Rebuilding Public Health Systems in an Era of Converging Crises: A Climate-Sensitive Resilience Framework

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Authors

, , , , , , , , , , ,
Chengwen Song (Corresponding Author)
ROR Kookmin University
https://orcid.org/0009-0000-4622-6177
[email protected]
Siheng Ma
ROR Air Force Medical University
https://orcid.org/0009-0008-4584-0587
Gulifeire Rousitanmu
ROR Kookmin University
Yuxuan He
ROR College of Life Sciences, Henan University, Kaifeng 475004, China
https://orcid.org/0009-0007-1149-5554
Yunze Lu
ROR China Pharmaceutical University
Jialuo Fang
ROR Hankuk University of Foreign Studies
Jiayi Li
ROR Shaanxi University of Chinese Medicine
https://orcid.org/0009-0003-1040-9731
Zhili Zhu
ROR Xiamen University
https://orcid.org/0009-0002-2236-0114
Qilong Wang
ROR Gansu University of Traditional Chinese Medicine
https://orcid.org/0009-0003-3973-8475
Xingkai Zhang
ROR Xinjiang Medical University
https://orcid.org/0009-0002-5389-8478
Wanlin Dong
ROR Southern University of Science and Technology
Yufei Shao
ROR Shanghai University

Abstract

Background: The COVID-19 pandemic exposed deep structural weaknesses in public health systems across the world, including fragmented surveillance, fragile service capacity, inconsistent risk communication, and persistent health inequities. At the same time, the climate crisis is intensifying heat-related illness, vector-borne disease, extreme weather disruptions, displacement, and pressures on health infrastructure and workforces. Contemporary health threats are increasingly converging rather than isolated.

Methods: Drawing on a conceptual synthesis of COVID-19 lessons, health system resilience scholarship, and recent guidance from the World Health Organization and the IPCC, this article develops the Integrated Climate-Sensitive Public Health Resilience (ICPHR) Framework, a four-dimensional and system-based model organized around preparedness, absorption, adaptation, and recovery.

Results: The framework conceptualizes resilience as a dynamic and cyclical process through which public health systems anticipate, withstand, learn from, and transform after shocks while maintaining essential functions. The analysis identifies five strategic pathways for resilient system transformation: integrated surveillance and early warning, stronger primary health care, trust-based risk communication, equity-centered design, and cross-sectoral governance.

Conclusions: Resilience in the coming decade must be climate-sensitive, institutionally embedded, and oriented toward long-term system transformation rather than temporary emergency response. Unlike existing models, the proposed framework explicitly integrates climate-sensitive risks into a cyclical and system-based structure. This framework provides actionable insights for public health system strengthening, particularly in integrating pandemic preparedness with climate-sensitive health risk management. Public health resilience should become the central paradigm guiding health system transformation in an era of converging global crises.

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Copyright remains with the author(s). All articles are published under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license permits use, sharing, adaptation, distribution, and reproduction in any medium or format, provided that appropriate credit is given to the original author(s) and the source, a link to the license is provided, and any changes are indicated.

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1.
Song C, Ma S, Rousitanmu G, et al. Rebuilding Public Health Systems in an Era of Converging Crises: A Climate-Sensitive Resilience Framework. Health Nexus. 2026;2:24-39. doi:10.63802/hn.V2.2026.308

References

World Health Organization. Building Health Systems Resilience for Universal Health Coverage and Health Security During the COVID-19 Pandemic and Beyond: WHO Position Paper. Published 2021. Accessed March 23, 2026. https://iris.who.int/handle/10665/346515

Haldane V, Foo CD, Abdalla SM, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021;27(6):964-980. doi:10.1038/s41591-021-01381-y DOI: https://doi.org/10.1038/s41591-021-01381-y

Sagan A, Webb E, Azzopardi-Muscat N, et al, eds. Health Systems Resilience During COVID-19: Lessons for Building Back Better. European Observatory on Health Systems and Policies; 2021.

