The End of the Charm Offensive

China's neighbors welcome a strong China, just not a dominant one -- and that's where the United States comes in.

Later this week, U.S. Secretary of State Hillary Clinton will visit Hanoi to attend the East Asian Summit, a five-year-old forum that brings together top officials from 16 East and Southeast Asian countries to discuss the future of the region. Clinton is a "special guest" in Hanoi, and her presence at the gathering reflects anticipation that the United States will be invited to join the summit as a permanent member in 2011. As with most diplomatic moves in Asia these days, that prospective invitation is as much about China as it is about the United States, and it speaks to a stark underlying reality for Asia's rising superpower: Beijing's vaunted statesmanship in the region is reaching the point of diminishing returns.

China has successfully convinced its neighbors that it is a legitimate and indispensable rising power in Asia, and that this is on balance a good thing. China was welcomed as a founding member of the ASEAN Regional Forum -- the first region-wide multilateral discussion of security issues in Asia -- in 1994, and this year joined with neighboring countries in launching a multilateral currency swap arrangement with a foreign exchange reserve pool worth $120 billion. But whether those countries want a dominant China is another matter entirely. The era of picking low-hanging diplomatic fruit is almost over. Beijing's neighbors are beginning to look for ways to hedge against China's rise and even help restrain Beijing's strategic options -- and that means that they're looking at the United States' presence in the region with new eyes.

China, in fact, understands this dynamic much better than its Western hemispheric rival; the reality of enduring American strengths and significant Chinese weaknesses is better appreciated in Beijing than in Washington. China knows that American power and influence in Asia is based on two things: its military and economic pre-eminence and Washington's unmatched several-decade record of underwriting peace and prosperity in the region. The vast majority of Asian states welcome the presence of the U.S. Seventh Fleet -- critical support, as America's forward deployments depend heavily on their acquiescence and cooperation.

China, by contrast, may be the loneliest rising power in recent history. Other countries in the region may look forward to the economic opportunities presented by China's rise, but Beijing has few genuine or reliable allies. It remains distrusted by almost every maritime power in the region. Domestically, even China's Premier Wen Jiabao recognizes that China is a potentially unstable combination of a strong and rich state ruling over a poor and weak country.

Beijing's lead in forging regional free trade agreements has helped enhance its economic clout. But for China to translate its economic growth and size into political leverage, it will have to become the dominant center of consumption in Asia. For now, in absolute terms, China's domestic consumption is roughly on par with France's. Chinese GDP growth is largely driven by domestically funded fixed investment that frequently offers little or no return -- think empty buildings and little-used highways -- and exports. About half of China's much-hyped trade within Asia is processing, assembling products destined for American and European markets.

Foreign companies benefit from the ease of setting up manufacturing and assembly plants in China, the country's cheap labor, and its undervalued yuan. But there is also resentment about the fact that millions of manufacturing jobs in the region have been lost to China; Indonesia has voiced concerns that the China-ASEAN Free Trade Agreement, activated in January, will devastate its garment and textiles industries. Until the appetites of Chinese consumers expand enough to create millions of jobs for regional workers, Beijing will find it difficult to extract political and strategic concessions from its neighbors.

Much of the problem has to do with the Chinese Communist Party's entrenched political economy, which holds down domestic consumption by directing economic gains to the few -- the state-controlled sector -- over the many, the burgeoning private sector. This means that income distribution in China has become the most unequal in all of Asia: While the income of the state-controlled sector has been growing at more than 10 percent a year over the past decade, household incomes have been improving by only 2-3 percent. Chinese state-sector procurement policies also follow rules that favor indigenous companies, making access to the most lucrative sector of the country's economy difficult for regional companies -- another grudge for neighbors to hold against the rising power.

Old habits have marred China's diplomatic forays as well. Despite impressive diplomacy over the past decade, Beijing has never given up its claims to disputed maritime territory in the East and South China Seas. Its reported statement that its claims in the latter are part of China's "core interests" is impolitic, but consistent with its long-term strategic ambitions: Beijing's strategy has been to ostensibly commit to the "peaceful resolution" of these issues while refusing to make serious attempts to actually resolve them. The result is widespread suspicion that a rising China is simply biding its time and will move on these contested claims when its political leverage is much more formidable.

While Asian states are generally comfortable with Washington's ongoing role as the preeminent security provider in Asia, they remain fearful that Beijing might well behave less benignly in the role of regional hegemon. Central to the rhetoric and self-image of the modern Communist Party is its claim that China will regain its status as Asia's "Middle Kingdom," the sort of bluntly hierarchical vision of regional geopolitics that neighbors tend not to be thrilled about. During a discussion of the South China Sea issue at a recent ASEAN meeting, Chinese Foreign Minister Yang Liechi lost his temper, declaring that "China is a big country and other countries are small countries, and that is just a fact." It was a chilling reminder to the region that a dominant China might well behave differently than a territorially distant and democratic power such as the United States.

