Exhausted by resilience: response to the commentaries

Evans, Brad; Reid, Julian

doi:10.1080/21693293.2015.1022991

Cited by 51 publications

(25 citation statements)

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“…Global health discourse and action appears biased in favour of hardware—building resilience is sometimes seen as demanding more money, more health workers, more hospitals, better surveillance systems (Oxfam 2015). This hardware bias has perhaps contributed to the criticism that health resilience thinking adopts the view that system actors are naïve, and neutral players, without political interests or influence (MacKinnon and Derickson 2013; Evans and Reid 2015). Applied this way, the concept is unable to capture actors’ power and agency (Béné et al 2012).…”

Section: Resilient Health Systems Have Well-matched Combinations Of Hmentioning

confidence: 99%

“…Another criticism of resilience as a concept is that is focuses attention on the anticipation of future crises, ensuring that the status quo is maintained (Evans and Reid 2013, 2015; Topp et al 2016). This criticism is warranted to the extent that resilience is conceptualized in the narrow ‘bouncing back’ engineering sense.…”

Section: Resilience Should Not Incentivize Inaction and Preserve Statmentioning

confidence: 99%

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From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening

Barasa

Cloete²,

Gilson

2017

Health Policy and Planning

181

159

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Recent health system shocks such as the Ebola disease outbreak have focused global health attention on the notion of resilient health systems. In this commentary, we reflect on the current framing of the concept of resilience in health systems discourse and propose a reframing. Specifically, we propose that: (1) in addition to sudden shocks, health systems face the ongoing strain of multiple factors. Health systems need the capacity to continue to deliver services of good quality and respond effectively to wider health challenges. We call this capacity everyday resilience; (2) health system resilience entails more than bouncing back from shock. In complex adaptive systems (CAS), resilience emerges from a combination of absorptive, adaptive and transformative strategies; (3) nurturing the resilience of health systems requires understanding health systems as comprising not only hardware elements (such as finances and infrastructure), but also software elements (such as leadership capacity, power relations, values and appropriate organizational culture). We also reflect on current criticisms of the concept of resilient health systems, such as that it assumes that systems are apolitical, ignoring actor agency, promoting inaction, and requiring that we accept and embrace vulnerability, rather than strive for stronger and more responsive systems. We observe that these criticisms are warranted to the extent that they refer to notions of resilience that are mismatched with the reality of health systems as CAS. We argue that the observed weaknesses of resilience thinking can be addressed by reframing and applying a resilience lens that is better suited to the attributes of health systems as CAS.Keywords: Health system resilience, complex adaptive systems, everyday resilience Key Messages• The concept of resilience can provide a useful framework for health systems strengthening, if it is reframed to align with the attributes of health systems as complex adaptive systems.• The resilience of health systems is an emergent property that results from the combination of absorptive, adaptive and transformative strategies applied within the system. These strategies are underpinned by cognitive, behavioural and contextual capacities.• Resilience is about (1) everyday resilience, not simply responses to sudden shocks, (2) health system software, not only its hardware and (3) creative adaptation, and transformation, rather than simply bouncing back.

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Section: Resilient Health Systems Have Well-matched Combinations Of Hmentioning

confidence: 99%

Section: Resilience Should Not Incentivize Inaction and Preserve Statmentioning

confidence: 99%

From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening

Barasa

Cloete²,

Gilson

2017

Health Policy and Planning

181

159

View full text Add to dashboard Cite

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“…Nature, minds, humans, nonhumans, and the earth are open and exposed to the environment and towards other beings, nonbeings and systems. In addition to vulnerability, other concepts like precariosity, fragility, risk, and resilience are also taken up in the discussions (Butler 2009;Fineman 2008;Sen 1982;Douglas 1966;Evans and Reid 2015;Brunila and Rossi 2018). The concept of resilience has outlined over the past two decades the conceptual background that makes comprehensible the important cluster of their mutual relationships.…”

Section: Introductionmentioning

confidence: 99%

Guest Editor's Introduction

Honkasalo

2019

Suomen Antropologi

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This introduction provides an analytical back ground for the notion of vulnerability as it is currently perceived mainly in social sciences, ethics, philosophy, queer studies and governmentality. Used both as descriptive and normative term, vulnerability, along with resilience and policy management, has acquired political dimensions, which are distant from those given by the philosophers Hannah Arendt and Emmanuel Levinas. In present day social and political discussions vulnerability has gained enormous popularity and seems to be a genuine 'sticky concept', an adhesive cluster of heterogeneous conceptual elements. Keywords: vulnerability, resilience, governmentality, intersectionality, racism, queer, vulnerable agency, sticky concept

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“…Evans and Reid note: “The real tragedy for us is the way the (resilience) doctrine forces us to become active participants in our own de-politicisation… it even demands a certain exposure to the threat before its occurrence so that we can be better prepared. Resilience as such appears to be a form of immunization.” 41 By internalizing resilience as the main principle of dealing with insecurity, it becomes part of self-policing. Neocleous concludes “In so doing resilience shapes our political imagination and thereby cuts off alternate political possibilities.” 42 This includes cutting of the moral imagination (the ability to imagine oneself in the shoes of others) that can enable to alter one’s outlook and actions significantly.…”

Section: The Status Quo Of Resilience and Multi-stakeholder Governancmentioning

confidence: 99%

Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism Comment on "Health Promotion in an Age of Normative Equity and Rampant Inequality"

Pas

2016

Int J Health Policy Manag

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There has been much reflection on the need for a new understanding of global health and the urgency of a paradigm shift to address global health issues. A crucial question is whether this is still possible in current modes of global governance based on capitalist values. Four reflections are provided. (1) Ecological –centered values must become central in any future global health framework. (2) The objectives of ‘sustainability’ and ‘economic growth’ present a profound contradiction. (3) The resilience discourse maintains a gridlock in the functioning of the global health system. (4) The legitimacy of multi-stakeholder governance arrangements in global health requires urgent attention. A dual track approach is suggested. It must be aimed to transform capitalism into something better for global health while in parallel there is an urgent need to imagine a future and pathways to a different world order rooted in the principles of social justice, protecting the commons and a central role for the preservation of ecology.

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Exhausted by resilience: response to the commentaries

Cited by 51 publications

References 0 publications

From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening

From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening

Guest Editor's Introduction

Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism Comment on "Health Promotion in an Age of Normative Equity and Rampant Inequality"

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