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2221. The War in Ukraine: Reality Check for Emerging Technologies and the Future of Warfare

Author:
Jean-Marc Rickli and Federico Mantellassi
Publication Date:
04-2024
Content Type:
Working Paper
Institution:
The Geneva Centre for Security Policy
Abstract:
Russia’s full-scale invasion of Ukraine in February 2022 marked the beginning of one of the most intense and brutal state-on-state conflicts opposing two modern militaries in recent memory. Despite Russia’s qualitative and quantitative advantages, Ukraine’s armed forces have so far put up strong resistance, foiling Russian plans of a quick victory and turning the conflict into a bloody war of attrition. Due to its scale and the nature of its belligerents, the conflict can provide us with a glimpse into what the future of warfare might look like and help us recentre the burgeoning conversation about the future of warfare in the current reality, especially as it relates to the presence and impact of emerging technologies. The war therefore offers us a way to understand how digital and off-the-shelf technologies such as artificial intelligence (AI) impact conflicts of this scale and how relevant they are to current modern warfare. The war can also help us see how new actors become involved in warfare, what new means of influencing nation states are becoming available, and which new tools armed forces can use to affect battlefield outcomes. Importantly, it can help us gauge their importance relative to more traditional aspects of warfare. The analysis is structured in four main parts. This introduction is followed by a short contextualisation to situate the analysis in the wider conversation about emerging technologies and the future of warfare (Part 2). Part 3 provides a short overview of the conflict so far, dividing it into six phases. Part 4 surveys the main elements of the conflict in Ukraine, outlining what emerging technologies have been present and critically assessing their role in the war. Part 5 delves into some implications for the future of warfare that can be understood from the dynamics analysed thus far, especially as they relate to the place of emerging technologies in future conflicts and their role in determining battlefield outcomes. We argue that while some new technologies have come to characterise modern warfare, the Russo-Ukrainian conflict shows that many features of warfighting remain unchanged. Emerging technologies, such as AI and cheaper technological alternatives to traditional armaments, such as drones, are undoubtedly starting to change the battlefield and will play an increasingly larger role in future conflicts. Cyberspace and the globalised digital information space are bringing new actors and new means to exert influence, provide nations’ armed forces with new tools, and make battlefields increasingly globalised and complex. However, the conflict also shows that traditional aspects of warfare will not decrease in importance or be sidelined. Conflicts remain a contest of wills and adaptation, where ammunition supplies, the quantity of traditional armaments such as tanks, and both the number and quality of personnel and the logistical and organisational ability to bring all these elements to bear all remain the most important determinants of success. While technology is playing an increasing role in this equation, it remains unable to determine the outcome of a conflict on its own.
Topic:
Science and Technology, Drones, Artificial Intelligence, Armed Conflict, and Russia-Ukraine War
Political Geography:
Russia, Europe, and Ukraine

2222. The Prospective of the Western Balkans to the EU Membership: Challenges and Possible Ways Forward

Author:
Anila Jelesijević
Publication Date:
03-2024
Content Type:
Working Paper
Institution:
The Geneva Centre for Security Policy
Abstract:
The integration of the Western Balkan countries into the European Union (EU) remains a slow process. The EU’s focus on the war in Ukraine and sanctions on Russia has negatively affected these countries’ motivation to proceed with the reforms needed to join the EU. Their aim is to become part of the EU family, but a real commitment and productive interaction from both sides that will lead to such an integration is an essential requirement. This Geneva Paper aims to develop recommendations for what can be done to allow the Western Balkan countries to join the EU as soon as possible.
Topic:
Reform, European Union, and Regional Integration
Political Geography:
Europe and Western Balkans

