The Impact of Systems of Care on International Health Security

International health security (IHS) prioritizes cross-border threats to nations such as epidemics, bioterrorism, and climate change. In the modern era, however, the leading causes of mortality are not infectious. Cardiovascular disease (CVD) is the leading cause of death worldwide. Over three-quarters of CVD deaths take place in low-income countries, illustrating a disparity in care. Traumatic injury also remains one of the leading causes of morbidity and mortality worldwide, placing a particularly heavy burden upon countries with limited resources. Cerebrovascular disease and acute stroke syndromes are major causes of mortality and disability worldwide. Programs leading to timely revascularization have proven to be the most powerful predictor of disease outcomes. The health of women and children is vital to creating a healthy world. The impact of neonatal resuscitation programs on mortality has been a major force in advancing international health security. Finally, the establishment of emergency medical services (EMS) systems has been shown to improve the health of communities in both high- and low-income nations. In order to address health security on a global scale, government authorities and public health institutions must incorporate access to modern systems of care addressing the major determinants of health and primary causes of mortality.

The Importance of Reduction in the Registry of Deaths to Ill-Defined Causes and Their Impact on Mortality Profile: The Brazilian Experience and Its Implications to International Health Security

This chapter aims to describe the strategies implemented by the Ministry of Health since 2004 to reduce deaths classified as ill-defined causes (IDC) and the impacts on the mortality profile. Since 1979, deaths occurring and recorded across the country have been stored electronically on the Datasus website (www.datasus.gov.br), which is in the public domain. From this database, it appears that the proportion of deaths from IDC in the country decreased from 20.1% in 1979 to 5.5% in 2017. In small municipalities, less than 20,000 inhabitants, which have the worst data quality and worse socioeconomic status and with the greatest inequities in health, requiring greater investments, the reduction was smaller. The Ministry of Health implemented several actions that involved suspending the transfer of resources from the federal fund to the municipal fund for non-compliance with the rules for the collection, flow and periodicity of information on deaths, in addition to training and qualification of human resources to record and code the causes of death and to investigate deaths by IDC through verbal autopsy. These are initiatives that can be replicated in other contexts, except, perhaps, of a legal nature, as they fit into the legal system that presents specificities in each country.

Health Security and the Refugee Crisis in Greece: The Refugee Perspective

The flight of refugees has been part of the human condition since the beginning of time. Recent events in the Middle East have caused a mass migration of refugees from Syria, Iraq, and Afghanistan. Their primary destination has been Europe, more specifically, the affluent, better industrialized countries of central and northern Europe. However, the European law currently requires that refugees must be processed at the first port of entry to Europe. In most cases, this involves the eastern Aegean Sea islands of Greece. Here the refugee camps have become overcrowded and underfunded, and have little medical care and security. The Greek government has limited resources and the response for support from the more affluent European countries has been underwhelming. Here we summarize the lack of health security from the refugee perspective of those that are awaiting entry to Europe and are encamped in Greece.

The Relationship of Adulthood Chronic Disease and Adverse Childhood Experiences (ACEs): Implications Regarding Prevention and Promotion in International Health

Several studies, including the innovative 1998 ACE Study by CDC-Kaiser Permanente, have assessed the association among adulthood chronic disease and the prevalence of maladaptive, health-harming behaviors including: excessive alcohol use, tobacco use, physical inactivity, psychiatric illness including suicidal ideation or attempts, promiscuous sexual behavior (>50 sex partners), history of STI/STD and severe obesity (obesity (BMI > 35 kg/m2)), subsequent to an individual’s exposure to adverse childhood experiences (ACEs). Individuals that have encountered numerous instances of ACEs are almost twice as likely to die before the age of 75, demonstrating a dose-dependent relationship between the instances of ACEs and an increased morbidity/mortality in regard to chronic disease. This excerpt examines the contribution of ACEs to chronic disease and the consequential maladaptive behavior to said adversity, the consequential physiologic and biomolecular changes explained by the Biological Embedding of Childhood Adversity Model in addition to the implications of recounted ACEs on international health security in regard to concepts like conflict, displacement and food insecurity. The apparent association among adulthood chronic disease and ACEs demand changes that promote preventative processes as a means to address the implications these interconnections have on international health.

Strengthening International Health Security by Embedding the Role of Civil Society Organizations in National Health Systems: Lessons from the 2014–2016 West Africa Ebola Response

Following the recent global health crises, such as the 2014 Ebola and 2016 ZIKA outbreaks, the international health community’s ability to deal with such threats has been debated. Amid discussions of how international health security (IHS) and related national health systems should and could be strengthened, the potential of harnessing the role of civil society organizations (CSOs) for more effective responses has been frequently raised. Such participation is often based on the notion that CSOs by their grassroots presence can more effectively help to address health security and health systems challenges in affected populations and communities. Using the World Health Organization’s (WHO) health systems’ building blocks as an evaluative framework, this chapter examines CSOs’ roles and responsibilities during the 2014–2016 West Africa Ebola Outbreak and how they can be further empowered to perform these functions. The chapter draws conclusions about the opportunities and challenges CSOs represent for strengthening IHS and national health systems during public health emergencies in low- and middle-income countries (LMICs).

