“It takes a village” isn’t just a saying – it’s a foundation backed by research. A new study out today examined community resilience and health and found that fewer healthcare resources, limited digital tools and weaker support systems link to poorer overall health for residents. The study was published in the American Journal of Preventive Medicine.
The study, led by University of Maryland School of Public Health Professor Jie Chen, Ph.D., compared a standardized measure of community resilience in over 3,100 U.S. counties against data on cognitive, mental and physical health outcomes of county residents. The study is entitled “Associations Between Community Resilience, Healthcare Resources, and Cognitive Disability, Distress, and Depression in the U.S.”
“During natural disasters and other large-scale disruptions, it is often the most vulnerable populations, such as older people, who are hit the hardest," said Chen, who is chair of the Department of Health Policy and Management. “This led us to examine resilience not only as an individual characteristic, but as a broader systems-level capacity.”
Chen says the study shows that resilience can be measured, strengthened and designed into our systems of care using tools like healthcare access, support networks, and technology.
[We] examined resilience not only as an individual characteristic but as a broader systems-level capacity.
The paper defines resilience as the ability of individuals, families, systems and communities to adapt and thrive amidst challenging circumstances. While resilience is often discussed in broad terms, this study shows that it can be measured and that it plays a meaningful role in shaping health at the population level. The framework was developed through the efforts of the Center for SUNSHINE, short for Seniors Uniting Nationwide to Support Health, INtegrated care, and Economics, and is based at the University of Maryland.
“Resilience should not be confined to post-disaster contexts,” said Chen. “It is also a critical, modifiable element with a significant impact on people’s everyday health, especially when you consider the social and systemic conditions in which people live.”
The research team conducted a cross-sectional analysis using data from FEMA’s National Risk Index, CDC PLACES – which offers local health data, and the Area Health Resources File, part of the federal Health Resources & Services Administration. The researchers examined how levels of community resilience were associated with five health outcomes: cognitive disability, frequent mental distress, physical distress, mobility disability and diagnosed depression.
“We found that counties with very low community resilience had significantly higher rates of cognitive disability, depression, mental and physical distress and mobility disability. These disparities were strongly associated with limited access to primary care, mental health services and digital infrastructure, suggesting that resilience is a modifiable and measurable factor tied to population health,” said co-investigator Charles F. Reynolds III, M.D., of University of Pittsburgh’s School of Medicine.
Counties with very low community resilience had significantly higher rates of cognitive disability, depression, mental and physical distress and mobility disability.
The most significant finding was that counties in the lowest resilience category had up to four percentage points higher prevalence of the five negative health outcomes compared to those with high resilience, even after adjusting for rurality, population size and healthcare shortages. Investigators also found that the presence of healthcare infrastructure, particularly digital tools such as telehealth and health information technology, was linked to better outcomes.
Healthcare infrastructure, including access to timely care and telehealth, is not currently included in most standardized resilience indices such as the FEMA National Risk Index. However, the findings of this study imply that these factors are essential to promoting health and supporting recovery.
“Resilience is both a reflection of the conditions in which people live and a driver of their health outcomes. By treating resilience as something that can be strengthened through healthcare access, system design and community investment, we can better support individuals, families and communities across the life course,” said Reynolds.
The study’s findings are especially timely as many communities continue to face challenges related to aging populations, limited infrastructure and uneven access to care. In some locations, people are simply not able to access services when they need them.
“What gives us hope is that many of these factors are modifiable. Resilience can be actively pursued – it is something we can build. Healthcare capacity, digital infrastructure, transportation and social services can be improved and aligned with community needs,” said Chen.
“This opens the door to designing systems that better serve older adults, individuals with mobility challenges and residents of underserved areas. We can break this cycle where limited resources lead to low resilience and poor health.”
From the UMD School of Public Health, faculty Seyeon Jang, Ph.D., and Stephen B. Thomas, Ph.D, also contributed to the research.
This study was supported by the National Institute on Aging (R01AG062315, RF1AG083175 and P30AG097158). The newly established Center for SUNSHINE, created for the study of resilience over the lifespan, is supported by a grant from the National Institute on Aging.
[adapted from original release first published by Elsevier]