2223. The Wagner Group, Russia’s Foreign Policy and Sub-Saharan Africa

Author:
Kemal Mohamedou
Publication Date:
03-2024
Content Type:
Working Paper
Institution:
The Geneva Centre for Security Policy
Abstract:
Set up in 2014 as a private organisation, the Wagner Group has conducted numerous military activities internationally that remain shrouded in mystery. Through documented investigations, it emerges that the group is less akin to a traditional private military contractor and more a tool in Russian president Vladimir Putin’s military arsenal. Through its deployment in the Central African Republic and Mali, the group has gained an important foothold in sub-Saharan Africa and has furthered Russian foreign policy aims in the region, enabling Moscow to advance three key aims: (1) achieving recognition for Russia as a great power through global geopolitical repositioning; (2) undermining Western interests by building a Russian sphere of influence; and (3) enhancing Russian soft power. The historical anti-imperial Soviet advances in the post-colonial era had facilitated present-day Russian endeavours in Africa, providing a narrative for the Russian state’s foreign policy goals. While the Wagner Group has employed various political strategies to exert soft-power influence, it has also resorted to a coercive approach to suppress anti-government and anti-Russian activity. Russian advisors have developed repressive tactics, instrumentalising local state institutions and national armed forces to threaten opponents. The Wagner Group’s activities in sub-Saharan Africa have demonstrated a concerted effort to enhance Russia’s influence in the region and secure the country’s strategic interests. While Russia is not the sole external actor in Africa, the current political orientation adopted by the Kremlin towards sub-Saharan Africa can ultimately be read as a move to fragment and unsettle Western presence across the continent. In this context, the merging of paramilitary and non-military actions in Africa is of particular relevance, allowing Russia to project power, exert influence and – crucially – unsettle local state-building projects.
Topic:
Foreign Policy, Wagner Group, and Private Military Companies (PMCs)
Political Geography:
Africa and Sub-Saharan Africa

2224. Economic Performance in US Fossil Fuel Communities

Author:
Noah Kaufman, Ariane Desrosiers, and Sarah Doctor
Publication Date:
12-2024
Content Type:
Special Report
Institution:
Center on Global Energy Policy (CGEP), Columbia University
Abstract:
Rapidly reducing greenhouse gas emissions from fossil fuels to address the severe threats of climate change requires economic transformations that pose challenges for regions heavily dependent on coal, oil, natural gas, or other carbon-intensive industries. The United States is the world’s largest producer of oil and natural gas and the fourth-largest producer of coal, and communities across the country depend heavily on fossil fuel industries for jobs, investments, and public revenues that fund schools and other critical services. These communities will need considerable support to successfully navigate a global transition away from fossil fuels, and a better understanding of their local economies will help policymakers design and implement pragmatic support. However, scant evidence exists for such use today. This report, part of the Resilient Energy Economies initiative co-led by the Center on Global Energy Policy at Columbia University SIPA, uses a novel dataset and case studies to establish a baseline of local economic performance in fossil fuel–dependent communities between 2004 and 2019. This period captures the peak and first decade of decline of the US coal industry as well as the shale revolution that boosted US oil and gas production.
Topic:
Climate Change, Energy Policy, Finance, Fossil Fuels, and Carbon Emissions
Political Geography:
North America and United States of America

2225. Lessons from the Nuclear Waste Negotiator Era of the 1990s for Today’s Consent-Based Siting Efforts

Author:
Matt Bowen
Publication Date:
09-2024
Content Type:
Special Report
Institution:
Center on Global Energy Policy (CGEP), Columbia University
Abstract:
Nuclear power is being weighed in energy transition plans around the world, as countries seek to replace fossil fuels with low-carbon alternatives while also meeting growing energy demand and maintaining reliability and affordability. When considering extension of existing nuclear reactor licenses as well as approving new ones, there is an ethical obligation for today’s users to develop plans for long-term management of the resulting nuclear waste and not defer its disposition to future generations. In the United States, the federal government is contractually obligated to take ownership of the spent nuclear fuel (SNF) produced at power plants, but this has not happened. The one deep geologic repository project named in law by Congress for potential disposal of SNF—Yucca Mountain in Nevada—has reached a stalemate, with Congress appropriating no money to move the project forward since 2010 due to Nevada’s opposition. Negotiations with US states and tribes to host storage and disposal facilities have been sensitive in the past due to both a stigma around nuclear waste and a perception of risk associated with such facilities. A federal “nuclear waste negotiator” role existed in the early 1990s to overcome these difficulties and find a state or tribe willing to host a repository or interim storage facility, though this short-lived, volunteer-based program did not lead to deployment of either. This report, part of a series of publications on nuclear waste policy at the Center on Global Energy Policy at Columbia University SIPA, reveals lessons learned from the experiences of the two prior negotiators that could benefit a recent, congressionally directed effort at the Department of Energy (DOE) to begin a “consent-based” siting program for nuclear waste. Those individuals were authorized to negotiate terms and conditions—including financial and institutional arrangements—with a state or tribe in a written agreement that would then have to be approved by Congress. Importantly, a state or tribe was assured it could explore the potential of hosting a site while retaining the right to withdraw at any time, and if it did proceed, would have a measure of power in setting terms for the project.
Topic:
Negotiation, Nuclear Waste, Inflation Reduction Act, and Consent
Political Geography:
North America and United States of America

