How we work and our areas of expertise
At the Centre for Health Crises, we work according to an 'all hazards perspective' and recognise health crises in a holistic and interconnected manner. To adequately address health crises requires an understanding of both vulnerabilities and hazards. That is why we work both with specific hazards and with themes that are common to all types of crises.
An 'all hazards perspective' and the importance of health system resilience
The world is increasingly experiencing multifaceted crises of various kinds: pandemics, wars and effects of extreme weather events on all continents, all in interlinked and complex contexts. At the Centre, we work according to an ’all hazards’ perspective. While certain characteristics are specific to certain types of crises, there are also common themes. These can include the need for surge capacity in critical care and/or diagnostics, how to protect vulnerable groups which are often the most affected, mental health challenges, the need for rapid evidence to guide decision-making, communication challenges/disinformation, etc.
In order to have this perspective guide our work, we must understand how different health threats or hazards, affect health systems and thus societies. This requires a wide range of expertise, such as specialists in infectious diseases, climate effects on health, disaster medicine and trauma, chemical incidents, and other types of hazards.
At the same time, we must also understand which vulnerabilities exist in a given context or system, how large the exposure to the hazard is and what the adaptive capacity of the system is. The more resilient a health system is, the better it will fare when exposed to a hazard - be it an acute hazard such as an earthquake or a longer-term stressor such as increased rates of antibiotic resistance.
The combination of the type and magnitude of the hazard, and the resilience of the system, will determine whether a given situation will develop into a health crisis or not.
In order to address both vulnerabilities and hazards, we engage different expert coordinators – below are descriptions of current expert coordinators’ areas of work and ongoing activities. The Centre is also in the process of recruiting experts in other areas.
Extreme weather, climate, and health effects
Climate change and increasingly extreme weather in the form of heat waves, drought, floods, cold spells etc, create significant negative health effects and threaten existing medical infrastructure and practice. Measures to mitigate and adapt to this must be conducted and evaluated through multidisciplinary research collaborations to determine and monitor efficient progress. Moreover, in view of the already increased frequency and intensity of extreme weather, we need to understand the implications for human health and how we might best prepare and prevent the negative health effects. To do so, collaborative research and educational efforts are needed.
The Centre has several ongoing activities in this area:
- Collaboration in the Stockholm Trio university alliance, with KTH Climate Action Centre and the Bolin Centre at Stockholm University, on research proposals and collective policy impact activities.
- Continued development of research projects on exploring the health system preparedness for the impact of climate change and determination the characteristics of heat waves pertinent to health.
- Investigation and mapping of potential collaborative partners and format for international collaborations.
Chemical and toxicological incidents
Health risks and crises that occur because of chemical and toxicological incidents are a significant threat to human and environmental health. Such incidents can involve emissions and releases of toxic materials, either in the form of gas, liquids, or solids, through events such as traffic accidents that cause a release of toxic goods, contamination of soil, groundwater or of the food supply chain, or intentional releases of toxic material to harm individuals or the society. Chemical incidents can cause major health crises that impact both individuals and society as a whole. These incidents can lead to immediate poisonings, as well as long-term health issues like an increased risk of cancer and emotional distress. Preventing such incidents and managing them appropriately is vital for our overall health and welfare.
The Centre's work in this field currently focuses on:
- Continuing the mapping and collaboration on defining basic and advanced educational needs in the field of chemical, radiological, and nuclear incidents in Sweden, as well as updating the section on disaster toxicology in KI's Masters programme in toxicology.
- Monitoring research initiatives and acting as a catalyst in ongoing research projects.
- Educate and inform a wider public on the risks of chemical and toxicological dangers. Among other things, this is done through Riskzonen, a podcast (in Swedish) about threats, risk factors, and how we deal with a health crisis and participation in the Uppsala Health Summit.
Critical care with limited resources
In almost all health crises, regardless of origin, the need for critical care of patients increases. At the same time, the resources and ability to conduct critical care often decrease, due to overburdening of the system, failing infrastructure, and other uncertainties. Consequently, the need to improve and strengthen critical care when resources are limited is necessary. A well-prepared critical care system that can scale up and change its methods is a bedrock for adequate health crises management.
The Centre's work at present focuses on:
- Mapping existing research and education on the topic and identifying future needs.
- Continuing a dialogue, with relevant actors, but also in the wider Swedish society, on the need to prioritise into critical care when needs exceeds available resources. Including hosting a multidisciplinary symposium on prioritising in times of crisis.
- Investigate how to set minimum standards for critical care in times of crisis and develop methods for assessing them in a quick and feasible manner during ongoing crises, in collaboration with the Essential Emergency and Critical Care (EECC) network.
Laboratory and diagnostic surge capacity
The need for laboratory infrastructure and diagnostic capability is a constant feature in many types of health crises, ranging from exposure to chemical spills to outbreaks of infectious diseases. Furthermore, the need to adapt and increase laboratory and diagnostic capacity in times of crisis is another perpetual feature and must be adequately considered to improve our preparedness. Based on experience from the COVID-19 pandemic, the aim of the Centre's efforts in this area is to cement and improve surge capacity abilities in laboratory and diagnostic work with a view to be better prepared when a new health crisis strike, regardless of what it may be.
