Over 84,000 reported cases, over 3,000 reported deaths, and infected people on all continents — the coronavirus (COVID-19) remains a rapidly spreading threat since its first reported incidents in December 2019. Possibly two years away from an effective vaccine, dealing with COVID-19 has become a new normal. Figure 1 is an interactive web-based dashboard that illustrates the COVID-19 Global Cases in “near real-time” or “nearly real-time” (NRT).
Source: Reference: Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis; published online Feb 19. https://doi.org/10.1016/S1473-3099(20)30120-1.
Globalization and ubiquitous communication spread myths and misinformation faster than the disease. This is a unique and novel virus. Its threat is not in its lethal effects so much as its rapid spread. At the rate this is spreading, there is no question if you or someone in your first circle of family and friends will catch the flu. It is only a question of when.
Globalization fragility
This may not be Armageddon or the Apocalypse, but this epidemic and its reverberations around the world reveal the fragility of globalization. Globalism has stretched governance systems-wide and thin. Systems lie upon other systems to form a complexly integrated nervous system. Neural nodes form where social, political, economic, and health issues find a nexus. “Pandemics are not just passing tragedies of sickness and death. The omnipresence of such mass-scale threats, and the uncertainty and fear that accompany them, lead to new behaviors and beliefs. People become both more suspicious and more credulous. Above all, they become less willing to engage with anything that seems foreign or strange” (James, 2020).
Photo by Michael Durham―courtesy of Bat Conservation International and Minden Pictures
Note: From phylogenetics analyses undertaken with available full genome sequences, bats appear to be the reservoir of COVID-19 virus, but the intermediate host(s) has not yet been identified.
Wuhan, China, the origin of CONVID-19, is one of those centers. The disease began somewhere in its streets, spread quickly, and agitated the world’s nervous system, triggering the collapse of financial markets, challenging medical readiness everywhere, and launching political blame games. “The spreading coronavirus is taking a toll on economic players around the world, from farmers and ranchers in the Americas to manufacturers of solar panels in India to tourism workers across Asia” (Letzing, 2020).
Global health and U.S. national security
China is, after all, the U.S.’s third-largest trade partner with a population hungry for the wealth of American farms, the product of its factories, the innovations of its universities, and more. Conversely, the U.S. depends on China as a source of automotive components, low-cost apparel, and high-quality electronics. With factories, schools, and retailers closing in China, Korea, Singapore, Japan, and Hong Kong, the financial security of the U.S. is at risk.
February 29th saw the first U.S. death from COVID-19. Another death near Seattle and multiplying cases of community infection are stoking citizen fears. While it is naïve to say the U.S. has this under control, the country is well-positioned to work on containment. Figure 2 acknowledges the United States has the best tools and measures in place to prepare for an epidemic.
China is, after all, the U.S.’s third-largest trade partner with a population hungry for the wealth of American farms, the product of its factories, the innovations of its universities, and more.
Figure 2: Countries Best and Worst Prepared for an Epidemic. Image from Statista
Note: 100=Greater level of preparation. Index benchmarks health security on factors critical to fighting disease outbreaks.
The United States is positioned to react and respond. But the current administration continues to undercut aid to global health interests reducing their capacity for prevention. The U.S. 2021 budget would drop 3-billion USD from the agencies commissioned to monitor and respond early to signs of health risks. “Recent proposed funding cuts demonstrate a failure to understand the importance — and potential vulnerabilities — of health to our economic, national, and social security” (Kerry, 2020).
Coronavirus and political polarization
The virus has also infected the U.S. political landscape. President Trump has blamed the collapse of U.S. investment markets on claims by Democratic presidential candidates. The influential right-wing populist Rush Limbaugh has dismissed the infection as little more than a “common cold.” Other reactionaries attribute the “panic” to deep state conspiracies against the President. At the same time, President Trump appears very Presidential, recommending calm and vesting confidence in the U.S.’s ability to contain and manage the disease.
