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Editorial
Adaptation with robustness: the case for clarity on the use of ‘resilience’ in health systems and global health
  1. Seye Abimbola1,2,
  2. Stephanie M Topp3,4
  1. 1School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  3. 3College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
  4. 4Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Seye Abimbola; Seye.Abimbola{at}sydney.edu.au

https://doi.org/10.1136/bmjgh-2018-000758

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    In the last 3 years, the concept of resilience has received much attention in the health systems and global health literature, triggered by the Ebola outbreak in West Africa (which, in 2014, exposed a lack of health system and global health resilience) and followed in 2016 by the Global Symposium on Health Systems Research (with the theme ‘Resilient and responsive health systems in a changing world’). Resilience has been widely embraced in the literature,1–5 and also by the immediate past6 and current7 WHO Director General. BMJ Global Health has also published several reports applying the concept of resilience to how health systems respond to acute shocks and chronic stress.8–10

    But there has also been persistent discomfort in the literature about the concept of resilience.11–13 While we find things to agree and disagree with in debates on and use of the concept of resilience by both its enthusiasts and critics, in our view, such debates and applications have been constrained by a lack of clarity on what resilience really means. The purpose of this editorial is therefore to propose a clear and intuitive definition of resilience that may inform future applications, and to ensure that future discussion and debates in the literature on what this concept brings to health systems and global health are based on a common understanding of the meaning of resilience.

    In the wake of the 2014–2016 Ebola outbreak, the global health governance system and the health systems in the three affected West African countries were described as vulnerable.2 In the face of acute shock, the global and national health systems lacked the reserves to draw on and so enable appropriate response to the outbreak. They lacked resilience. For us, resilience implies adaptability in a context of robustness.14 But only the first …

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