Review of the monograph# Mateusz Kuczabski’s Health Security Implications for National Security

The reviewed monography by Mateusz entitled J. Kuczabski „Health Security Implications for National Security” fills a significant gap, because, despite the availability of extensive foreign and domestic literature on health safety, it is difficult to find a commonly agreed definition. The potentially useful distinction between “health and safety”, “health system”, “healthcare system” and “health security” has not been developed in the literature. Interestingly, the author notes significant discrepancies in the understanding and application of the concept of health security existing even in UN agencies, for example between the United Nations Development Program (UNDP) and the World Health Organization (WHO). The results of the research by M. J. Kuczabski presented and prepared by the author may serve as an indication of the direction of future transformations in the field of health security and health policy in relation to the Polish security system.

Introduction

At the outset, it should be noted that both the subject and the time limits of the study were accurately defined by its author. The complexity of the issues and phenomena in the area of ​​health security and their permanent topicality, recently additionally conditioned by the epidemic threat, has become a premise for the author to undertake deeper research in this area. The key motivation is primarily the interests of M. J. Kuczabski resulting from research on the interface between the problems of health and state security. There are many problems with the quality of life, social adaptation, and the impact of ICT on human health in the broad context of building social resilience. The reviewed book fills a significant gap, because, despite the availability of extensive foreign and domestic literature on health safety, it is difficult to find a commonly agreed definition. The potentially useful distinction between “health and safety”, “health system”, “healthcare system” and “health security” has not been developed in the literature. As M. J. Kuczabski notes, the confusion arose from very divergent views, state priorities in the field of politics, the emergence of various public health programs, and also from the fact that problems related to the concept of health safety occur as if at the intersection of several fields or scientific disciplines. Interestingly, the author notes significant discrepancies in the understanding and application of the concept of health security existing even in UN agencies, for example between the United Nations Development Program (UNDP) [1] and the World Health Organization (WHO). The subject of the review is a scientific monograph by Mateusz J. Kuczabski, published by the Publishing House of the War Studies University, devoted to the analysis of the effects of health security issues on national security.

Review

The monograph - preceded by an introduction (where we can find the justification for the choice of issues, a research methodology that characterizes the structure of the book and its source base), and summarized in the ending - is built according to the problem key of two main parts, which include the considerations of M. J. Kuczabski in two research trends. The first stream covered theoretical considerations aimed at enriching the existing knowledge in the field of the research subject in terms of the determinants of the functioning of health security, especially condensing the analytical attention on the problems of the health crisis caused by the pandemic in a wide spectrum of health problems, from global to national ones. The second line of cognitive research by M. J. Kuczabski is empirical research devoted to the social perception of threats resulting from the impact of a pandemic and the conditions for combating it, in terms of implications from the individual to the effects for the state. Importantly, social research by M. J. Kuczabski showed high susceptibility of people to threats resulting from the pandemic, both current and future consequences. Respondents revealed in their responses what they are afraid of, which phenomena cause fear, and what irritation, they fear, and at the same time indicate their attitude to the effectiveness of epidemic management, to restrictions and prohibitions. The revealed emotions reflect a low level of perceived health security, which is not surprising. On the other hand, the author’s analysis of evaluation and emotions reveals social needs in the field of health security, which should constitute the basis of the state’s health policy. In particular, the pandemic and the method of managing the risk have indicated a dysfunction of crisis management in the health security system, lowering its level. In the work of M. J. Kuczabski, he discusses extensively the set of fundamental assumptions concerning the theory of the health security system and its vulnerability, which was previously signaled in the scientific article. The data obtained from preliminary risk impact assessments is supplemented by studies on the resilience of the health security system based on social assessment. The conclusions from the theoretical research, diagnosis, and observation, as well as the exploration of various security areas, are encouraging M. J. Kuczabski to state that, in particular for the national security management system, there is a need for systemic studies in transdisciplinary teams on health security in the face of the challenges that the whole world has experienced in connection with the COVID-19 pandemic [2]. This is not the only challenge and threat to contemporary health security systems, as the author anticipates the consequences of other large-scale threats, such as climate change and migration, as well as the escalation of the Russia-Ukraine conflict.

