Kayvan Bozorgmehr
1,2,3* 
, Andreas Zick
2,4,5 , Tobias Hecker
2,6 1 Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany.
2 Institute for Interdisciplinary Research on Conflict & Violence (IKG), Bielefeld University, Bielefeld, Germany.
3 Section for Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany.
4 Faculty of Educational Science, Bielefeld University, Bielefeld, Germany.
5 Research Institute Social Cohesion (FGZ/RISC), Bielefeld, Germany.
6 Working Unit Clinical Developmental Psychopathology, Faculty for Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany.
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has created opportunities to study resilience in multiple, interrelated societal systems while considering the institutional, community and individual level. We aim to discuss critical, yet underrepresented, issues in resilience discourses which are fundamental to advance theories, concepts and measurement of health system resilience. These relate to a better understanding of (i) how government’s handle and use uncertainties to facilitate or impede change, including the role of negotiation and conflicts, (ii) the intersections of health with multiple, co-occurring crises (systemic intersections), and (iii) cross-level interactions, ie, the interrelation between individual-level resilience, the collective resilience of groups and communities, and the resilience of a system as a whole (and vice versa). Analyses of these aspects can help to “contextualize” our understanding of resilience in complex adaptive systems. However, conceptual clarity is needed whether resilience is considered an underlying feature, outcome, or intermediate determinant of a (health) system’s performance.