Big Ideas Taiwan 2017: Young UofT Scholars with Big Ideas
The Big Ideas Competition at U of T awards motivated students to carry out original research and creative projects in Taiwan. At the beginning of each calendar year, students across three UofT campuses, both undergraduate and graduate, are invited to pitch an idea to study Taiwan. Selected awardees are provided with feedback in various workshops and work with faculty advisors between January and April before they conduct field research during summertime. The research findings are reported in August, and presented in September at the Munk School of Global Affairs as a public event.
Observing Taiwan through the lens of Israel:
A Comparative Analysis on Formal Recognition and Identity Politics.
By Benjamin Alperstein and Joannie Fu
Benjamin Alperstein is a fourth year student at the University of Toronto completing a dual specialist in History and Peace, Conflict, and Justice, along with a minor in Sociology. He is primarily interested in modern international relations, with a regional focus on East Asia, Israel, and the United States. As an American Jew, diaspora relations are also of personal relevance to him. He is extraordinarily grateful for the opportunity provided, and hopes to use it to advance the discourse on identity politics and the far-reaching effects it has on diplomacy and other political decisions.
Joannie Fu is a fourth year student at the University of Toronto specializing in International Relations, majoring in Contemporary Asian Studies. Her research interest lies in identity-politics and diaspora studies. As a Taiwanese-Canadian she appreciates the duality of perspectives that she was exposed to growing up. She enjoyed learning more about the subject and is grateful the Global Taiwan Project for funding this research initiative.
RESEARCH SUMMARY:
Original research question: Which factors account for the differences in the international status and recognition of Taiwan as compared to Israel, given the many circumstantial similarities surrounding the two countries? This research project aims to create a comparative analysis in order to better understand how the processes of national unity impact international recognition. We will first draw on the relevance of external global powers in giving or taking away the international legitimacy and recognition of nation-states. For example, while the United States and other countries largely support Israel, they fail to offer the same formal recognition of Taiwan. After observing how this affects the country’s overarching legitimacy, we will then delve into why this disparity occurs. In doing so, we will discuss the relevance of the formation of unique Israeli and Taiwanese identities as a factor accounting for international legitimacy.
Methodology:
My partner and I spent 5 weeks conducting field research in Taiwan/Israel thanks to a $4500 grant provided as winner of the Global Taiwan competition. Research methods included a number of interviews with key Israeli/Taiwanese government officials and journalists, including Jiang Yi-Huah (former Premier of Taiwan), Ming Tong (Minister of Taiwan’s Mainland Affairs Committee), Kenneth Chou (famous journalist, though he wrote under a pen name), Rafael Barak (former Israeli ambassador to Canada), Tor Akiva (Director of Special Projects at Israel’s Ministry of Foreign Affairs), and Shmuel Rosner (prominent Israeli author/blogger). We also visited museums and archives, and delved into the shifting “Taiwanese” identity (e.g. what does it mean to be “Taiwanese”?), and the role of time period in discourse. For example, the current Taiwanese identity is already quite different than that of 20 years ago, and the changing identity is a continuous, fluid process. Outside of field research, we also read a myriad of secondary sources on their history, nationalism, identity politics, and international legitimacy.
Results:
We presented our findings at a Munk School conference in September. Overall, we found many essential differences between the two countries that must be considered, modifying the original hypothesis that nationalism/identity is a key factor. That said, there are still a number of important identity themes to take away from the research that are valuable to the situation. In particular, we recommend the fostering of community spirit within the diaspora population as well as a country’s own borders. Furthermore, there is immense value in promoting support amongst more than just Taiwanese citizens. The history of the Palestinian movement, which in recent years has greatly increased in support from not just those with ties to Palestine but the Arab world more generally, serves as a useful example of this. Consequently, Taiwan should seek to foster further support specifically amongst the greater Asian population as well as the international community more generally.
Access to Female Adolescent Health in Taiwanese Aboriginal Communities
By Angela Hou and Nicole Mahadeo
Angela Hou is a third-year undergraduate student studying International Relations and Contemporary Asian Studies at the University of Toronto. She is a Chinese national and Canadian permanent resident, who received the Big Ideas in Taiwan fund to visit Taiwan on a two-week research excursion this past August. Along with her partner Nicole Mahadeo, they conducted field research on the topic of access to culturally sensitive health care in Taiwan indigenous communities.
Nicole is a recent graduate from the University of Toronto with an Honours Bachelor of Arts, having double-majored in political science and philosophy. Along with her colleague Angela Hou, she recently travelled to Taiwan to conduct field research on indigenous health as a recipient of the Big Ideas in Taiwan Award. She hopes their work will shed light on some important issues and disparities in healthcare for under-represented groups not only in Taiwan, but worldwide.