At present, activities in this area include:
- Continuing to maintain and advance national and international collaborations that began during the COVID-19 pandemic.
- Investigating potential educational initiatives in leadership, preparedness, and repetition in the field of laboratory and diagnostic work.
- Developing what the key issues are and how to best approach them, when it comes to the role of laboratory and diagnostic capacities at universities in a crisis.
Health system resilience
A health crisis is not solely determined by what type of hazard an individual or a society is exposed to, but also how vulnerable they are to the exposure. The level of vulnerability, both in the individual and society, will determine the capacity to prepare, handle and learn from a crisis. How resilient a health system is under ordinary circumstances has an impact on how and to what extent it is able to handle the unusual and more difficult circumstances it will inevitably face in any given health crisis. Consequently, finding efficient and useful means to strengthen health systems and improve resilience will lead to increased preparedness and ability to handle health crises. However, it is important that this is done with an understanding of the context and conditions for the health system in question.
The Centre is currently focusing its work in this area on:
- Conducting education, as part of various courses on different levels at KI, on health system resilience.
- Catalysing interdisciplinary research within the area, including a research project on factors that contribute to maintaining health system capacity in times of crisis in Sweden and Cameroon.
- Mapping of actors working in the field of health system resilience in Sweden.
Policy and preparedness
A health crisis, of any type and origin, does not occur in a vacuum, but rather it unfolds within a context. The context will determine the level of preparedness, as well as how the crisis will be managed and how both the individual and society will evaluate and move on from it. It is therefore vital to understand how politics, public policy, and societal structures prepare and handle crises, and what the limitations, options and tools are that can be used and developed. The Centre for Health Crises strives to be a constructive partner in contemporary crisis management by stimulating policy development and collaboration, as well as setting an agenda for increased health crises preparedness. Our aim is to achieve intensified policy dialogue on how research findings on health crises can contribute to improved preparedness and response.
In this area the Centre's activities include:
- Drive a continued analysis and discussion about what the universities' role is and should be in a health crisis.
- Contribute to a constructive policy dialogue on health crises and identifying where that dialogue most effectively takes place.
- Continued involvement in research and education on matters where the issue of politics and policy is relevant to understanding prevention, preparedness and response to health crises.
Infectious diseases and vaccine preparedness
Infectious and communicable diseases can pose a serious health threat and result in both local and global health crises, especially when basic levels of resources are poor in terms of health care infrastructure. Vaccines are effective and reliable tools to combat many infectious diseases. To understand how the spreading of infectious diseases are best combated and how vaccines are best used is a vital aspect of health crisis preparedness. At the same time, effective management of cases and vaccine implementation is equally important once the crisis hit. The Centre aims to support initiatives to explore how vaccine competence and development, trust in vaccines, collaboration, logistics, and handling can be improved under normal circumstances, and how we thereby create improved conditions to handle a health crisis.
Activities at the Centre in this area include:
- Identifying educational needs in the field of vaccinology across professions, and explore the potential need for courses to further knowledge and education for those who already teach and instruct in the field.
- Based on ongoing mapping of the unequal spread of vaccines (nationally, regionally, and globally), identify where and how improvements could be implemented.
Outbreak preparedness and response
When faced with a health crisis, regardless of scale, that is occurring due to the outbreak of an infectious disease, a speedy and effective response is crucial. Far from every infectious disease is preventable through vaccines. Outbreaks of diseases that are difficult, or even impossible, to cure and can consequently only be managed in the most adequate way possible, must be dealt with to prevent an escalating health crisis. Because of the contagious nature of infectious diseases, the risk of escalation of an outbreak is a threat that puts a health system’s resilience and ability to adapt to serious test. Therefore, the level of preparedness will play a crucial role in the response. With our focus on a holistic understanding of health crises, the Centre works to strengthen capacities in both preparedness and response to infectious disease outbreaks.
The Centre's activities in this area include:
- Participation in education activities and PhD courses to increase knowledge on outbreak epidemiology across professions.
- Comparative mapping on how countries address supply needs as part of outbreak preparedness across the EU.
- Initiate collaborations aimed at increasing awareness on the effects of climate change on outbreaks of infectious diseases.
Emergency surgery is a feature in many different types of health crises. It requires prioritisation, especially when the needs exceed the available resources, which is a basic feature of crises and disasters. Moreover, at the moment, a lot of attention is placed on highly specialised medicine and care, emergency surgery provides a much-needed generalist skill. It can be combined with multiple specialist competences and utilised in emergencies and crises, as well as in day-to-day work. In the current climate of polycrises and a desire to improve the Swedish Total Defence’s ability, the need for the competence and skill that emergency and trauma-surgery possess will increase. Hence, it is vital to retain and expand said competence and skill, through training, research, education, and collaboration.
The Centre's work in this field currently focuses on:
- Continuing the development of surgical and health care courses in, among other things, management of mass casualty incidents and surgery with limited resources, on a national level
- Advocating for the importance of generalist skills in health care and as part of the Total Defence