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African Health Sciences African Health Sciences DECEMBER 2008 VOLUME 8 SPECIAL ISSUE Editorial: Resilience to Disasters: A Paradigm Shift from Vulnerability to Strength. S1 Astier M. Almedom and James K. Tumwine ORIGINAL CONTRIBUTIONS Resilience research and policy/practice discourse in health, social, behavioral, S5 and environmental sciences over the last ten years. Astier M. Almedom. Resilience among first responders S14 Luca Pietrantoni and Gabriele Prati. Resilience in Post-Katrina New Orleans, Louisiana: A Preliminary Study. S21 Douglas M. Glandon, Jocelyn Muller, Astier M. Almedom. Exploring the Dynamics of social-ecological resilience in East and West Africa: S28 Preliminary evidence from Tanzania and Niger. Strauch AM, Muller JM, Almedom AM. What can emergency planners learn from research on human resilience? S33 Richard Amlôt, Holly Carter. Civil courage: Good people in an evil time, building and promoting resilience S36 Svetlana Broz. From trauma to resilience S39 Lene Christensen. Developing and measuring resilience for population health. S41 Sarah Cowley. Resilience in MSF and its Personnel. S44 Annick Filot and Carla Uriarte. Animals as key promoters of human resilience. S46 Joann M. Lindenmayer. Renewal and Resilience: the role of social innovation in building institutional resilience S47 Frances Westley MAKERERE MEDICAL SCHOOL EDITORIAL Resilience to Disasters: A Paradigm Shift from Vulnerability to Strength Astier M. Almedom (Guest Editor) and James K. Tumwine (Editor-in-Chief) African Health Sciences, Editorial Office, Makerere University College of Health Sciences, Kampala, Uganda African Health Sciences 2008; 8(S): 1-4 The idea of producing a special issue on the theme of workshop concluded with a consensus on the need for resilience was first proposed in late 2006 as part of the a programmatic applied research strategy to develop the plans to disseminate the deliberations of our first envisioned multi-dimensional and cross-scale “Resilience International Resilience Workshop held at Talloires, Index” (RI) for the purposes of gauging sustained global France, in July 2007. The workshop brought together a public health and well-being encompassing human, group of interested researchers, planners, practitioners institutional and social-ecological resilience. Subsequent and policy makers from the disaster response and health international conference and seminar venues have sectors, both academic researchers and practitioners to provided avenues for further development of the present and discuss the salient points of convergence in interdisciplinary and cross-sector discussions initiated their work on human, ecosystem and/or institutional/ at Talloires, most notably Resilience 2008, convened in structural resilience. The abstracts submitted and Stockholm by the Resilience Alliance (April 2008), and presented for discussion at Talloires were then two panel discussions on building community resilience developed into the articles included in this volume. – one at the Institute of Health, Warwick University, UK Graduate students made up over a third of the workshop (July 2008) and the other at the University of participants, and the case studies and innovative ideas Massachusetts in Boston (November 2008) engaging discussed included resilience of emergency responders the leadership of the guest editor as a key speaker and/ (Pietrantoni and Prati, Italy), the role of civic courage or discussion moderator/facilitator. and Upstanders during the war in Bosnia and Herzegovina (Broz), the role of social innovation in building The International Resilience Workshop – Talloires 2007 institutional resilience (Westley), national emergency tackled the following set of key questions: response planning in the UK (Amlôt), measures of i. What is resilience, and how is it assessed and/or resilience in the UK national health service (Cowley), measured? the Federation of International Red Cross and Red ii. How are the questions “resilience of whom or what?” Crescent Societies (IFRC) Psychosocial Support and “resilience to what?” being addressed in different Centre’s shift in policy from trauma counseling to disciplines and/or practice sectors? resilience building (Christensen), a pilot study of resilience in New Orleans, Louisiana, post-Hurricane i. What is resilience, and how is it assessed or Katrina (Glandon et al.), a preliminary analysis of social- measured? ecological resilience with respect to traditional water A multi-dimensional construct, resilience is defined as resource management in rural Tanzania and traditional the capacity of individuals, families, communities, ecological knowledge concerning plant uses in rural systems, and institutions to anticipate, withstand and/ Niger (Strauch et al.), the role of animals (pets