Beyond resilience (editorial)
Dear reader,
Resilience is the next “big thing” in global health and health systems development. It is a reaction to the impact of the Ebola epidemic in West Africa, the financial meltdown in the US and EU, and global climate change. The principle has been firmly anchored in the Sustainable Development Goals: “By 2030, build the resilience of the poor and those in vulnerable situations and reduce their exposure and vulnerability to climate-related extreme events and other economic, social and environmental shocks and disasters” (UN Sustainable Development Goals, target 1.5).
The term now also frequently appears in global health policies. “Resilient health systems” was the theme of this year’s World Health Assembly, but in the first meeting of the WHO Review Committee on the Role of the International Health Regulations in the Ebola Outbreak and Response in August, the concept was not mentioned. It also doesn’t appear in WHO DG Margaret Chan’s opening remarks to the Review Committee. On the other hand, the World Bank favors the resilience approach, and also the Rockefeller Foundation has developed much interest in resilient health systems. This is not surprising as its president Judith Rodin is the writer of the book “The Resilience Dividend”. The theme of next year’s 4th Global Symposium on Health Systems Research will be “resilient and responsive health systems for a changing world”.
I argue that we should distinguish between the resilience discourse as applied in complex adaptive systems, ecology and psychology and its use in normative, political, decision making for health systems. While the first is a useful method to assess the flexibility, responsiveness and shock-absorbing capacity of health systems there is much criticism of the resilience discourse by political scientists. One of those critiques is that the resilience discourse colonizes our political imagination. It hinders us to develop universal and strong systems based on the principles of health equity and to take action on the Social Determinants of Health. As resilience is mainly about anticipating a future crisis, we maintain the status quo. My analysis of the resilience approach to health systems is that it is a modern expression of the decades-old debate of selective versus complementary primary health care, and the political choices behind it. In a recent interesting political sciences article called “Exhausted by resilience” the authors even move beyond: “The real tragedy for us is the way the doctrine forces us to become active participants in our own de-politicisation… It promotes adaptability so that life may go on living despite experiencing certain destruction. Indeed 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. Yes, the doctrine of resilience at the level of policy and power is ubiquitous. And yet in terms of emancipating the political, it is already dead.”
The authors challenge its readers to a new imaginary for rethinking politics, emancipation and the formation of political communities in the twenty-first century. Applied to global health, this would mean a reformulation of what we consider being the necessary conditions for a meaningful, dignified, healthy life. The capability approach developed by Martha Nussbaum and Amartya Sen can guide us. Universal access to essential health services whether people live in high-, low- or middle-income countries would be a core element in this. Such a cosmopolitan approach will move us beyond the iron cage of the nation states we live in and the false security it brings.
Yes, it is a re-imagination of an alternative world order. But we can’t continue with the status quo where we continuously consume beyond Earth’s carrying capacity, global temperature is to rise, global financial markets are casinos beyond control, and refugee patterns are likely to continue. There is no other option than moving beyond the status quo and working on true alternatives for social justice and health. At the minimum, we have to move beyond resilience.
Remco van de Pas, ITM Antwerp
Member of the MMI Board
(In the meantime, a blog by MMI Executive Secretary Thomas Schwarz on resilient health systems has been published by Medicus Mundi Switzerland in German and French.)
MMI Network: Events and resources
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Network event: MMI, i+solutions, Cordaid
MMI Network meeting
The Hague, 7-8 October 2015
The internal MMI events will take place Wednesday 7 October (planning workshop in the afternoon) and Thursday morning (Extraordinary Assembly) at the Cordaid office in The Hague. After this, we are invited to participate in the jubilee symposium “innovation brainstorm” of i+solutions (by invitation only). If you have not received an invitation from i+solutions and are interested to participate in their symposium, please get in touch as soon as possible with the i+solutions secretariat.
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Network event: Medicus Mundi Switzerland
A challenge for Switzerland: Achieving health for all in a changing world
Basel, 28 October 2015
“The UN’s Sustainable Development Goals (SDGs) have changed the frame of reference for development policy worldwide. By applying a new strategy for international cooperation, Switzerland seeks to live up to SDG expectations. Will Switzerland be able to meet its responsibilities in a changing environment? What can it contribute to maximising health across all stages of life? This year’s MMS Symposium will analyse existing challenges and debate comprehensive approaches to strengthening health for all in this new phase.”
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Network event: Medicus Mundi Switzerland
Drug resistance: From mechanism to management
Basel, 10-11 December 2015
“Drug resistance is emerging globally as a major public health and economic problem. It is both urgent and highly complex, affecting key aspects of human and animal health as well as agriculture and the environment in many interconnected ways. Whether they target pathogens such as viruses, bacteria, parasites or their vectors, few drugs exist today, for which resistance has not already been documented. Join health professionals, researchers and students in a two-day multidisciplinary symposium bringing together national and international experts from a variety of fields to examine and discuss the central aspects of drug resistance, ranging from the molecular and evolutionary mechanisms of resistance to the clinical, epidemiological and economic implications.” Symposium of the Swiss TPH, a member of Medicus Mundi Switzerland.
> http://www.swisstph.ch/news-events/symposia/winter-symposium-2015.html
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Network conference documentation: medico international
Fit for Catastrophe?
Frankfurt a.M., 5-6 June 2015. On its 10th anniversary the foundation medico international wanted to have a critical look at the concept of resilience that in the past years emerged as a panacea against all kinds of crisis and problems that societies and individuals are facing nowadays. The symposium was mainly held in German. The remarkable input by Marc Neocleous on “Resisting Resilience.” is the only contribution currently available in English.
> https://www.medico.de/fit-fuer-die-katastrophe-15981/
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Network conference documentation: ACHAP
Global Conference on Religion and Sustainable Development affirms role of faith actors
Washington DC, 7-9 July 2015. “A highly significant conference brought together 130 attendees to discuss Religion and Sustainable Development. (…) The conference attracted a unique combination of policy makers, multilateral and bilateral agencies, religious leaders, development professionals from faith-based organisations and academics. The goals of the conference were to connect frontline policy makers to the evidence base and expertise to support more effective partnerships with religious and faith-based groups in the common cause of ending extreme poverty and promoting sustainable development.” MMI Network member ACHAP participated in this conference.
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Network reporting:
Annual Reports 2014
Two more MMI Network members have recently published their annual reports.