority.
My ongoing book project develops this framework through a comparative historical analysis of smallpox control in China and India. Smallpox occupies a unique place in human history as both one of humanity’s deadliest diseases and the only human disease successfully eradicated worldwide. The study examines two paired comparisons across different historical moments. The first compares nineteenth-century Canton and Calcutta, where the Jennerian vaccine arrived through the same imperial networks but diffused at dramatically different rates. The second compares postcolonial China and India in the mid-twentieth century, when both confronted widespread poverty, weak health systems, and severe infectious disease burdens, yet achieved starkly different timelines of smallpox elimination. Drawing on multi-sited archival research across China, India, Britain, Switzerland, and the United States, the project demonstrates how moral relationalities shaped both state commitment and popular cooperation in disease control. In doing so, it offers a new theoretical framework for understanding public health, state capacity, and collective action in comparative politics.
Primary health care provision across Karnataka, Rajasthan and Odisha 2014-2025: Examining trajectories and intersections
Priyadarshini Singh
Fellow, Human Development Research Program, Centre for Social and Economic Progress, New Delhi, India
Primary Healthcare Centres (PHCs[1]) in urban (U-PHC) and rural (R-PHC) India are the focus of intense socio-economic and political activity at the facility level. Yet, primary care is not a priority at the state-level in terms of budget allocations, number and nature of initiatives and overall positioning of primary care provision in the social welfare agenda.
This trend appears across three states that I have studied in an ongoing project—Karnataka, Rajasthan and Odisha. Despite varying levels of urbanisation, per capita incomes, health and education outcomes, political mobilisations, history of health initiatives by the state government, social movements, as well as politics-bureaucracy relation, primary care is not a policy focus. Even a state like Odisha, which has surplus revenue and debilitating primary health related outcomes such as reversals in urban IMR, stark difference in immunisation rates across its different districts (Cuttack versus Mayurbhanj) and notable gaps in facilities and staff has not focused on strengthening primary care.
My project builds on this ongoing three-state study on the drivers of urban primary care and elementary education. The research question for that study is ‘why and when did a state undertake new state-initiatives for urban primary care and elementary education during 2014-2024’? My project for the ICI fellowship focused on “Why has primary health care remained side-lined within the state’s health sector priorities, in terms of budget allocations, number and nature of initiatives and range of ground problems prioritised across Karnataka, Rajasthan and Odisha?”
Seeking Hygeia: Time, State Identities, and Pandemic Responses Across the world
Aseema Sinha
The Wagener Chair of Comparative Politics and George R. Roberts Fellow, Claremont McKenna College, U.S.
“Seeking Hygeia: Time, State Identities, and Pandemic Responses Across the world” offers a thematically driven book-length treatment of five respiratory pandemics to explore how countries that experienced SARS in 2003, HIN1 in 2009 and MERS in 2015 learnt from and remembered those past crises to respond to COVID-19.
Through this analysis I argue that memories of past diseases, state control of infections and compliance, and policy learning is central to diverse policy responses in South Korea, Taiwan, China, Canada, Kerala (India), and United Kingdom, with varying effects in terms of what they learnt from prior pandemics in responding to COVID. These responses resonate with underlying state identities and their capacities to remember or forget in the countries under study. Through this comparative examination I develop a social theory of the state’s roles in public health, which positions policy analysis and state responses within the social relations and webs of meaning, memories, and processes of learning specific to each society. This project’s focus on Asia in a comparative and historical vein will be of interest to the ICI’s global health fellowship program.
Building a Legal Framework for Universal Health Coverage in China
Jiwei Qian
Senior Research Fellow, East Asian Institute, National University of Singapore
This project examines the legal foundations of universal health coverage in China through an analysis of the 2025 draft Medical Insurance Law. Although China has achieved near-universal insurance coverage, the system remains fragmented and uneven due to its highly decentralised governance structure.
The study argues that the draft law represents a critical effort to establish a coherent legal framework for social health insurance by translating policy goals into formal rights, obligations, and governance mechanisms. It aims to standardise financing, benefit design, and administrative responsibilities across regions, while strengthening accountability, supervision, and enforcement in fund management. More broadly, the reform reflects a process of legal institutionalisation, embedding social policy within a more rule-based system of governance.
However, the study shows that the effectiveness of this framework is constrained by underlying institutional conditions. First, decentralisation limits uniform implementation, as local governments retain substantial discretion. Second, key provisions remain under-specified, particularly regarding catastrophic cost protection and benefit portability, both central to meaningful entitlement. Third, enforcement challenges persist due to local bargaining between firms and authorities in contribution collection, as well as weaknesses in fund management, including oversight and compliance.
Situating China’s reform within comparative social health insurance law, the study highlights how legal frameworks interact with state capacity, fiscal constraints, and labour market structures. It contributes to global health debates by showing that formal codification of universal coverage does not automatically ensure equitable access, especially in large, decentralised systems.
Emma Willoughby
Postdoctoral Research Fellow, Asia Research Institute, National University of Singapore
Why do states intervene in markets? In the discipline of public health, the state is often viewed as the protector of the public from market-based failures. States can solve problems of information asymmetry, negative externalities, and pricing within health policies.
The study argues that the draft law represents a critical effort to establish a coherent legal framework for social health insurance by translating policy goals into formal rights, obligations, and governance mechanisms. It aims to standardise financing, benefit design, and administrative responsibilities across regions, while strengthening accountability, supervision, and enforcement in fund management. More broadly, the reform reflects a process of legal institutionalisation, embedding social policy within a more rule-based system of governance.
However, the study shows that the effectiveness of this framework is constrained by underlying institutional conditions. First, decentralisation limits uniform implementation, as local governments retain substantial discretion. Second, key provisions remain under-specified, particularly regarding catastrophic cost protection and benefit portability, both central to meaningful entitlement. Third, enforcement challenges persist due to local bargaining between firms and authorities in contribution collection, as well as weaknesses in fund management, including oversight and compliance.
Situating China’s reform within comparative social health insurance law, the study highlights how legal frameworks interact with state capacity, fiscal constraints, and labour market structures. It contributes to global health debates by showing that formal codification of universal coverage does not automatically ensure equitable access, especially in large, decentralised systems.