The result is that key regional states are not just hedging against China's rise but subtly bandwagoning with Washington in order to hem in Beijing's strategic options. Inviting the United States to join the East Asian Summit as a permanent member is just one illustration of this strategic dynamic; others include Seoul, Jakarta, and Hanoi eagerly agreeing to strengthen military ties with Washington over the past six months.

Secretary Clinton's upcoming tour of Vietnam, Cambodia, Malaysia, Papua New Guinea, New Zealand, and Australia thus comes at an opportune moment. The United States still needs to commit more manpower and ships to the region, and reassure the region's capitals that unlike China, its grand designs are limited to maintaining stability in Asia. But as the starter, simply showing up can sometimes work wonders.

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Why Democracies Don't Get Cholera

It's about a lot more than just clean water.

Amartya Sen famously said that famines do not occur in well-run, democratic countries. The same is almost always true for cholera epidemics.

Not long after Haiti's earthquake in January, public health officials warned that poor sanitation and lack of potable water were creating conditions ripe for an outbreak of infectious disease. They were right. In the last week, a cholera outbreak has swept this impoverished country, with more than 3,100 confirmed cases and 250 deaths reported so far. So why -- if we knew that there was a danger of cholera -- couldn't it have been avoided? In short, because disease and democracy often work in opposite directions: vulnerable populations and inadequate government action create both the conditions for cholera epidemics to emerge and to become unmanageable.

Cholera epidemics stem from the same basic cause: poor people living in crowded and unsanitary conditions, with inefficient public health monitoring and limited health care. Cholera is a bacterial infection caused by the ingestion of fecally contaminated water or food. When an outbreak starts, it gains momentum fast.

But another cause is government denial and cover-up. Governments don't want to admit the failure of health-care or surveillance systems, and they are afraid of the trade and travel sanctions that may result from a large outbreak. But inaction leads to larger epidemics: Treating a few cases of cholera with oral rehydration salts or intravenous fluids is relatively straightforward, managing hundreds or thousands of cases is not. With prompt and proper treatment, less than 1 percent of those infected die. Without a fast response, death rates of five percent or more are not unheard of.

Unfortunately, there are more than enough examples of this worldwide. In 2008, in Zimbabwe, a cholera outbreak infected more than 100,000 people. In the past few months, nearly 50,000 people have been infected in four central African countries. Nigeria has been hardest hit, with about 40,000 cases and 2,000 deaths. Other outbreaks have occurred in the past few years in Kenya and Iraq. Two weeks ago, in flooded regions of Pakistan, 99 confirmed cholera cases were reported. In fact, cholera is on the increase across the globe. Each year, an estimated 3 million to 5 million people are infected with cholera; 100,000 to 120,000 of them die.

Haiti was vulnerable to this outbreak not only because of the January earthquake, but also because the country's rural population has long been marginalized, which has continued during reconstruction. Though rural villages and towns absorbed hundreds of thousands of individuals displaced after the earthquake, they have been largely excluded from the aid response. In rural communities, the already-stretched food and water infrastructure, has been pushed to the limits, while the humanitarian response has focused more on the earthquake-affected areas near Port-au-Prince.  

A second factor that predisposed Haiti to crisis was a weakened central government. Both prior to and particularly after the earthquake, the government was largely unable to deliver services. Instead, a precarious web of NGOs and relief organizations took on the job. This patchwork has supported water projects throughout rural Haiti, at various levels of functioning and disarray, meaning that communities often rely solely upon the charity of private groups. When projects fail, there is no accountability. 

Even if the infrastructure were perfect, however, clean water is not enough to prevent epidemics. You still need a government, and attention to housing and human rights. For several months, human rights organizations have been decrying the lack of a government plan for housing the 1.3 million people who still live in camps. To reduce the risk of cholera, the squalid living conditions in camps need to be addressed. This is not a task easily conducted by NGOs in piecemeal. Relief organizations and international donors must work to strengthen the capacity of the Haitian government, and to strengthen and empower local civil society.

The role of human rights in promoting accountability is frequently discounted in the immediate aftermath of a crisis. Similarly, the right to health is often misunderstood: It does not mean that everyone has a right to be healthy. Rather it means that governments, at a minimum, need to act to counter foreseeable health risks. Haiti has limited means to provide a broad guarantee to the right to health. But, with the support of private groups and international donors, the government can prevent the cholera epidemic from continuing to escalate and from affecting not just thousands, but hundreds of thousands, of people.

The bottom line is that cholera is avoidable and cholera deaths are preventable. When the immediate crisis is over, attention will turn back to rebuilding Haiti. By listening to the needs of rural residents, by ensuring that planning is participatory and inclusive, by building the capacity of the government to deliver services and fulfill the rights to health, water, and shelter, post-earthquake-rebuilding efforts can reduce vulnerability to cholera and ensure that the Haitian government can protect and fulfill the rights of its people. If it can do that, Haiti can provide an example for countries around the world.