IDEAS home Printed from https://ideas.repec.org/a/bla/ijhplm/v40y2025i2p322-334.html

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

Author

Listed:
  • Hannah Vaughan‐Lee
  • Lezlie C. Morinière
  • Nancy Stroupe

Abstract

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.

Suggested Citation

  • Hannah Vaughan‐Lee & Lezlie C. Morinière & Nancy Stroupe, 2025. "Fragility, Health and the Risk Paradigm: A Health‐Sensitive Framework," International Journal of Health Planning and Management, Wiley Blackwell, vol. 40(2), pages 322-334, March.
    • Handle: RePEc:bla:ijhplm:v:40:y:2025:i:2:p:322-334
    DOI: 10.1002/hpm.3871
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hpm.3871
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hpm.3871?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Derick W. Brinkerhoff, 2014. "State fragility and failure as wicked problems: beyond naming and taming," Third World Quarterly, Taylor & Francis Journals, vol. 35(2), pages 333-344, February.
    2. Bertone, Maria Paola & Jowett, Matthew & Dale, Elina & Witter, Sophie, 2019. "Health financing in fragile and conflict-affected settings: What do we know, seven years on?," Social Science & Medicine, Elsevier, vol. 232(C), pages 209-219.
    3. Ines A. Ferreira, 2017. "Measuring state fragility: a review of the theoretical groundings of existing approaches," Third World Quarterly, Taylor & Francis Journals, vol. 38(6), pages 1291-1309, June.
    4. Arakelyan, Stella & Jailobaeva, Kanykey & Dakessian, Arek & Diaconu, Karin & Caperon, Lizzie & Strang, Alison & Bou-Orm, Ibrahim R. & Witter, Sophie & Ager, Alastair, 2021. "The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study," Social Science & Medicine, Elsevier, vol. 291(C).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Martin-Shields, Charles, 2017. "State fragility as a cause of forced displacement: identifying theoretical channels for empirical research," IDOS Discussion Papers 30/2017, German Institute of Development and Sustainability (IDOS).
    2. Anuradha Joshi, 2023. "What makes “difficult” settings difficult? Contextual challenges for accountability," Development Policy Review, Overseas Development Institute, vol. 41(S1), March.
    3. Sweet, Rachel & Kasali, Noé, 2024. "Public health intervention amidst conflict: Violence, politics, and knowledge frames in the 2018-20 Ebola epidemic in Democratic Republic of the Congo," Social Science & Medicine, Elsevier, vol. 350(C).
    4. Tim Glawion & Lotje de Vries & Andreas Mehler, 2019. "Handle with Care! A Qualitative Comparison of the Fragile States Index's Bottom Three Countries: Central African Republic, Somalia and South Sudan," Development and Change, International Institute of Social Studies, vol. 50(2), pages 277-300, March.
    5. Cristian Barra & Vincenzo D’Atteo & Edgardo Sica, 2025. "Enhancing efficiency in secondary biomass supply: the role of institutional quality in the EU regions," Economic Change and Restructuring, Springer, vol. 58(5), pages 1-43, October.
    6. Bertone, Maria Paola & Palmer, Natasha & Witter, Sophie, 2025. "Integrating healthcare financing for refugees into national health systems: Findings from a rapid review of the literature," Social Science & Medicine, Elsevier, vol. 387(C).
    7. Rachel M. Gisselquist, 2015. "State Capability and Prospects for Close Co-ordination: Considerations for Industrial Policy in Africa," WIDER Working Paper Series wp-2015-035, World Institute for Development Economic Research (UNU-WIDER).
    8. Rachel M. Gisselquist, 2015. "State capability and prospects for close co-ordination: Considerations for industrial policy in Africa," WIDER Working Paper Series 035, World Institute for Development Economic Research (UNU-WIDER).
    9. Charly Ondobo Tsala & Raymond Ekodo & Henri Tabi Ngoa, 2025. "Does Decentralization Decrease State Fragility? Evidence from Developing Countries," Journal of the Knowledge Economy, Springer;Portland International Center for Management of Engineering and Technology (PICMET), vol. 16(4), pages 15228-15259, October.
    10. Adama A. Gross & Uriah G. Bailey & Inioluwa Ogunseye, 2024. "Corruption, Prebendalism and the Fragile State: A Case Study on Liberia," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 8(2), pages 1445-1457, February.
    11. Alina Hovhannisyan & Celene Philip & Jemma Arakelyan & Gevorg Tamamyan & Stella Arakelyan, 2024. "Barriers to access to cancer care for patients from the conflict-affected region of the Nagorno-Karabakh Republic: A qualitative study," PLOS Global Public Health, Public Library of Science, vol. 4(7), pages 1-14, July.
    12. Klejda Mulaj, 2019. "On State-Building and Wicked Problems: Stateness, Nationhood and Mimicry," International Studies, , vol. 56(2-3), pages 129-146, April.
    13. Samuel Lordemus & Noemi Kreif & Rodrigo Moreno‐Serra, 2024. "Public Healthcare Financing during Counterinsurgency Efforts: Evidence from Colombia," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 86(5), pages 1230-1259, October.
    14. Francois Xavier Ngah Obama & Hans Tino Mpenya Ayamena & Francis Baye Menjo, 2026. "Fragile state and capital flight in Africa," International Economics and Economic Policy, Springer, vol. 23(2), pages 1-33, May.
    15. Wafaa Hassan SH Hassan, 2025. "The Impact of Transitional Justice on Humanitarian Operations in Post-Conflict Somalia," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 9(8), pages 5528-5550, August.
    16. Ihsanullah Omarkhail, 2024. "Perceptions of informed Afghans on the Taliban's Islamic Emirate and the former Afghan government," World Affairs, John Wiley & Sons, vol. 187(4), pages 476-495, December.
    17. Davidson, Angus Alexander & Young, Michael Denis & Leake, John Espie & O’Connor, Patrick, 2022. "Aid and forgetting the enemy: A systematic review of the unintended consequences of international development in fragile and conflict-affected situations," Evaluation and Program Planning, Elsevier, vol. 92(C).
    18. Ariel I. Ahram, 2024. "In Search of a Middle East and North Africa Peace System," Contemporary Review of the Middle East, , vol. 11(2), pages 168-191, June.
    19. Federica Margini, 2020. "A synthesis of key aspects of health systems and policy design affecting the refugee populations in Uganda - Report Structure," Working Papers 176cherp, Centre for Health Economics, University of York.
    20. Joan Margalef & Laura Mayoral & Hannes Mueller & Christopher Rauh, 2025. "A framework for fragility," WIDER Working Paper Series wp-2025-58, World Institute for Development Economic Research (UNU-WIDER).

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:ijhplm:v:40:y:2025:i:2:p:322-334. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www.blackwellpublishing.com/journal.asp?ref=0749-6753 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.