Beyond Health and Safety at Work: Reflections on Biopolitics in Occupational Health as an Important Component of International Health Security

The general objective in this chapter is to reflect on health and safety at work based on biopolitics and biopower. The intention will be to clarify unequal processes in health and safety at work. In addition to occupational health, occupational health and safety actions aim to increase control over workers’ bodies, as well as reduce costs in the work process. The intention is still to establish a dialogue with the French philosopher Michel Foucault and with the Italian philosopher Giorgio Agamben, both discussing the consequences of biopolitics and biopower in industrial society modern. The proposed reflections go beyond the benefits of occupational health and safety at work, as they aim to understand the centrality of life in industrial organizations. It is important and necessary to minimize the negative effects of inequality in health and safety at work. Only then will there be a reduction or elimination of health and safety risks at work.

Ransomware and Academic International Medicine

Healthcare is among the leading industries targeted by cyber-criminals. Ransomware exploits vulnerabilities to hijack target information technology (IT) infrastructures for monetary gain. Due to the nature and value of information, access to medical information enables cyber-criminals to commit identity theft, medical fraud, and extortion, and illegally obtain controlled substances. The utility and versatility of medical information, extensive centralized storage of medical information, relatively weak IT security systems, and the expanding use of healthcare IT infrastructure all contribute to an increase in cyber-attacks on healthcare entities. Research suggests that an individual’s medical information is 20–50 times more valuable to cyber-criminals than personal financial information. As such, cyber-attacks targeting medical information are increasing 22% per year. This chapter explores the history of ransomware attacks in healthcare, ransomware types, ransom payment, healthcare vulnerabilities, implications for international health security, and means of institutional protection.

A Moral Perspective on Refugee Healthcare

There is currently an increasing number of international refugees due to political warfare and natural calamities. Over the recent years, countries are shying away from assisting with the provision of healthcare to this vulnerable population either in their home country through humanitarian aid and services or in the host country by providing free healthcare coverage. World leaders and politicians have attempted to ignore the morality behind these decisions and have put forth a false narrative of scarcity and racism to appeal to the population of developed countries. As this question remains unsolved, we have attempted to look at the question from the perspective of our moral obligations as a species. We have discussed some of the popular moral theories that support providing healthcare services to global refugees and refuted theories that object to the same. We conclude with a brief look at the direction that countries could take without violating established moral code while attempting (without evidence) to prioritize the welfare of their citizens.

The Evolving Interplay between Social Media and International Health Security: A Point of View

Human communication and interaction had been rapidly evolving with the advent and continuing influence of social media (SM) thereby accelerating information exchange and increasing global connectivity. Despite clear advantages, this new technology can present unintended consequences including medical misinformation and “fake news.” Although International Health Security (IHS) stands to benefit tremendously from various SM platforms, high-level decision-makers and other stakeholders must also be aware of the dangers related to its intentional and unintentional misuse (and abuse). An overview of SM utility in fighting disease, disseminating life-saving information, and organizing people and teams in a constructive fashion is discussed herein. The potential negatives associated with SM misuse, including intentional and unintentional misinformation, as well as the ability to organize people in a disruptive fashion, will also be presented. Our treatise will additionally outline how deliberate misinformation may lead to harmful behaviors, public health panics, and orchestrated patterns of distrust. In terms of both its affirmative and destructive considerations, SM can be viewed as an asymmetric influencing force, with observed effects (whether beneficial or harmful) being disproportionately greater than the cost of the intervention.

mHealth-Based Microfluidic Lab-on-a-Chip for International Health Security

The increasing threats of emerging and reemerging infectious disease outbreaks demand research and development (R&D) of effective and fit-for-all-purpose tools and technologies for international public health security. Recent advances in biomedical engineering, mostly related to the convergence of communication and network technology in health, i.e., mobile health with microfluidic Lab-on-a-Chip technology can improve the international public health crises and employ in international public health security. Lab-on-a-Chip technology is now commonly found in most research centers, hospitals, and clinics where health care infrastructure is weak, and access to quality and timely medical care is challenging. Microfluidic devices—also known as Lab-on-a-Chip (LoC)—are an alternative for accessible, cost-effective, and early detection medical trials. The mHealth-based microfluidic LoC technology has been under rapid development, and they are becoming influential tools in a wide range of biomedical research and international public health applications. The perspective in this chapter demonstrates a potentially transformative opportunity for the deployment of mHealth with LoC with the fabrication protocols and their potential for strengthening and improving the international public health security. This attempt is not conclusive and exhaustive, and it is anticipated that such a discussion will enable the exchange of ideas between biomedical engineering, microfluidic LoC technology professionals, international public health, and health security experts.