Monday 13 December 2010 Global Health Initiative Health in Crisis Thematic Working Group

1. Monday 13 December 2010 Global Health Initiative Health in Crisis Thematic Working Group Social Ecology of Crisis: Human, Social & Cultural Capital as the Basis of Relief and Recovery Alastair Ager Program on Forced Migration and Health Executive Director, Global Health Initiative Mailman School of Public Health

2. Overview • The Rationale for TWGs • The Rationale for a Health in Crisis TWG • A Social Ecological Framework for Psychosocial Intervention in Complex Emergencies • An Approach of Wider Utility in Conceptualizing (Interventions Addressing) Health in Crisis? After Ager (1997)

3. The Rationale for TWGs

4. The Rationale for a Health in Crisis TWG

5. TWG: Health in Crisis • Bringing together innovative research from fields of MSPH global leadership (e.g. climate change, disasters, conflict, HIV-impact etc.) to consider such questions as: • What are the continuities – and discontinuities – across differing forms of ‘crisis’? • What conceptualizations are most promising in the formulation of crisis settings such that effective action can be planned? • What common sources of vulnerability – and resilience – can be identified across crisis settings? • To what extent can concepts such as social capital provide insight into mechanisms of community recovery and population resilience? • What settings and scenarios are most promising to model multi-level interventions supporting recovery? • How can ‘cross crisis’ studies of mental health and social resilience inform action? • How can economic understandings be integrated into analyses of recovery of household, community and broader societal systems following crisis? • How do we work towards sustainable development that better protects vulnerable populations and donor investment in fragile, crisis-affected settings?

6. TWG: Health in Crisis • PROJECT INITIATIVES • Development of ‘Institute for Public Health’ in Amman providing training and operational research expertise related to regional conflict and migration • Joint initiative considering preparedness, mitigation and development stages of crisis response in climate-induced migration • SEMINAR SERIES AND CONFERENCES • Drawing together Mailman and wider CU expertise - with relevant external speakers - on issues of crisis response • e.g. October 22 Panel discussion with the Office of Foreign Disaster Assistance, International Research Institute for Climate Prediction/Earth Institute and Mailman School of Public Health • e.g. Potential Spring Event jointly sponsored with the Global Mental Health Program: Lynne Jones to discuss psychiatric illness during crises • WORKING PAPERS • Literature and practice reviews drawing together learning from research groups across the school/university (and partners) • EDUCATIONAL DEVELOPMENTS • ‘Global Classroom‘ (online course) roll-out with GHI partner institutions on key topics in health in crisis • Intensive training workshops on health in crisis topics • HEALTH IN CRISIS COORDINATION GROUP • Establishment of clear procedures and protocols for coordinating communication

7. A Social Ecological Framework for Psychosocial Intervention in Complex Emergencies

14. Psychosocial Intervention In Complex Emergencies: A Contested Territory ‘As a field of work, psychosocial intervention remains characterised by a lack of consensus on goals, strategy and best practice’.

15. The Psychosocial Working Group • International Rescue Committee • Save the Children - US • Christian Children’s Fund • Medecins sans Frontieres - Holland • Mercy Corps

16. The Psychosocial Working Group • IIHD, Queen Margaret University College, Edinburgh • Refugee Studies Centre, University of Oxford • Program on Forced Migration & Health, Columbia School of Public Health • Harvard Program on Refugee Trauma • Asch Center, UPenn

17. mental health HUMAN CAPITAL knowledge & skills livelihoods

18. family & peers SOCIAL CAPITAL HUMAN CAPITAL community social & service infrastructure

19. SOCIAL CAPITAL HUMAN CAPITAL cultural practices human rights religious beliefs CULTURAL CAPITAL

20. PHYSICAL RESOURCES SOCIAL CAPITAL HUMAN CAPITAL ECONOMIC RESOURCES ENVIRONMENTAL RESOURCES CULTURAL CAPITAL

21. PHYSICAL RESOURCES SOCIAL CAPITAL HUMAN CAPITAL ECONOMIC RESOURCES ENVIRONMENTAL RESOURCES Human Capital CULTURAL CAPITAL

22. PHYSICAL RESOURCES SOCIAL ECOLOGY HUMAN CAPITAL ECONOMIC RESOURCES ENVIRONMENTAL RESOURCES Social Capital CULTURE & VALUES

