# Socioeconomic inequality and decomposition of core capacity in global health security: the role of health system

## TL;DR

This study shows that health system disparities are a major cause of inequality in global health security, suggesting that strengthening health systems can help achieve more equitable health outcomes.

## Contribution

The study introduces a novel decomposition method to quantify how health systems contribute to socioeconomic inequalities in global health security.

## Key findings

- Health system disparities were the leading cause of inequality in global health security capacities.
- From 2019 to 2021, economic status was the main driver of changes in health security inequality.
- Strengthening health systems, especially through universal health coverage, is critical for achieving equitable health security.

## Abstract

Core capacities in preparedness, detection, and response to health emergencies were fundamental to achieving health equity. However, evidence on the socioeconomic inequalities in country-level global health security (GHS) capacities remains limited, and the role of the health system in contributing to these disparities is insufficiently understood.

We assessed the socioeconomic inequalities in country-level GHS capacities and decomposed the role of health systems in shaping these inequalities by applying the GHS index and Joint External Evaluation. We conducted the decomposition based on a linear regression model with the determinants reflecting economic status, social development, and the health system. We also decomposed the changes in the concentration index (CI) using an Oaxaca-type decomposition.

Disparities in country-level health security capacities in response to health emergencies have been reported (CI = 0.143; P < 0.001). Economic status accounted for 44.639% of the total inequality, while social development accounted for −13.386%, and the health system for 67.454%. Disparity of the health system was the leading cause of inequality in health security capacity. From 2019 to 2021, economic status contributed to the change of inequality by 70.168%, social development by −62.544%, and the health system by −42.219%.

Our results emphasised the fundamental role of health system strengthening in improving health security. Strengthening health systems, particularly through the enhancement of the universal health coverage framework by recognising the interconnection between health systems and health security, offers a viable strategy for achieving equality-driven GHS goals.