By Dennis Archambault
At a time when society is undergoing a difficult transition, one in which the future of the Afforable Care Act — specifically expanded Medicaid, as well as the support of community health centers and graduate medical education teaching health centers is in doubt, it is helpful to consider the value of resilience.
Richard Heinburg, in his essay, “A Hard-Nosed Optimism,” refers to the “optimism of the will” in discussing the notion of community resilience.
Referring to the 20th century writer, Antonio Gramsci’s concept, “pessimism of the spirit; optimism of the will,” during challenging times, people need to be aware of the realty retain sufficient optimism to endure.
“Persistence of the best of what we humans are and have achieved will require us to build resilient, enduring communities—ones with high internal levels of mutual trust, and that are capable of adapting quickly to changing conditions and responding effectively to a range of threats. Such communities arise and sustain themselves only by nurturing and prizing certain qualities of character on the part of their members.
“The people who are most likely to be of use in such communities are those who exhibit old-fashioned virtues, including honesty, bravery, self-control, cheerfulness, humility, and generosity. The ability to amuse and entertain oneself and others will be a welcome bonus; likewise the ability to speak convincingly, and the willingness both to endure discomfort and to find satisfaction in small things. I think qualities like these may start to get at what Gramsci meant by ‘optimism of the will.’”
The Community Health Resilience Initiative http://oha.inl.gov:7777/pls/apex/f?p=101:HOME states, “Regardless of the event, a community’s ability to successfully return to a “new normal” is based on its resilience, or its capacity to withstand, respond positively to, adapt, and recover expeditiously from a crisis or adversity.” There is no signal definition accepted for community resilience. Variations include:
• “The ability to prepare for and adapt to changing conditions and withstand and recover rapidly from disruptions, including deliberate attacks, accidents, or natural occurring threats and incidents.”
• “The ongoing and developing capacity of the community to account for its vulnerabilities and develop capabilities that aid that community in (1) preventing, withstanding, and mitigating the stress of a health incident; (2) recovering in a way that restores the community to a state of self-sufficiency and at least the same level of health and social functioning after a health incident; and (3) using knowledge from a past response to strengthen the community’s ability to withstand the next health incident.”
• “Community resilience is the ability of a community to use its assets to strengthen public health and healthcare systems and to improve the community’s physical, behavioral, and social health to withstand, adapt to, and recover from adversity.”
Regardless of the definition used, the concept deserves consideration in population health, especially within impoverished communities.
Dennis Archambault is vice president of Public Affairs for Authority Health.