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  • Author: Maxine Builder
  • Publication Date: 01-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Growing rates of antimicrobial resistance (AMR) pose a threat to public health that could undo many of the medical advances made over the last seventy years, eroding the global medical safety net and posing a significant threat to national security. Diseases once eliminated by a single course of antibiotics show drug resistance, often to several different classes of drugs. Some of the implications of increasing rates of AMR are intuitive, such as longer duration of illness, extended hospital stays, and higher rates of mortality. But other effects of a postantibiotics world are less obvious, such as the inability to perform life-saving operations or the ability for a simple scratch on the arm to kill. Humanity could soon find itself living in a reality in which communicable diseases such as tuberculosis, cholera, pneumonia, and other common infections cannot be controlled. This potentially catastrophic problem still can be abated, and the global health community, including the World Health Organization (WHO), has highlighted AMR as a priority in global health. But all sectors of the international community, not simply those in public health, need to take immediate steps to reverse the current trends and eliminate the systematic misuse of antimicrobial drugs, especially in livestock, and restore the pipeline of new antimicrobial drugs. The significant health and economic costs of AMR are difficult to quantify due to incomplete data that often underreports the extent of the problem, since there are no standard metrics or consensus on methodology to measure rates of AMR. But even the piecemeal statistics that exist paint a bleak picture. In a 2013 report, the US Centers for Disease Control and Prevention (CDC) reports at least two million Americans acquire serious infections to one or more strains of AMR bacteria annually, and at least 23,000 people die of these infections.1 A 2008 study estimated the excess direct costs to the US medical system attributable to AMR infections at $20 billion, with additional estimated productivity losses to be as high as $35 billion.2 With the increase in resistant infections and continuing rise in medical costs, the cost to the American medical system no doubt also has increased. This trend is not a uniquely American problem; it is truly global in scope. The European Union (EU) reports about 25,000 deaths annually due to drug-resistant bacteria, at an overall, combined cost of $2 billion in healthcare costs and productivity losses.3 There were over 14.7 million incidents of moderate-to-severe adverse reactions to antibiotics each year between 2001 and 2005 in China. Of these, 150,000 patients died annually.4 The most recent available data on China estimates that treatment of AMR infections during that same time period cost at least $477 million, with productivity losses of more than $55 million each year.5 A 2005 study of the United Kingdom (UK) found that the real annual gross domestic losses due to AMR were between 0.4 and 1.6 percent.6 Although slightly outdated, this estimate may be a useful guide in assessing the global impact of AMR, and given the trend of increasing resistance, it is likely that the impact will also increase accordingly. That said, it is prudent to repeat that the disparities in the quality of data reporting standards across China, the United States, the United Kingdom, and the European Union make it difficult to directly compare the severity of the impacts AMR has on each entity. The primary cause of AMR globally is antibiotic overuse and misuse, be it from doctors inappropriately prescribing antibiotics to treat viral infections or individuals seeking over-the-counter antibiotics for self-treatment. But another driver, less obvious than overuse in humans, is the use of antimicrobials in livestock, and the ratio of use in animals as compared to humans is astounding. In the United States, about 80 percent of all antibiotics are consumed in either agriculture or aquaculture. Generally, these drugs are administered to livestock as growth promoters and are medically unnecessary. Resistance in livestock quickly spreads to humans, and many community-acquired infections are the result of a contaminated food supply. Although most infections are acquired in the community, most deaths attributed to resistant infections occur in healthcare settings, and healthcare-acquired (or nosocomial) infections are another driver of AMR. At this point, AMR does not pose an immediate and direct threat to national security. Rather, this is a creeping global security crisis. If current trends continue, these drugs upon which the world relies will lose effectiveness. The gains made in fighting infectious diseases will be reversed, and a wide range of routine surgeries and easily treatable infections will become much more dangerous and deadly. This will cause the health of the world's working population to deteriorate, and the economic productivity and social cohesion of the globe to decline. At any time, a “black swan” event—triggered by an outbreak of drug-resistant tuberculosis, cholera, or pneumonia, for example—could prove catastrophic, endangering the fabric of societies and our globalized economy, forcing a stop to international trade and travel to prevent further spread. The issue of AMR is a tragedy of the commons in which individual incentives lead to the overuse and eventual destruction of a shared resource. International cooperation is required to walk back from this ledge and avoid a postantibiotics world, even though it is impossible to completely reverse the damage already done.
  • Topic: Health, National Security, Infectious Diseases, Health Care Policy
  • Political Geography: United States, China, United Kingdom, America, Europe
  • Author: Enrique Dussel Peters
  • Publication Date: 09-2015
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Weeks before Chinese President Xi Jinping meets with President Barack Obama in Washington, the Atlantic Council's Latin America Center launched a new report that unravels the complexities of the Latin America-China relationship. Titled China's Evolving Role in Latin America: Can it Be a Win-Win?, the report provides five recommendations to help both China and Latin America usher in a mutually beneficial post-commodity-boom relationship. The key to long-term success will be to insure that the relationship promotes—rather than delays—economic growth and social progress in the hemisphere. In the report, renowned Mexico-based China Expert Enrique Dussel Peters, an Atlantic Coucil author and Professor at the Graduate School of Economics at the National Autonomous University of Mexico (UNAM), calls for a ratcheting up of strategic planning and multilateral support so the relation¬ship is a win-win for all parties, including the United States. A deep dive of the state of play is provided for five countries: Argentina, Brazil, Cuba, Mexico, and Venezuela. These countries illustrate the spectrum of ties with China, ranging from those with long and complex historical relation¬ships to those almost entirely structured around recent opportunities for economic cooperation.