Baral P. Health systems and services during COVID-19: lessons and evidence from previous crises: a rapid scoping review to inform the United Nations Research Roadmap for the COVID-19 recovery. Int J Health Serv. 2021;51(4):474-493. doi:10.1177/0020731421997088 DOI: https://doi.org/10.1177/0020731421997088

Moynihan R, Sanders S, Michaleff ZA, et al. Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open. 2021;11(3):e045343. doi:10.1136/bmjopen-2020-045343 DOI: https://doi.org/10.1136/bmjopen-2020-045343

Intergovernmental Panel on Climate Change. Climate Change 2023: Synthesis Report. Contribution of Working Groups I, II and III to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. IPCC; 2023. doi:10.59327/IPCC/AR6-9789291691647 DOI: https://doi.org/10.59327/IPCC/AR6-9789291691647

World Health Organization. Climate change and health. Accessed March 23, 2026. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

World Health Organization. Heat and health. Accessed March 23, 2026. https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health

World Health Organization. Vector-borne diseases. Accessed March 23, 2026. https://www.who.int/news-room/fact-sheets/detail/vector-borne-diseases

Romanello M, Walawender M, Hsu SC, et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. Lancet. 2024;404(10465):1847-1896. doi:10.1016/S0140-6736(24)01822-1 DOI: https://doi.org/10.1016/S0140-6736(24)01822-1

Horton R. Offline: COVID-19 is not a pandemic. Lancet. 2020;396(10255):874. doi:10.1016/S0140-6736(20)32000-6 DOI: https://doi.org/10.1016/S0140-6736(20)32000-6

Mendenhall E. The COVID-19 syndemic is not global: context matters. Lancet. 2020;396(10264):1731. doi:10.1016/S0140-6736(20)32218-2 DOI: https://doi.org/10.1016/S0140-6736(20)32218-2

Kwamie A, Causevic S, Tomson G, et al. Prepared for the polycrisis? The need for complexity science and systems thinking to address global and national evidence gaps. BMJ Glob Health. 2024;9(9):e014887. doi:10.1136/bmjgh-2023-014887 DOI: https://doi.org/10.1136/bmjgh-2023-014887

Jorgensen PS, Jansen REV, Avila Ortega DI, et al. Evolution of the polycrisis: Anthropocene traps that challenge global sustainability. Philos Trans R Soc Lond B Biol Sci. 2024;379(1893):20220261. doi:10.1098/rstb.2022.0261 DOI: https://doi.org/10.1098/rstb.2022.0261

Blanchet K, Nam SL, Ramalingam B, Pozo-Martin F. Governance and capacity to manage resilience of health systems: towards a new conceptual framework. Int J Health Policy Manag. 2017;6(8):431-435. doi:10.15171/ijhpm.2017.36 DOI: https://doi.org/10.15171/ijhpm.2017.36

Biddle L, Wahedi K, Bozorgmehr K. Health system resilience: a literature review of empirical research. Health Policy Plan. 2020;35(8):1084-1109. doi:10.1093/heapol/czaa032 DOI: https://doi.org/10.1093/heapol/czaa032

Fridell M, Edwin S, von Schreeb J, Saulnier DD. Health system resilience: what are we talking about? A scoping review mapping characteristics and keywords. Int J Health Policy Manag. 2020;9(1):6-16. doi:10.15171/ijhpm.2019.71 DOI: https://doi.org/10.15171/ijhpm.2019.71

Ansah EW, Amoadu M, Obeng P, Sarfo JO. Health systems response to climate change adaptation: a scoping review of global evidence. BMC Public Health. 2024;24(1):2015. doi:10.1186/s12889-024-19459-w DOI: https://doi.org/10.1186/s12889-024-19459-w

Witter S, Thomas S, Topp SM, et al. Health system resilience: a critical review and reconceptualisation. Lancet Glob Health. 2023;11(9):e1454-e1458. doi:10.1016/S2214-109X(23)00279-6 DOI: https://doi.org/10.1016/S2214-109X(23)00279-6

World Health Organization. Defining Collaborative Surveillance: A Core Concept for Strengthening the Global Architecture for Health Emergency Preparedness, Response, and Resilience (HEPR). Published 2023. Accessed March 23, 2026. https://iris.who.int/handle/10665/367927

World Health Organization. Future Surveillance for Epidemic and Pandemic Diseases: A 2023 Perspective. Published 2023. Accessed March 23, 2026. https://iris.who.int/handle/10665/374992

