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Governance in the age of complexity: building resilience to COVID-19 and future pandemics

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This policy brief aims to promote a holistic mindset about the COVID-19 pandemic by 1) applying a complexity lens to understand its drivers, nature, and impact, 2) proposing actions to build resilient societies to pandemics, and 3) deriving principles to govern complex systemic crises. Building resilience to prevent, react to, and recover from systemic shocks need to become a core foundation of how societies are governed. This requires an integrated approach between health, social, economic, environmental, and institutional systems. The brief has been developed by a team of researchers coming from both the natural and social sciences. Reviewed by a group of policy actors, the brief aims to foster a dialogue between academic institutions and policymakers.
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... Based on the workshop discussions and the diverse experiences of the participants, we propose a research agenda for health system resilience that embraces complexity and recognises the embedding of health intrarelated systems in the broader sociocultural, economic and political environment. 18 Below, we offer five key research areas for health systems resilience and discuss approaches to implementing resilience research. ...
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Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.
... Based on the workshop discussions and the diverse experiences of the participants, we propose a research agenda for health system resilience that embraces complexity and recognises the embedding of health intrarelated systems in the broader sociocultural, economic and political environment. 18 Below, we offer five key research areas for health systems resilience and discuss approaches to implementing resilience research. ...
Article
Full-text available
Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ability of complex adaptive systems that is derived from dynamic behaviour and interactions, or as both. However, there is little congruence on the theory and the existing frameworks have not been widely used, which as diluted the research applications for health system resilience. A global group of health system researchers were convened in March 2021 to discuss and identify priorities for health system resilience research and implementation based on lessons from COVID-19 and other health emergencies. Five research priority areas were identified: (1) measuring and managing systems dynamic performance, (2) the linkages between societal resilience and health system resilience, (3) the effect of governance on the capacity for resilience, (4) creating legitimacy and (5) the influence of the private sector on health system resilience. A key to filling these research gaps will be longitudinal and comparative case studies that use cocreation and coproduction approaches that go beyond researchers to include policy-makers, practitioners and the public.
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Significance The 2008 Great Recession widened socioeconomic inequities among young adults, people of color, and those without a college degree. The COVID-19 pandemic raises renewed concerns about inequality. Leveraging pre–post data from a population-representative sample of Indiana residents, we examine employment and food, housing, and financial insecurity. Comparing data before COVID-19 reached the state and during the initial stay-at-home orders, we find socioeconomic shocks disproportionately affecting vulnerable groups, controlling for prepandemic status. Findings are consistent with patterns of inequality observed following other disasters, including Hurricane Katrina, the Chicago Heatwave, the Buffalo Creek Flood, and the Great Recession. As with these disasters, additional surges are likely to escalate short-term hardships, revealing the axes of social devastation that translate into durable inequality.
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The Sustainable Development Goals (SDGs) provide a realistic approach to navigate societies through and beyond the COVID-19 pandemic. But the SDG Agenda is not without flaws. Even before the pandemic, progress towards achieving the SDGs has been too slow. COVID-19 presents a stress test for the SDG approach. The SDG Agenda provides three 'logics' that could help transform towards sustainable societies: (1) a governance logic that sets goals, adopts policies, and tracks progress to steer impacts; (2) a systems (nexus) logic that manages SDG interactions; and (3) a strategic logic that enables (micro-level) companies to develop strategies that impact (macro-level) policy goals. We discuss key hurdles that each of these SDG logics face. Transforming towards sustainable societies beyond COVID-19 requires that multinational enterprises and policy makers (better) apply these logics, and that they address operational challenges to overcome flaws in the present approach to the SDGs.
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Development of new biocides has dominated human responses to evolution of antibiotic and pesticide resistance. Increasing and uniform biocide use, the spread of resistance genes, and the lack of new classes of compounds indicate the importance of navigating toward more sustainable coevolutionary dynamics between human culture and species that evolve resistance. To inform this challenge, we introduce the concept of coevolutionary governance and propose three priorities for its implementation: (i) new norms and mental models for lowering use, (ii) diversifying practices to reduce directional selection, and (iii) investment in collective action institutions to govern connectivity. We highlight the availability of solutions that facilitate broader sustainable development, which for antibiotic resistance include improved sanitation and hygiene, strong health systems, and decreased meat consumption.
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This policy brief aims to promote a holistic mindset about the COVID-19 pandemic by 1) applying a complexity lens to understand its drivers, nature, and impact, 2) proposing actions to build resilient societies to pandemics, and 3) deriving principles to govern complex systemic crises. Building resilience to prevent, react to, and recover from systemic shocks need to become a core element of how societies are governed. This requires an integrated approach between health, social, economic, environmental, and institutional systems. The brief has been developed by a team of researchers coming from both the natural and social sciences.1 Reviewed by a group of policy actors,2 the brief aims to foster a dialogue between academic institutions and policymakers.
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