Abstract

Global health security comprises all efforts taken to prepare, respond, and recover from public health events that adversely impact the safety of the entire global population. Threats to global health security have traditionally been epidemic in nature; however natural disasters, social upheaval, war, and other destabilizers of human societies can also disrupt the health of the public worldwide and should be considered when creating sound global health security policies. The Global Health Security Index shows that most countries are, in fact, not well prepared to handle threats to global health security. The current approach to address this deficiency is the concept of a One Health approach, which recognizes and addresses the interconnectedness of health-related events in different countries and how human health is associated with animal and environmental health, as well.

The Current State of Global Health Security

Many organizations have attempted to define global health security. These definitions vary in scope, often capturing the role each organization has in the larger goal of minimizing the negative impacts of events that endanger people’s health across international borders.¹ For example, the Centers for Disease Control and Prevention (CDC) define the term as “the existence of strong and resilient public health systems that can prevent, detect, and respond to infectious disease threats, wherever they occur in the world.”² This definition highlights an evident preoccupation that is often placed on emerging infectious diseases. But threats to public health can come from other sources. The National Association of County and City Health Officials captures more of what is meant by the term and defines global health security as efforts taken to prepare, respond, and recover from public health events that adversely impact the safety of the entire global population.³ Such a definition is specific enough for the purposes of this article, while also allowing consideration of the many components that constitute global health security. 

Emphasis is justifiably often placed on emerging infectious diseases because many of the recent public health emergencies that have manifested across country borders have been epidemic in nature.⁴⁵⁶⁷⁸⁹ However, global health security threats can come from many sources, ((Hodge Jr, J. G., & Weidenaar, K. (2017). Public health emergencies as threats to national security. Nat’l Sec. L. & Pol’y, 9, 81. https://heinonline.org/HOL/LandingPage?handle=hein.journals/jnatselp9&div=8&id=&page=)) including natural disasters and man-made disasters from the mishandling of chemical, biological, radiological, nuclear, and explosive agents.¹⁰ Threats can also emerge from vulnerable food systems, markets, and supply chains. All of these can be exacerbated by war and civil unrest.¹⁰ Invariably, global health security threats endanger global safety by disrupting public health, economies, social cohesiveness, and government.¹⁰ This article briefly explores the world’s general state of preparedness regarding threats to global health security both from infectious disease and other threats. 

Infectious Diseases

Recent decades have seen tremendous technological advances that enhance our ability to fight epidemics through the provision of safe water and sewage systems, vaccines, antibiotics, and public health programs.¹¹ But, the threat of naturally emerging infectious diseases and biological warfare remain top priorities in homeland and international security.

Infectious disease outbreaks in one geographical location may affect the entire world if not addressed properly. ((Chattu, V. K., Kumar, R., Kumary, S., Kajal, F., & David, J. K. (2018). Nipah virus epidemic in southern India and emphasizing “One Health” approach to ensure global health security. Journal of family medicine and primary care, 7(2), 275.https://doi.org/10.4103%2Fjfmpc.jfmpc_137_18)) For instance, in 2019 the COVID-19 pandemic strained every health system and economy on earth and forced national and international policymakers to rethink how global health security efforts should be conducted. ((Knauer, N. J. (2020). The COVID-19 pandemic and federalism: Who decides?. NYUJ Legis. & Pub. Pol’y, 23, 1. https://heinonline.org/HOL/LandingPage?handle=hein.journals/nyulpp23&div=4&id=&page=)) Fortunately, countries have shown unprecedented cooperation in the production and distribution of vaccines and other countermeasures.¹² The pandemic also highlighted how misinformation campaigns and political and financial interests have all gotten in the way of a proper response both internationally and within most democratic nations.¹² As governments scrambled to respond to the crisis, many adopted centralized, authoritative stances to curb the spread of disease, resulting in severe limitations of public freedoms and a stagnation of economies.¹³ Now the literature is filled with articles about the COVID-19 pandemic that try to make sense of what happened and what could have been improved. The general consensus: the world simply was not prepared for such a crisis.