World Health Organization. Wastewater and Environmental Surveillance for One or More Pathogens: Guidance on Prioritization, Implementation and Integration. Published 2024. Accessed March 23, 2026. https://www.who.int/publications/m/item/wastewater-and-environmental-surveillance-for-one-or-more-pathogens--guidance-on-prioritization--implementation-and-integration

Brosky H, Prasek SM, Innes GK, et al. A framework for integrating wastewater-based epidemiology and public health. Front Public Health. 2024;12:1418681. doi:10.3389/fpubh.2024.1418681 DOI: https://doi.org/10.3389/fpubh.2024.1418681

McNeil C, Verlander S, Divi N, Smolinski M. The landscape of participatory surveillance systems across the One Health spectrum: systematic review. JMIR Public Health Surveill. 2022;8(8):e38551. doi:10.2196/38551 DOI: https://doi.org/10.2196/38551

Lal A, Erondu NA, Heymann DL, Gitahi G, Yates R. Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage. Lancet. 2021;397(10268):61-67. doi:10.1016/S0140-6736(20)32228-5 DOI: https://doi.org/10.1016/S0140-6736(20)32228-5

Legido-Quigley H, Asgari N, Teo YY, et al. Are high-performing health systems resilient against the COVID-19 epidemic? Lancet. 2020;395(10227):848-850. doi:10.1016/S0140-6736(20)30551-1 DOI: https://doi.org/10.1016/S0140-6736(20)30551-1

Khan S, Mishra J, Ahmed N, et al. Risk communication and community engagement during COVID-19. Int J Disaster Risk Reduct. 2022;74:102903. doi:10.1016/j.ijdrr.2022.102903 DOI: https://doi.org/10.1016/j.ijdrr.2022.102903

World Health Organization. Infodemic. Accessed March 23, 2026. https://www.who.int/health-topics/infodemic

Abbott R, Bethel A, Rogers M, et al. Characteristics, quality and volume of the first 5 months of the COVID-19 evidence synthesis infodemic: a meta-research study. BMJ Evid Based Med. 2022;27(3):169-177. doi:10.1136/bmjebm-2021-111710 DOI: https://doi.org/10.1136/bmjebm-2021-111710

Wojczewski S, Grohma P, Kutalek R. Risk communication and community engagement with vulnerable groups: perceptions of social-services CSOs during COVID-19. Int J Disaster Risk Reduct. 2023;94:103817. doi:10.1016/j.ijdrr.2023.103817 DOI: https://doi.org/10.1016/j.ijdrr.2023.103817

Abuhaloob L, Purnat TD, Tabche C, et al. Management of infodemics in outbreaks or health crises: a systematic review. Front Public Health. 2024;12:1343902. doi:10.3389/fpubh.2024.1343902 DOI: https://doi.org/10.3389/fpubh.2024.1343902

SteelFisher GK, Findling MG, Caporello HL, et al. Trust in US federal, state, and local public health agencies during COVID-19: responses and policy implications. Health Aff (Millwood). 2023;42(3):328-337. doi:10.1377/hlthaff.2022.01204 DOI: https://doi.org/10.1377/hlthaff.2022.01204

Magesh S, John D, Li WT, et al. Disparities in COVID-19 outcomes by race, ethnicity, and socioeconomic status: a systematic review and meta-analysis. JAMA Netw Open. 2021;4(11):e2134147. doi:10.1001/jamanetworkopen.2021.34147 DOI: https://doi.org/10.1001/jamanetworkopen.2021.34147

Khanijahani A, Iezadi S, Gholipour K, Azami-Aghdash S, Naghibi D. A systematic review of racial/ethnic and socioeconomic disparities in COVID-19. Int J Equity Health. 2021;20(1):248. doi:10.1186/s12939-021-01582-4 DOI: https://doi.org/10.1186/s12939-021-01582-4

Hennis AJM, Coates A, Del Pino S, et al. COVID-19 and inequities in the Americas: lessons learned and implications for essential health services. Rev Panam Salud Publica. 2021;45:e130. doi:10.26633/RPSP.2021.130 DOI: https://doi.org/10.26633/RPSP.2021.130

