Ewa Maria Marciniak
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Marciniak E.M., Health and society. Observations made when reading Mateusz J. Kuczabski’s book entitled Health Security. Implications for National Security, “Polish Journal of Political Science”, 2022, Vol. 8, Issue 4, pp. 62–73, DOI: 10.58183/pjps.04052022.
ABSTRACT
The article refers to Mateusz J. Kuczabski’s research presented in the book entitled “Health Security. Implications for National Security”. First, the article describes the contexts of research taken up by M.J. Kuczabski. Second, it presents and analyses the assumptions and organisation of the book under review. Third, it outlines further directions of research mapped out by the monograph. The paper fits into the area of research of security, politics and health studies.
Keywords: Poland’s national security, health security, Mateusz J. Kuczabski, human security
Introduction
Security has been unceasingly a subject of numerous scientific explorations, which on one hand makes this research area very dynamic, reaching out to ever new research fields, though still theoretically and methodologically coherent, on the other. This coherence, so important when we speak about a relatively new field of study, is effectively supported by the intellectual technique represented by researchers, which neutralises potential distractors the newly emerging disciplines are particularly sensitive to. It should be noted that the security studies somehow integrate the categorical apparatus and cognitive procedures from the disciplines which in the systematics of science in Poland explored the matters of security, security systems at various levels, including military and extra-military security. In such context, the problem of health security appears as another area of research within the security studies, which should be treated as extremely significant or even fundamental not only because of the development of science, but also with a view to the pragmatic or utilitarian aspect. In the case of health security, the de lege ferenda conclusions are of key importance for public policies carried out by the state.
Considering all of the above, worthy of due noting is the research conducted by Mateusz J. Kuczabski, presented in the book “Health security. Implications for national security”, Wydawnictwo Akademii Sztuki Wojennej, Warszawa 2022, ISBN 978-83-8263-306-1, pp. 392.[1]
The analysis
This monograph discusses the analysis of the effects of the relationship between health security and national security. It should be noted that this issues ever more often becomes subject of academic reflection.[2] The COVID-19 pandemic turned out as an important impulse for the research – frequently very detailed and mapping out new areas of systematic cognition.[3] The complexity of the indicated issues and phenomena, especially in the area of health security, and their permanent topicality have become a prerequisite for undertaking more in-depth exploration in this regard by the Author. It should be noted that the monographs fits into the hitherto area of M.J. Kuczabski’s research concerning issues associated with life quality,[4] social adjustment and the impact of ICT on human health[5] in the broad context of building social resilience.[6]
The book under review fills a significant cognitive gap since despite availability of extensive foreign and domestic literature on health security it is hard to find clear-cut descriptions and defnitions of this phenomenon. No potentially useful distinction between “health and security”, “health protection system”, healthcare system” and “health security” has been yet worked out in the available literature on the subject. As noted by M.J. Kuczabski, in this context, terminological ambiguity has originated from very divergent views, policy priorities of governments, emergence of various public health programmes, as well as the fact that the problems associated with the concept of health security occur as if at the crossroads of many scientific domains or disciplines. What is interesting is that the Author notes significant discrepancies as regards the comprehension and applications of the notion of health security existing even in UN agencies, e.g. between the United Nations Development Programme (UNDP)[7] and the World Health Organisation (WHO).
The monograph – preceded by an introduction (outlining a justification for the choice of the problem and the methodology of research, which characterises the structure of the book and its source base) and summarised with a conclusion – has been made up, according to the problem key, from two basic parts which place M.J. Kuczabski’s reflections in two research currents. The first current consists of theoretical considerations aimed at enriching the knowledge that exists with respect to the subject of research from the viewpoint of the health security functioning conditions. The second current of M.J. Kuczabski’s cognitive quests includes empirical studies, which he devoted to social perception of threats arising from the pandemic and the conditions for its elimination. What is important is that M.J. Kuczabski’s social surveys showed that there was high susceptibility of people to the threats arising from the pandemic, both the current one and those whose consequences would turn out in the future. The respondents revealed in their answers what they were afraid of, which phenomena arouse fears and which arouse only irritation, what they feared, at the same time indicating their attitude to the effectiveness of epidemic management, to the restrictions and bans. The emotions that were revealed reflected a low level of senses health security, which is by no means a surprise. On the other hand, the analysis of assessments and emotions performed by the Author reveals social needs in the area of health security, which should form a basis for the health policy of the state. In particular, that the pandemic and how the emergency had been managed revealed the dysfunction of crisis management in the health security system, thus lowering its standard.