However, it is not only emerging infectious diseases that threaten global health security. Other epidemics  – like HIV, malaria, and tuberculosis – also rage on chronically and strain national and international resources, thereby compounding the difficulties of handling new threats.¹⁴ This results in constant preoccupation of possible spillover of currently localized crises, as countries with few resources struggle to contain infectious diseases and beg more powerful ones to intervene for their own safety.¹⁵ Clearly there is much to learn about the importance of international spending and how this can protect homeland security in the developed world. 

Other Threats to Global Health Security 

The threats discussed below trail closely behind infectious diseases in importance with relation to global health security. The list is not comprehensive but rather meant to illustrate how complex global health security has become with globalization in recent decades and how instabilities and vulnerabilities halfway across the world can affect us at home. 

Global Inequalities

Over recent decades, social determinants of health have been increasingly recognized as being of paramount importance to public health. This is because the circumstances within which an individual lives will directly determine his or her health-related behaviors; this includes access to water, food, shelter, sanitation, and health services, which all drive health outcomes.¹⁶ Recognizing this, the international community has developed the Inequality-Adjusted Human Development Index to assess nations in their capacity to foster the wellbeing of their citizens.¹⁷ The index is based on general markers of health outcomes, typical educational attainment, and standards of living, and it adjusts for inequalities within each country. While most developed countries, by definition, score highly on this measure before accounting for inequality, all of them still have significant inequalities in life expectancy, education, and income, which lower their final score. The United States, for example, ranks 25th out of 155 countries with an IHDI of 80.6%, and it loses 11.7% to inequalities. Furthermore, the human development index varies from country to country, with at least 70 countries falling below the world average of 59%, which itself leaves ample room for improvement.¹⁸

War

Times of war bring about the obvious destruction of human life, in addition to other deep and widespread effects, ranging from crippling economies to the destruction of infrastructure essential for public health to disruptions in international trade and access to essential goods. Therefore, military conflicts remain an intractable and serious threat to global health security. A recent examples is the Russian invasion of Ukraine in February 2022.¹⁹ Before the war, both countries were major exporters of food, energy, metals, and other manufactured goods. The war has severely hindered both countries in providing these essential resources to the world through sheer destruction of life, facilities, and economic sanctions placed on Russia by the international community.²⁰ This caused supply chain disruptions that affected multiple international industries including food, energy, and healthcare. 

As of May 2023, the Geneva Academy reported at least 110 active conflicts throughout the world ranging from civil wars to international conflicts; most of these are happening in developing nations.²¹ Such conflicts exemplify the need for better peacekeeping efforts in the world to prevent violence and all its deleterious effects to global health security. 

Social Upheaval

Social instabilities are both the cause and the result of public health crises.²² The limitation of resources in poor countries and the widening gap between the rich and poor too often result in a desperate public having to protest world inequalities. Such events are easily fueled by crises, whereby government resources are strained beyond their means to provide for the public.²³ Authoritarian governments respond to this with violent crackdowns and even violations of basic human rights. When such internal conflict arises it is not uncommon for the basic needs of the public to go unmet and public health programs to break down; this results in excess disease and death as well as displacement of populations and even civil unrest spilling over into neighboring countries.²⁴ This is why civil unrest, which itself is often the result of long-lasting social inequality, represents a threat to global health security and why the international community should intervene to prevent such events.

Global Health Security Index 

The Global Security Index is a tool developed by the international community to assess 195 countries in the categories of epidemic disease prevention, detection and response, health system robustness, compliance with international norms, and risk/vulnerability to biological threats.²⁵ The index reveals most countries are underprepared to face global health security threats. For this reason, the international community is placing a high emphasis on the “One Health Approach,” which recognizes the interconnectedness of health-related events between different countries and the contribution of poverty, gender, climate change, the social and environmental determinants of health, clean air, safe drinking water, sufficient food, and secure shelter.²⁶ The hope is that by working together to protect human, animal, and environmental health, nations can improve the global state of preparedness against threats to global health security.