Fragility, Health and the Risk Paradigm: A Health-Sensitive Framework

Recognising that fragile contexts present a significant challenge to the Sustainable Development Goals, this paper examines the relationship between fragility and health, proposing a health-sensitive conceptual framework for understanding the impact of fragility on health outcomes. Through a comprehensive literature review and comparison of existing fragility frameworks, the study identifies five key characteristics of fragility: alignment with the risk paradigm; multidimensionality; systems perspective; state-society relationship; and appreciating fragility in relation to 'contexts' rather than 'states'. In doing so, the paper highlights the need for a multidimensional approach to fragility that includes a distinct health dimension in addition to political, security, economic, social, environmental domains. Rather than proposing a way to score or measure fragility, the authors argue in favour of a nuanced and dynamic understanding of fragility based on the interactions between the different dimensions of fragility, emphasising the impact on/interactions with health.