Despite advice from the Centers for Prevention and Control (CDC) and National Institutes of Health (NIH), Republicans and Democrats feud about the amount of money needed to manage CONVID-19 with no idea where that money will go. “Domestically, this administration and a Republican Congress have chipped away at our most vulnerable and poor with cuts that: undermine the number of U.S. citizens insured, endanger our citizens’ health and wallets when sick and undermine access and coverage essential for surveillance, detection and early response in an outbreak” (Kerry, 2020).
Globalization Economics
Economic Globalization has gained momentum that makes it irreversible. “Economic globalization refers to the increasing interdependence of world economies as a result of the growing scale of cross-border trade of commodities and services, the flow of international capital and wide and rapid spread of technologies” (Shangquan, 2000). This sensitive network evolved from linear procurement thinking. The system has been built on strict rational assumptions that all things can be reduced to a digital sequence. As a result, any variance or disruption felt within the system set off alarms. In fact, the strict rational infrastructure must treat variations and interruptions as bad.
As configured, the global economic system has no alternative response mode. It can only reverberate until it regains its stability. It must respond with tension and violence. So, disruption among China’s economic providers inevitably undercuts markets elsewhere.
As configured, the global economic system has no alternative response mode. It can only reverberate until it regains its stability. It must respond with tension and violence. So, disruption among China’s economic providers inevitably undercuts markets elsewhere. Now, when that static reaches the financial markets in the U.S. — already bloated and ripe for adjustment, it sets up markets for collapse. “The process of economy globalization is also the process of global industrial restructuring and readjustment” (Shangquan, 2000, p. 3), but it has not included changes in the world health system.
The problem is universal
In this era of globalization and hyper-human mobility, managing health crises is rarely straightforward or unambiguous. Today’s health systems — with the challenges they present to public health transformation — require a new strategic and systems thinking mindset. Health systems must serve a population group by improving its public health systems as felt in community health systems. “Ideally, population health management and public health initiatives should all include collaboration across the care continuum and into the community” (Bresnick, 2017). Without that community collaboration, any system is bound to exacerbate existing social inequities.
In this era of globalization and hyper-human mobility, managing health crises is rarely straightforward or unambiguous.
Systems thinking is a worldview — as well as a process. It can be used for both the development and understanding of a system or systems of systems and for the approach used to solve problems. Health systems thinking marks a dramatic shift from the traditional linear or reductionist way of thinking used by social and public actors. The World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) embraced systems thinking long ago. It focuses on non-linear assumptions and feedback loops to determine a system’s behavior over time and find leverage points aimed at creating reliable and sustainable public health systems. Unfortunately, public health systems in many countries still use regressive, out-of-date approaches without achieving improved population health. Most of the investment in the health sector is allocated to spending on expensive curative medical interventions without considering the strategic Value for Money principles.
Systems thinking is a worldview — as well as a process. It can be used for both the development and understanding of a system or systesms of systems, and for the approach used to solve problems.
Global health concerns address health issues that cross borders. “Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighborhood, or as big as an entire country or region of the world” (What Is Public Health?, 2020). However, “Research and commentary must address not only the clinical presentation and epidemiological features of health and disease across the globe but also the social and political realities that jeopardize the advancement of health and well-being of people and countries, including political unrest, compromised health and public health systems, and social, economic, cultural and environmental factors” (Winkler & Farris, 2015).
The necessary One Global Eco-system thinking for infectious diseases challenges and empowers decisions as policymakers assess the interdependencies among elements or components within the continuum of health systems where appropriate and make sense as global investments. Alternatively, reconstituting every country’s overall health system with sustainable solutions will never happen if the focus remains on deconstructing the elements of the health systems at the national level, where the focus is usually on designing how each system should function. At the global level, the limitations on human mobility have not prevented crises such as SARS, MERS, and COVID10. Any attempt will ultimately lead to global economic collapse. It is like “shooting oneself in the foot.”
