Constructing Equitable Health Resilience: A Call for a Systems Approach to Intersectionality

Document Type : Letter to Editor


1 Faculty of Social Sciences, University of Tehran, Tehran, Iran

2 Department of Population Health Sciences, University of Bristol, Bristol, UK

3 School of Business, University of Essex, Colchester, UK

4 School of Health and Social Care, University of Essex, Colchester, UK


Resilience within the healthcare system is defined by its capacity to anticipate and respond effectively to emergencies whilst upholding its core functions.1 These emergencies can range from acute challenges, such as sanctions,2 wars, epidemics, and natural disasters like earthquakes and floods, to chronic issues like migration and drought caused by climate change.3 Throughout such occurrences, those exposed to death, sickness, severe injuries, discomfort (such as malnutrition) and other health problems are the society’s most vulnerable and marginalized communities. .... (Read more...)

  1. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910-1912. doi:1016/s0140-6736(15)60755-3
  2. Sajadi H, Yahyaei F, Ehsani-Chimeh E, Majdzadeh R. The human cost of economic sanctions and strategies for building health system resilience: a scoping review of studies in Iran. Int J Health Plann Manage. 2023;38. doi:1002/hpm.3651
  3. World Health Organization (WHO). Health Systems Resilience Toolkit: A WHO Global Public Health Good to Support Building and Strengthening of Sustainable Health Systems Resilience in Countries with Various Contexts. Geneva: WHO; 2022.
  4. Bourdieu P. Distinction: A Social Critique of the Judgement of Taste. London: Routledge; 1984.
  5. Shannon G, Morgan R, Zeinali Z, et al. Intersectional insights into racism and health: not just a question of identity. Lancet. 2022;400(10368):2125-2136. doi:1016/s0140-6736(22)02304-2
  6. Hankivsky O. Intersectionality 101. Vancouver: Institute for Intersectionality Research & Policy, Simon Fraser University; 2014.
  7. Grimm PY, Oliver S, Merten S, Han WW, Wyss K. Enhancing the understanding of resilience in health systems of low- and middle-income countries: a qualitative evidence synthesis. Int J Health Policy Manag. 2021;11(7):899-911. doi:34172/ijhpm.2020.261
  8. Siller H, Aydin N. Using an intersectional lens on vulnerability and resilience in minority and/or marginalized groups during the COVID-19 pandemic: a narrative review. Front Psychol. 2022;13:894103. doi:3389/fpsyg.2022.894103
  9. Chisty MA, Dola SE, Khan NA, Rahman MM. Intersectionality, vulnerability and resilience: why it is important to review the diversifications within groups at risk to achieve a resilient community. Continuity & Resilience Review. 2021;3(2):119-131. doi:1108/crr-03-2021-0007
  10. Linkov I, Keenan JM, Trump BD. COVID-19: Systemic Risk and Resilience. New York: Springer; 2021.
  11. Lotfata A, Munenzon D. The interplay of intersectionality and vulnerability towards equitable resilience: learning from climate adaptation practices. In: Brears RC, ed. The Palgrave Encyclopedia of Urban and Regional Futures. Cham: Palgrave Macmillan; 2022:1-16. doi:1007/978-3-030-51812-7_324-1
  12. Versey HS, Russell CN. The impact of COVID-19 and housing insecurity on lower-income Black women. J Soc Issues. 2022. doi:1111/josi.12555
  13. Ryan NE, El Ayadi AM. A call for a gender-responsive, intersectional approach to address COVID-19. Glob Public Health. 2020;15(9):1404-1412. doi:1080/17441692.2020.1791214
  14. Delker BC, Salton R, McLean KC. Giving voice to silence: empowerment and disempowerment in the developmental shift from trauma ‘victim’ to ‘survivor-advocate’. J Trauma Dissociation. 2020;21(2):242-263. doi:1080/15299732.2019.1678212
  15. Chaplin D, Twigg J, Lovell E. Intersectional Approaches to Vulnerability Reduction and Resilience-Building. Resilience Intel. 2019;12:1-35.
  16. Njeze C, Bird-Naytowhow K, Pearl T, Hatala AR. Intersectionality of resilience: a strengths-based case study approach with Indigenous youth in an urban Canadian context. Qual Health Res. 2020;30(13):2001-2018. doi:1177/1049732320940702
  17. Wolfe R, Molyneux S, Morgan R, Gilson L. Using Intersectionality to Better Understand Health System Resilience. RESYST London School of Hygiene & Tropical Medicine; 2017.
  18. Samra R, Hankivsky O. Adopting an intersectionality framework to address power and equity in medicine. Lancet. 2021;397(10277):857-859. doi:1016/s0140-6736(20)32513-7
  19. Ghasemi E, Rajabi F, Majdzadeh R. Intersectionality in UHC: from blue-sky to day-to-day practice. Lancet. 2021;397(10291):2252. doi:1016/s0140-6736(21)00935-1
  20. Lakoff A. Unprepared: Global Health in a Time of Emergency. University of California Press; 2017.