The undeniable relationship between health, welfare and peace demands a revolution in multilateral cooperation, researchers from the Harvard Medical School Program in Global Surgery and Social Change argue in an opinion piece published June 4 in the Journal of International Affairs.

While the international community must respond collectively when faced with pandemics, the traditional concept of pandemic preparedness is inadequate to keep the world safe from this threat, and international efforts must instead focus on strengthening entire health systems and addressing the root causes of health inequity and insecurity, the authors wrote.

Get more HMS news here

“Until recently, the countries of West Africa, unlike other extraordinarily poor countries like North Korea or Yemen, were considered unlikely to destabilize states outside their immediate vicinity,” said John Meara, the Steven C. and Carmella R. Kletjian Professor of Global Health and Social Medicine in the field of Global Surgery at HMS. “The Ebola outbreak of 2014 fundamentally upended this calculus.”

The impact of the outbreak was felt in 10 countries, the authors wrote, including four high-income nations, and the cost of the global response surpassed $4 billion—$2.4 billion of this was borne by the United States.

The threat to security isn’t only from outbreaks of deadly infections, the authors added.

“Health deserts, like those found in Syria and Venezuela, imperil neighboring states and the broader world in multiple ways,” said the article’s co-author Brian Till, who was a visiting graduate student and research associate in the HMS Program in Global Surgery and Social Change.

The authors analyzed the economic, political, historical and cultural context surrounding the concept of global health security, noting that, in an increasingly interconnected world, achieving such security will require transnational cooperation and investment focused on strengthening entire health systems, as opposed to the kind of narrow, disease or crisis specific interventions that have gained favor in recent years.

Alarmingly, the authors note, this trend coincides with a new global emphasis on rising nationalist sentiments that threaten international cooperative efforts. Efforts to address global health security without addressing deeper causes have consistently failed to provide the desired outcomes, the authors wrote.

On the other hand, countries that have focused efforts on providing basic health insurance, building health infrastructure and growing the health care workforce show high rates of return on investments, growth in the overall workforce and improvement of a variety of social welfare indicators—all factors that are associated with decreased risk of coup and political violence and increased security and stability.

“The vast majority of disease, pandemic included, is born from a confluence of poverty, health inequity and poor health delivery systems,” said Meara, who is also director of the HMS Program in Global Surgery and Social Change at Harvard Medical School. “Instead of rushing from crisis to crisis, offering too little help when it’s already too late, it’s time to start building the systems necessary to treat the root causes of health inequity before this pathological injustice manifests as costly and catastrophic emergencies.”