Breaking the Cycle of Vulnerability: Study Identifies Modifiable Elements to Build Community Resilience and Improve Health

A novel study empirically linking a standardized measure of community resilience in more than 3,100 U.S. counties to cognitive, mental, and physical health outcomes shows that counties with fewer healthcare resources, limited digital tools, and weaker support systems exhibit poorer overall health among their residents. The article appearing in the American Journal of Preventive Medicine, published by Elsevier, indicates that resilience can be measured, strengthened, and designed into our systems of care using modifiable tools like healthcare access, support networks, and technology.

Resilience is the capacity to adapt, maintain, or regain well-being in the face of adversity. “During natural disasters and other large-scale disruptions, it is often the most vulnerable populations, such as older adults, individuals with mobility limitations, and those needing caregiving, who are affected the most,” notes lead investigator Jie Chen, PhD, University of Maryland School of Public Health. “This led us to examine resilience not only as an individual characteristic but as a broader systems-level capacity.”

This study utilizes the SUNSHINE framework, in which resilience is defined 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. Dr. Chen points out, “Resilience should not be confined to post-disaster contexts. It must also be recognized as a critical, modifiable social determinant of health that shapes population health through the social and systemic conditions in which people live.”

The researchers conducted a cross-sectional analysis using data from FEMA’s National Risk Index, CDC PLACES, and the Area Health Resources File. They examined how levels of community resilience were associated with five health outcomes: cognitive disability, frequent mental distress, physical distress, mobility disability, and diagnosed depression.

Co-investigator Charles F. Reynolds III, MD, University of Pittsburgh School of Medicine, says, “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.”

The most significant finding was that counties in the lowest resilience category had up to four percentage points higher prevalence of the five 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.

One unexpected insight was that 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.

Dr. Reynolds points out, “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.”

As many communities continue to face challenges related to aging populations, limited infrastructure, and uneven access to care, the findings of this study are especially relevant. In some areas, people are simply not able to access services when they need them.

Dr. Chen concludes, “What gives us hope is that many of these factors are modifiable. Resilience is not just something we have, instead, it is something we can build. Healthcare capacity, digital infrastructure, transportation, and social services can be improved and aligned with community needs. This opens the door to designing systems that better serve older adults, individuals with mobility challenges, and residents of underserved areas. We can break the cycle where limited resources lead to low resilience and poor health. That is a promising and actionable direction.”

Notes for editors

The article is “Associations Between Community Resilience, Healthcare Resources, and Cognitive Disability, Distress, and Depression in the U.S.,” by Jie Chen, PhD, Seyeon Jang, PhD, Poushali Banerjee, MS, Stephen B. Thomas, PhD, Howard Goldman, MD, PhD, and Charles F. Reynolds III, MD (https://doi.org/10.1016/j.amepre.2025.108168). It appears online in the American Journal of Preventive Medicine, published by Elsevier.

The article is openly available at https://www.ajpmonline.org/article/S0749-3797(25)00636-1/fulltext.

Full text of this article is also available to credentialed journalists upon request; contact Astrid Engelen at +31 6 14395474 or [email protected]. Journalists wishing to interview the authors should contact Jie Chen, PhD, at [email protected].

This study was supported by the National Institute on Aging (R01AG062315, RF1AG083175, and P30AG097158).

The newly established (September 2025) Center for Seniors Uniting Nationwide to Support Health, INtegrated care, and Economics, (SUNSHINE), aimed at studying resilience and aging, is supported by a grant from the National Institute on Aging.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org

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