23. PHYSICAL RESOURCES SOCIAL CAPITAL HUMAN CAPITAL ECONOMIC RESOURCES ENVIRONMENTAL RESOURCES CULTURE & VALUES Cultural Capital

24. PHYSICAL RESOURCES SOCIAL CAPITAL HUMAN CAPITAL ECONOMIC RESOURCES ENVIRONMENTAL RESOURCES CULTURAL CAPITAL

25. SOCIAL CAPITAL HUMAN CAPITAL CULTURAL CAPITAL

26. SOCIAL CAPITAL HUMAN CAPITAL CULTURAL CAPITAL

27. Engagement SOCIAL CAPITAL HUMAN CAPITAL CULTURAL CAPITAL

29. Negotiation

30. Transformation

31. Transformation

32. Transformation

33. PHYSICAL RESOURCES SOCIAL CAPITAL HUMAN CAPITAL ECONOMIC RESOURCES ENVIRONMENTAL RESOURCES CULTURAL CAPITAL

34. Summary of Key Features of Model • 3 key domains of resource (human, social and cultural capital) • 3 perspectives on resource (loss, retained capacity, ‘bolstering’) • 3 key processes (engagement, negotiation, transformation) • 3 dimensions of social capital (bonds, bridges and links)

36. An Approach of Wider Utility in Conceptualizing (Interventions Addressing) Health in Crisis?

37. Psychosocial: The Role? • ‘The development [or facilitation] of personal agency [or engagement] within prevailing social context’ • Corollaries: • hope • self-esteem • enterprise • community development

38. Psychosocial: The Future? • Psychosocial concerns: • increasingly decoupled from the discourse of mental health and psychopathology, and • increasingly addressed as a mainstream element of [post-conflict] social development

39. ‘Conservation of Resources’ (COR) Theory Resource Acquisition Spirals vs. Resource Loss Spirals

40. General Propositions from Community Social Ecological Analysis • Crisis involves abrupt resource loss • Resources are required to support recovery • Resources can be both internal & external • Diverse resources support recovery • Community-driven resource acquisition spirals are key to sustained recovery • Capacity to exchange/deploy resources is crucial for development of such spirals

41. Reintegration of girls formerly associated with armed groups in Sierra Leone Ager, A , Stark, L, Olsen, J, Wessells, M & & Boothby, N (2010) Sealing the Past, Facing the Future: An evaluation of a Program to Support the Reintegration of Girls and Young Women Formerly Associated with Armed Groups and Forces in Sierra Leone, Girlhood Studies, in press

42. Reintegration of girls formerly associated with armed groups in Sierra Leone Ager, A , Stark, L, Olsen, J, Wessells, M & & Boothby, N (2010) Sealing the Past, Facing the Future: An evaluation of a Program to Support the Reintegration of Girls and Young Women Formerly Associated with Armed Groups and Forces in Sierra Leone, Girlhood Studies, in press

43. Reintegration of girls formerly associated with armed groups in Sierra Leone Ager, A , Stark, L, Olsen, J, Wessells, M & & Boothby, N (2010) Sealing the Past, Facing the Future: An evaluation of a Program to Support the Reintegration of Girls and Young Women Formerly Associated with Armed Groups and Forces in Sierra Leone, Girlhood Studies, in press

44. Reintegration of girls formerly associated with armed groups in Sierra Leone Ager, A , Stark, L, Olsen, J, Wessells, M & & Boothby, N (2010) Sealing the Past, Facing the Future: An evaluation of a Program to Support the Reintegration of Girls and Young Women Formerly Associated with Armed Groups and Forces in Sierra Leone, Girlhood Studies, in press

45. Psychosocial structured activities in conflict-affected schools in N Uganda McCollister, F., Stark, L., Akesson, B., Okot, B & Ager, A. (2008) An evaluation of psychosocial structured activities for conflict-affected children in N Uganda. PFMH, New York: Report to Save the Children in Uganda,.

46. Psychosocial structured activities in conflict-affected schools in N Uganda McCollister, F., Stark, L., Akesson, B., Okot, B & Ager, A. (2008) An evaluation of psychosocial structured activities for conflict-affected children in N Uganda. PFMH, New York: Report to Save the Children in Uganda,.