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1. Rethinking Social Security from a Global Perspective: What Congress Can Learn from the Experiences of Canada, Germany, New Zealand, and Sweden

Author:
Romina Boccia and Ivane Nachkebia
Publication Date:
06-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Social Security is projected to reach technical insolvency by 2033, threatening retirees with automatic 23 percent benefit cuts as the program will be unable to pay full benefits on time. The program’s looming trust-fund insolvency creates a legislative forcing mechanism and thus presents an opportunity to reimagine how Social Security could work. Policymakers should consider fundamentally rethinking the program’s structure and transform it into a system that ensures seniors are protected from poverty when they can no longer work, while also freeing up resources for younger workers to save more on their own. With Social Security running large and rising cash-flow deficits since 2010, and given a political desire to protect most current retirees from being affected by benefit reductions, Congress should act now to stabilize the system—not procrastinate any longer, which only ensures that inevitable changes will be more drastic and economically harmful. The longer Congress waits, the more people will be locked into the current unsustainable system, and the higher the burden will be on younger generations to finance it.
Topic:
Poverty, Reform, Fiscal Policy, Social Security, and Sustainability
Political Geography:
Canada, Germany, Sweden, and New Zealand

2. 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

3. 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

4. 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

5. Smooth sailing? Australia, New Zealand and the United States partnering in–and with–the Pacific islands

Author:
Joanne Wallis and Anna Powles
Publication Date:
05-2023
Content Type:
Special Report
Institution:
Australian Strategic Policy Institute (ASPI)
Abstract:
Australia, New Zealand and the United States should help create an ASEAN-style forum for Pacific island nations to discuss security and manage geopolitical challenges. The call for a dialogue, modelled on the ASEAN regional forum, is one of several recommendations to improve security partnerships and coordination in the region, reducing the risk that the three countries trip over one another and lose sight of the Pacific’s own priorities as they deepen their Pacific ties out of strategic necessity amid China’s growing interest. While focussing on those three countries, this report stresses that wider partnerships should be considered, including with France, India, Japan, South Korea, the United Kingdom and European Union. The report states that the three countries will have to get used to greater Chinese involvement in the Pacific, even if they don’t accept it, much less like it.
Topic:
Defense Policy, National Security, Alliance, ASEAN, AUKUS, and ANZUS
Political Geography:
Australia, New Zealand, Asia-Pacific, and United States of America

6. Climate resilience and Cook Islands' relationship of Free Association with Aotearoa / New Zealand

Author:
David J. Kilcullen
Publication Date:
05-2023
Content Type:
Policy Brief
Institution:
Danish Institute for International Studies (DIIS)
Abstract:
On 1 January 2020, the Cook Islands was removed from the OECD Development Assistance Committee’s List of Official Development Assistance (ODA) Recipients. Having been assessed as a “high-income status country”, this re-classification rendered the Cook Islands ineligible for OECD development assistance. It was unfortunate timing. The Covid-19 pandemic hit a few months later and caused a significant contraction in the tourism sector on which the Cook Islands is economically dependent. The result was, by the government’s own description, a “severe recession” with a total contraction of -21.6% of GDP in 2020/ 2021. Thus, only months after being recognized as having a sufficiently high income as to no longer warrant OECD development-assistance, the Cook Islands lost nearly a quarter of its GDP. This was especially significant for a country that is particularly susceptible to climate change and weather-related hazards. The Cook Islands is made up of 15 coral atolls and volcanic islands. Over 90% of the residents of the 12 inhabited islands live within one kilometer of a coastline. In addition, its already modest population of just under 15,000 people is rapidly decreasing (down from approximately 17,500 in 2016), undermining social and economic resilience to shocks. Despite notable economic growth in the years preceding Covid-19, greater infrastructure and other investment remains essential to brace the country for future climate-related changes. A question thus arises as to the benefits of Free Association in circumstances where the former colony faces crises.
Topic:
Foreign Policy, Climate Change, History, and Resilience
Political Geography:
Europe, Denmark, New Zealand, and Cook Islands

