Written by Steve Thomas

Steve Thomas is an editor of The Elgar Handbook of Health System Resilience which investigates the scope health system resilience research across the globe, contrasting theories and perspectives, comparing case studies of shocks and drawing learning for the future.

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There is much potency internationally in understanding how to steer a health system through a crisis. The COVID-19 pandemic was estimated to cause the death of well over 100,000 health workers in its first year. It brought unprecedented health system burden in terms of the extra demands of detecting, containing, treating and eventually vaccinating against the disease. It also crowded out the delivery of normal care. It lives large, not only in long-COVID but in population mental health, the burn-out of health workers, pent-up demand for care, long waiting lists and increased technology in health care delivery. It has transformed lifestyles for whole populations. More recently, the cost of living crisis caused by supply chain disruptions, and fuelled by price hikes of fossil fuels and the impact of wars, has challenged the affordability of health care for many households and squeezed already burdened health workers financially. Add the looming effects of the climate crisis – hurricanes, floods, heat and drought  – and it is no wonder that terms such as permacrisis (one shock after another) and polycrisis (multiple shocks at once) have taken hold.

In such an unstable environment and uncertain future the importance of health system resilience would seem to be paramount: the ability to navigate a health system through shocks while preserving access to and delivery of good quality care. Yet analysts are only now coming to terms with the key elements of the concept, the methods with which to measure and analyse it and the effective strategies for governments to pursue.

Part of the problem is that the study of health system resilience is immature, barely a decade old. It is still being worked out. A key dilemma is it is an apparently conservative concept – the preservation of what we have come to expect in health system performance. Nevertheless, the problem with conservation is that it may consolidate the inefficiencies, inequalities and general poor performance of health systems. Furthermore, seeking to ensure that the health system gets through a crisis without collapsing may result in an expedient or malign form of resilience that throws the responsibility onto health workers without support, or denies some patients services that are critically needed (at least in the short run). We must therefore be careful in how we define and measure health system resilience to ensure that potential abuses of power and equity are prevented.

It is hoped that the fruits of effective research on health system resilience can be impactful and lasting. The careful analysis of shocks and their impact highlights the vulnerabilities and invites strategies to protect our nurses and doctors, to deploy finances quickly to where they are needed and to build information systems that allow for fast and effective government responses. Furthermore, the detailed analysis of decision-making in the midst of shocks can also highlight good practices: effective linkages, communication channels and processes that work to help build capacity so that we are well-rehearsed for the future. In-depth analysis of governance can also hold to account those who may seek to subvert a crisis response for their own means, something that both COVID 19 and previous shocks have done. There is significant potential for positive transformation of health systems in crisis, and true health system resilience often means moving beyond conservation to radical change – putting in place much needed reform by utilising the opportunity that a crisis can afford.

While there is rich potential for health system resilience to be an effective tool for change, there is also the potential for researchers to get stuck in silo thinking and to fail to look outside their own preferred world view. However, the world may be rightly impatient of such academic tribalism as the next decade promises more extreme climate shocks alongside war, migration and other emergencies. There is still much to work do to meet the challenge of guaranteeing better access to better healthcare in all circumstances. To build health system resilience research, both academic and practical – must be a priority.

Handbook of Health System Resilience

Edited by Steve Thomas, Edward Kennedy Professor of Health Policy and Management and Padraic Fleming, Research Fellow, Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Ireland

Find more information on this title here.
Read the introduction for free on Elgaronline.