Systematically identifying and evaluating strategies for strengthening community resilience

The COVID-19 pandemic overwhelmed public health systems and societal functions, with vulnerable populations most affected, including the elderly, those with underlying conditions, low-income groups, and people with limited access to care. The impact was less severe in places prepared to respond, where early care-seeking and balanced strategies helped sustain communities and livelihoods while protecting lives. This underscores the importance of understanding how interconnected systems are, and how weaknesses in public health can ripple across other sectors.

This project identified, assessed and prioritized actions to strengthen community and public health system resilience for pandemics and disasters. It explored alignment of the UNDRR Public Health System Resilience Scorecard (aligned with WHO’s Health Emergency and Disaster Risk Management (Health EDRM) Framework) which was developed after application of the Disaster Resilience Scorecard for Cities showed the need for deeper investigation into the health sector. The Scorecard, developed by multisectoral experts helped to identify local challenges and opportunities.

The project focused on local government areas to align with existing structures and compare factors such as urban and rural settings, disaster risks, cultural beliefs, and COVID-19 responses. Applying this approach across multiple communities provided the diversity required to develop generalizable strategies to “build back better” and strengthen community and public health system resilience.

The project followed sequential phases: team training, local workshops using the Public Health System Resilience Scorecard, and a joint workshop in Incheon, South Korea. Workshops engaged diverse stakeholders to assess 23 indicators of resilience, scored on a Likert scale. Site leads facilitated discussions, aggregated scores, and guided consensus on low-scoring indicators, leading to strategies prioritized through an impact vs difficulty process. Locations and participants were selected via purposeful and snowball sampling, including health, emergency, and community service providers. The joint workshop applied a modified Delphi process to refine, rank, and reach consensus on strategies to strengthen resilience.

Following an online train-the-trainer session, participants (including emergency professionals, doctors, nurses, environmental health specialists, researchers, and government officials) at eight individual workshops developed priority actions for areas needing improvement in mental health, ecosystems, public health and societal capacity, and disaster scenarios. 

Following this, participants at the joint workshop in Incheon, South Korea, prioritized results and the data from all 13 workshops were collected and analyzed using a sequential modified Delphi process to reach consensus on which strategies were to be prioritized for action. Measures to improve resilience, coordination, and community preparedness for emergencies included:

• Emergency Planning: Incorporate public health risks into disaster plans.
• Multidisciplinary Teams: Integrate diverse expertise to address societal needs during crises.
• Surge Capacity: Map health facility interconnections, deploy non hospital staff, and strengthen public–private system links.
• Transport & Multi Sector Integration: Enhance local transport and cross sector systems to support prevention, preparedness, response, and recovery.

The Scorecard is a reliable, adaptable tool for assessing resilience and guiding public health policy. Combined with the Health EDRM, it supports a systems based approach to identify vulnerabilities across services, logistics, and ecosystems, enabling community led resilience actions for disaster risk reduction.

To advance this work, a pipeline should link Scorecard use to multi year action plans, supported by a practical guide. This approach strengthens transdisciplinary preparedness and recovery, addresses urban and rural vulnerabilities, and allows rapid, routine prioritization of resilience measures amid evolving environmental, social, and fiscal challenges.

• Ryan, B., Kako, M., Fink, R., Şimşek, P., Barach, P., Acosta, J., Bhatia, S., Brickhouse, M., Fendt, M., Fontenot, A., Garcia, N., Garner, S., Gunduz, A., Hardin, M., Hatch, T., Malrey-Horne, L., Kato, M., Kayano, R., McKone, J., Noel, C., Nomura, S., Novak, J., Strickland, A., Swienton, R., Tayfur, I. & Brooks, B (accepted). Strategies for Strengthening the Resilience of Public Health Systems for Pandemics, Disasters, and other Emergencies. Disaster Medicine and Public Health Preparedness.
• Tayfur, I., Simsek, P., Gunduz, A., Kako, M., Nomura, S. & Ryan, B. (submitted). Evaluation of Public Health System Resilience Against COVID-19 Pandemic and Other Disasters: An Example From Türkiye. International Journal of Disaster Risk Reduction.
• Ryan, B., Kako, M., Brooks, B., Rahman, M., Rahman, S., Hardin, M., Siewnton, R., Novak, J., Fink, R., & Simsek, P. (2023). Systematically Identifying and Evaluating Strategies for Strengthening Community Resilience. Prehospital and Disaster Medicine, 38(S1), S72-S72. DOI: https://doi.org/10.1017/S1049023X23002133

• August 1, 2023 – Systematically Identifying and Evaluating Strategies for Strengthening Public Health System Resilience, National Environmental Health Association Annual Educational Conference, New Orleans, Louisiana, USA.
• June 14, 2023 – Public Health Scorecard: Systematically Identifying and Evaluating Strategies for Strengthening Community Resilience, UNDRR GETI, UNOSSC, PAHO/WHO, WHO Joint Certificate Training Program (video link)
• June 9, 2023 – Disaster Resilience Scorecard for Cities: Public Health System Resilience – Addendum, UNDRR Americas and Caribbean Regional Scientific Advisory Group (online).
• May 9, 2023 – Systematically Identifying and Evaluating Strategies for Strengthening Community Resilience, WADEM Congress on Disaster and Emergency Medicine, Killarney, Ireland.
• June 30, 2022 – Systematically identifying and evaluating strategies for strengthening community and public health resilience, National Environmental Health Association Annual Educational Conference, Spokane, Washington, USA.