Conceptualizing resilience in public health: a philosophical approach.

Abstract

Background: The initial inquiry into the concept revealed its usage as a boundary object and how this facilitated its interdisciplinary utilization. The same feature enabled the shift to literature within other disciplines and then identify its conceptualization in them. This led to the understanding that though many disciplines have used the term resilience to describe a phenomenon with a general understanding of "bouncing back to original position", its multi-disciplinary usage has added a lexical ambiguity to the term. The purpose of the study is to utilize this broad and overlapping nature of resilience to identify those elements, models or pathways that might enable conceptualizing resilience in the context of public health. In this process we uncover the underlying philosophical elements that converge or diverge with the whole conceptualization process of resilience in the discipline of public health.

Methods: We used a modified integrated review of the body of literature while also reflecting on how the concept of resilience has evolved from a narrow, "Substance Metaphysics," "Reductionist" phenomenon to a more expansive, "Multi-Dimensional," "Intersectional," and "Dynamic phenomenon." Afterwards, existing philosophical theories that converged or diverged with the conceptualization process were used to further validate the entire process that resulted in the definition of resilience in the context of public health emergencies.

Results: The critical evaluation of existing literature led to the identification of two patterns by which resilience has been conceptualized across disciplines. One on the basis of engagement with acute or enduring crisis resulting in trajectories that enables stability or growth and transformation. Another on the basis of the levels at which it was conceptualized by various authors from multiple disciplines. The two approaches were later critically evaluated so as to conceptualize resilience in the context of public health.

Conclusion: An integrated response to the crisis may be necessary to preserve people's health and the health of communities in order for them to be resilient. Resilience in public health is a result of the successful engagement of relevant stakeholders responsible for health preservation to current and emerging health inequalities that places them in enabling trajectories of sustenance or growth leading to the development of potential capabilities that are sensitive to diverse health disparities.