RESEARCH SUMMARY:
Globally, indigenous communities experience various forms of disparity and inequality, especially with regards to political representation and healthcare access. From traditional healing methods that differ from mainstream healthcare systems to structural socio-economic inequalities, indigenous communities around the world currently experience a lower ability and willingness to access mainstream medical systems. This project aims to investigate two main aspects of healthcare access for aboriginal communities in Taiwan: (1) the existing barriers to access, and (2) cultural sensitivity and safety in the medical system. Drawing from the disciplinary perspectives of political science and medical anthropology, this project consists of semi-structured interviews with various stakeholders, as well as consultations of secondary documents. This project finds that the issue of medical access speaks to broader issues of social cohesion and resource distribution. The significance of institutional variants is key to ensuring more equitable healthcare access in indigenous, and despite the existing efforts of the government of Taiwan, health inequality continues to persist in financial, geographic, and cultural forms. This research explores the challenges facing aboriginal communities, the role of the government in bridging such gaps in healthcare access, and the importance of listening to the needs of indigenous people with a less paternalistic approach.
The Authoritarian’s New Clothes: legitimacy and reform in Taiwan’s legislature during 1980s
By Kevin Wei Luo
Kevin is currently a 3rd year PhD student in Political Science at the University of Toronto. His main research interests revolve around the study of comparative authoritarian regimes and East Asian political economy. His dissertation project centers on the interplay between land development practices, fiscal capacity, and redistributive policies in contemporary China. His other current projects include the study of Taiwan’s legislature during the authoritarian era and historical legacies of mobilization on Chinese economic development. A native of Tainan, Taiwan, he graduated with a Bachelor of Arts degree (with honors) in Political Science from the University of Chicago in 2012, and a Master of Arts degree from the Regional Studies: East Asia (RSEA) program at Harvard University in 2015.
RESEARCH SUMMARY:
How do authoritarian elites think about their sources of regime legitimacy and respond to moments of political instability, and do these responses have repercussions for potential democratization? By examining the content of legislative sessions during Kuomintang’s (KMT) authoritarian rule on Taiwan in three episodes of political crises during the 1980s, I argue that the altering of discourse framing signaled an incremental yet paradigmatic shift in the regime’s ‘legitimacy formula’ (Slater and Wong 2013). By analyzing the policy priorities listed by pro-regime legislators in their speeches, I found that throughout the decade, an emergent ‘wing’ of legislative elites increasingly relied more on critiques and proposals related to performance legitimacy instead of ideological commitments to anti-communism and reunification. Yet contra previous theories, I do not find that support for the argument that democracy was thought to be the anecdote to forestall legitimacy failure within the regime, at least not from the perspective of parliamentary elites. This is particularly surprising given that despite failing confidence in the regime in the 1980s, discussion of political or democratic reform was generally avoided in the legislature among the pro-party elites, even as the parliamentarians were cognizant of the political challenges against regime legitimacy.
While on the one hand this shift signaled that a critical mass of legislators was habitually invested in the regime’s performance legitimacy instead of double-downing on complete ideological and social control, this also on the other hand arguably nudged the regime down the path of more open political contestation instead of outright repression. Essentially, this suggests that while parliamentary elites did not lead the move to preemptively democratize, it does highlight a pattern of ‘contained contestation’ around issues of socioeconomic development and collaterally led to less aggressive behaviors by the authoritarian regime during this critical moment in Taiwanese political history. On a broader comparative level, this move away from traditional formations of ideological legitimacy to a ‘softer’ conception of performance legitimacy can be seen throughout many cases of state-led development in post-Cold War Asia as well, and further invites us to think about how 1980s Taiwan as a case study can shed light on the possibilities of regime transition elsewhere in Asian developing states and around the world.
Addressing Antimicrobial Resistance in Taiwan: What Lessons Can We Learn?
By Jillian Sprenger
Jillian is a third-year undergraduate student majoring in Global Health, and minoring in Contemporary Asian Studies and Immunology. Passionate about health and development, her previous research has focused on innovations to address child malnutrition in Myanmar, sustainable environmental governance models in Ecuador, and interventions for food security in Ethiopia. She has a strong background in interviewing, having led over thirty interviews with a variety of stakeholders (including United Nations and World Health Organization officials, private sector business owners, foreign government officials, NGO employees, and community leaders). She has also worked for the SickKids Centre for Global Child Health on several projects pertaining to newborn health in rural Pakistan. In her spare time, Jillian loves to travel, and has visited 24 countries across five continents.
RESEARCH INTRO
In 2016, the United Nations General Assembly committed to tackling the growing global threat of antimicrobial resistance. At the time, it was projected that at the current rate of the spread of antimicrobial resistance, there could be up to 10 million additional deaths around the world by 2050. As a major threat to the attainment of the Sustainable Development Goals, particularly in developing countries, it is clear that this is a pressing problem.
In Taiwan, rampant overuse of antibiotics has been a major cause for concern for years. When antibiotics are overused or are used incorrectly, bacteria can build up resistance, rendering the drugs ineffective. Interestingly, the structure of the Taiwanese health system itself is a major factor contributing to overuse. Run under a national health insurance system, doctors claim reimbursement on a fee-for-service basis, including the prescription of drugs. Doctors are encouraged to prescribe more drugs to retain their patients, who frequently insist on receiving medication. In 2001, 30% of Taiwanese people diagnosed with a common cold were given antibiotics, even though the cold is a viral rather than bacterial infection. In addition, due to short wait times and poor gatekeeping to specialist services, patients often seek second or third opinions from several doctors, and can receive more than one prescription.
