What resilience is and why it matters to small countries

The word “resilience” comes from the Latin verb “risalire”, which means to rise again (to bounce back). A resilient community is able to cope with change and to retain its structures and functions after disturbances in order to keep up with continuous development.

The concept of resilience represents 1 of the 4 cross-cutting priority areas of Health 2020 and the Sustainable Development Goals. Despite its recent popularity, resilience is not yet fully understood when applied to the health sector. This could be because of a pathological view of health rather than one that addresses factors that make systems healthy.

Small countries with a population under 1 million exemplify the importance of resilience for sustainable development. Small states have some disadvantages, for example, in terms of infrastructure, which is very expensive in a small country, few choices for work, a lack of mobility, small domestic markets and a large administrative burden of regulation. Small states may be more vulnerable. However, they can succeed if they adopt policies that enable them to best deal with their vulnerability and become even more resilient.

High-level Meeting of Small Countries

During the Second High-level Meeting of Small Countries in Andorra in July 2015, Member States highlighted the need to better understand the definition of resilience, and how to strengthen it in their countries, through in-depth analysis of explanatory case studies. At the 3rd High-level Meeting in Monaco in October 2016, Member States presented the first outcomes of their interest and commitment to this topic.

During the session, participants found that the number of times this term is used at individual, community and system levels has increased. There is a growing interest in system-level resilience within the 2030 Agenda for Sustainable Development. Moreover, resilience can be developed over a lifetime (i.e. with a life-course approach), which is a pillar both of Health 2020 and the 2030 Agenda.

Country case stories

Iceland, Luxembourg, Malta and San Marino presented successful stories of implementing this concept in their countries. Iceland explained its commitment to avoiding re-traumatization of victims of child abuse.

Luxembourg presented the Red Cross's commitment in offering translation and interpretation services to citizens who do not speak French, German or the local language. These services started during the war in the former Yugoslavia when Luxembourg welcomed a considerable number of migrants. The translation services now cover more than 20 languages.

Malta presented a case study on strengthening health system resilience through retention and development of human resources. San Marino detailed an initiative that supports people with disabilities and favours social inclusion.

Next steps

The 8 members of the small countries initiative plan to create official documents on this topic that also focus on the successful case stories already implemented. Dr Zsuzsanna Jakab, WHO Regional Director for Europe, stated: “I would like to take the work on resilience to the Regional Committee next year, and I would like to take this to other countries beyond the small countries.”