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11. 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

12. 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

13. 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

14. 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

15. Engaging Employers in Growing Refugee Labor Pathways

Author:
Emma Dorst, Kate Hooper, Meghan Benton, and Beatrice Dain
Publication Date:
07-2024
Content Type:
Special Report
Institution:
Migration Policy Institute (MPI)
Abstract:
Refugee labor pathways, which focus on helping displaced people with in-demand skills access existing economic immigration channels, have attracted considerable attention in recent years. The appeal is two-fold: From a humanitarian perspective, they open additional opportunities for refugees and other displaced people to move to safety. From a labor market perspective, they offer access to an additional talent pool at a time when many employers are struggling to recruit qualified workers. Such programs now exist in several countries, with the largest in Australia, Canada, and the United Kingdom. Designed and implemented as a partnership between these countries’ governments and the nongovernmental organization Talent Beyond Boundaries (TBB), these pathways aim to help jobseekers overcome obstacles that can be exacerbated by displacement, such as difficulty connecting with potential employers or providing identity or credential documentation. As these programs progress from the pilot stage, the central role employers play and their impact on efforts to achieve scale have gone largely unexplored. This first-of-its-kind report aims to fill this gap by examining employers’ experiences with recruiting displaced talent and ideas for program improvements. The analysis, conducted by MPI and drawing on unpublished TBB survey data on employer engagement, draws in part on consultations with employers, policymakers, and civil-society stakeholders.
Topic:
Labor Issues, Employment, and Refugees
Political Geography:
United Kingdom, Canada, Australia, and Global Focus

16. Competing Ideas: Canada’s Competition Reform Conversation

Author:
Vass Bednar and Keldon Bester
Publication Date:
04-2024
Content Type:
Working Paper
Institution:
Centre for International Governance Innovation (CIGI)
Abstract:
The Government of Canada’s recent review of and updates to the Competition Act have sparked a closer examination of how competition is protected and promoted in Canada. Competition affects all Canadians, especially in the face of rising costs of living and a shrinking number of competitors in key markets. Yet the laws that govern competition are not easily understood by average consumers, leaving them out of the public policy conversation. This paper looks at why better competition law is needed and examines previous reform efforts.
Topic:
Reform, Public Policy, and Competition
Political Geography:
Canada and North America

17. The LGBT Purge, its Demise, and the Aftermath: Retired Servicewomen Paving the Way

Author:
Charlotte Duval-Lantoine
Publication Date:
02-2024
Content Type:
Journal Article
Journal:
Journal of Military and Strategic Studies
Institution:
Centre for Military, Security and Strategic Studies
Abstract:
In 1992, a court case lifted put an end to the persecution of 2SLGBTQI+ service members in the Canadian Armed Forces (CAF). To some researchers, the end of discriminatory policies translated into tolerance for and the welcoming of 2SLGBTQI+ Canadians in the rank of the military. However, scandals over sexual misconduct, gender-based violence, and homo- and transphobic incidents in the CAF is painting a drastically different picture. Instead of a history of burgeoning inclusion and diversity, the end of what became known as the LGBT Purge led to different types of violence and struggles for 2SLGBTQI+ members. This article provides a chronology of the last years of the LGBT Purge in the military and the aftermath of Douglas v. the Canadian Armed Forces. It recounts an history of an institution that did not live up to its duty of care obligations because of members’ sexual orientation and gender identity. But this piece also underlines the role that women, both serving and retired, in bringing the issues to light and drive change in the military.
Topic:
Armed Forces, Women, LGBT+, Indigenous, and Military
Political Geography:
Canada and North America