2226. Triggering Investment in First-of-a-Kind and Early Near-Zero Emissions Industrial Facilities

Author:
Chris Bataille, Seton Stiebert, and Jonas Algers
Publication Date:
08-2024
Content Type:
Special Report
Institution:
Center on Global Energy Policy (CGEP), Columbia University
Abstract:
Among the most significant challenges to achieving the Paris Agreement goal of global net-zero CO2 emissions by 2055–2075 is addressing the so-called “hard-to-abate” heavy industrial sectors such as iron and steel, cement and concrete, ammonia, methanol, and high value feedstock chemicals like olefins. These sectors accounted for 7.5 Gt CO2 or 20.4 percent of global emissions in 2021, and global demand for their products will only rise until broad development goals are met everywhere. Moreover, nearly all heavy industrial plants being planned or in construction today are fossil based, with the exception being a handful of small-scale pilot facilities. Given that plants tend to operate for at least 20 years before their first deep renovation, and 40–80+ years overall, these new ones will likely still be in operation by the time global CO2 emissions must be net-zero (~2050–2060), after which heavy industry players that are still emitting will likely need to pay for CO2 removal (CDR) from the atmosphere. The cumulative CO2 emissions between now and then and the likely very high cost of CDR are driving society, governments, and firms to make near-zero emissions the default minimum standard for all new and retrofit facilities by the end of the 2020s. However, fulfilling that standard is no easy task. The main bottleneck is less technological in nature than financial and market based. At the current state of the art, near-zero emissions plants simply cost more than fossil-based plants, and meanwhile, no demand pull or market exists for lower-emission industrial products. Given the urgency of the task at hand amid the global climate crisis and the current lack of a business case to undertake it, strong policy signals can be used to incentivize early investment in near-zero-carbon heavy industry. This report, part of the Carbon Management Research Initiative at the Center on Global Energy Policy at Columbia University SIPA, explores financial policy instruments that can make first-of-a-kind (FOAK) near-zero emission industrial facilities viable. The report finds that such FOAKs can then be used as low-risk, replicable models for rapidly transforming the “hard-to-abate” sectors and ultimately facilitating a transition to full net-zero emissions for industry as a whole.
Topic:
Climate Change, Investment, Industry, Carbon Emissions, Net Zero, and Abatement
Political Geography:
Global Focus

2227. Revisiting GTCC and GTCC-Like Nuclear Waste Disposal in the United States

Author:
Matt Bowen, Maya Lameche, and Marine Gapihan
Publication Date:
07-2024
Content Type:
Special Report
Institution:
Center on Global Energy Policy (CGEP), Columbia University
Abstract:
While the United States (US) has facilities that can and do dispose of most low-level nuclear waste (LLW), it does not yet have a viable disposal pathway for two categories of waste: so-called greater-than-class-c (GTCC) nuclear waste, and nuclear waste with characteristics similar to it, or “GTCC-like.” These two categories essentially straddle the United States’ LLW inventory, for which disposal facilities are in operation, and high-level nuclear waste (HLW) inventory, for which no disposal capability exists. GTCC nuclear waste is produced by multiple sources: commercial nuclear power plants, medical procedures, industrial and research activities, and Department of Energy (DOE) missions, including those related to national security and the cleanup of legacy facilities. These activities carry with them an ethical responsibility to dispose of the nuclear waste they generate rather than pass it on to the next generation. Security task forces have also identified the lack of a disposal pathway for sealed sources of GTCC nuclear waste as a concern, given the potential for its theft and use in a dispersal device. This report, part of a series of publications on nuclear waste policy at the Center on Global Energy Policy, Columbia University SIPA, explores the history of DOE, Nuclear Regulatory Commission (NRC), and state efforts to develop disposal capabilities for GTCC and GTCC-like inventories. It explains why this gap merits greater attention from policymakers now and identifies measures Congress, the DOE, and the NRC could take, should they decide to address it. US government efforts to develop disposal capabilities for GTCC waste date back to 1985 when Congress made it a federal responsibility. For a time, disposal in the planned repository at Yucca Mountain, Nevada, was contemplated. But in the absence of appropriations to move that project forward since 2010, the federal government recently issued planning documents that identify generic commercial LLW disposal facilities and the Waste Isolation Pilot Plant (WIPP) deep geologic repository in New Mexico as preferred alternatives. Of the commercial LLW disposal facilities in operation, only the WCS facility in Texas has expressed interest in the GTCC disposal mission. The political climate for GTCC disposal in both New Mexico and Texas has darkened in recent years, though, casting doubt on the federal government’s plans. If the US government decides to prioritize the goal of establishing disposal capability for GTCC and GTCC-like nuclear waste, Congress, the DOE, and the NRC could take the following steps to help realize it in the near term.
Topic:
Regulation, Nuclear Waste, Nuclear Energy, and Energy
Political Geography:
North America and United States of America