Asundi A, O'Leary C, Bhadelia N. Global COVID-19 vaccine inequity: the scope, the impact, and the challenges. Cell Host Microbe. 2021;29(7):1036-1039. doi:10.1016/j.chom.2021.06.007 DOI: https://doi.org/10.1016/j.chom.2021.06.007

Gleeson D, Townsend B, Tenni BF, Phillips T. Global inequities in access to COVID-19 health products and technologies: a political economy analysis. Health Place. 2023;83:103051. doi:10.1016/j.healthplace.2023.103051 DOI: https://doi.org/10.1016/j.healthplace.2023.103051

Ferraz D, Barreira D. Preparing for future pandemics while responding to the current ones in the midst of a planetary climate crisis: can we face this triple global health challenge? Glob Public Health. 2024;19(1):2351593. doi:10.1080/17441692.2024.2351593 DOI: https://doi.org/10.1080/17441692.2024.2351593

Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet. 2015;385(9980):1910-1912. doi:10.1016/S0140-6736(15)60755-3 DOI: https://doi.org/10.1016/S0140-6736(15)60755-3

Pailliard Turenne C, Gautier L, Degroote S, Guillard E, Chabrol F, Ridde V. Conceptual analysis of health systems resilience: a scoping review. Soc Sci Med. 2019;232:168-180. doi:10.1016/j.socscimed.2019.04.020 DOI: https://doi.org/10.1016/j.socscimed.2019.04.020

World Health Organization. Building Health System Resilience to Public Health Challenges: Guidance for Implementation in Countries. Published 2024. Accessed March 23, 2026. https://iris.who.int/handle/10665/377652

World Health Organization. Health systems resilience. Accessed March 23, 2026. https://www.who.int/teams/primary-health-care/health-systems-resilience

World Health Organization. Measuring the Climate Resilience of Health Systems. Published 2022. Accessed March 23, 2026. https://iris.who.int/handle/10665/354542

World Health Organization. Planning for Health System Recovery: Guidance for Application in Countries. Published 2024. Accessed March 23, 2026. https://iris.who.int/handle/10665/378458

World Health Organization. Operational Framework for Building Climate Resilient and Low Carbon Health Systems. Published 2023. Accessed March 23, 2026. https://iris.who.int/handle/10665/373837

World Health Organization. Integrated surveillance and climate-informed health early warning systems. Accessed March 23, 2026. https://www.who.int/teams/environment-climate-change-and-health/climate-change-and-health/country-support/integrated-surveillance-and-climate-informed-health-early-warning-systems

Aarestrup FM, Bonten M, Koopmans M. Pandemics- One Health preparedness for the next. Lancet Reg Health Eur. 2021;9:100210. doi:10.1016/j.lanepe.2021.100210 DOI: https://doi.org/10.1016/j.lanepe.2021.100210

Dente MG, Riccardo F, Van Kerkhove MD, et al. Strengthening preparedness against global health threats: a paradigm shift based on One Health approaches. One Health. 2022;14:100396. doi:10.1016/j.onehlt.2022.100396 DOI: https://doi.org/10.1016/j.onehlt.2022.100396

Avanthay Strus J, Sankam J, Green S, et al. Adaptation and mitigation for the planetary health crisis: a scoping review from the perspective of primary health care providers. J Clim Change Health. 2025;100440. doi:10.1016/j.joclim.2025.100440 DOI: https://doi.org/10.1016/j.joclim.2025.100440

Mosadeghrad AM, Afshari M, Isfahani P, et al. Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review. BMC Health Serv Res. 2024;24(1):841. doi:10.1186/s12913-024-11278-4 DOI: https://doi.org/10.1186/s12913-024-11278-4

Ballard M, Olsen HE, Millear A, et al. Continuity of community-based healthcare provision during COVID-19: a multicountry interrupted time series analysis. BMJ Open. 2022;12(5):e052407. doi:10.1136/bmjopen-2021-052407 DOI: https://doi.org/10.1136/bmjopen-2021-052407

Carrillo de Albornoz S, Sia KL, Harris A. The effectiveness of teleconsultations in primary care: systematic review. Fam Pract. 2022;39(1):168-182. doi:10.1093/fampra/cmab077 DOI: https://doi.org/10.1093/fampra/cmab077

