Preface

International health security (IHS) is a broad and highly heterogeneous area. Within this general context, IHS encompasses subdomains that potentially influence (and more specifically endanger) the well-being and wellness of humans. The general umbrella of IHS includes, but is not limited to, natural disasters, emerging infectious diseases (EID) and pandemics, social determinants of health, systemic racism and discrimination, rapid urbanization, population growth, environmental matters, civilian violence, warfare and terrorism, inappropriate use of antibiotics, and the abuse of social media (SM). The need for this expanded definition of health security stems from the realization that topics such as EID; food, water, and pharmaceutical supply chain safety; medical and health information cybersecurity; and bioterrorism, although important within the overall realm of health security, are not only able to actively modulate the wellness and health of human populations, but also are likely do so in a synergistic fashion.

The editors of this book believe that the broadly defined IHS inherently encompasses the plurality of concepts that include "public health," "global health security," and "planetary health." At the same time, it is important to ensure that the overall context of IHS implementation maintains compatibility with the modern concept of the world constituting a collection of independent countries and states that operate within a well-defined set of international conventions, organizations, and frameworks. This is the foundation and the starting point of our approach, upon which we expand and build our multi-pronged argument for the more broadly defined and understood IHS.

This inaugural tome of our multi-volume collection, Contemporary Developments and Perspectives in International Health Security, introduces many of the topics directly relevant to modern IHS theory and practice. Starting with a summative assessment by the IHS Working Group of the American College of Academic International Medicine, the book then moves on to discuss a variety of contemporary topics such as refugee crises, cybersecurity, SM, big data analytics, scientist training, and point-of-care diagnostics. Unique contributions to Volume 1 include a compendium by Reis and Cipolla on the impact of organized systems of care on IHS, focusing on the tremendous value of such systems to our overall healthcare security landscape.

Of importance, a new set of insidious threats to health security emerged with the widespread adoption of the Internet and various SM platforms. These important topics are covered in two excellent chapters by Miller, et al., and Conti, et al. The first of the two chapters discusses an all-too-common phenomenon of ransomware that increasingly plagues our healthcare systems and contributes to significant risk of critical data loss. The second chapter discusses both the benefits and the dangers of modern SM technology, including some of the proposed approaches to mitigate the negative aspects. Of special concern is the emerging evidence regarding the very design of SM platforms, with the key element of the business model being the ability to fractionate people into self-reinforcing, opinion-based camps.

The book then shifts focus to very important and emerging topics of the refugee crisis and refugee healthcare. Attributable to a confluence of multiple factors,

including armed conflict, planetary climate change, economic uncertainty, and food security, the percentage of the human population considered to be refugees is increasing. Spearheaded by Papadimos, et al., and Sparkle, et al., this section discusses key concepts related to human, economic, and healthcare aspects of the ongoing global refugee crisis, including dilemmas created for governments and refugees regarding manipulation, displacement, human rights, sexual exploitation, and the need for robust legal options and remedies.

Within the greater context of this inaugural volume, pandemics are addressed as humankind's socio-political constructs that, at some point in history, either require or outright force a major paradigm shift. Such is the case with the current coronavirus disease 2019 (COVID-19) pandemic. The book concludes with both unique and diverse chapters on the role of civil society organizations in national health systems during the 2014–2016 Ebola outbreak by Hushie, et al.; the importance of big data and health registries within the overall IHS framework by Martins, Jr.; an insightful perspective on nurturing responsible future generations of scientists by Naroeni, et al.; an exploration of a relationship between adverse childhood experiences and adult chronic disease by Bhatt, et al.; a compendium on biopolitics in occupational health by Mendes, et al.; and, finally, a contribution that discusses lab-on-a-chip, point-of-care approaches within the international public health security context by Baig, et al.

With this unique and paradigm-changing content, we hope that this inaugural volume of Contemporary Developments and Perspectives in International Health Security will provide a solid foundation for future installments of this important and relevant book series. We hope that the foundation created by this editorial team will provide a solid springboard for an insightful and captivating second installment of the current book series, complete with a robust discussion of the COVID-19 pandemic and related topics.

> **Stanislaw P. Stawicki** St. Luke's University Health Network, USA

> > **Michael S. Firstenberg** The Medical Center of Aurora, USA

**Ricardo Izurieta** University of South Florida, USA

> **Sagar C. Galwankar** Florida State University, USA

> > **1**

**Chapter 1**

Introductory Chapter:

International Health Security

International health security (IHS) is a complex and highly heterogenous area under the broader umbrella of health sciences. Within that general context, IHS encompasses all domains that potentially influence (and more specifically potentially endanger) the well-being of human health and wellness, from natural disasters to outbreaks and pandemics, including rapid urbanization, population growth, various environmental matters, critical supply chain vulnerabilities, misuse of antibiotics leading to unpredictable microbial resistance patterns, and even social media (SM) misinformation. The need for this expanded definition of health security came about with the realization that topics such as emerging infectious diseases (EID), food, water, and pharmaceutical supply chain safety, medical and health information cybersecurity, and bioterrorism – although clearly dominant factors within the overall realm of health security – constitute only a small proportion of forces able to actively modulate the wellness and health of human

There are ample resources for IHS experts, and many available literature sources are characterized by very high content quality. Why then, one might ask, embark on another book project on the topic? There are several important reasons. The first, and most relevant reason, is the narrow focus on the previously published scholarly literature on this increasingly complex subject. Today's IHS is a much broader and diverse discipline, with highly nuanced and rapidly evolving new areas and subdomains (**Table 1**). Some authorities on this topic even go as far as referring to Planetary Health as the next conceptual development [8, 9]. The authors and Editors of this collection of chapters believe that the broadly defined IHS inherently encompasses the plurality of concepts that include "public health," "global health security," and "planetary health" while ensuring that the overall context of its implementation maintains the compatibility with the modern understanding of the world constituting a collection of independent countries and states that operate within a well-defined set of international conventions, organizations and frameworks [10–12]. By covering new topics and providing varied solutions and

Expanded and Re-Defined

*Stanislaw P. Stawicki, Thomas J. Papadimos,* 

*Sagar Galwankar, Ricardo Izurieta* 

*and Michael S. Firstenberg*

**1. Background**

populations [1–7].

**2. Why did we embark on this project?**

**Thomas Papadimos** The Ohio State Wexner Medical Center, USA **Chapter 1**