2228. Using New Marginal Emissions Data to Improve State Renewable Portfolio Standards

Author:
Devan Samant, Abraham Silverman, and Zachary A. Wendling
Publication Date:
05-2024
Content Type:
Special Report
Institution:
Center on Global Energy Policy (CGEP), Columbia University
Abstract:
The majority of US states use a renewable portfolio standard (RPS) to achieve clean energy targets. RPS programs typically set annual clean energy production levels, but they ignore the significant variations in greenhouse gas (GHG) emissions intensity of the grid at different times of the day and at different locations. Newly available locational marginal emissions (LME) data, which are collected at thousands of physical locations and updated every five minutes, provide insights into where and when the electricity sector produces the most and least GHG emissions. Incorporating LMEs into RPSs would allow states to identify and reward “high impact” clean energy production: that which replaces the dirtiest generation. This report examines the impact that incentivizing clean energy production at high LME times and locations could have on reducing emissions in RPS programs. In five scenarios based on data from four states in the PJM grid (Illinois, New Jersey, Pennsylvania, and Virginia), the authors examine hypothetical shifts in energy production from times and geographic areas with differing clean or dirty generation mixes. The proof-of-concept exercises the authors ran found that shifting clean energy production into the three dirtiest hours of the day resulted in approximately 10% less emissions than the baseline case. Geographically shifting production to displace energy at a dirtier locale resulted in 9%–20% less emissions, depending on the LME makeup at the given location versus the baseline.
Topic:
Regulation, Electricity, Carbon Emissions, and Energy
Political Geography:
Global Focus

2229. Outlook for Pending Generation in the PJM Interconnection Queue

Author:
Abraham Silverman, Zachary A. Wendling, and Kavyaa Rizal
Publication Date:
05-2024
Content Type:
Special Report
Institution:
Center on Global Energy Policy (CGEP), Columbia University
Abstract:
The United States is witnessing rapidly growing interest in clean electricity generation, driven by soaring consumer demand for clean energy and the country’s goal to reduce greenhouse gas emissions. In parallel, the time it takes for new, clean generation projects to move from design to execution in the US has lengthened, meaning that the rising interest has not been matched by supply. The country’s largest grid operator, PJM Interconnection (PJM), has experienced the most severe delays and backlog in new generation—projects entering the queue today have little chance of coming online before 2030. It is widely understood that an increasingly lengthy interconnection process, which involves a series of studies and upgrades grid operators must take to ensure projects can connect to the grid safely and reliably, is responsible for this state of affairs. It is not clear how this longer process interacts with other known project development challenges—such as siting and permitting issues, supply chain constraints, and inflationary pressures—and to what extent such interactions may lengthen the timeline for bringing projects online. Understanding these dynamics can help answer critical questions about grid reliability going forward, including whether it will be necessary to delay or cancel the planned retirement of aging fossil fuel-fired generation resources that the new generation is intended to replace. This report attempts to fill this knowledge gap. It presents results of an author-developed survey of those best positioned to understand the impacts of interconnection process delays: project developers in the PJM market. The key finding from the survey is that PJM’s increasingly lengthy interconnection process is exacerbating siting and permitting challenges and leading to knock-on delays in equipment procurement and financing decisions, suggesting the timeline for new generation in this market will likely remain long for the foreseeable future. Given the importance of new entry to keeping prices competitive and maintaining reliability amid the retirement of older fossil resources, PJM will need to find ways to reduce interconnection delays or reconsider when those fossil resources should be retired.
Topic:
Electricity, Carbon Emissions, Connectivity, and Inflation Reduction Act
Political Geography:
North America and United States of America