World Health Organization Regional Office for Europe. Managing the infodemic. Accessed March 23, 2026. https://www.who.int/europe/activities/managing-the-infodemic

Smith R, Chen K, Winner D, Friedhoff S, Wardle C. A systematic review of COVID-19 misinformation interventions: lessons learned. Health Aff (Millwood). 2023;42(12):1738-1746. doi:10.1377/hlthaff.2023.00717 DOI: https://doi.org/10.1377/hlthaff.2023.00717

Bolte G, Dandolo L, Gepp S, Hornberg C, Lopez Lumbi S. Climate change and health equity: a public health perspective on climate justice. J Health Monit. 2023;8(suppl 6):3-35. doi:10.25646/11772

Cole BL, Del Rosario I, Hendricks A, Eisenman DP. Advancing health equity in community-based climate action: from concept to practice. Am J Public Health. 2023;113(2):185-193. doi:10.2105/AJPH.2022.307143 DOI: https://doi.org/10.2105/AJPH.2022.307143

World Health Organization Regional Office for Europe. Support Tool to Strengthen Health Information Systems: Guidance for Health Information System Assessment and Strategy Development, Second Edition. Published 2024. Accessed March 23, 2026. https://www.who.int/europe/publications/i/item/9789289061148

Saulnier DD, Duchenko A, Ottilie-Kovelman S, Tediosi F, Blanchet K. Re-evaluating our knowledge of health system resilience during COVID-19: lessons from the first two years of the pandemic. Int J Health Policy Manag. 2023;12:6659. doi:10.34172/ijhpm.2022.6659 DOI: https://doi.org/10.34172/ijhpm.2022.6659

Copeland S, Hinrichs-Krapels S, Fecondo F, et al. A resilience view on health system resilience: a scoping review of empirical studies and reviews. BMC Health Serv Res. 2023;23(1):1297. doi:10.1186/s12913-023-10022-8 DOI: https://doi.org/10.1186/s12913-023-10022-8

Forsgren L, Tediosi F, Blanchet K, Saulnier DD. Health systems resilience in practice: a scoping review to identify strategies for building resilience. BMC Health Serv Res. 2022;22(1):1173. doi:10.1186/s12913-022-08544-8 DOI: https://doi.org/10.1186/s12913-022-08544-8

Palmeiro-Silva Y, Aravena-Contreras R, Izcue Gana J, et al. Climate-related health impact indicators for public health surveillance in a changing climate: a systematic review and local suitability analysis. Lancet Reg Health Am. 2024;38:100854. doi:10.1016/j.lana.2024.100854 DOI: https://doi.org/10.1016/j.lana.2024.100854

Hamilton KA, Wade MJ, Barnes KG, Street RA, Paterson S. Wastewater-based epidemiology as a public health resource in low- and middle-income settings. Environ Pollut. 2024;351:124045. doi:10.1016/j.envpol.2024.124045 DOI: https://doi.org/10.1016/j.envpol.2024.124045

de Savigny D, Adam T, eds. Systems Thinking for Health Systems Strengthening. World Health Organization; 2009. https://iris.who.int/handle/10665/44204

Duit A, Galaz V, Eckerberg K, Ebbesson J. Governance, complexity, and resilience. Glob Environ Change. 2010;20(3):363-368. doi:10.1016/j.gloenvcha.2010.04.006 DOI: https://doi.org/10.1016/j.gloenvcha.2010.04.006

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Article Information
Issue Vol. 2 (2026): Focus on Healthy Aging and Chronic Disease Prevention
Pages24-39
Published2026-04-19
DOI10.63802/hn.V2.2026.308
SectionSpecial Section: Public Health and SDGs
EISSN3053-7037
AccessOpen Access
Keywords
public health resilience COVID-19 climate change health systems strengthening global health
Data Availability Statement

Not applicable. This study is a conceptual framework study based on a synthesis of existing literature and did not generate or analyze a new dataset.

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Copyright (c) 2026 Chengwen Song, Siheng Ma, Gulifeire Rousitanmu, Yuxuan He, Yunze Lu, Jialuo Fang, Jiayi Li, Zhili Zhu, Qilong Wang, Xingkai Zhang, Wanlin Dong, Yufei Shao (Author)

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