In the literature on the subject, M. J. Kuczabski notices three basic research concepts, namely:

1. Prioritizing health security over health care systems.
2. Treating health security as a uniqueness focusing on acute emergencies.
3. Conceptualization of health security as “state security” rather than “human security” or population health.

Theoretical and social research prompts M. J. Kuczabski to formulate the following conclusions:

1. The relationship between health and safety has become a dominant issue in health policy over the past two decades.
2. Health security research varies in levels of analysis from global to national to the individual; moreover, the differences relate to the acceptance of what can be considered a security risk in the health securitization process.
3. Health securitization has gone beyond a rhetorical tool, it now includes the direct involvement of the security, military, and defense sectors. The concept of health security has been expanded to such an extent that many health problems are constructed as threats to health security also for non-health problems.
4. Practical links between healthcare (healthcare) systems and health security are historically valid, but the conceptual links between these areas remain poorly defined and explored - creating a research gap relevant to safety science exploration.
5. The need to close this cognitive gap is gaining importance in light of the effects of the COVID-19 pandemic, as it has demonstrated a key link between the capabilities of the health system (health care) and an effective health security response (mobilization of additional forces and resources outside the health care system).
6. Significant changes are taking place in global health security, consisting of the expansion of the activities of military entities; there is an increase in very real threats to people taking up work in the field of health safety (missions) [3].

M J. Kuczabski emphasizes that there are no proposals indicating specific ways to rationalize the healthcare system and its components that may increase long-term health security. Modeling the health protection and health safety system is another area for exploration in safety sciences. The concept of health security as an internal security sector has not yet been clearly defined. From the idea of ​​human security - human security, which is expressed in ensuring, inter alia, health security, which the author already pointed out in the monograph Humanistic Aspects of Security - it follows that as a separate theoretical category, it still requires more clarification, especially regarding the cognitive values ​​of this category - which, according to the author, is another area of ​​exploration in security sciences. As part of the research, M. J. Kuczabski recommends the development of a concept of health security analysis, which would provide a space for the assessment of key features, both clear and hidden, as a set of parameters for the assessment of the health security of the state and the assessment of social policy. M. J. Kuczabski points out that the essence of the state policy taking into account the health of the society was adopted in Polish strategic documents quite recently, linking health security problems with state security, defining the priority of values ​​recognized by the state. He notes that global health security is expressed in the need to ensure health both for soldiers and the population living in war zones. It also covers military security and defense operations, crisis response operations, and humanitarian operations [4]. In terms of health security, the implemented activities are related to such objectives as civil protection, preventing humanitarian disasters, and responding to situations violating human rights, the effects of which most often have a health dimension.

As M. J. Kuczabski points out: in crisis situations related to the health of society (public health), resilient health systems are important, i.e. those with the ability to flexibly respond to difficult situations, as well as adaptive abilities consisting in the ability to learn from past experiences and adapt to future challenges. Transformative capacity means the ability to build organizations and institutions that foster social resilience to future crises. The analysis of management processes carried out by M. J. Kuczabski during the pandemic showed that the reason for the limited effectiveness was the dispersed nature of healthcare management, which made it difficult to coordinate at the system level, a dysfunctional information system (susceptibility to disinformation), the lack of coordinated activities in the creation and operation of medical entities, lack of coordination in terms of patient care, system resources insufficient or inadequate to the present and future health needs of the population.

