Using Chomsky's Writings to Read His Disappointing Engagement with Epstein

Undated photo of Jeffrey Epstein, right, speaking to academic and linguist Noam Chomsky. 

Photograph: House Oversight Democrats/AFP/Getty Images

On 3 February 2026, Ramon Antonio Vargas reported in The Guardian in an article titled 'Newly released files shed new light on Chomsky and Epstein relationship' that a tranche of U.S. Justice Department records released under a congressional transparency law documents an extensive and friendly relationship between Noam Chomsky and Jeffrey Epstein. The emails show sustained social contact, financial coordination, casual familiarity, and private advice offered by Chomsky to Epstein after Epstein’s 2008 conviction for soliciting a minor. The records also include Chomsky reaching out to Steve Bannon, using contact details supplied by Epstein, to request a meeting. Collectively, the material challenges earlier characterisations of Chomsky’s relationship with Epstein as primarily financial and limited in scope.

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For those of us who came of age intellectually reading Chomsky—his work on linguistics, media, and the structural analysis of political power—these disclosures are difficult to reconcile with the intellectual project he advanced. 

Chomsky taught generations of scholars to recognise how elite networks normalise impunity and reproduce power through informal social and financial ties. Seen in that light, the newly released material is not merely surprising; it is destabilising. It forces a confrontation between a structural critique of power that many of us learned from Chomsky and evidence of personal conduct that appears to sit uneasily within the very networks that critique sought to expose. 

What makes the recent release of evidence so unsettling is that Chomsky’s own work taught us to treat such relationships as structural mechanisms of power, not as morally neutral personal ties.

With Epstein, the ethical problem deepens. This was not abstract engagement undertaken to understand power, but sustained social familiarity and private counsel that minimised public concern about sexual abuse. What it reveals, using Chomsky's own work to make sense of his behaviour, is how deep and ordinary elite power networks (particularly male power networks) can be—even among their most formidable critics—and how easily structural critique can coexist with personal participation in those networks. 

By his own standards, the problem is not that Chomsky spoke to people he opposed, but that he normalised and privately assisted figures whose power he taught generations of students to analyse as corrosive. 

The sadness here is not scandal; it is the dissonance between an intellectually rigorous structural critique and personal conduct that quietly reproduces the very arrangements it sought to expose.

 

 

 

Are Our Global Commitments Collapsing Because of Social Psychological Strain? Yes—and America Is Just One Example

Across countries and at the global level, the social fabric is fraying, and our standard explanations are missing the root of the problem. We keep pointing to leaders, polarisation, or failing institutions, but those accounts stay on the surface. The deeper issue is one of social psychology.

I apply a social psychological lens—grounded in a rereading of Freud’s Civilization and Its Discontents and informed by complexity thinking—to argue that what is breaking down is our capacity to sustain demanding forms of commitment. A ‘social psychology of commitment,’ then, is about the patterned ways individuals and groups experience, tolerate, resist, or withdraw from civil society obligations under strain.

This current breakdown is driven, in large measure, by a deeply interdependent globalised world marked by globalisation’s unequal impacts and failed promises. The consequences for civil society are no longer quietly accumulating; they are spilling out across societies in ways that mark a historically significant crisis. We have seen before how difficult it is to rebuild civil society once it fractures. If we misread this breakdown as merely an ideological or institutional problem, we will fail to confront the underlying psychological crisis now shaping our politics and public life.

For this post I will do the following:

o   I begin by briefly revisiting my 2019 book, The Defiance of Global Commitment, written well before the current moment but directly concerned with the dynamics now coming into view.

o   I then draw selectively on that framework to apply its central diagnosis to what is unfolding in the United States, both domestically and in its global commitments.

Still, the post is not just about the United States. The States certainly holds headline news presently, but the fraying of our social psychology of civil commitment is happening across the globe. As such my focus on the States is just one case study – albeit a very dramatic one – with the hope that others will test this framework’s utility for other parts of the world. In short, the value of the framework I outline here lies in its portability: it does not explain events by reference to national traits or political cultures, but by tracing how commitment strain is organised and negotiated under specific structural conditions.