In his work, M.J. Kuczabski extensively discusses the set of fundamental assumptions concerning the theory of a health security system. The data obtained from the preliminary appraisal of the consequences of the pandemic have been complemented with the research on the resilience of the health security system on the basis of its public assessment. The conclusions from the theoretical study, from the diagnoses and observations, as well as explorations of various areas of security make M.J. Kuczabski claim that for the national security management system in particular there is a need for systemic studies carried out by transdisciplinary teams as regards social security given the challenges experienced by the entire world in connection with the COVID-19 pandemic. This is not the sole challenge and threat to contemporary health security systems as the Author foresees consequences of other great threats, such as the climate change and migrations, as well as the escalation of Russia-Ukraine conflict.
In the literature on the subject, M.J. Kuczabski discerns three basic concepts of research:
- Priority treatment of health security over healthcare systems.
- Treatment of health security as exceptional, focusing on critical crisis situations.
- Conceptualisation of health security as “state security” rather than “people’s security” or health of the population.
Theoretical and social studies make M.J. Kuczabski draw the following conclusions:
– The relationship between health and security has become a dominant issue in health policies over the last two decades.
– Studies on health security differ by the levels of analysis from global to domestic; moreover, the differences concern adoptability of what may be considered as a threat to security in the process of health securitisation.
– Health securitisation has gone beyond the rhetorical tool; at present, it covers direct involvement of the security sector, the military and the defence. The concept of health security has been expanded so that that many health problems are construed as a threat to health security also in the case of problems that have nothing to do with health.
– Practical links between healthcare (health protection) systems and health security are historically justified, though conceptual links between those areas remain poorly defined and investigated – they form a research gap that is significant for exploration in security studies.
– The need to eliminated the cognitive gap becomes more significant in view of the consequences of the COVID-19 pandemic since it has revealed a key relationship between the capabilities of a healthcare (health protection) system and an effective response in the area of health security (mobilisation of additional efforts and means from outside the health protection system).
– Significant changes are taking place in global health security, which consist in expanding the activities of military entities; a growth of very real threats to people who become engaged in health security work (missions) is observed
Mateusz J. Kuczabski stresses that that there are few propositions for concrete methods to rationalise the healthcare system and its components that could enhance long-term health security. Modelling of a health protection and health security system is but another area for exploration in security studies. The concept of health security as a sector of internal security has not been yet univocally specified. From the idea of human security, which manifests itself, inter alia, by ensuring health security – which the Author noted already in the monograph The humanist aspects of security[8] – it follows that as a separate theoretical category it still requires needs further specification, especially as regards the cognitive values of this category, which in the Author’s opinion constitutes another area of exploration in security studies. In his research, M.J. Kuczabski recommends creation of a concept of a health security analysis, which would provide space for assessment of the key explicit and implicit characteristics as a set of parameters used for evaluating health security of a state and assessments of its social policy. M.J. Kuczabski shows that the essence of the government policy covering public health was adopted in Polish strategic documents quite recently, linking the problems of health security with the security of the state. The Author notes that global health security is also expressed in the need to ensure adequate conditions for the health of soldiers as well as the people in war zones. It also covers military security and defence operations,[9] crisis response operations[10] and humanitarian operations.[11] As regards health security, the implemented measures are linked with such objectives as: protection of the population, prevention of humanitarian disasters, responding to situations violating human rights,[12] the consequences of which are frequently of such nature that directly touches upon the health category.
As M.J. Kuczabski notes: In the crisis situations associated with public health, of importance are resilient healthcare systems, i.e. such that are capable of responding flexibly to difficult situations, and are also able to adapt, which means they a able to learn from past experiences and adjust themselves to future challenges. Transformation capabilities mean the aptitudes to set up organisations and institutions supporting the building of social resilience to future crises. M.J. Kuczbski’s analysis of the management processes during the pandemic showed that the reason for their limited effectiveness was the scattered character of healthcare management, which impeded coordination at the level of the system, the dysfunctional information system (susceptibility to disinformation), no coordinated efforts as regards the creation and functioning of healthcare institutions, no coordination of patient care, the resources of the system that were insufficient or inadequate for current and future health needs of the populations.
