Investment and Efficiency in Global Health Security 2016-2021: A Modeling Study
1
Department of Global Health, School of Public Health, Peking University, Beijing, China
2
China Center for Health Development Studies, Peking University, Beijing, China
3
Institute for Global Health, Peking University, Beijing, China
4
Beijing Institute for Health Development, Peking University, Beijing, China
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
[Introduction] Global health security (GHS) is a core framework for addressing transnational threats. However, investment in GHS and its resource utilization efficiency remained unevaluated. This study systematically evaluates GHS investment and its efficiency to inform allocation strategies, particularly for low- and middle-income countries (LMICs). [Methods] We analysed 193 State Parties to the International Health Regulations (2005). Using multi-source datasets from WHO, the World Bank, and other agencies, we applied a Bayesian spatial Gaussian regression model to retrospectively estimate GHS investment during 2016–2021. Taking the State Party Self-Assessment Report (SPAR) index as output, we used three-stage data envelopment analysis (DEA) and Tobit regression to assess investment efficiency and its determinants. Subgroup analyses by World Bank income group examined macro-structural determinants and relationship between health workforce categories and technical efficiency. [Results] GHS investment rose modestly from US$2.27 to US$2.52 per capita, with marked regional and income-group disparities. Europe had the highest per-capita investment (US$6.60), whereas Africa and South-East Asia were lowest (US$0.61 and US$0.59). Meanwhile, overall technical efficiency declined from 74.21% to 63.76%, mainly due to the reduction of scale efficiency. LMICs were more efficient than high-income countries (HICs). In LMICs, higher GDP, population density, and urbanisation were associated with lower efficiency, whereas in HICs GDP was positively associated; population ageing was inversely associated with efficiency in both groups. Environmental health officers were positively associated with efficiency in LMICs, while in HICs psychologists showed positive and physicians and nursing personnel negative associations. [Conclusion] GHS investment remains modest and is often inefficiently translated into capacity, with substantial inequities across regions and income groups. Strengthening a supportive ecological health system is essential to improve returns on investment, in LMICs by prioritising environmental health workers and related public health functions, and in HICs by enhancing mental health services and their integration into health security frameworks.
[Introduction] Global health security (GHS) is a core framework for addressing transnational threats. However, investment in GHS and its resource utilization efficiency remained unevaluated. This study systematically evaluates GHS investment and its efficiency to inform allocation strategies, particularly for low- and middle-income countries (LMICs). [Methods] We analysed 193 State Parties to the International Health Regulations (2005). Using multi-source datasets from WHO, the World Bank, and other agencies, we applied a Bayesian spatial Gaussian regression model to retrospectively estimate GHS investment during 2016–2021. Taking the State Party Self-Assessment Report (SPAR) index as output, we used three-stage data envelopment analysis (DEA) and Tobit regression to assess investment efficiency and its determinants. Subgroup analyses by World Bank income group examined macro-structural determinants and relationship between health workforce categories and technical efficiency. [Results] GHS investment rose modestly from US$2.27 to US$2.52 per capita, with marked regional and income-group disparities. Europe had the highest per-capita investment (US$6.60), whereas Africa and South-East Asia were lowest (US$0.61 and US$0.59). Meanwhile, overall technical efficiency declined from 74.21% to 63.76%, mainly due to the reduction of scale efficiency. LMICs were more efficient than high-income countries (HICs). In LMICs, higher GDP, population density, and urbanisation were associated with lower efficiency, whereas in HICs GDP was positively associated; population ageing was inversely associated with efficiency in both groups. Environmental health officers were positively associated with efficiency in LMICs, while in HICs psychologists showed positive and physicians and nursing personnel negative associations. [Conclusion] GHS investment remains modest and is often inefficiently translated into capacity, with substantial inequities across regions and income groups. Strengthening a supportive ecological health system is essential to improve returns on investment, in LMICs by prioritising environmental health workers and related public health functions, and in HICs by enhancing mental health services and their integration into health security frameworks.
| eISSN: | 2654-1459 |
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