2230. Estimating the Number of Women Household Biomass Producers, the Largest Segment of the Global Energy Labor Force

Author:
Philippe Benoit and Siyuan Ding
Publication Date:
01-2024
Content Type:
Special Report
Institution:
Center on Global Energy Policy (CGEP), Columbia University
Abstract:
While tens of millions of people work in formal energy jobs around the world, another group that comprises a massive and key labor segment in this sector is often overlooked: women and girls producing biomass to meet the basic energy needs of millions of poorer households across the developing world. Some 2 billion people rely on biomass for cooking (and some for heating), making those who gather it critical players in the global energy supply system. Women and girls in many developing countries constitute the majority of people collecting fuelwood for household consumption—an often strenuous and time-consuming effort—and estimating their number could elevate the importance attached to improving their working and living conditions. While some initial estimates of this labor force have been made, analyses remain superficial. This report, part of ongoing research into energy for development and gender dynamics at the Center on Global Energy Policy at Columbia University SIPA, attempts to improve this deficit, providing a systemic albeit rough estimation—given minimal available data—of the number of women household biomass producers. An analysis of clean cooking access rates, population figures, and average household sizes for both rural and urban areas in 92 developing countries estimates that 389 million women and girls undertake this work, which would represent the largest labor segment of today’s global energy system.
Topic:
Development, Labor Issues, Women, Energy, and Biomass
Political Geography:
Global Focus

2231. A Quantitative Analysis of Variables Affecting Power Transmission Infrastructure Projects in the US

Author:
Lewis (Zhaoyu) Wu, Abraham Silverman, and Harrison Fell
Publication Date:
04-2024
Content Type:
Special Report
Institution:
Center on Global Energy Policy (CGEP), Columbia University
Abstract:
Upgrading the US electric grid is vital to a successful energy transition. Transmission expansion lowers electricity costs for consumers; speeds deployment of new generation resources; provides economic opportunities for communities; increases system reliability, particularly in the face of extreme weather events; and enables large-scale transfers of power from areas of the country with high renewable energy potential to customers. But experience over the past twenty years has shown that new transmission projects often face extensive delays, impeding or even denying these potential benefits to consumers and communities. In response, policymakers at the state and federal level are considering reforms to transmission finance, cost allocation, siting and permitting, advanced technologies, and other areas to help jumpstart the United States’ currently moribund transmission expansion processes. As part of this process, policymakers and other stakeholders are debating the merits of various transmission planning policies in terms of project success, but the impact of specific variables can be hard to quantify. This can lead stakeholders to rely largely on anecdotal or qualitative arguments to support their positions. The wide variation in the way utilities are regulated and transmission planning processes are implemented across the United States further compounds the difficulty of evaluating the relative effectiveness of different transmission planning policies. This report, a joint project of the Non-Technical Barriers to the Clean Energy Transition Initiative and the Energy Systems Modeling and Analytic Platform at the Center on Global Energy Policy, Columbia University SIPA, applies a data-driven approach to this policy debate. Using statistical analysis and machine learning models to analyze a dataset from the data company MAPSearch of planned transmission projects of at least 100 kilovolts (kV) conceived between 2005 and 2023, which includes more than 1,300 transmission projects, the report provides a systematic assessment of the impact of key variables on the likelihood that a proposed transmission line will actually be built. The results of this assessment can help those interested in expanding transmission infrastructure understand which variables may be worth prioritizing in a particular geographical area or region, given its unique combination of attributes, needs, and challenges.
Topic:
Infrastructure, Energy Sector, and Transmission
Political Geography:
North America and United States of America

