**2. International health security: the mechanism for sustainable development**

To streamline the Consensus Group's (CG) effort, the discussion will focus on the most relevant topics within the overall scope of IHS, with the following general operational outline:


At this juncture, a brief outline of the summative assessment (SA) discussion structure will be provided, focusing on the IHS improvement cycle that starts and ends with prevention (**Figure 1**):


**15**

**Figure 1.**

*DOI: http://dx.doi.org/10.5772/intechopen.93214*

item-specific risk(s) and urgency

sponding levels of priority/urgency

place in case of prevention failures

system to avoid potentially harmful delays

*International Health Security: A Summative Assessment by ACAIM Consensus Group*

strict definitions and expectation of timeliness should be built into the reporting

3.**Assessment**: An organized, system-based approach toward evaluating potential IHS threats and categorizing such potential threats into a reportable database. An important part of the assessment process is the estimation of

4.**Reporting**: A structured communication procedure consisting of categorized items that are grouped according to IHS threat type and are assigned corre-

5.**Response**: An organized and highly coordinated series of steps designed to proactively address any potential IHS threats while setting up the stage to address any associated population health needs; mitigation efforts are put into

6.**Addressing needs**: A structured process that features its own assessment cycle, designed to catalog, prioritize, and provide resources (financial and nonfinancial) required to effectively deal with the IHS threat aftermath; embedded within this phase is also the early stage of short-term and long-term preventive efforts

7.**Cycle repeats**: Once completed, the process returns to the preventive focus, with detection of new IHS threats triggering new/additional operational cycles.

*The international health security improvement cycle: safety & surveillance through prevention, detection and* 

*assessment; action through reporting, response, and addressing needs.*

strict definitions and expectation of timeliness should be built into the reporting system to avoid potentially harmful delays


#### **Figure 1.**

*The international health security improvement cycle: safety & surveillance through prevention, detection and assessment; action through reporting, response, and addressing needs.*

At this point, our attention will turn to a list of specific IHS threats, beginning with emerging infectious diseases and ending with the emerging risk of weaponizing social media to disseminate potentially harmful medical/health-related information.

#### **3. Emerging infectious diseases**

The emergence (and re-emergence) of pathogens represents a significant threat to public health, including both high-income regions (HIRs) and low/middle-income regions (LMIRs) [13–17]. Detection of new IHS threats in this domain is challenging, primarily due to the nonspecific and often insidious nature of the emergence of a particular infection or pathogen [18–20]. Potential EIDs can arise from epidemic-prone, vaccine-preventable, vector-borne, food-borne, zoonotic, and/or antibiotic-resistant pathogens, or from a lack of access to safe water and sanitation [21–23]. In addition to lost lives, these diseases can lead to significant economic strain and may overburden local health system(s) capacity [24]. The lessons learned from prior outbreaks can help to improve future responses to emerging infectious diseases [24, 25].

For example, the well-documented response to the 2014 Ebola outbreak not only revealed a vulnerability to this important IHS threat, but also exposed significant inefficiencies of the current global public health infrastructure [26]. The initial response was disorganized and uncoordinated. The tracking of cases was also inadequate as the case trajectory deceptively appeared to decline before the true transmission spanned internationally [27]. Moreover, transmission was able to increase at an accelerating rate due to an overburdening of local health-care systems, lack of communication timeliness within the existing surveillance system, rapid urbanization, and widespread poverty where people lacked access to adequate water and waste management infrastructure [28–32]. Finally, even when there are ample resources available to address EID threats, local conflicts may effectively render any public health initiatives and medical efforts either highly dangerous or potentially impossible [33, 34].

To prevent the emergence or re-emergence of potentially life-threatening diseases, necessary measures must be initiated. Such measures include, but are not limited to, active surveillance for (timely response to) outbreaks. Emphasis must be placed on education and dissemination of key information to all stakeholders, antibiotic stewardship, vector control, and increased efforts toward combatting poverty and improving water and waste management [15, 35–37]. One important factor to consider when combatting EIDs is the need to coordinate all efforts as a unified, global front [16]. In a world characterized by continual globalization, phenomena such as mass migration and increasing ease of travel take on extreme importance to IHS [38, 39]. Collectively, the above factors may lead to accelerated spread of certain diseases and when coupled with inadequate response, lack of recognition, and limited awareness of various associated risks, local outbreaks can easily escalate into pandemics [20, 40, 41]. Finally, as the global community begins to expand the collective focus to include some of the more prevalent chronic, communicable and noncommunicable diseases, necessary assurances will be required that any corresponding public health initiatives will receive ample funding across all domains and services. Moreover, systemic mechanisms will need to be established to ensure continuous reassessment, training, and readiness to prevent the emergence of international complacency.

#### **4. Chronic health conditions and access to care**

With the aging of the world population, the increasing prevalence of chronic health conditions (CHCs), from diabetes to depression, is becoming an urgent

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the community [65, 66].

*DOI: http://dx.doi.org/10.5772/intechopen.93214*

with LMIRs challenged the hardest [48, 51–53].

bers about in-home care for the aging.