There are several recommendations arising from the analysis of the early effects of the pandemic, which – as M.J. Kuczabski stressed – should be taken into account for the elaboration of laws necessary for the situation of a pandemic, since the currently applicable law on infectious diseases contains too many provisions that allow for imposing extensive restrictions of freedoms and rights; at the moment of the greatest intensity of coronavirus infections the Polish health service was at times inefficient; the struggle against the epidemic adversely affected the protection of the right to life and health of those who suffered from other disorders. On this basis, the Author recommends that the amendment of the law on infectious diseases should provide for a clear and constitutionally compliant specification of the permissible limits for restrictions of freedoms and rights under the state of epidemic as well as in the situations of epidemic emergency. In M.J. Kuczbski’s opinion, health security should be appraised on the basis of a monitoring system expanded with a set of indicators dedicated for the areas that determine the level of health security, thus creating a complex index of the efficiency of the health security system. There is a need to consolidate so-called health competences in the society, understood as the ability to utilise technological support as regards health information and services; the competences with respect to personal health, i.e. self-awareness of the value of health. Therefore, as regards raising individual and social resilience, including instruction at each educational level (educational programmes and social campaigns) a permanent change of behaviours is needed. An important conclusion seems to be the proposal to introduce “health security” classes into the school and university curricula. M.J. Kuczabski notes that interventions in the area of public health aimed at raising health security should include efforts in the following three areas: organisational, informational and medical. In the first one, in order to preserve organisational safety of the health protection system, it is necessary to specify – through separate dedicated procedures – concrete solutions; there needs to be certainty as to the guidelines for proceedings, coordination of individual efforts, including support systems for containment of the effects of any crisis generating phenomenon, including a pandemic. In the informational area – an extremely important thing during a pandemic is to adjust and supplement the form of information message to the perception abilities of the audience, not to generate contradictory messages; there is a need to base the information message on the opinions of scientists not only from medical professions, but also other fields, e.g. social communication, social psychology, psychiatry, economics, pedagogy. The information message effects a change of social moods and behaviours, stimulates emotions,[13] incites or alleviates panic,[14] which in turn is extremely important for maintaining psychological security.[15] A reliable message that does not aggravate fear creates the environment of the reality. Finally, as regards the medical dimension, it boils down to offering medical services that comply with the standards, comforting and giving professional and reliable advice.
Of special value for the security studies seems to be M.J. Kuczabski’s proposal to focus the inquiries on three research areas in the context of state security, which defines health as a strategic category, namely:
– Health of the society (demographic context).
– Health as an objective per se (one of the dimensions of national interest, desirable value, social and intellectual capital).
– Health as a strategic asset (a factor of the national strategic potential, e.g. mobilisation resources for the military, social resilience).
Other problems which in M.J. Kuczbski’s opinion should be reflected by research in the security studies include:
– investigating the relations of the politicians, the media and the society under the pandemic condition, in a situation of emergency and prevention of infectious diseases,
– investigating the problems of systemic resilience of the state,
– investigating the relationships between building people’s prosperity, stability of the state and health security,
– transdisciplinary, multidisciplinary investigation of the consequences of the pandemic,
– a comprehensive systemic analysis of the investigation of the consequences of the pandemic,
– investigation of systemic resilience, sensitivity and susceptibility of the health security system to threats,
– investigation of the conditions, threats and challenges for the development processes of health security,
– investigation of the effect of various types of crises on the level of health security,
– investigation of social assessment of the level of health security and its correlation with national security,
– investigation of organisational and functional structures in order to optimise management of the health security system,
– investigation of the problems of the area associated with rescue and medical operations of uniformed services,
– analysis of the principle of cooperation of the health security system entities,
– investigation of state security in the face of extraordinary threats,
– investigation of the flexibility of adjustment of health security systems to health emergency situations,
– investigation of the effectiveness and efficiency of health security subsystems,
– investigation of the social valuation of technologies for the needs of health security,
– investigation of information security of the health sector,
– investigation of cybersecurity of the infrastructure of health protection systems.
