Submission ID 118389
| Issue/Objective | Since the 1990s, fragility emerged as concept describing the nation states of low- and middle-income countries (LMIC). International monetary and development organizations continue to define, measure, and classify state fragility. Global health research and practice, in terms of what topics are studied and the way interventions are designed and implemented, are influenced by assumptions regarding fragility. |
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| Methodology/Approach | In conducting an integrated review of the 'fragility' concept as applied in global health and critiquing the underlying assumptions of this evidence base, we apply and extend the harms of damage centered research to the concept of state fragility. |
| Results | We argue that labeling and classification systems of fragility are not neutral representations of the world. Rather, these measurement systems are underscored by the power hierarchies that further engender fragility. In this spirit, we critique 'state fragility' as a concept applied exclusively applied to LMICs and the people living in so called 'fragile countries.' Drawing on the synthesis from the integrative review, we introduce a novel model of global health fragility that distills the nature of fragility among institutions in high income countries and amplifies expressions of self-governance as forms of everyday resistance and survival among people living in fragile countries. |
| Discussion/Conclusion | This conceptual model highlights what global health promotion researchers and practitioners might overlook when adopting the fragility labeling and classification system developed by The World Bank and the Organization for Economic Co-operation and Development. In drawing on Haiti as a case study of collective citizen resistance to state fragility and the hidden and emerging forms of institutional fragility in the United States, we illustrate the less measured expressions of everyday strength in and ideological fragility. This global health fragility conceptual model can inform a different global health agenda; one that is imagined and scaled from the bottom up and more robustly engages with hidden forms of fragility in high income countries. |
| Presenters and affiliations | Luissa Vahedi Sick Kids Centre for Global Child Health; University of Toronto Carmen Logie University of Toronto |
