Advancing public health resilience: A review of proposed strategies for enhancing emergency preparedness in rural and underserved communities

Background: Natural hazards and infectious disease outbreaks pose significant threats to public health globally. Rural and underserved communities often have limited resources and capacities to prepare for, respond to, and recover from such emergencies. There is a need to systematically identify strategies to enhance emergency preparedness and build resilience in vulnerable communities. Aim: This review aims to comprehensively evaluate proposed strategies for advancing public health resilience with a focus on enhancing emergency preparedness in rural and underserved communities. Method: A systematic literature review was conducted using PubMed, Scopus, Web of Science, and Informit Health databases. Search terms included "public health resilience", "emergency preparedness", "rural communities", and "underserved communities". Studies proposing strategies to enhance resilience at the individual, community, health systems and policy levels were included. Quality of evidence was assessed using the GRADE system and key themes were identified through inductive thematic analysis. Reporting was guided by Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 61 articles were included in the review. Key themes that emerged on strategies to enhance rural public health resilience included: strengthening partnerships and cross-sector collaborations; training and developing a skilled workforce; investing in technology and infrastructure upgrades; bolstering community engagement and social cohesion; and establishing coordinated emergency plans and protocols. Conclusion: Implementing a combination of organizational, community and technological strategies offers potential for improving rural public health systems' ability to anticipate, absorb, adapt and recover from crises in a timely manner. Further research and resources are needed to translate evidence into practice, particularly in under-resourced settings.