The term resilience has dominated the discourse among health systems researchers since 2014 and the onset of the Ebola outbreak in West Africa. There is wide consensus that the global community has to help build more resilient health systems. But do we really know what resilience means, and do we all have the same vision of resilience? The present paper presents a new conceptual framework on governance of resilience based on systems thinking and complexity theories. In this paper, we see resilience of a health system as its capacity to absorb, adapt and transform when exposed to a shock such as a pandemic, natural disaster or armed conflict and still retain the same control over its structure and functions.

Table of Contents This chapter assesses how countries are managing current and projected disaster risks, given knowledge of how risks are changing with observations and projections of weather and climate extremes [Table 3-2, 3.3], vulnerability and exposure [4.3], and impacts [4.4]. It focuses on the design of national systems for managing such risks, the roles played by actors involved in the system, and the functions they perform, acknowledging that complementary actions to manage risks are also taken at local and international level as described in Chapters 5 and 7. National systems are at the core of countries' capacity to meet the challenges of observed and projected trends in exposure, vulnerability, and weather and climate extremes (high agreement, robust evidence). Effective national systems comprise multiple actors from national and sub-national governments, private sector, research bodies, and civil society, including community-based organizations, playing differential but complementary roles to manage risk according to their accepted functions and capacities. These actors work in partnership across temporal, spatial, administrative, and social scales, supported by relevant scientific and traditional knowledge. Specific characteristics of national systems vary between countries and across scales depending on their socio-cultural, political, and administrative environments and development status. [6.2] The national level plays a key role in governing and managing disaster risks because national government is central to providing risk management-related public goods as it commonly maintains financial and organizational authority in planning and implementing these goods (high agreement, robust evidence). National governments are charged with the provision of public goods such as ensuring the economic and social wellbeing, safety, and security of their citizens from disasters, including the protection of the poorest and most vulnerable citizens. They also control budgetary allocations as well as creating legislative frameworks to guide actions by other actors. Often, national governments are considered to be the 'insurer of last resort'. In line with the delivery of public goods, national governments and public authorities 'own' a large part of current and future disaster risks (public infrastructure, public assets, and relief spending). In terms of managing risk, national governments act as risk aggregators and by pooling risk, hold a large portfolio of public liabilities. This provides governments responsibility to accurately quantify and manage risks associated with this portfolio-functions that are expected to become more important given projected impacts of climate change and trends in vulnerability and exposure. [6.2.1] In providing such public goods, governments choose to manage disaster risk by enabling national systems to guide and support stakeholders to reduce risk where possible, transfer risk where feasible, and manage residual risk, recognizing that risks can never be totally eliminated (high ...

The contemporary global community is increasingly interdependent and confronted with systemic risks posed by the actions and interactions of actors existing beneath the level of formal institutions, often operating outside effective governance structures. Frequently, these actors are human agents, such as rogue traders or aggressive financial innovators, terrorists, groups of dissidents, or unauthorized sources of sensitive or secret information about government or private sector activities. In other instances, influential "actors" take the form of climate change, communications technologies, or socioeconomic globalization. Although these individual forces may be small relative to state governments or international institutions, or may operate on long time scales, the changes they catalyze can pose significant challenges to the analysis and practice of international relations through the operation of complex feedbacks and interactions of individual agents and interconnected systems. We call these challenges "femtorisks," and emphasize their importance for two reasons. First, in isolation, they may be inconsequential and semiautonomous; but when embedded in complex adaptive systems, characterized by individual agents able to change, learn from experience, and pursue their own agendas, the strategic interaction between actors can propel systems down paths of increasing, even global, instability. Second, because their influence stems from complex interactions at interfaces of multiple systems (e.g., social, financial, political, technological, ecological, etc.), femtorisks challenge standard approaches to risk assessment, as higher-order consequences cascade across the boundaries of socially constructed complex systems. We argue that new approaches to assessing and managing systemic risk in international relations are required, inspired by principles of evolutionary theory and development of resilient ecological systems.complex adaptive systems | systemic risk | risk analysis | contagion | resilience

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