U.S. health system resilience

This chapter assesses the resilience of the U.S. health system to everyday and shock-related stresses (COVID-19) using Haldane and colleagues’ (2021) four resilience elements integrated with attributes of resilience identified by Nuzzo and colleagues (2019). Resilience challenges are identified and suggestions for improvement are made. We find that although the U.S. has some resilience strengths, there are fundamental challenges: high income and wealth inequality and poverty, weak public health and primary care systems, lack of universal access to healthcare, and a distressed and shrinking healthcare workforce. Other challenges include poor communication between the public health system and the population, inadequate protection of vulnerable populations and inadequate preparation for future shocks. Significant changes are needed-to build stronger and more equitable socio-economic and public health systems, achieve universal healthcare coverage, and ensure an adequate healthcare workforce and acute-care supply. Public health decisions must be free from political influence or interference that puts the economy ahead of population health. Government, researchers, clinicians, and communities need to work together to assess resiliency needs without bias, draw lessons, and communicate plans clearly. To make these changes the political system must be democratized. The way forward is difficult, but with recognition of what is needed, steps can be taken, and the U.S. healthcare system can thrive.