Disease epidemics: Lessons for resilience in an increasingly connected world
In public health, the term resilience often refers to the personality traits that individuals possess which help them endure and recover from stressors. However, resilience as a system characteristic, especially in regards to complex social-ecological systems, can be informative for public health at scales larger than the individual. Acute shocks to systems occur against a background of existing conditions, which are crucial determinants of the eventual public health outcomes of those shocks, and in the context of complex dependencies among and between ecological and societal elements. Many components of a system's baseline condition are chronic public health concerns themselves and diminish the capacity of the system to perform in the face of acute shocks. The emerging field of resilience management is concerned with holistically assessing and improving a system's ability to prepare for and absorb disruption, and then recover and adapt across physical, information, environmental and social domains. Integrating resilience considerations into current risk- and evidence-based approaches to disease control and prevention1 can move public health efforts toward more proactive and comprehensive solutions for protecting and improving the health of communities. Here, we look to the case of the Black Death as an illustrative case of a dramatic transformation in human history, an acute shock to a system that was underlain by chronic social maladies, to derive lessons about resilience management for public health in contemporary systems.