Witter, Sophie, Thomas, Steve, Topp, Stephanie, Barasa, Edwine, Chopra, Mickey, Cobos, Daniel, Blanchet, Karl, Teddy, Gina, Atun, Rifat, and Ager, Alistair (2023) Health system resilience: a critical review and reconceptualisation. The Lancet Global Health, 11 (9). e1454-e1458.

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Abstract

This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and—as amply shown during the COVID-19 pandemic—relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities—what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance.

Item ID:	79922
Item Type:	Article (Scholarly Work)
ISSN:	2214-109X
Copyright Information:	© 2023 The Author(s). Published by Elsevier Ltd.
Date Deposited:	16 Aug 2023 00:30
FoR Codes:	42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 50% 44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 25% 44 HUMAN SOCIETY > 4408 Political science > 440899 Political science not elsewhere classified @ 25%
SEO Codes:	28 EXPANDING KNOWLEDGE > 2801 Expanding knowledge > 280112 Expanding knowledge in the health sciences @ 50% 20 HEALTH > 2002 Evaluation of health and support services > 200206 Health system performance (incl. effectiveness of programs) @ 50%
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