Four Ways Health Systems Can Build Resilience Against Shocks and Stressors

During a community workshop in Katlehong, South Africa, children were asked what would happen if a life-threatening flood hit while they were home alone. They listed the hazards: rising water, drains backing up, the tap turning brown. But when asked what they could do to keep themselves safe, the group fell silent. One boy finally raised his hand. “I’d lock the door and wait.”

In Katlehong, South Africa, more than 200 residents — schoolchildren, elders, and community leaders — gathered for a workshop organized by the South African Weather Service (SAWS), with support from the Met Office, the UK’s weather and climate service, as part of the WISER Health programme. It focused on designing better ways of getting climate and weather warnings to people with the fewest resources to act on them. (Photo Credit: Met Office, UK’s weather and climate service and WISER)

Today, many health systems lack the capacity to see threats coming with enough time to act, resulting in countless lives and livelihoods lost. Consider this year alone: In Europe, 35,000 excess deaths were recorded after back-to-back heatwaves suffocated cities and in Latin America, supercharged El Niño rains threaten to fuel a record-breaking number of dengue cases; and in Central Africa, an Ebola outbreak Ebola outbreak.

The next phase of modern public health must move beyond static preparedness to dynamic resilience — systems that see a shock coming and act in time to avoid or blunt the damage.

This is now within reach. Advances in science and technology can help us see risks earlier, and countries and cities are already using these innovations to make their health systems more resilient. The ultimate test of a strong health system is whether it leaves communities better able to get ahead of the next threat.

2. Agree on Responsibilities Ahead of Time

An early warning is only as good as the response it triggers. In a resilient system, know-how and authority rest with the same trusted institution, with thresholds agreed in advance, so a warning leads to action.

In some of the hottest sugarcane-growing regions of Central America, warnings about dangerous heat are tied to a set of actions that workers and supervisors already understand. Under La Isla Network’s PREP model, heat conditions trigger protocols for rest, shade, and hydration designed to protect workers before heat stress sets in. In Nicaragua, the approach reduced hospital-treated acute kidney injury — a common effect of routine heat exposure — by more than 94 percent.

4. Rely on Local Leaders and Experts

Resilience is strongest when the people closest to a risk have the ability to act on it.

In Senegal, that principle is built into the country’s approach to extreme heat. While national agencies provide forecasts and guidance, Regional Climate-Health Committees in Fatick, Kaffrine, and Matam are helping translate that information into action on the ground. They identify vulnerable populations, coordinate preparedness efforts among local agencies and health services, and ensure that local experience and community needs help shape future responses.

The world will not become less volatile. But health systems can become better equipped to protect people through it. The next generation of public health should be judged not only by how it responds to crises, but by how effectively it anticipates threats, and acts on them in time.