One Global Ecosystem
The current and recent viral threats require One Global Ecosystem thinking. With One Global Ecosystem thinking, health leaders and policymakers look at the entire Ecosystem rather than its individual parts. Looking at the whole (Global Heath Security), they increase their capability for seeing interrelationships and patterns over time. They begin to understand that problems may be clues or symptoms of deeper issues within a system or system of systems.
One Global Ecosystem thinking about infectious epidemics challenges leaders and policymakers to look for root causes and constraints so sustainable solutions can emerge. Leaders, thus, move away from national tunnel vision and focus on globally desired outcomes. In other words, One Global Ecosystem thinking involves much more than a reaction to present events. It demands a deeper understanding of the causes of inequity, barriers to prosperity, linkages, relationships, interactions, and behaviors among the systems that characterize our Ecosystem.
Because health challenges are complex, solutions will differ depending on a wide range of national and sub-national social, cultural, economic, and medical variables and determinants. Imposing legacy strategies or “off-the-shelf” solutions on such crises will not yield a sustainable and transformative impact.
Because health challenges are complex, solutions will differ depending on a wide range of national and sub-national social, cultural, economic, and medical variables and determinants. Imposing legacy strategies or “off-the-shelf” solutions on such crises will not yield a sustainable and transformative impact.
Major philanthropist Bill Gates, suggests draconian but achievable actions: “Investments to tackle treatment which is too risky for private companies to make; control of the market price of treatments and vaccines, which would otherwise skyrocket were makers allowed to maximize profits from them; and international aid, which would strengthen the health systems of low-income countries and reduce the spread of the virus” (Merelli, 2020).
We must embrace the connectivity and complexity of each country’s entire health systems and its role within a national and global context. Global Health Ecosystem thinking is needed when dealing with epidemics. We must approach this in a different way and from a different point of view rather than just looking at it as another nation’s crisis.
One Complex Adaptive Ecosystem
“it is not possible to develop best-practice manuals that contain rule-based formulas for dealing with complexity” (Prieser, Biggs, De Vos, & Folke, 2018). Change when we have a One Complex Adaptive Ecosystem (OCAES) enabling a more integrated approach to crises like COVID-19 in unison with short and longer terms joint investments. This approach is not new; it is already embracing the WHO advocacy of “Health in All Policies.” Whenever a ministry in a country, other than the Ministry of Health/ Public Health, develops policy, they must reach out to the Ministry of Health/ Public Health at national levels to identify the health implications of the policy: synchronization, dissonance, synergism, amplifying, and buffering effects. Moreover, they can map threats and opportunities probability and impact jointly during the implementation phase.
Another policy level systems approach introduces the One Health Initiative paradigm at national levels, a worldwide strategy for expanding interdisciplinary collaboration and communication in all aspects of health for humans, animals, and the environment. The initiative looks for linkages within and between these three domains. With the current and future rise of infectious diseases of zoonotic origins like COVID-19 and the increase in environmental disasters, welcoming this approach is timely — and urgent!
With the current and future rise of infectious diseases of zoonotic origins like COVID-19 and the increase in environmental disasters, welcoming One Health Initiative is timely — and urgent!
Global Health Systems operate in an increasingly dynamic, uncertain, complex, and ambiguous environment. We must prioritize legislative organizing measures, promotion, and prevention with a multi-sectorial and multi-disciplinary response, including a robust Public-Private Partnership (PPP) that creates an enabling environment that promotes partnership in health efforts before a crisis strikes everyone home.
Complex Adaptive Systems (CAS) should follow fundamental principles (adapted from Prieser, Biggs, De Vos, & Folke, 2018):
- Principle 1: CAS are constituted relationally. They are defined by interactions.
- Principle 2: CAS have adaptive capacities. They adapt in time to feedback from interactions between system elements and elements and their environment.
- Principle 3: Dynamic processes generate CAS behavior. The dynamic interactions are non-linear, so the magnitude of system outputs cannot be measured directly against the magnitude of its causes.