18. Servicewomen as Whistleblowers: Canadian Servicewomen and the Revelations of Military Sexual Violence

Author:
Claire Cookson-Hills
Publication Date:
02-2024
Content Type:
Journal Article
Journal:
Journal of Military and Strategic Studies
Institution:
Centre for Military, Security and Strategic Studies
Abstract:
This article documents the history of revelations of sexual misconduct within the military, and places that history in the paradoxical context of the responses of Canadian Armed Forces (CAF) and the Veterans Affairs Canada (VAC). Starting in 1998 with the Maclean’s reporting, servicewomen have publicly shared their personal experiences of military sexual trauma. The history of these revelations has been written by journalists in conversation with servicewomen. Journalists have been supportive and ham-handed advocates of justice for survivors of military sexual violence. By contrast, both CAF and VAC have been reactionary in their responses to military sexual violence. Such focus on sexual violence stands in contrast to how servicewomen place the violence in the wider context of their career. After 2015, servicewomen have taken steps to advocate, organize, write their own stories publicly, and thereby put pressure on the Armed Forces and Veterans Affairs to change.
Topic:
Armed Forces, Women, Sexual Violence, Whistle Blowing, and Military
Political Geography:
Canada and North America

19. Military Service and Serving the Community: How the Second World War Propelled Activism Forward for Indigenous and Native American Servicewomen

Author:
Isabella Sun
Publication Date:
02-2024
Content Type:
Journal Article
Journal:
Journal of Military and Strategic Studies
Institution:
Centre for Military, Security and Strategic Studies
Abstract:
The Native Canadian Centre of Toronto (NCCT), originally named the Native American Indian Club of Toronto, was founded in 1950 by community volunteers – the majority of whom were Indigenous women.1 The club was founded to build a network and create an inclusive social space through shared culture, art, and language in Toronto. Indigenous women-led organizations such as the NCCT were not uncommon to find after the Second World War, since the wartime era empowered many Indigenous women to find and create their place in society. Today, the NCCT continues to prioritize Indigenous community building through promoting traditional knowledge and culture through language courses, art classes, and other events. Although this centre is unrelated to the war effort, it can be considered a by-product of Indigenous empowerment after the Second World War. Whether Indigenous women voluntarily enlisted or not, the war changed the daily realities of these many women. This article will explore similar themes of Indigenous servicewomen’s experiences throughout the Second World War and afterwards in Canada, and compare it with those of Native American servicewomen in the United States. It will highlight how their service affected post-war actions and activism for Indigenous rights in the latter twentieth century.
Topic:
Women, Indigenous, Activism, and Military
Political Geography:
Canada and North America

20. Sitting Ducks and Strategic Change. The Air Division in Europe, 1959 to 1967

Author:
Isabel Campbell
Publication Date:
02-2024
Content Type:
Journal Article
Journal:
Journal of Military and Strategic Studies
Institution:
Centre for Military, Security and Strategic Studies
Abstract:
History and historical analysis can prepare the RCAF as an institution for inevitable change, specifically on transitions initiated by advancements in the science and technologies of air power. Having personally experienced the transition from CF-104 to the CF-18 fighter aircraft during the Cold War and with the incorporation of the F-35 Joint Strike Fighter (JSF) underway in the RCAF, there are informative accounts to be told and lessons learned that may require reflection in the transition from fourth to fifth generation fighter.1With peer-on-peer great power competition re-emerging as a geo-political reality, there are many aspects of Canadian fighter operations and capabilities that do not have to be relearned.War is a political condition between states or armed factions; warfare is the physical activity conducted between militaries in the context of war. “Technology shapes warfare, not war, ...and conversely war, not warfare, shapes technology. Technology has been the primary source of military innovation throughout history. It drives changes in warfare more than any other factor.”2Military technology is not deterministic as advancements do not ensure success, but rather, technology facilitates innovation. The unique characteristics, or distinguishing features, of the air environment, provide air power with different strengths and weaknesses from those of sea and land power. Fundamental air power tenets, or organizational principles, ensure the optimization of air power. These characteristics and tenets do not change with technology but rather technology is used to optimize these features to gain advantage.
Topic:
History, Armed Forces, and Military Equipment
Political Geography:
Canada and North America