*International Health Security: A Summative Assessment by ACAIM Consensus Group*

public health issue [42–44]. This is especially true in the context of access to care across LMIR. The aging world population (ages ≥60 years) is increasing and expected to triple in size from 962 million in 2017 to 3.1 billion in 2100 [45]. A significant proportion of this growing population segment will come from today's LMIR [46], and much of this growth has been attributed to improved medical care, resulting in longer life expectancy [47, 48]. In addition, the world population is aging in association with decreased fertility rates [49, 50]. Along with an aging population come CHCs that collectively must be viewed as an international security threat, especially as resource-to-patient ratios begin to decline. Dementia, heart disease, diabetes, obesity, mental health disorders, stroke, human immunodeficiency virus (HIV), sexually transmitted diseases (STDs), malnutrition, sensory impairments, substance abuse, polypharmacy, bladder irregularities, and mobility issues are a few of the most common CHCs facing this emerging elderly population,

These barriers may become further compounded by external factors. Competing forces such as rising health-care costs and physician/provider shortages will require creative solutions. Strategies aiming for long-term sustainability can utilize technology, focus on innovation, and create global economies of scale [43, 54]. Specific examples include at-home primary care, telemedicine, preventative initiatives, and community/family engagement [43, 54–56]. As access to care in many LMIRs is difficult, home health and telemedicine programs will need to replace less efficient models where transportation to and from health-care facilities was the norm [57, 58]. Community educational programs can aid in informing patients and family mem-

Thanks to rapid advances in telecommunication, most of the world has access to "smart phone" technology, and telemedicine options based on this technology can provide portable care in places where traditional health-care information infrastructure is inadequate or outdated [59, 60]. Improved preventative measures such as diabetes/cardiovascular screening may be initiated with point-of-care (POC) technology, including behavioral modifications that result in improved health, wellness, and continuity of care [61, 62]. Community engagement, with dedicated non-health care degree personnel trained in specific interventions, will be valuable when expanding the existing health-care workforce. Similarly, providing employment or volunteering opportunities for the elderly can keep the aging population

In addition to the operational solutions described above, CHCs in the aging LMIR populations can benefit from patient-centered care. To ensure sustainability, decreasing overall disability in the geriatric population will become imperative. Providing proper dental care, hearing aids, glasses, devices to assist in mobility, and relevant group activities can promote personal independence, socialization, and mobility [53]. Nutrition support from local farming connected to food banks, meal delivery from food programs, or food sharing mechanisms involving group meals can ensure that patients are achieving a proper diet while remaining invested within

Important from a variety of perspectives and dimensions, early discussions of end-of-life (EOL) care can help reconcile patient and community goals while decreasing unnecessary, costly EOL interventions [67]. Home hospice, ethical EOL policy measures, and better community education can improve patient experiences [68]. CHCs in the aging population of LMIRs must be addressed in a proactive and systematic manner. Highlighting goals of care to maximize the quality of life, enhancing independence while decreasing disability, and creating safe, secure access to health-care in an innovative, technological manner will be imperative for health systems to effectively address the emerging elderly population in LMIRs [68, 69].

engaged, active, and reinvested in their own communities [63, 64].

#### *DOI: http://dx.doi.org/10.5772/intechopen.93214 International Health Security: A Summative Assessment by ACAIM Consensus Group*

public health issue [42–44]. This is especially true in the context of access to care across LMIR. The aging world population (ages ≥60 years) is increasing and expected to triple in size from 962 million in 2017 to 3.1 billion in 2100 [45]. A significant proportion of this growing population segment will come from today's LMIR [46], and much of this growth has been attributed to improved medical care, resulting in longer life expectancy [47, 48]. In addition, the world population is aging in association with decreased fertility rates [49, 50]. Along with an aging population come CHCs that collectively must be viewed as an international security threat, especially as resource-to-patient ratios begin to decline. Dementia, heart disease, diabetes, obesity, mental health disorders, stroke, human immunodeficiency virus (HIV), sexually transmitted diseases (STDs), malnutrition, sensory impairments, substance abuse, polypharmacy, bladder irregularities, and mobility issues are a few of the most common CHCs facing this emerging elderly population, with LMIRs challenged the hardest [48, 51–53].

These barriers may become further compounded by external factors. Competing forces such as rising health-care costs and physician/provider shortages will require creative solutions. Strategies aiming for long-term sustainability can utilize technology, focus on innovation, and create global economies of scale [43, 54]. Specific examples include at-home primary care, telemedicine, preventative initiatives, and community/family engagement [43, 54–56]. As access to care in many LMIRs is difficult, home health and telemedicine programs will need to replace less efficient models where transportation to and from health-care facilities was the norm [57, 58]. Community educational programs can aid in informing patients and family members about in-home care for the aging.

Thanks to rapid advances in telecommunication, most of the world has access to "smart phone" technology, and telemedicine options based on this technology can provide portable care in places where traditional health-care information infrastructure is inadequate or outdated [59, 60]. Improved preventative measures such as diabetes/cardiovascular screening may be initiated with point-of-care (POC) technology, including behavioral modifications that result in improved health, wellness, and continuity of care [61, 62]. Community engagement, with dedicated non-health care degree personnel trained in specific interventions, will be valuable when expanding the existing health-care workforce. Similarly, providing employment or volunteering opportunities for the elderly can keep the aging population engaged, active, and reinvested in their own communities [63, 64].

In addition to the operational solutions described above, CHCs in the aging LMIR populations can benefit from patient-centered care. To ensure sustainability, decreasing overall disability in the geriatric population will become imperative. Providing proper dental care, hearing aids, glasses, devices to assist in mobility, and relevant group activities can promote personal independence, socialization, and mobility [53]. Nutrition support from local farming connected to food banks, meal delivery from food programs, or food sharing mechanisms involving group meals can ensure that patients are achieving a proper diet while remaining invested within the community [65, 66].

Important from a variety of perspectives and dimensions, early discussions of end-of-life (EOL) care can help reconcile patient and community goals while decreasing unnecessary, costly EOL interventions [67]. Home hospice, ethical EOL policy measures, and better community education can improve patient experiences [68]. CHCs in the aging population of LMIRs must be addressed in a proactive and systematic manner. Highlighting goals of care to maximize the quality of life, enhancing independence while decreasing disability, and creating safe, secure access to health-care in an innovative, technological manner will be imperative for health systems to effectively address the emerging elderly population in LMIRs [68, 69].
