A transdisciplinary research agenda for resilience

Health system resilience is typically framed as the capacity to absorb, adapt and respond to acute shocks. 1 The coronavirus disease 2019 (COVID-19) boosted global interest in health system resilience, and since 2020, an increasing body of work frames resilience as a goal of health system performance and a driver for public health and health system transformation.However, the concept of health systems resilience carries inherent tension.Even before the pandemic, debates emerged about its application to public health and health systems, with now ongoing discourse to better define and apply the concept of resilience, determine its scope and critically reflect upon what makes a health system resilient amid multiple and interacting crises. 2 Today, critics warn that resilience risks functioning as a technocratic label that emphasizes adaptation while neglecting the underlying political determinants and inequitable distribution of resources, risks and capacities during periods of stress. 2 Others maintain that resilience offers a distinct conceptual lens for understanding how systems navigate uncertainty and chronic stress, especially where instability is the norm. 2 This article aims to set a conceptual agenda, drawing on an ongoing transdisciplinary collaboration between Fundação Oswaldo Cruz, University of Leeds, University of Toronto and Imperial College London.Our shared concern is that dominant framings of resilience, built around episodic preparedness, measurement frameworks and recovery from acute crises systematically miss the more persistent forms of resilience that constitute everyday life in health and social care systems.3 We argue that the conceptual centre of gravity in resilience research must shift from shock to the ordinary.We propose that the analytical work missing from current discussions is a clearer explanation of how chronic stressors interact with system functioning, not as isolated events to be repelled, but as accumulating pressure that demands continuous recalibration.