The Impact of Systems of Care on International Health Security

*Nicholas Reis and James Cipolla*

## **Abstract**

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.

**Keywords:** health security, international, trauma, ATLS, ACLS, EMS, NRP, stroke

#### **1. Introduction**

International health security is a new and evolving concept within the global health community. Despite apparent differences in understanding and use of the concept in different settings, international health security, in its most general sense, prioritizes cross-border threats to the modern and future achievements of nations such as the emergence of disease epidemics, bioterrorism, and climate change [1]. The gravity of these threats and their potential impact on people the world over has fostered greater health diplomacy between nations. There is greater cooperation and health information sharing now than in any other time in history, allowing for an evaluation of the impact contemporary systems of care may have on international health security. While global public health achievements in large part stem from greater ability to prevent and control the spread of infectious disease, this is not the sole determinate of global health and life expectancy. In the modern era, the leading causes of mortality worldwide are not infectious (**Table 1**). Cardiovascular disease is, in fact, the number one cause of mortality worldwide, inclusive of all ages and demographics. Cerebrovascular disease is the second most common cause of death. Out-of-hospital cardiac arrest, traumatic injury, and peripartum

complications leading to neonatal death continue to have a significant impact on global mortality. Emergency medical services and programs such as ATLS, Advanced Cardiac Life Support (ACLS), and the Neonatal Resuscitation Program (NRP) were created to help deliver essential knowledge and skills to communities with low resources and increased disease burden. In this chapter, we will review the impact of these programs and initiatives aimed at improving health outcomes globally.