M.J. Kuczabski believes that in the future it will be necessary to change the approach to health protection – understood as a necessary precondition for the socio-economic development of the country and ensuring national security, treating health protection and health security of the citi zens as an investment for the future,[16] and finally building systemic and social resilience basing. In the conclusion of his book M.J. Kuczabski acknowledges that the publication constitutes an important contribution to the development of security studies (and I as a reviewer share this conclusion) since:
- It explains the causes and phenomena that have influences the processes of the contemporary perception of security and health within the category of health security.
- It shows changes in the area of health security at the global level and its effect on the domestic health security system, and prospectively on national security.
- It shows the specificity of a health crisis situation, when it becomes necessary to use special means as well as systems of security, the military and defence.
- It presents the problems of security and health security in dual, substantively complementary types of research: theoretical and empirical.
- It effects a rational transfer of knowledge from the area of research of health security and contemporary research methods to the discipline of security studies, indicating prospective problem areas for further research in the field of security studies.
The obvious merits of M.J. Kuczabski’s monograph include: the logical structure of the argument; the narration of the Author, who skilfully combines the presentation of interesting facts and processes with his own opinions and assessment as well as aptly selected quotations harmoniously entwined into the text and illustrating the scientific argument. The high level of the Author’s penmanship is manifested inter alia in the correctly, legibly and transparently arranged footnotes and references as well as the abundand bibliography. Worthy of praise is also M.J. Kuczabski’s care for equipping the book with interesting annexes closely linked to its contents. They constitute a necessary supplement to the narration, presenting those aspects of health security which have not been subject to an in-depth reflection in the main body of the monograph. A proof of M.J. Kuczabski’s scientific reliability is also a broad base of sources and literature on the subject, which includes over 700 items and which underlies the Author’s reflections and conclusions. The above numerous arguments unequivocally speak in favour of the considerable scientific and cognitive value of the reviewed publication, though they do not mean that it is absolutely free from defects – both structural and of a substantive nature. The former includes undoubtedly the disproportionate volume of two main parts of the monograph. Insofar as the first one comprises five chapters, the other has only one. Clearly those differences are due to their subject, and thus the volume of the material (sources and literature) on the basis of which they have been written. However, a question may be justifiably asked whether the Author, being aware of those disproportions, should not contemplate proposing another thematic division of the book. In turn, as regards charges of a substantive nature, pointed out may be the fact that the Author has waived the possibility of inserting all diagrams in the part devoted to social perception. It would be most welcome and would allow for a more transparent presentation of the material.
Conclusion
The remarks presented herein have no effect on the generally high – in my opinion – assessment of the book under review. The Polish scientific literature on national security, though – it must be noted – also politological issues, health policy being undoubtedly one of, has been enriched with a very fine monograph, soundly anchored in the sources and hitherto literature on the subject, presenting a less known and less often investigated though extremely important and interesting aspect of the functioning of the state. The results of M.J. Kuczbski’s research presented, analysed and synthesised herein, may serve as an indication of the direction for future transformations in the area of health security and health policy within the Polish system of security. Detailed and interdisciplinary studies in this area are by all means necessary.[17] Therefore, apart from the cognitive dimension (filling the gap regarding the subject of research), the book has a considerable utilitarian value, which is very significant from the viewpoint of the times in which we live.
References
[1] M.J. Kuczabski, Bezpieczeństwo zdrowotne Implikacje dla bezpieczeństwa narodowego, Wydawnictwo Akademii Sztuki Wojennej 2022.
[2] F.M. Szymanski, C. Smuniewski, A.E. Platek, Will the COVID-19 Pandemic Change National Security and Healthcare in the Spectrum of Cardiovascular Disease?, “Current Problems in Cardiology”, 2020, 45 (9), pp. 1–9. DOI: 10.1016/j.cpcardiol.2020.100645.
[3] See: P. Kępski, Społeczny wymiar pandemii. Biopolityka i medykalizacja w czasach pandemii COVID-19, “Przegląd Socjologiczny”, 2022, 71 (3), pp. 79–97. DOI: 10.26485/PS/2022/71.3/4; E. Marciniak, Ocena zdrowia i stanu psychicznego Polaków, in: Pomiędzy pandemią Covid-19 a wojną w Ukrainie. Diagnoza stanu polskiego społeczeństwa, ed. R.M. Staniszewski, Wydawnictwo ToC 2022, pp. 121–134; C. Smuniewski, Praktyki religijne, in: Pomiędzy pandemią Covid-19 a wojną w Ukrainie. Diagnoza stanu polskiego społeczeństwa, ed. R.M. Staniszewski, Wydawnictwo ToC 2022, pp. 105–120; C. Smuniewski, M. Składanowski, Ł. Przepiórka, The contribution of the Roman Catholic Church in Poland to creating health security at the beginning of the SARS-CoV-2 pandemic, “Polish Journal of Political Science”, 2020, Volume 6, Issue 2, pp. 91–127.
