Understanding fragility
Implications for global health research and practice
Bibliographic Data
Advances in population health outcomes risk being slowed—and potentially reversed—by a range of threats increasingly presented as ‘fragility’. Widely used and critiqued within the development arena, the concept is increasingly used in the field of global health, where its relationship to population health, health service delivery, access and utilization is poorly specified. We present the first scoping review seeking to clarify the meaning, definitions and applications of the term in the global health literature. Adopting the theoretical framework of concept analysis, 10 bibliographic and grey literature sources, and five key journals, were searched to retrieve documents relating to fragility and health. Reviewers screened titles and abstracts and retained documents applying the term fragility in relation to health systems, services, health outcomes and population or community health. Data were extracted according to the protocol; all documents underwent bibliometric analysis. Narrative synthesis was then used to identify defining attributes of the concept in the field of global health. A total of 377 documents met inclusion criteria. There has been an exponential increase in applications of the concept in published literature over the last 10 years. Formal definitions of the term continue to be focused on the characteristics of ‘fragile and conflict-affected states’. However, synthesis indicates diverse use of the concept with respect to: level of application (e.g. from state to local community); emphasis on particular antecedent stressors (including factors beyond conflict and weak governance); and focus on health system or community resources (with an increasing tendency to focus on the interface between two). Amongst several themes identified, trust is noted as a key locus of fragility at this interface, with critical implications for health seeking, service utilization and health system and community resilience
Environmental health · Grey literature · MEDLINE · Political science · Population · Population health · Public relations · Global Maternal and Child Health · Global Public Health Policies and Epidemiology · Healthcare Systems and Reforms · Medicine
How effective have international humanitarian agencies been in responding to the health crisis in Gaza? What have been the features of the most effective efforts, and what can be learned from these to improve responses to this and other humanitarian emergencies?
Adapting and implementing training, guidelines and treatment cards to improve primary care-based hypertension and diabetes management in a fragile context
Fragile, handle with care
Influences of community engagement and health system strengthening for cholera control in cholera reporting countries
Primary healthcare system and provider responses to the Taliban takeover in Afghanistan
Building resilient health professions education in fragile contexts
Food insecurity, state fragility and youth mental health
Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting
Primary Healthcare Quality in Conflict and Fragility
Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings
Identifying opportunities to engage communities with social mobilisation activities to tackle NCDs in El Salvador in the context of the global Covid-19 pandemic
“Crises are a perpetual restart”—A comparative analysis of maternal and newborn health political prioritization across four fragile and conflict affected settings
A community–based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon
Covid‐19 lockdown consequences on body mass index and perceived fragility related to physical activity
Enablers and barriers to implementing cholera interventions in Nigeria
Linking communities and health facilities to improve child health in low-resource settings
Implications of the fragility of opioid agonist treatment continuity on hepatitis C re-exposure concerns among people in prison
The role of trust in health-seeking for non-communicable disease services in fragile contexts
Perceptions of Covid-19 in faith communities in DR Congo
Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017
The Lancet Countdown on health and climate change
Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017
Scoping reviews
Scoping studies
High-quality health systems in the Sustainable Development Goals era
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Rational trust in resilient health systems
Scoping studies
Patients as team members
| Unique citing works | 19 |
|---|---|
| Citations per year | 3,17 |
| Citation span | 2020 - 2026 (7) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 18 |