Through Too Western-Centric a Lens: Inadequate Consideration of the Chinese Perspective in US-China Policymaking After the Cold War

From the end of the Cold War until 2016, the US Foreign Policy (FP) Establishment remained committed to a grand strategy of global hegemony. Four consecutive Presidential Administrations, Republican and Democrat alike, pursued America’s commitment to global leadership. They, in fact, created the opportunity and conditions in which the Peoples’ Republic of China (PRC) has risen to become the United States’ most formidable strategic competitor, an aspiring, regional hegemon in the Pacific, and an “emerging potential superpower”[1]. China, throughout the same time, has risen to become the world’s 2nd largest economy and transformed its military – moving it closer to parity with US Forces in the Pacific.[2] In 2001, the PRC joined the World Trade Organization (WTO) and gained access, on favorable terms, to Western markets and foreign investment.[3] Contrary to the objectives of the US FP strategy of Engagement, China remains an illiberal, authoritarian regime and pursues increasingly aggressive foreign policy abroad. Most observers concede that the “liberal bet that China would integrate as a ‘responsible stakeholder’ into a US-led liberal order has failed.”[4] This paper argues that the leading cause for the marked disparity between the US plan for its relations with China and how those relations have and continue to unfold is the US failure to adequately consider the Chinese perspective. The US FP Establishment, between the end of the Cold War and 2016, continued to view China through too “Western Centric” a lens. The paper will review examples of the statements and actions, made over this period by leaders within the PRC. It will also review examples of the US FP Establishment analyses, efforts to develop, and decisions to implement US-China policy as a response to China’s statements and actions. The paper presents evidence that supports the claim that the US FP Establishment’s efforts – i.e., to diagnose as well as to develop prescriptive policy in response to China’s actions on the world stage – were undertaken without adequately considering the Chinese perspective. Examples reviewed include China’s increasingly tense, Cross-strait relations with Taiwan, China’s increasingly assertive behavior in the South and East China Seas, and China’s People’s Liberation Army (PLA) modernization efforts. Failure was manifest in the continued belief that increased economic liberalization would necessarily lead to increased political liberalization, China’s embrace of liberal ideals, and assimilation into a US-led Liberal International Order. It has not. The paper contrasts the Western perspective with the perspective that drove China and their FP actions throughout this period. Specifically, it highlights the difference between the Western and Chinese perspectives on strategy, conflict, struggle, and war. To present and begin to accurately understand the Chinese perspective, the paper looks to translations of official, Chinese government sources. To strengthen this paper’s conclusions made from a review of Chinese sources, the paper also looks to Western scholars who likewise relied heavily upon Chinese sources in their arguments. This brief exploration and consideration of China’s perspective indicates that the “liberal bet” (mentioned above) was never a well-informed one. China, as is unambiguously supported by solid evidence, has had a grand strategic plan that does not include remaining subordinated to a hegemonic America. The final question seeks to understand how the US FP Establishment has gotten this so wrong. To answer, it examines a number of factors and conditions that have stood as obstacles to attaining a better, more accurate understanding of China’s actions on the world stage as well as to developing and implementing US-China policy that might have better served US interests. This research is presented not simply as a critique of liberal-internationalist policy. It is intended to instigate acknowledgement of these obstacles as well as curiosity and acceptance of a perspective not America’s own. As US-China relations continue to develop, the US FP Establishment must more comprehensively understand and incorporate the Chinese perspective as well as China’s grand strategic intentions and objectives. If they fail, or choose not to try, the possibility for peaceful cooperation or collaboration will likely be increasingly displaced by an intensification of competition and conflict. [1] Brooks and Wolforth, 2016, 43. [2] Chhabra, 2019, 3. [3] Gertler, 2004, 21-22. [4] Ikenberry, 2020, 135

The impact of rapid handpump repairs on diarrhea morbidity in children: cross-sectional study in Kwale County, Kenya