[4] M.J. Kuczabski, Medyczne determinanty jakości życia, in: Bezpieczeństwo obywateli RP jako czynnik jakości życia, eds. H. Świeboda, P. Sienkiewicz, AON 2009, pp. 35–56.
[5] M.J. Kuczabski, Cyfrowe technologie uzależniające a bezpieczeństwo państwa, in: Problemy bezpieczeństwa wobec współczesnych zagrożeń, ed. M.J. Kuczabski, ASzWoj 2021, pp. 169–198. [6] M.J. Kuczabski, Fake News as a Threat to Social Resilience, “European Research Studies Journal”, 2022, Volume XXV, Issue 1, pp. 765–782. DOI: 10.35808/ersj/2886.
[7] Human Development Report 1994: New Dimensions of Human Security, https://hdr.undp.org/system/files/documents/hdr1994encompletenostatspdf.pdf, (access 01.09.2022)
[8] M.J. Kuczabski, Bezpieczeństwo psychiczne jednostki jako podstawa humanistycznego podejścia do bezpieczeństwa narodowego, in: Humanistyczne aspekty bezpieczeństwa, ed. K. Drabik, Wydawnictwo Akademii Sztuki Wojennej 2020, pp. 255–275.
[9] Under the Treaty on European Union, UN, NATO.
[10] E.g. the largest NATO mission established in 1999, which is also a good example of cooperation with the EU.
[11] Broadly on the mission in the publication: K. Zajączkowski, Misje cywilne i operacje wojskowe unii europejskiej w perspektywie wybranych teorii stosunków międzynarodowych i integracji europejskiej, Centrum Europejskie Uniwersytetu Warszawskiego, Oficyna Wydawnicza ASPRA-JR 2021. More in: M. Marszałek, Operacje wsparcia i pokoju. Geneza. Stan aktualny. Perspektywy, ASzWoj 2021.
[12] The Polish Armed Forces have been taking part in international missions since 1953. Since then, over 120 000 troops and military personnel have participated in 89 operations. As an active participant in international relations Poland makes its contribution to the consolidation of international peace and security. See: Missions of the Polish Armed Forces, https://www.gov.pl/web/obrona-narodowa/misje, (access 01.09.2022).
[13] And what follows – indirectly influencing decisions of the electorate. After: M. Bartoszewicz, Rama interpretacyjna “pandemii COVID-19” a wybrane zasady propagandy politycznej – propozycja zestawienia zakresu użyteczności, “Acta Politica Polonica”, 2020, No. 2 (50), pp. 65–74. DOI: 10.18276/ap.2020.50-06.
[14] The effect of the information message on the society is confirmed by research, e.g. M.J. Kuczabski, Fake News as…, op. cit., pp. 765–782.
[15] E. Marciniak, Psychologiczne aspekty poczucia bezpieczeństwa, in: Bezpieczeństwo wewnętrzne państwa. Wybrane zagadnienia, eds. S. Sulowski, M. Brzeziński, Elipsa 2009, pp. 56–65.
[16] The view expressed by Professor Gielerak: Prof. Gielerak: ochrona zdrowia nie jest wyłącznie kosztem. To koło zamachowe gospodarki, https://www.rynekzdrowia.pl/Polityka-zdrowotna/Prof-Gielerak-ochrona-zdrowia-nie-jest-wylacznie-kosztem-To-kolo-zamachowe-gospodarki,233024,14.html, (access 01.09.2022).
[17] C. Smuniewski, K.P. Kądzielski, The City, NGOs and COVID-19. Non-governmental organisations in Warsaw and the new horizons of societal security during the pandemic (research concept), “Polish Journal of Political Science”, 2022, Vol. 8, Issue 1, pp. 50–64. DOI: 10.58183/ pjps.01102022.