When states are fragile, but people are not: refusing damage-centered research in global health promotion

Since the 1990s, fragility has emerged as a concept that describes the nation states of low- and middle-income countries. The assumptions about people living in so-called fragile countries have influenced health promotion research and practice in terms of the topic areas studied and the way interventions are designed and implemented. In critiquing the assumptions underlying fragility, we apply and extend the harms of damage-centered research to the concept of state fragility. We argue that fragility labeling and classification systems are not neutral representations of the world. Rather, these approaches are underscored by the power hierarchies that further engender fragility. In this spirit, we critique 'state fragility' as a concept applied to people living in so-called 'fragile countries'. Further, by amplifying expressions of self-governance as forms of everyday resistance and survival among people living in fragile countries, we highlight what global health promotion researchers and practitioners might overlook when adopting the fragility labeling and classification system. In drawing on Haiti as a case study of collective citizen resistance to state fragility, we illustrate the less measured expressions of everyday strength that can inform a new global health promotion agenda that is imagined and scaled from the bottom up.