An observation from the analysis of the early effects of the pandemic is a few remarks, which, as M. J. Kuczabski emphasized, should be taken into account when developing regulations necessary for a pandemic situation, namely the current act on infectious diseases contains too many provisions allowing for the imposition of broad restrictions on freedoms and rights; at the time of the greatest increase in coronavirus infections, the Polish health care system could be inefficient; the fight against the epidemic had a negative impact on the protection of the right to life and health of people suffering from other diseases. On this basis, the author recommends that the amendment to the act on infectious diseases should contain a clear and consistent with the Constitution of the Republic of Poland [5] definition of the permissible limits of restrictions on freedom and rights in the state of epidemics, as well as in the state of epidemic threat. In the opinion of M. J. Kuczabski, health safety should be assessed on the basis of a monitoring system expanded with a set of indicators dedicated to the areas determining the level of health safety, creating a complex index of the health safety system efficiency. It is necessary to strengthen the so-called health competencies understood as the ability to use technological support in the field of health information and services; competencies in the field of personal health, i.e. self-awareness of the value of health. As part of increasing individual and social resilience, taking into account education at all levels of education, (educational programs) and social campaigns, it is, therefore, necessary to permanently change behavior. An important conclusion seems to be the proposal to include classes on the subject of “health safety” in the curricula for schools and universities. M. J. Kuczabski notes that the directions of intervention in the field of public health favoring the improvement of health safety should include activities in three dimensions: organizational, information, and medical. In the first one, in order to maintain the safety of the organizational health care system, separate, dedicated procedures and specific solutions must be defined, there must be certainty as to the guidelines of the procedure, coordination of individual activities, including systems supporting the actions of managing the effects of each crisis - organic phenomenon, including a pandemic. In informational - an extremely important issue during a pandemic is to adapt and supplement the form of information transfer to the perception of recipients, not to generate contradictory messages; it is necessary to base the information message on the opinions of scientists not only from medical professions, but also from various fields, e.g. social communication, social psychology, psychiatry, economics, and pedagogy. The information message influences the change of moods and social behavior stimulates emotions and arouses or suppresses panic [6], which in turn is extremely important in maintaining mental safety [7]. A reliable message that does not increase fear creates an environment of reality. Finally, in the medical dimension, providing medical services in line with the standards, calming down, and providing professional and reliable information.

The proposal of M. J. Kuczabski that for the security sciences the focus of research effort should be focused on three areas of research in the context of state security, recognizing health as a strategic category, seems to be particularly valuable, namely:

− The health of citizens and the health of the nation, and society (demographic context).

− Health is an end in itself (one of the dimensions of the national interest, the desired value, the resource of social and intellectual capital).

− Health as a strategic resource (factor of national strategic potential, e.g. mobilization resources for the army, resilience of the society).

− In addition, the problems that, according to M. J. Kuczabski, should be reflected in research in security sciences are:

− Study of relations between the political class, the media, and society in pandemic conditions, as well as in situations of threat and prevention of infectious diseases,

− Examining the problems of the country’s systemic resistance,

− Exploring the relationship between building the nation’s prosperity and the stability of the state and health safety,

− Trans disciplinary, multidisciplinary study of the effects of a pandemic,

− Comprehensive system analysis of the pandemic impact study,

− Testing systemic resistance, sensitivity, and vulnerability of the health security system to threats,

− Study of conditions, threats, and challenges for health safety development processes,

− Research on the impact of crises of various origins on the level of health security,

− Study of the social assessment of the level of health security and its correlation with national security,

− Examination of organizational and functional structures in order to optimize the management of the health security system,

− Researching the problems of the area related to rescue and medical activities of uniformed services,

− Analysis of the principles of cooperation between entities of the health security system,

− State security research in the face of extraordinary threats,

− Testing the flexibility of adapting health security systems to health crisis situations,

− Testing the effectiveness and efficiency of the operation of health safety subsystems,

− Research on the social valuation of technology for the purposes of health security,

− Research on information security in the health sector,

− Researching the cybersecurity of the healthcare system infrastructure [3].