- Principle 4: CAS are radically open. Energy, information, and matter are exchanged between the system and environment without defined boundaries.
- Principle 5: CAS are contextually determined. Unlike linear processes that can be effectively isolated from external influence, CAS are context-dependent emerging from relationships and interaction.
- Principle 6: Novel qualities emerge through complex causality. These systems find value in the uncertainty, a context for the novel, creative, and innovative.
The world isn’t what it used to be!
Globalization has made the world smaller. People, information, and resources are intricately and effectively accessible as never before. However, that same network spreads lie, disinformation, and disease faster than ever before. The proximity of everyone and everything presents opportunities for great good, but the contact also presents existential threats.
Infection can strike global networks at any time and at any point. The next high impact issue is already underway —if not yet apparent. But legacy approaches see these infections are horizontal, supply chain, sequential events. What they require is the transformational dynamic recommended by S4F.Solutions™ — a framework created from design, systems, and agile thinking. Only its multi-level, multi-factor, and multi-talent strategy can adopt, adapt, and transform the ecosystems that enable existential threats.
WRITTEN BY
Asaad Taha, Ph.D., PRINCE2®, MSP®
Senior Managing Partner @S4F.Solutions™
Asaad Taha is a leading Social Impact Entrepreneur, Futurist and Senior Principal Adviser with multi-sectoral expertise on the continuum of social impact programs — from the strategic level to frontline delivery.
References
- Bresnick, J. (2017, July 19th). How Do Population Health, Public Health, Community Health Differ? Retrieved from Health Analytics: https://healthitanalytics.com/news/how-do-population-health-public-health-community-health-differ
- Cemma, M. (2017, September 26th). What’s the Difference? Global Health Defined. Retrieved from Global Health Now: https://www.globalhealthnow.org/2017-09/whats-difference-global-health-defined
- James, H. (2020, February 28th). Opinion: How the coronavirus could precipitate the waning of globalization. Retrieved from Market Watch: https://www.marketwatch.com/story/how-the-coronavirus-could-precipitate-the-waning-of-globalization-2020-02-28
- Kerry, V. (2020, February 28th). Coronavirus: Global health is key to U.S. security, so why does Trump want to cut funds? Retrieved from USA Today: https://www.usatoday.com/story/opinion/2020/02/28/coronavirus-bottom-line-global-health-security-national-security-column/4872524002/
- Letzing, J. (2020, February 21st). The economic toll of the coronavirus – from iPhones to solar panels to tourism. Retrieved from World Economic Forum: https://www.weforum.org/agenda/2020/02/economic-toll-coronavirus-manufacturing-tourism-china-asia/
- Merelli, A. (2020, February 28th). Bill Gates’s plan to tackle a possible pandemic only works if governments handle health care. Retrieved from Quartz: https://qz.com/1810018/how-bill-gates-wants-us-to-respond-to-coronavirus/
- Prieser, R., Biggs, R., De Vos, A., & Folke, C. (2018). Social-ecological systems as complex adaptive systems: organizing principles for advancing research methods and approaches. Ecology and Society, 23(4), 46. Retrieved from https://www.ecologyandsociety.org/vol23/iss4/art46/
- Public Health vs. Global Health: Understanding The Difference. (n.d.). Retrieved from the University of Nevada, Reno: https://onlinedegrees.unr.edu/blog/public-health-vs-global-health-understanding-the-difference/
- Shangquan, G. (2000). Economic Globalization: Trends, Risks and Risk Prevention. New York, NY: U.N. Department of Economic and Social Affairs. Retrieved from https://www.un.org/en/development/desa/policy/cdp/cdp_background_papers/bp2000_1.pdf
- What Is Public Health? (2020). Retrieved from CDC Foundation: https://www.cdcfoundation.org/what-public-health
- Winkler, M., & Farris, L. (2015, July). Promoting Global Health: The World Association of Medical Editors Position on Editors’ Responsibility. Balkan Medical Journal, 32(3), 241-243. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4497688/