2232. Health Care for Women: How the U.S. Compares Internationally

Author:
Munira Z. Gunja, Relebohile Masitha, and Laurie Zephyrin
Publication Date:
08-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Recently released federal data once again show the United States with by far the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic.1 Racial disparities are also extreme: Black women in the U.S. are nearly three times more likely to die from pregnancy-related complications than white women are. But maternal deaths and complications may be an indicator of the nation’s wider failures with respect to women’s health and health care. Compared to women in other high-income countries, American women have long had worse access to the health care they need. While the U.S. spends more on health care than other countries do, surveys regularly find that Americans avoid seeking care because of costs at the highest rates, even as the U.S. continues to lead in the prevalence of chronic disease.2 At the same time, limited access to primary care and inadequate coordination of health services are likely factors in the nation’s poor performance when it comes to the prevention, diagnosis, and management of diseases.3 In this brief, we compare selected measures of health care access and outcomes for women in high-income countries. We drew upon data from four sources: the Commonwealth Fund’s 2023 International Health Policy Survey of Australia, Canada, France, Germany, the Netherlands, New Zealand, Switzerland, the United Kingdom, and the United States, which allowed us to analyze responses by race and ethnicity;4 the Centers for Disease Control and Prevention National Vital Statistics System; the Organisation for Economic Co-operation and Development (OECD); and the Institute for Health Metrics and Evaluation Global Burden of Disease. The latter two data sets permitted us to show results on selected measures for five additional countries — Chile, Japan, Korea, Norway, and Sweden. (See “How We Conducted This Survey” for more details.)
Topic:
Women, Public Health, Healthcare System, and Life Expectancy
Political Geography:
United Kingdom, Canada, France, Germany, Australia, and United States of America

2233. Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System

Author:
David Blumenthal, Evan D. Gumas, Arnav Shah, Munira Z. Gunja, and Reginald D. Williams II
Publication Date:
09-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Goal: Compare health system performance in 10 countries, including the United States, to glean insights for U.S. improvement. Methods: Analysis of 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower. Conclusion: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.
Topic:
Development, Public Health, Efficiency, and Healthcare System
Political Geography:
North America and United States of America

2234. Boosting Childhood Vaccination Rates Post-Pandemic: Lessons from Five Countries

Author:
Irene Papanicolas, Robert A. Berenson, and Laura Skopec
Publication Date:
10-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Issue: Childhood vaccination rates fell worldwide during the COVID-19 pandemic. However, reductions in childhood vaccination were not universal, which may be related to differences in vaccine eligibility, vaccine hesitancy, and vaccine administration programs across countries. Goals: Explore how childhood vaccination rates changed during the COVID-19 pandemic in five high-income countries with varying approaches to vaccine policy. Methods: Surveys of in-country experts and analysis of secondary data sources in Australia, Germany, Singapore, the United Kingdom, and the United States. Key Findings and Conclusion: While vaccination rates fell worldwide during the COVID-19 pandemic, the high-income countries in our study maintained high childhood vaccination rates for polio and measles-mumps-rubella (MMR) near or above the herd immunity threshold (80% for polio and 95% for measles). Australia and Singapore, which have the strictest vaccine requirements, boasted the highest polio vaccination rates in both 2018 and 2021. No countries require the human papillomavirus (HPV) vaccination nationwide, but Australia, Singapore, and the U.K. have school-based HPV vaccination programs and high vaccination rates. Strong vaccine requirements, combined with school-based immunization or catch-up programs, may help boost childhood vaccination rates where they lagged during the pandemic.
Topic:
Children, Vaccine, COVID-19, and Healthcare System
Political Geography:
United Kingdom, Germany, Australia, Singapore, and United States of America

2235. Finger on the Pulse: The State of Primary Care in the U.S. and Nine Other Countries

Author:
Evan D. Gumas, Corinne Lewis, Celli Horstman, and Munira Z. Gunja
Publication Date:
03-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
For many people, primary care is their first point of contact with the health system, and decades of evidence shows it is critical for population health, health equity, and the overall efficiency of health care systems.1 Primary care is also uniquely positioned to screen for social needs and provide integrated behavioral health services.2 Ensuring people have access to high-quality, comprehensive primary care is vital to good health outcomes and positive experiences with the health system at large. Despite the importance of primary care, health systems around the world are facing challenges at the patient and provider level. Many countries struggle to ensure access to care, or first contact; continuity of care; comprehensiveness of care; and coordination of care. These four core components of high-quality primary care are essential to better overall health outcomes.3 Factors like workforce shortages, physician burnout, and dwindling access for patients, driven in part by underinvestment and growing administrative burdens, pose significant barriers to care.4 To better understand how patient care can be improved in a changing primary care landscape, this brief compares the state of primary care in the United States with nine other high-income nations. It updates an earlier Commonwealth Fund study comparing primary care performance in the U.S. with nine peer countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom. Our data come from the Commonwealth Fund’s 2022 International Health Policy Survey of Primary Care Physicians and the 2023 International Health Policy Survey of adults age 18 and older. The 2022 and 2023 surveys asked different questions of the participating physicians and responding adults, so this edition includes new measures on access to telehealth, preparedness to treat behavioral health conditions, and care coordination. For more details on our methods, see “How We Conducted This Study.”
Topic:
Equity, Primary Care, and Healthcare System
Political Geography:
United Kingdom, Canada, France, Germany, Australia, Switzerland, North America, Sweden, Netherlands, New Zealand, and United States of America

