What is resilience and why does it matter for small countries?
Today, resilience has become a sort of buzzword in academia as well as in a wide range of policy contexts. Many people at all levels speak about resilience, often incorrectly and/or without defining it. Despite some differences, there is agreement in the scientific literature that resilience is related to processes and skills that influence good individual and community health outcomes, in spite of negative events, serious threats and hazards.
Strengthening individual and community resilience requires the availability and development of supportive environments for population health and well-being. Supportive environments are instrumental to building resilience and population health outcomes, as explained in the WHO’s Health 2020 policy framework (within its priority area 4).
“In this sense supportive environments are a pre-requisite for strengthening resilience,” stated Dr Erio Ziglio, former Head of the WHO European Office for Investment for Health and Development (Venice), and author of the upcoming WHO Regional Office for Europe publication entitled “The importance of building resilience and supportive environments in implementing Health 2020 and the SDGs”. The report is part of a series of publications created within the framework of the WHO Europe Small Countries Initiative.
The presence of supportive environments offers people protection from factors that can threaten their health; they are basic conditions to ensure that individual and population health are protected and promoted, despite various threats and hazards. Supportive environments enable people to expand their capabilities and capacity for self-reliance, and are critical for strengthening individual and community resilience.
“A fundamental thing to remember is that resilience is not a kind of given personal and unmodifiable characteristic one is born with. Rather, resilience is a developmental process that can be strengthened over time and circumstances,” the author explains. People could have the capacity to absorb a crisis, bad news or adverse events – and in this sense health systems should support them in this process – but they could also have the capacity to adapt and anticipate bad consequences from a health-threatening situation. We also speak of the capacity of an organization (e.g. an operational part of the health system) to transform itself when it becomes obsolete and is no longer able to meet effectively the needs of the population it serves. These capacities are further described as anticipatory, absorptive, adaptive, anticipatory and transformative resilience, but any of them is a type of resilience. “Resilience is a broader concept,” the author adds, “not only a reaction, but rather the sum of all the efforts made to strengthen the context where people live and cope with life.”
The report argues that resilience should be strengthened at 3 levels: individual, community and system or societal level. This means that interventions aiming to strengthen resilience are more effective when supported by protective and promotive environments for population health and well-being, whereby all these 3 levels are considered.
Report states it is worth noting that “resilience has a very prominent role basically in all the Sustainable Development Goals”. Thus, within the SDGs the process of strengthening resilience is related to the effort to tackle health and social inequities. This, the author adds, is “totally in line with the strategic objectives embodied in Heath 2020”. Since resilience is not something genetic, but rather the result of a process and policy decisions, the ultimate goal for society and government is to ensure no-one is left behind – as one of the main buzzwords of the 2030 Agenda has so effectively put forward.
Strengthening resilience is one of the principal topics of discussion and exchange during the next High-Level Meeting of Small Countries in Malta in June 2017. Small countries are often examples of both resilience and vulnerability. Resilience is associated with the future of countries with small populations in order to tackle their vulnerabilities in terms of human resources and other social and economic parameters.
The report on building resilience and supportive environments also describes on-the-ground experiences of strengthening resilience in Iceland, in the area of prevention of re-traumatization and re-victimization of child abuse victims; in Malta, in terms of reducing vulnerability of health workforce; and in San Marino, in developing a supportive multi-level infrastructure to meet the human rights of disabled children and their families. These country experiences are analysed as inspirational examples of strengthening resilience and developing supportive environments for population health and well-being.
In conclusion, the report provides a much-needed review of the scientific literature related to resilience and its definition. It describes the practical reasons for and the scientific evidence behind the rationale of strengthening community resilience and developing supportive environments in the context of Health 2020. It explains why strengthening resilience is so crucial in national and subnational efforts to align policies and reforms towards Health 2020 and the SDGs.