As M. J. Kuczabski writes, the issue of the future is the need to change the approach to health protection - understanding it as a necessary condition for the socio-economic development of the country and ensuring national security, treating the health protection and health safety of citizens as an investment in the future, and finally, building system and social resilience based on programs, training in the form of sham exercises (so-called stress test). At the end of the work, M. J. Kuczabski acknowledges that the publication makes a significant contribution to the development of security science because:

1. Explains the causes and phenomena that influenced the processes of the contemporary perception of safety and health in terms of health safety.
2. Explains changes in the area of ​​health security at the global level and its impact on the national health security system, and the perspective on national security.
3. Shows the specificity of a health crisis situation, in which it becomes necessary to use special measures, as well as security, military, and defense systems.
4. Student recognizes the problems of safety and health safety in the two complementary content types of research: theoretical and empirical.
5. Points out that he makes a rational transfer of knowledge in the area of ​​health security research and modern research methods to the discipline of safety science.
6. Formulates perspective problem areas for further research in the discipline of security science.
7. The results of the conducted research contribute to the development of social sciences, presenting problems of a holistic-systemic and multidisciplinary nature, research was previously undertaken mainly in monodisciplines.

Conclusion

In the summary of the review, in addition to the well-chosen topic previously mentioned, the undoubted advantages of M. J. Kuczabski’s monograph include logical problematic construction; the author’s narrative, who skillfully combines the presentation of interesting facts and processes with his own opinions and assessments, as well as harmoniously woven into the text, carefully selected quotes illustrating the scientific argument. The high level of the author’s workshop skills is expressed, inter alia, in in a correctly, clearly, and legibly prepared apparatus of footnotes and cross-references, reliable correction (resulting in the absence of typographical errors and stylistic ambiguities) and including a rich bibliography. The care of M. J. Kuczabski to equip the book with interesting and justified appendices deserves praise. They constitute the necessary complement to the narrative, presenting those aspects of health safety that have not become the subject of deeper reflection in the main text of the monograph. The proof of M. J. Kuczabski’s scientific reliability is also an extensive source and literature database of over 700 items, which he made the basis for his considerations and conclusions in the study. The above numerous arguments unequivocally speak in favor of the high scientific and cognitive value of the reviewed publication, but it does not mean that it is completely devoid of shortcomings - both in terms of design and content. The first of these is certainly the disproportionate volume of the two main parts of the monograph. While the first is structured from five chapters, the second covers only one. Of course, these differences are caused by their subject matter, and thus - the volume of material (sources and literature) that became the basis for their writing. However, it is legitimate to ask whether the Author, aware of these disproportions, should not consider proposing a different thematic division of the book. On the other hand, among the objections of a substantive nature, it is possible to indicate the author’s resignation from using the possibility of including all colored charts in the part devoted to research on social perception. It would be most advisable and would allow for a more transparent display of the material, but it remains only to guess that the “self-limiting” decision of the author and the publisher was certainly influenced by material arguments, resulting from a significant increase in publication costs in the case of reproducing colored illustrations in it.

However, the above critical remarks have no impact on the generally high, in the opinion of the writer, assessment of the reviewed item. Polish scientific literature relating to the issues of national security, but what should also be noted in political science, because health policy is undoubtedly one of them, was enriched with a very successful monograph; firmly anchored in the sources and the previous literature on the subject; presenting a less known and less studied, but extremely important and interesting aspect of the functioning of the state. The results of the research by M. J. Kuczabski presented and prepared by the author may serve as an indication of the direction of future transformations in the field of health security and health policy in relation to the Polish security system.

1. United Nations Development Program, Human Development Report 1994. http://hdr.undp.org/sites/default/ files/reports/255/hdr_1994_en_complete_nostats.pdf.
2. Hemmati A, Rahmani AM. Internet of Medical Things in the COVID-19 Era: A Systematic Literature Review. Sustainability. 2022; 14(19):12637. doi: 10.3390/su141912637.
3. Kuczabski MJ, Health Security Implications for National Security. Publishing House of the War Studies University, Warsaw 2022.
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5. Constitution of the Republic of Poland of 2nd April, 1997. As published in Dziennik Ustaw No. 78, item 483.
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