2236. Insights into the U.S. Maternal Mortality Crisis: An International Comparison

Author:
Munira Z. Gunja, Evan D. Gumas, Relebohile Masitha, and Laurie Zephyrin
Publication Date:
06-2024
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
The United States continues to have the highest rate of maternal deaths of any high-income nation, despite a decline since the COVID-19 pandemic. And within the U.S., the rate is by far the highest for Black women. Most of these deaths — over 80 percent — are likely preventable.1 With policies and systems in place to support women during the perinatal period, several high-income countries report virtually no maternal deaths. As policymakers and health care delivery system leaders in the U.S. seek ways to end the nation’s maternal mortality crisis, these countries may offer viable solutions. This brief updates an earlier Commonwealth Fund study of differences in maternal mortality, maternal care workforce composition, and access to postpartum care and social protections between the U.S. and other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom.2 In this edition, we have also included data on Chile, Japan, and Korea — all high-income countries with universal health care systems. For our analysis, we used the most recently available data from the U.S. Centers for Disease Control and Prevention (CDC) and from the Organisation for Economic Co-operation and Development (OECD), of which the U.S. is a member. Where country-specific data are more than five years old, we note whether more recent published data from other sources are available for that country. Readers should be aware that because the methods we used to derive updated numbers from other sources may be different from methods the OECD uses, data points may not be comparable to the U.S. rates. For complete details on our methods, see “How We Conducted This Study.”
Topic:
Development, Inequality, Public Health, and Maternal Mortality
Political Geography:
United Kingdom, Canada, Norway, France, Germany, Australia, Switzerland, North America, Sweden, Netherlands, New Zealand, and United States of America

2237. Hospital Global Budgeting: Lessons from Maryland and Selected Nations

Author:
Bob Atlas
Publication Date:
06-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Issue: Maryland has utilized hospital global budgeting for a decade, but the approach is rarely used elsewhere in this country. The Centers for Medicare and Medicaid Services now hopes to test global budgeting in more states to help scale up this form of cost containment. Goals: Examine the ways Maryland, Canada, the Netherlands, New Zealand, and Norway employ hospital global budgeting and the lessons they offer to those hoping to see wider adoption in the United States. Methods: Analysis of the various health systems and expert interviews. Key Findings and Conclusion: Maryland and the four selected countries vary significantly in their approaches to hospital global budgeting. With its previous experience using price controls and current global budgeting approach, Maryland has succeeded in holding hospital spending growth steady for nearly a decade. While Norway combines fixed and variable payments to support global budgeting, the Netherlands and Canada’s province of Ontario are moving away from global budgeting in favor of other approaches. Meanwhile, New Zealand has added multiyear rolling forecasts and budgets to support its own model. Future approaches in the U.S. could prove more effective by factoring in the complexities, conflicting incentives, and potential unintended consequences of global budgeting.
Topic:
Public Health, Healthcare System, and Budgeting
Political Geography:
Canada, Maryland, Netherlands, New Zealand, and United States of America

2238. Ads and Editorials: How Pretreatment Reduces the Persuasiveness of Interest Group Advertisements

Author:
Matthew Lesenyie
Publication Date:
01-2024
Content Type:
Journal Article
Journal:
California Journal of Politics and Policy
Institution:
Institute of Governmental Studies, UC Berkeley
Abstract:
Advertising studies commonly examine the effects of one-sided treatments. However, political communication campaigns are competitive environments where voters are likely to hear more than one perspective. Because of this dynamic, the persuasive effects of single-sided ads may be less likely to hold in a competitive environment. When respondents are exposed to arguments from both sides of a ballot proposition issue, can the disclosure of a credible group help an advertisement overcome prior opinions? I address this question using a randomized experiment that includes ballot proposition campaign ads. In the experiments, I manipulate the pretreatment environment by exposing some respondents to a newspaper editorial in order to provide them with prior opinions that might cause them to resist subsequent advertisements. I also vary the presence or absence of campaign finance disclosure within the advertisements. In all cases, the presence of a credible editorial is associated with a change in support for the initiative. However, the use of a credible campaign finance disclosure has a far less consistent effect. While campaign finance disclosures from credible groups can help counteract prior beliefs that citizens may hold, I find that the magnitude of these changes is somewhat small.
Topic:
Politics, Elections, Campaign Finance, Advertising, and Interest Groups
Political Geography:
Global Focus