  • Topic: Diplomacy, Economics, Bilateral Relations
  • Political Geography: China, Latin America
  • Author: Shuja Nawaz, Mohan Guruswamy
  • Publication Date: 04-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: India and Pakistan, born out of a single British-ruled entity in 1947, have continued an implacable rivalry marked by periodic wars and hostilities as well as through proxies. This unending conflict has led them to invest heavily in their militaries and even to choose nuclear weaponry as a deterrence on the part of Pakistan toward India and on India's part toward both Pakistan and China. Although there have been occasional moves toward confidence building measures and most recently toward more open borders for trade, deep mistrust and suspicion mark this sibling rivalry. Their mutual fears have fuelled an arms race, even though increasingly civil society actors now appear to favor rapprochement and some sort of an entente. The question is whether these new trends will help diminish the military spending on both sides.
  • Topic: Security, Foreign Policy, Economics, International Trade and Finance, Reform
  • Political Geography: Pakistan, China, India, Asia, Southeast Asia
  • Author: Jason Marczak, Peter Schechter
  • Publication Date: 02-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Why is now the right moment to commission a poll on the US public's views toward Cuba and US-Cuba relations? Why is a new, nonpartisan Latin America center reaching out to grab the third rail of Latin American foreign policy in the United States? Both good questions. Sometimes in foreign policy, structural impediments or stark policy differences will stymie progress in a certain area. Relations with China could not proceed until the United States recognized a “one China” policy that forever downgraded US relations with Taiwan. An activist foreign policy with Africa was impossible until the United States denounced apartheid.
  • Topic: International Relations, Foreign Policy, Reform
  • Political Geography: Africa, United States, China, Cuba, Latin America
  • Author: Jason Healey, Klara Tothova Jordan, John C. Mallery, Nathaniel V. V. Youd
  • Publication Date: 11-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: Confidence-building measures (CBMs) are an instrument of international politics, negotiated by and applied between states to strengthen international peace and security by reducing and eliminating the causes of mistrust, fear, misunderstanding, and miscalculations that states have about the military activities of other states.
  • Political Geography: Russia, China, America
  • Author: Daniel H. Rosen
  • Publication Date: 10-2014
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: PRESIDENT XI JINPING ANNOUNCED a sweeping overhaul for China's economy in November 2013, with pledges to make market forces decisive, treat homegrown and foreign investors with the same laws and regulations, and change the mission statement of the government. The reform program, known as the Decisions plan and presented at the Communist Party leadership's Third Plenum meeting, is comprehensive and marks a turning point in China's modern history. The degree of boldness also indicates that after 35 years of world-beating economic performance, China's development model is obsolete and in need of urgent, not gradual, replacement. To justify the risks, President Xi quoted an impassioned plea for policy modernization by his predecessor Deng Xiaoping: the only way to avoid a dead end – a blind alley – is to deepen reform and opening both at home and with the world.
  • Topic: Economics, International Trade and Finance, Political Economy, Reform
  • Political Geography: China
  • Publication Date: 09-2013
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: The world has achieved unprecedented peace, prosperity, and interdependence, but past achievements—and further progress—are threatened by a host of looming challenges. Global institutions that served us well and transformed the world are becoming victims of their own success and must be reformed or replaced to deal with new challenges and take advantage of new opportunities. Governments everywhere face rising expectations and increasing demands but find themselves less able to manage the challenges they face.
  • Topic: Foreign Policy, Diplomacy, International Cooperation, Bilateral Relations
  • Political Geography: United States, China, Asia
  • Author: John R. Lyman
  • Publication Date: 07-2009
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: In 2007, the Atlantic Council of the United States (the Council) partnered with the U.S./China Energy and Environment Technology Center (EETC) at Tsinghua and Tulane Universities to hold a series of dialogues to foster cooperation between the United States and China on developing secure and sustainable energy supplies. Over the past several years, the Council and EETC have invited key organizations, experts from industry and government, and representatives from relevant United States (U.S.) and Chinese government agencies to become directly involved in several meetings designed to identify concrete recommendations for increasing official governmental and industry cooperation.
  • Topic: Security, Foreign Policy, Climate Change, Diplomacy, Energy Policy, Bilateral Relations, Nuclear Power
  • Political Geography: United States, China, Asia
  • Publication Date: 10-2009
  • Content Type: Working Paper
  • Institution: Atlantic Council
  • Abstract: The Atlantic Council of the United States (the Council) and the U.S./China Energy and Environmental Technology Center (EETC) at Tsinghua and Tulane Universities cosponsored a Dialogue, “U.S.-China Cooperation on Low-Emissions Coal Technologies” in Beijing from June 24-26, 2009. This report synthesizes and summarizes the information presented during the Dialogue to allow for an ongoing exchange of information and ideas between the meeting participants and key stakeholders in the effort to lower emissions from the use of coal.
  • Topic: International Relations, Foreign Policy, Diplomacy, Economics, Energy Policy, Environment, Bilateral Relations
  • Political Geography: United States, China, Atlantic Ocean