Since the early 2000s the Centre for Disease Control of Taiwan has undertaken efforts to curb antimicrobial resistance (or AMR as it is commonly known). Resistance rates in Taiwan have since improved significantly, and are in fact better than many neighboring states. How was this implemented this successfully? What actions were most beneficial? I was fascinated by these questions and wondered if lessons could be learned from Taiwan’s efforts that could then be applicable to Canada and to other countries.
I spent several weeks in Taiwan conducting interviews with policymakers, doctors, and academic researchers, to answer the following question: what specific actions has Taiwan taken to address antimicrobial resistance, and more importantly, what lessons can be learned from their experiences?
Overall, the interviews were very rewarding, and it became clear that we have much to learn from Taiwan. In 2001, Taiwan introduced a policy reform on antibiotic prescription procedures. From this point forward, doctors have been required to present evidence (such as a bacterial culture or swab) to prove that a patient truly requires antibiotics. Without this evidence, doctors are not reimbursed for the antibiotics they prescribe. Policymakers used the national health insurance system to their advantage with this intervention, by withholding payment from those who do not abide by the rules. Though this reform has been successful, it is challenged by the recent rise in the number of people paying privately for antibiotics. The drugs are relatively inexpensive, so people are sometimes willing to bypass the insurance system.
Taiwan has also introduced a policy to restrict certain prescriptions. Doctors must now consult an infectious disease specialist if they would like to prescribe a 2nd or 3rd line antibiotic. It was generally agreed that this is one of the most successful policies implemented. Most doctors now think twice about prescribing, and only do so if really necessary. Then, a specialist who is highly educated on the topic of AMR determines if it is a case that truly necessitates that type of drug. Of course, some controversy does exist around restricting physician autonomy.
Besides these policies, other smaller-scale programs have also been implemented. In 2013, seeing the need for renewed efforts to address AMR, the Centre for Disease Control introduced the Antimicrobial Stewardship program. There were 2 arms to the project: antibiotic control and infection control. The antibiotic control portion involved audits, effective health information systems, and education for patients and doctors. The infection control portion involved hand hygiene and resistance data analysis. The program has just wrapped up recently, but researchers expect to see a reduction in the consumption of antibiotics, a reduction in resistance, and a reduction in healthcare-associated infections.
Taiwan has also piloted interesting technology-based interventions to help address this issue. For example, a team of researchers used a social media platform to reach a wide audience with educational messages on reducing healthcare-associated infections. Usually, these campaigns are dry and academic, but in this case a series of fun Youtube videos was uploaded to Facebook to reach people more effectively. Another tech-based program used the idea of “big data” to evaluate risks and opportunities. A computer program used a matrix to determine the most common infections in each ward at individual hospitals, and identify the most effective drug for each strain. It was highly specific, right down to the level of an individual ward in a specific hospital. This helps to avoid resistance that can develop when an infection is first treated with an ineffective drug.
An interesting facet of this research was understanding the challenges Taiwan faces for its global health diplomacy. Taiwan is not currently allowed to formally be a part of the World Health Organization and other such bodies, and as a result, cooperation and discussion on international health issues can be a challenge. In our increasingly interconnected world, resistant strains of microbes and bacteria are easily spread across regional borders. Infrastructures and health systems of countries may be different, but sharing experiences and designing plans to avoid the spread of resistant microbes is crucial.
Taiwan should continue to be a leader in addressing antimicrobial resistance. If we are to effectively address this seemingly intractable problem, we will certainly need strong and effective policymaking, as well as the introduction of new innovations, in the years to come.
Foreign Direct Investment, Trade, and Security in the Taiwan Strait.
By Michael Thomas
Michael is a graduate of the Master of Global Affairs (MGA) program at the Munk School of Global Affairs and currently works in public finance with DBRS. His major interests lie in political economy, global capital markets, and Asia-Pacific studies, and he has worked in trade-related roles with Descartes Systems Group and the Thai-Canadian Chamber of Commerce in Bangkok. Michael also holds a Bachelor of Arts in Political Science from Carleton University and was a 2017 recipient of the Gordon Cressy Student Leadership Award at the University of Toronto.
RESEARCH SUMMARY:
The Taiwan Strait has been home to political friction for over 65 years, but recent events have led many to speculate that a flashpoint is on the horizon. Taiwanese President Tsai Ing-Wen’s New Southbound Policy (NSP) is an attempt to diversify trade and investment flows by diverting them away from the People’s Republic of China (PRC) in order to reduce Taiwan’s economic dependence on the mainland. Moreover, U.S. President-Elect Trump’s call with President Tsai breaks a nearly 40-year tradition of a U.S. President or President-Elect speaking directly with the president of Taiwan. These two events can be perceived as a loss of bargaining power for mainland China. Empirical data suggests that mainland China has only used force in territorial disputes when they perceived a decline in their bargaining power. This paper argues that Taiwan’s status quo and mainland China’s red line on Taiwanese independence are on a collision course because of potential strengthened U.S.-Taiwanese relations and the NSP’s impact on mainland China’s perceptions of Taiwanese intentions.