Background: Handpumps are used by millions of people as their main source of water. Although handpumps represent only a basic form of water provision, there have been continuous efforts to improve the performance of these systems as they are likely to remain in use for many years to come. The introduction of a professional maintenance service in southern Kenya has shown an order of magnitude improvement in operational performance over community-based management, with 90% of handpump faults repaired within 3 days of being reported. One driver behind these efforts is the assumption that a more reliable water supply will lead to a reduction in water-related disease. However, it is not clear if operational improvements lead to health gains. Despite limited empirical evidence, some modeling studies suggest that even short periods of drinking contaminated water can lead to disproportionate negative health impacts. Objective: The aim of this study was to assess whether the improvements in operational performance from the rapid professional maintenance of rural handpumps lead to improved household health outcomes. Methods: From a sample of households using handpumps as their primary water source in Kwale County, Kenya, we measured the 2-week prevalence of World Health Organization–defined diarrhea in children, reported by the adult respondent for each household. We compared the rates before and after a period during which the households’ handpumps were being professionally maintained. We then conducted a cross-sectional analysis, fitting logistic regression models with reported diarrhea as the dependent variable and speed of repair as the independent exposure of interest, adjusting for household socioeconomic characteristics; dwelling construction; and Water, Sanitation, and Hygiene (WASH)-related factors. We fitted an additional model to examine select interactions between covariates. Results: Reported diarrhea in children was lower in households whose pumps had been repaired within 24 hours (adjusted odds ratio 0.35, 95% CI 0.24-0.51). This effect was robust to the inclusion of multiple categories of covariates. No reduction was seen in households whose pump repairs took more than 24 hours. Analysis of interaction terms showed that certain interventions associated with improved WASH outcomes were only associated with reductions in diarrhea in conjunction with socioeconomic improvements. Conclusions: Only pump repairs consistently made within 24 hours of failure led to a reduction in diarrhea in the children of families using handpumps. While the efficacy of reduction in diarrhea is substantial, the operational challenges of guaranteeing same-day repairs limits the effectiveness of even best-in-class pump maintenance. Maintenance regimes that cannot bring handpump downtimes close to zero will struggle to generate health benefits. Other factors that reduce diarrhea prevalence have limited effect in isolation, suggesting that WASH interventions will be more effective when undertaken as part of more holistic poverty-reduction efforts

Group therapy for adolescents with repeated self harm: randomised controlled trial with economic evaluation

Objective To examine the effectiveness and cost-effectiveness of group therapy for self harm in young people

An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence

Aims: To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of healthcare resources. Design: A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and healthcare cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. Settings and participants: Data on attendance to vaccination from a UK cluster randomised trial. Intervention: Two contingency management options were examined in the trial: fixed vs. escalating schedule financial incentives. Measurement: Lifetime healthcare costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. Findings: The resulting estimate for the incremental lifetime healthcare cost of the contingency management strategy versus usual care was £22 (95% CI: -£12 to £40) per person offered the incentive. For 1,000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI: 8 to 30). The probabilistic incremental cost per quality adjusted life year gained of the contingency management programme was estimated to be £6,738 (95% CI: £6,297 to £7,172), with an 89% probability of being considered cost-effective at a threshold of £20,000 per quality-adjusted life years gained (98% at £30,000). Conclusions: Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of healthcare resources in the UK as long as the incidence remains above 1.2%

Comparison of high and low intensity contact between secondary and primary care to detect people at ultra-high risk for psychosis: study protocol for a theory-based, cluster randomized controlled trial.

BACKGROUND: The early detection and referral to specialized services of young people at ultra-high risk (UHR) for psychosis may reduce the duration of untreated psychosis and, therefore, improve prognosis. General practitioners (GPs) are usually the healthcare professionals contacted first on the help-seeking pathway of these individuals. METHODS/DESIGN: This is a cluster randomized controlled trial (cRCT) of primary care practices in Cambridgeshire and Peterborough, UK. Practices are randomly allocated into two groups in order to establish which is the most effective and cost-effective way to identify people at UHR for psychosis. One group will receive postal information about the local early intervention in psychosis service, including how to identify young people who may be in the early stages of a psychotic illness. The second group will receive the same information plus an additional, ongoing theory-based educational intervention with dedicated liaison practitioners to train clinical staff at each site. The primary outcome of this trial is count data over a 2-year period: the yield - number of UHR for psychosis referrals to a specialist early intervention in psychosis service - per primary care practice. DISCUSSION: There is little guidance on the essential components of effective and cost-effective educational interventions in primary mental health care. Furthermore, no study has demonstrated an effect of a theory-based intervention to help GPs identify young people at UHR for psychosis. This study protocol is underpinned by a robust scientific rationale that intends to address these limitations. TRIAL REGISTRATION: Current Controlled Trials ISRCTN70185866.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are