2239. Learning from experience: Are African governments prepared for another pandemic?

Author:
Tunde A. Alabi and Matthias Krönke
Publication Date:
06-2024
Content Type:
Policy Brief
Institution:
Afrobarometer
Abstract:
According to the Africa Centres for Disease Control and Prevention (CDC) (2020), Africa’s first case of COVID-19 was recorded in Egypt in mid-February 2020. Six months later, the continent’s death toll exceeded 19,000, representing 3% of global COVID-19 mortality. As the virus spread across Africa, governments began to enforce national lockdowns and other restrictions to minimise the impact of the pandemic. In addition to being a global health emergency, COVID-19 had other wide-ranging consequences. Many parts of government bureaucracies, as well as the private sector, shut down except for “essential” workers (Wickham, 2022). Children were unable to go to school for months, increasing dropout rates with knock-on effects on their nutrition and mental health (UNICEF Africa, 2022; Kidman, Breton, Behrman, & Kohler, 2022). Moreover, African governments’ responses to the pandemic affected trends in poverty on the continent. For example, Afrobarometer analyses found that “more restrictive government responses were associated with larger increases in lived poverty” (Mattes & Patel, 2022, p. 1). Faced with economic uncertainty and mobility restrictions, Africans turned to their governments for support and a coordinated public health response to the pandemic. The latest Afrobarometer surveys in 39 countries document how citizens experienced the pandemic, their views on how their governments handled the pandemic, and whether they think their governments are prepared for future health emergencies. Responses indicate that about one in seven households experienced a case of COVID-19, while more than a quarter suffered the loss of a primary source of income. Despite the severe economic effects of the pandemic, fewer than a quarter of households received pandemic related assistance from the government. Most respondents say that the distribution of relief was unfair and that corruption claimed funds intended for the pandemic response. Even so, most Africans say their government managed the pandemic well. When it comes to giving up democratic rights during a pandemic, a majority of Africans accept the use of the military or police to enforce public health mandates, but censoring the media and postponing elections are more controversial steps. Africans are divided in their assessments of their governments’ readiness for a future pandemic, and a majority say additional investments in such preparations are needed.
Topic:
Education, Health, Social Services, Pandemic, and COVID-19
Political Geography:
Africa

2240. Health for everyone, everywhere?

Author:
Lionel Osse Essima and Matthias Krönke
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Afrobarometer
Abstract:
The theme of World Health Day 2024 (7 April) is “My health, my right” (World Health Organization, 2024). A key component of the message is to encourage governments to deliver on citizens’ right to health by making health services “available, accessible, acceptable and of good quality for everyone, everywhere.” How close are African governments to meeting this ambitious goal? Since 1990, the burden of disease has decreased substantially in Africa (Roser, Ritchie, & Spooner, 2024; also see Figure A.1 in the Appendix). Between 2000 and 2019, Africa recorded the world’s greatest growth in healthy life expectancy, which rose from 46 to 56 years (Adepoju & Fletcher, 2022). Further, between 2015 and 2021, the under-5 mortality rate fell from 87 to 74 deaths per 1,000 live births across sub-Saharan Africa (United Nations, 2023). According to the World Health Organization, these gains were achieved through increased provision of essential health services and better access to care and disease prevention services (Adepoju & Fletcher, 2022). Despite these important advances, however, many Africans still do not have access to high quality health care. Compared to other world regions, the gap is particularly acute when it comes to communicable, neonatal, maternal, and nutritional diseases (as opposed to non communicable diseases and injuries) (see Figure A.2 in the Appendix). While sub-Saharan Africa saw the world’s fastest growth between 2015 and 2022 in the proportion of births attended by skilled health personnel, from 59% to 70%, the continent also recorded about 70% of the world’s maternal deaths (United Nations, 2023). At least part of the explanation is a lack of health workers; as of 2021, sub-Saharan Africa had an average of 2.3 medical doctors and 12.6 nursing/midwifery personnel per 10,000 people, compared to 39.4 and 89.5 in Europe (United Nations, 2023).
Topic:
Education, Public Opinion, Social Services, Public Health, and Healthcare System
Political Geography:
Africa