Preface

In 2019, the World Health Organization (WHO) named the following top ten threats to global health: air pollution and climate change, non-communicable diseases, global influenza pandemic, fragile and vulnerable settings, antimicrobial resistance, Ebola and other high-threat pathogens, weak primary health care, vaccine hesitancy, dengue, and HIV. In 2017, approximately 56 million deaths were recorded worldwide. Many of the deaths from these conditions and exposures on the WHO's watch list occur in hospitals.

This book examines the issue of hospital mortality from the perspective of Lowand Middle-Income Countries (LMICs) and presents a mix of strategies in support of strengthening health systems and reducing mortality. The strategies for reducing hospital mortality are shown in this book to lie within a clinical-public health nexus and, as such, are not only the domain of the hospitalist or clinical administrator. Quality of care is an important overarching theme within which a sound argument on hospital mortality reduction can be built. Achieving such quality of care calls for consideration of a structured system for quality management supported by appropriate epidemiological and management information.

This book targets academics, clinicians, health administrators, and policy makers, as well as students of public health. It engages these groups in an examination of health conditions, clinical management tools, and other related issues that require policy and programmatic interventions best suited to the population health realm.

The WHO (2011) defined health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make basic health decisions for themselves and their loved ones. Health literacy and its relationship with health outcomes is well placed in the discussion of hospital mortality and appropriate interventions for researchers and healthcare professionals to reduce the negative impact on these outcomes. There is need for research to advance the conceptualization of health literacy in reducing hospital mortality and morbidity.

The discussion around surgical care and applying guidelines and protocols in patient care is much needed for LMICs. It is relevant to overall hospital mortality reduction as such interventions around standardizing care are needed and will bring similar returns in all areas of a hospital where high-volume, complex care takes place. The surgical environment has become more complex with a wider range of procedures and changes in approaches and use of technology. Additionally, patient expectations have grown. This is more important in developing countries where access to resources are limited but access to information globally has improved. There is no doubt that the streamlining of the patient:-treatment: outcome continuum can be made better with the use of various standard operating procedures, such as the use of guidelines, protocols, and checklists with a multidisciplinary team where all stakeholders are actively engaged.

The importance of nutrition across the lifespan is well recognized. Clinical management approaches and algorithms for nutritional management procedures in the hospital setting are discussed in the book. However, resource-limited environments pose a threat to implementing well-known nutritional adequacy interventions that can reduce hospital mortality.

With the changing epidemiological profile and a growing elderly population, there is a need to examine the health system's response to the older population. A special area to be highlighted is the causes and prognosis of older patients admitted in ICU. Despite the severity of many of the conditions contributing to mortality, there is a need for application of quality management protocols in this setting.

Currently, three out of four people die from a chronic non-communicable disease (CNCD), and 40% are premature deaths occurring between ages 30 years and 69 years. In considering mortality as a key indicator of the health of a population, with life expectancy a commonly reported measure, it is noted that there are significant regional differences in global life expectancy at birth. LMICs need to have evidencebased models that are relevant to their setting and aimed at reducing the associated morbidity burden and mortality in these resource-limited environments. Policy development around critical issues in these countries is an important step to reducing mortality across the demographic spectrum. From a quality perspective, there is likely to be an overall positive effect of a robust hospital quality-of-care system in LMICs.

On behalf of the editorial team, I wish to thank the authors who made their contribution to this work and trust that this publication will help to open up this conversation across the academic-public discourse nexus. If this publication can support action to reduce hospital mortality, increase healthy life expectancy, and improve quality of life in resource-limited settings across the globe, the contributions of the authors and editors would have given added value and meaning to this effort.

> **Dr. Jasneth Mullings** The University of the West Indies, Mona, Kingston, Jamaica

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Section 1

Reducing Hospital

Mortality: Programmatic

and Policy Interventions

## Section 1