and or judiciously engage with catastrophic events and/or livestock) in promoting resilience (Lindenmayer), and experiences; actively making meaning with the goal of resilience of international humanitarian workers maintaining normal function without fundamental loss operating in Africa (Filot and Uriarte, Belgium and Spain, of identity.1 At the individual level, human resilience is a respectively). Abstracts submitted to the workshop normal and common response to adversity.2-7 At the level but not developed into articles have been included in of family and/or community, the capacity to anticipate, this volume. withstand and maintain normal function following A wide range of conceptualizations and disasters is mediated by right types, timing, and levels of definitions of resilience with corresponding indicators social support of which international humanitarian and/or assessment/measurement scales were examined assistance is one form.8 in small working group and plenary sessions. The African Health Sciences Vol 8 Special Issue December 2008 S1 Sixty-two years ago, the United Nations held is a process, mediated by social and economic capital, its inaugural international health conference in New also known as “resources for health”. 10-12 The same may York where it adopted a holistic definition of health as “a be true of resilience. As explained by the theory of state of complete physical, mental and social well-being Salutogenesis (origins of health)13 the dynamics of health and not merely the absence of disease or infirmity.”9 and ill health demonstrate a wide spectrum of levels of Health is a dynamic steady state, a state of successful adaptation along the ease ⇔ dis-ease continuum (see adaptation to the stresses and strains that may be chronic Figure). or acute, of ordinary or extraordinary magnitude. Health Figure: The theory of Salutogenesis (Origins of Health) Ease Dis-ease • Adaptive state • Maladaptive state • Resilience • Vulnerability The assumption here is that good health reflects an social networks and support systems that contribute to adaptive state (a dynamic steady-state, and not a static the integrity of the emotional ecosystem in which human state), while ill health/disease demonstrates the lives and livelihoods thrive, often in the face of adversity opposite, a maladaptive state of vulnerability. While of different forms and levels of magnitude (including systems of health care delivery have traditionally focused complex emergencies triggered by floods, droughts, on curative measures of disease control, dwelling on and/or armed conflict); environmental scientists vulnerability, health promotion through prevention of (including ecologists, economists, conservation vulnerability to disease has increasingly been taking a biologists, anthropologists, and sociologists) have also more long-term view of removing the obstacles to health advanced our understanding of resilience of the natural/ by focusing on the root causes of disease, most of which physical ecosystem as part and parcel of the coupled lie outside the mandate of health care services and in the natural and social systems that contribute to the domain of social, cultural, economic and geo-political sustainability of our planet, and/or threaten it, as the situation of communities, countries, and/or regions. case may be. It is important to note that humans are the Hence the focus on resilience as a basis for sustainability, dominant players in social-ecological interactions that also with respect to the physical/natural environment have brought the planet to the state of imminent peril, and the inter-connected social-ecological systems loss of resilience and reduced sustainability of resources, which influence international humanitarian policy and including human resources. However, not all humans public health practice are in turn impacted by them. are equal: some are more equal than others in terms of their contributions to sustainability. ii. How are the questions “resilience of whom or As articulated clearly by the Resilience what?” and “resilience to what?” being addressed Alliance, “Ecosystem resilience is the capacity of an in different disciplines and/or practice sectors? ecosystem to tolerate disturbance without collapsing into a qualitatively different state that is controlled by a Health in a broad sense of the term is thus not only the different set of processes. A resilient ecosystem can absence of disease, but also the presence of capacity, withstand shocks and rebuild itself when necessary. motivation and conditions that promote wellness. Health Resilience in social systems has the added capacity of promotion is about creating and sustaining dynamic humans to anticipate and plan for the future. Humans steady states of well-being. Human
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