Militaries and global health: peace, conflict, and disaster response

Michaud, Joshua; Moss, Kellie; Licina, Derek; Waldman, Ron; Kamradt‐Scott, Adam; Bartee, Maureen; Lim, Matthew L.; Williamson, Jamie; Burkle, Frederick M.; Polyak, Christina S.; Thomson, Nicholas; Heymann, David L.; Lillywhite, Louis

doi:10.1016/s0140-6736(18)32838-1

Cited by 106 publications

(82 citation statements)

References 45 publications

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“…Despite the challenges and concerns about the role of the defense sector in global health security, it is important to recognize that militaries throughout the world are already engaged in these activities, with increasing involvement both within national borders and internationally (Wenham 2019;Michaud et al 2019). As emerging infectious disease threats are increasingly considered a national security and economic development concern (Fidler 2011), the role of militaries will likely continue to increase.…”

Section: Discussionmentioning

confidence: 99%

“…As emerging infectious disease threats are increasingly considered a national security and economic development concern (Fidler 2011), the role of militaries will likely continue to increase. Therefore, the question becomes how to constructively incorporate their military's capabilities into each country's framework to improve whole-of-country capability, while remaining consistent with national priorities and international guidelines (Michaud et al 2019).…”

Section: Discussionmentioning

confidence: 99%

“…It is not subject to copyright under 17 USC 105 and is also made available (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 2011) Among African militaries surveyed, as much as 50% to 80% of delivered healthcare by military medical services is provided to civilians with no military affiliation Militaries can provide a range of capabilities in security, transportation, logistics, and communications (Licina 2011;Michaud, Moss, et al 2019), and, less frequently, direct patient care, as happened during the Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in the Republic of Korea. The military often also plays a critical role in national biodefense issues, due to the need to prevent or respond to the potential misuse of biological agents as bioweapons (Fidler 2011).…”

Section: Introductionmentioning

confidence: 99%

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Military participation in health security: analysis of Joint External Evaluation mission reports and National Action Plans for Health Security

Forshey

Woodward

Sánchez

et al. 2020

Preprint

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Militaries across the world play an important but at times poorly defined and underappreciated role in global health security. For example, they are often called upon to support civilian authorities in humanitarian crises and to provide routine healthcare for civilians. Furthermore, military personnel are a unique population in a health security context, as they are highly mobile and often deploy to austere settings domestically and internationally, which may increase exposure to infectious diseases. Despite the role of militaries, few studies have systematically evaluated the involvement of militaries in global health security activities, including the Global Health Security Agenda (GHSA).To address this shortcoming, we analyzed Joint External Evaluation (JEE) mission reports (n=91) and National Action Plans for Health Security (n=11) that had been completed as of October 2019 (n=91) to determine the extent to which military organizations have been involved in the evaluation process, country military contributions to health security are accounted for, and specific recommendations are provided for the country's military. For JEE reports, military involvement was highest for the "Respond" core area (73%) but much lower for the Prevent (36%) and Detect (30%) core areas. Similarly, 73% of NAPHS documents mentioned military involvement in the Respond core area, compared to 27% and 36% for Prevent and Detect, respectively.Additionally, only 26% of JEE reports provide recommendations for the military in any of the core areas. Our results indicate the need to more fully incorporate military roles and contributions into the GHSA framework and other health security activities in order to improve national capabilities to prevent, detect, and respond to infectious disease threats.for use under a CC0 license.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Military participation in health security: analysis of Joint External Evaluation mission reports and National Action Plans for Health Security

Forshey

Woodward

Sánchez

et al. 2020

Preprint

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“…Military medical systems are often an integral part of the country's emergency preparedness and response system as it is the only health system that is organised for field deployment and relatively uncommitted to the local civilian community. 14 The Ministry of Interior is usually responsible for internal security through the management of police services. Police services may be split by different functions including border security, local policing, national response and paramilitary population control.…”

Section: The 'Security Ministries'-ministries Of Defence Interior Anmentioning

confidence: 99%

Understanding the structure of a country’s health service providers for defence health engagement

et al. 2020

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There are a variety of structural and systems frameworks for describing the building blocks of country’s public health and health systems. In this paper, we propose a conceptual framework for a holistic view of a country’s health service providers in order to inform the plan for Defence Health Engagement activities with partner countries. This includes all potential government ministries involved in healthcare provision, the independent, private sector and the non-government organisation/charity sector. The framework provides a visualisation to support the analysis of a country’s health services providers. We propose that recognising and analysing the different contributions of all these national health providers is essential for understanding the wider political economy of a nation’s health systems. This can inform a plan of Defence Health Engagement for capacity building in crisis response, development and health systems strengthening.

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“…Recent publications note the benefits of combining military and civilian healthcare resources, particularly in LMICs42–44:…”

Section: Justification For Mass Casualty Centre Networkmentioning

confidence: 99%

Global health, global surgery and mass casualties. I. Rationale for integrated mass casualty centres

et al. 2019

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It has been well-documented recently that 5 billion people globally lack surgical care. Also well-documented is the need to improve mass casualty disaster response. Many of the United Nations (UN) Sustainable Development Goals (SDGs) for 2030—healthcare and economic milestones—require significant improvement in global surgical care, particularly in low-income and middle-income countries. Trauma/stroke centres evolved in high-income countries with evidence that 24/7/365 surgical and critical care markedly improved morbidity and mortality for trauma and stroke and for cardiovascular events, difficult childbirth, acute abdomen. Duplication of emergency services, especially civilian and military, often results in suboptimal, expensive care. By combining all healthcare resources within the ongoing healthcare system, more efficient care for both individual emergencies and mass casualty situations can be achieved. We describe progress in establishing mass casualty centres in Chile and Pakistan. In both locations, planning among the stakeholders (primarily civilian and military) indicates the feasibility of such integrated surgical and emergency care. We also review other programmes and initiatives to provide integrated mass casualty disaster response. Integrated mass casualty centres are a feasible means to improve both day-to-day surgical care and mass casualty disaster response. The humanitarian aspect of mass casualty disasters facilitates integration among stakeholders—from local healthcare systems to military resources to international healthcare organisations. The benefits of mass casualty centres—both healthcare and economic—can facilitate achieving the 2030 UN SDGs.

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Militaries and global health: peace, conflict, and disaster response

Cited by 106 publications

References 45 publications

Military participation in health security: analysis of Joint External Evaluation mission reports and National Action Plans for Health Security

Military participation in health security: analysis of Joint External Evaluation mission reports and National Action Plans for Health Security

Understanding the structure of a country’s health service providers for defence health engagement

Global health, global surgery and mass casualties. I. Rationale for integrated mass casualty centres

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