Understanding Community Resilience in the Context of National Health Security
A Literature Review
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Building community resilience, or the capability to rebound from a disaster is a cornerstone of public health emergency preparedness. Recent regional meetings with stakeholders to develop the National Health Security Strategy (NHSS) revealed that questions remain unanswered as to how to develop and measure a community’s resilience in the face of manmade and natural threats. To date, we have many theoretical models articulating factors that contribute to community resilience such as community cohesion and the ability to marshal resources quickly, but we have less empirical evidence about what constitutes the integral components of resiliency. Despite a limited evidence base, enhanced resilience is considered critical to mitigating vulnerabilities, reducing negative health consequences, and rapidly restoring community functioning. According to the Homeland Security Presidential Directive-21 (HSPD-21), resilience is essential to limiting the need for prolonged assistance post disaster. In order to improve resilience, Bruneau (2003) argues that communities must build capabilities that are characterized by robustness (the ability to withstand stress), redundancy (resource diversity), and rapidity (the ability to mobilize resources quickly). These efforts ensure that communities (and especially those with resource poor neighborhoods) will have the ability during an event to respond quickly, even when critical parts of the community are severely impacted, and to return to normal functioning with little delay. Despite an understanding that community resilience is critical, the stakeholders responsible for ensuring national health security (both government and non-governmental organizations) do not have a working definition or a clear understanding of how to measure resilience for health security. Further, we have limited information about key strategies to enhance resilience. This literature review synthesizes the existing evidence base on resilience to identify drivers for health-related emergency planning. The review lays a foundation for upcoming analyses that will provide a working definition of community resilience, identify activities for building resilience, and offer associated metrics. These activities and metrics will be integrated into the NHSS implementation plan.
The research in this report was prepared for the Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services and conducted by RAND Health.
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