7. Using Risk Analysis to Shape Border Management: A Review of Approaches during the COVID-19 Pandemic

Author:
Kelley Lee, Julianne Piper, and Jennifer Fang
Publication Date:
01-2023
Content Type:
Special Report
Institution:
Migration Policy Institute (MPI)
Abstract:
The near universal adoption of travel measures by governments to control the spread of COVID-19 has proved controversial during the pandemic. National responses have been highly varied and frequently changing, and the use of travel measures—ranging from advisories and screening to quarantine, testing, immunity certification, and restrictions on entry—has been poorly coordinated across jurisdictions. Particularly in the early stages of the crisis, this created chaos for travelers and the travel sector, and caused significant economic and social harms. Many governments also failed to clearly communicate the rationale for using travel measures, the evidence underpinning them, and the measures’ role within overall pandemic response strategies. There is now substantial evidence that these measures’ early and stringent use by some governments during the initial stages of the pandemic slowed the importation of the virus and reduced its onward transmission. Yet, there is also growing recognition of weaknesses in the quality of evidence available to inform policy decisions. Evaluating the appropriateness of travel measures and applying them effectively during future public-health emergencies will depend on international consensus on methodologies that lead to a more harmonized and coordinated approach and to greater public trust in policy decisions. This report presents a comparative analysis of 11 publicly available methodologies used to assess travel-related risks during the pandemic—those of Hong Kong, New Zealand, South Korea, Taiwan, United Kingdom, United States, International Civil Aviation Organization, International Air Transport Association, World Health Organization, Organization for Economic Cooperation and Development, and European Union. It offers a set of lessons learned and recommendations, including a proposed decision instrument that could improve the use of risk analysis for border management during future public-health emergencies.
Topic:
Security, International Cooperation, International Organization, Governance, Border Control, and COVID-19
Political Geography:
United Kingdom, Taiwan, South Korea, New Zealand, Hong Kong, Global Focus, and United States of America

8. Factcheck: Christchurch Terror Attacks on Mosques

Author:
Bridge Initiative Team
Publication Date:
04-2023
Content Type:
Working Paper
Institution:
The Bridge Initiative, Georgetown University
Abstract:
In March 2019, a white supremacist opened fire at two mosques in Christchurch, Aotearoa New Zealand, killing 51 people and live-streaming the entire attack on Facebook. The perpetrator published a manifesto outlining his racist, Islamophobic, and xenophobic views. Following the attack, the Royal Commission of Inquiry highlighted the lack of official resources devoted to countering far-right extremism. In the aftermath, ongoing dialogues between the Muslim community and the government were established, significant changes made to the firearms licensing system, and a global initiative launched to eliminate violent extremist content online.
Topic:
Islamophobia, Far Right, Mass Shootings, and Muslims
Political Geography:
New Zealand and Christchurch

9. Challenges for Feminist-Informed Foreign Policy: Militarisation and Australia’s engagements via AUKUS and NATO

Author:
Christine Agius, Annika Bergman Rosamond, Toni Haastrup, and Katharine A.M. Wright
Publication Date:
12-2023
Content Type:
Working Paper
Institution:
International Women's Development Agency (IWDA)
Abstract:
In recent years, Australia has assessed the global and regional security environment as increasingly unstable.i The rising economic and military power of China and broader challenges to the ‘rules based international order’ seemingly signal a period of instability, prompting a reconsideration of Australia’s defence capacity and role in the region. Meanwhile, new forms of cooperation with like-minded states have emerged, most notably the AUKUS agreement, announced in 2021 by then Prime Minister Scott Morison with bipartisan support, which binds Australia more closely with the United Kingdom (UK) and the United States (US) militarily. Australia has also strengthened its relations with NATO, aspiring to play a central role in the Indo-Pacific region as a NATO partner, alongside Japan, South Korea, and New Zealand. In this AFFPC Issues Paper, we explore the contradictions and tensions that emerge in the framing of national security threats and whether there are opportunities for more inclusive peace and security as promoted by the principles of feminist-informed foreign policy. For example, amidst this focus on militarisation, when the Australian Labor Party (led by Prime Minister Albanese) assumed power in 2022, Foreign Minister Penny Wong articulated a new foreign policy direction, which seemed to leverage broader attention towards feminist-informed acts and commitments. Wong promised that Australia would focus more attention on listening to its regional Pacific partners and committed to enacting a First Nations foreign policy.
Topic:
Foreign Policy, NATO, International Cooperation, Feminism, Militarization, and AUKUS
Political Geography:
Japan, South Korea, Australia, New Zealand, and Indo-Pacific

10. The Tampa, Afghan Refugees and New Zealand: A Commentary on the Duty to Protect and Refugee Integration

Author:
Edwina Pio Onzm and Sakina Ewazi
Publication Date:
03-2023
Content Type:
Journal Article
Journal:
Journal on Migration and Human Security
Institution:
Center for Migration Studies of New York
Abstract:
New Zealand has a long history of receiving persons in search of safety and security. These populations span Danes fleeing suppression during the German occupation in the 1870s, Jews escaping persecution from Tsarist Russia in the 1880s, Polish orphans during World War II, Asians expelled from Uganda in 1972–73, Vietnamese boat people between 1997 and 1993, and refugees from Afghanistan starting in 2001. New Zealand’s formal refugee resettlement program dates from 1944 with the arrival of the Polish orphans and their caregivers. This commentary discusses a case that builds on this history — New Zealand’s reception of Afghan refugees who were rescued by the MV Tampa, a Norwegian container ship. The authors — a researcher and a refugee saved by MV Tampa — explore New Zealand’s reception of refugees in light of the “Kew Garden” ethical principles on the responsibility to assist imperiled persons.
Topic:
History, Refugees, Integration, and Protection
Political Geography:
Afghanistan, South Asia, New Zealand, and Asia-Pacific