Enabling health system resilience through resilient cities

Health systems are embedded within larger societal structures, including communities and cities. Globally, societies are rapidly changing through urbanization such that most of the world’s population is living in cities more than ever in history. There is also now a strong and growing recognition of the critical role that cities have on population health and health systems. The resources and structure of cities can dramatically impact the initial impact of the shock and even more so the downstream effects and recovery efforts. In particular, the wide inequities that are seen because of both the direct shock and the medium- to long-term aftereffects vary greatly depending on the physical and social infrastructure in cities. This chapter will articulate critical features of cities that influence the health of citizens following a shock and detail the important building blocks needed in cities to enable health system resilience. The first concept relates to social connectedness, which includes the structures and features of cities that promote and build social connections. These factors enable strong community support to absorb the shock, distribute health services equitably, enable recovery efforts, and promote psychological resilience. The second component is centered on the physical and social infrastructure in cities, including the institutions providing services and amenities to their citizens and the places facilitating community support. Thirdly, the role of organizations and local government which are critical for building trust and facilitating communication is discussed. Finally, the role of data and analytics in enabling the three components mentioned above will be presented, including a framework that presents the structure and functions of city-level data and analytic outputs needed to support health system resilience. All components will be linked and explicated for how they can mitigate the widening health inequities that follow shocks. All components will be linked to all stages of the shock cycle. Several examples from different crises will be presented, including the COVID-19 pandemic and natural disasters, as well as links to theoretical frameworks that explain how a lens of cities is an essential element of a resilient health system. Overall, this chapter will articulate the necessary components and theories for pragmatic action in the design and role of cities to improve health system resilience and health equity.