 

THE DEFIANCE OF GLOBAL COMMITMENT – SELECTED SUMMARY

The Defiance of Global Commitment is a sustained argument that the central crisis of the contemporary global order is not best understood as a failure of policy, governance, or institutional coordination, but as a failure rooted in the social psychology of commitment itself. The book advances the claim that globalization has outpaced the social psychological capacities through which humans historically manage obligation, restraint, and shared responsibility. As a result, the very commitments required to sustain global civil society—ethical, ecological, political, economic and social—are increasingly experienced not as collective necessities, but as intrusive demands that threaten individual and group-based pursuits of security, status, and wellbeing. The outcome is not withdrawal alone, but patterned resistance, backlash, and, in many cases, open defiance and its normalisation.

Working through a critical rereading of Freud’s Civilization and Its Discontents, the book reframes discontent as a structurally unavoidable social psychological feature of social life, rather than a moral defect or ideological error. Civilization, Freud argued, advances by restricting instinctual freedom, and this restriction generates resentment, aggression, and resistance.

The present study extends this insight into the global era, arguing that globalization intensifies this psychic tension in two key ways. First is the deep global interdependence it produces, binding economic, political, and social processes across distance and scale. Decisions made far from everyday life increasingly shape local conditions, demanding commitments to distant others, abstract systems, and long-term collective goods under conditions of inequality, uncertainty, and perceived loss of control. What changes is not the basic drama of commitment and resistance, but its scale, speed, and stakes.

Second are globalisation’s unequal impacts and failed promises. Globalisation operated as a promise of shared benefit that required sacrifice in advance, yet it distributed rewards unevenly while making the costs of adjustment immediate and tangible. For many—particularly those lower on the socioeconomic ladder—the promised gains never materialised. In this context, global obligations were experienced less as reciprocal commitments than as external demands tied to a fragile and uneven bargain. The resistance that followed was not a moral failure or misunderstanding, but a predictable response to a persistent gap between promise and lived experience.

Across its early chapters, the book develops a diagnostic vocabulary for understanding how individuals and groups respond to these pressures. It identifies recurring orientations—nostalgic retreat, global aggression, affluent resentment, and forms of defensive in-group and out-group consolidation—not as ideological positions to be debated, but as patterned social psychological responses to perceived threats to agency, identity, and recognition. These orientations cut across political divides, but they do not carry equal consequences. On the far right, fear of loss is readily transformed into exclusionary politics, moralised aggression, and the normalisation of violence, directed both at targeted groups and at the institutions of civil society themselves. Under these conditions, commitment to pluralism, restraint, and democratic process is reframed as weakness or betrayal, and aggression becomes a legitimate means of restoring order. A different-but-similar dynamic appears in liberal contexts, where symbolic struggles over identity politics, language, and moral standing offer a lower-cost substitute for confronting material inequality, structural disadvantage, and steep social gradients—often from positions of relative privilege. What unites these responses is not moral equivalence, but a shared function: reducing social psychological strain by narrowing responsibility, simplifying conflict, and deflecting the deeper demands of genuinely global commitment.

The analytic core of the book is its distinction between therapeutic and non-therapeutic power, and between healthy resistance and unhealthy defiance. Power, the book insists, always provokes resistance; the critical issue is what kind of resistance emerges, under what conditions, and in response to which forms of power. Therapeutic power aims to cultivate insight, responsibility, and collective capacity, even when it enforces limits. Non-therapeutic power operates through coercion, humiliation, deception, or moralisation, often while claiming ethical legitimacy. When global commitments are advanced primarily through non-therapeutic means—especially under conditions of inequality and loss of voice—resistance predictably shifts from defensive and corrective forms toward denial, scapegoating, and aggression.

By treating these reactions to global commitments as intelligible rather than inexplicable, the book provides a framework for understanding why global civil society remains both necessary and perpetually unstable, and why efforts to sustain it repeatedly collide with the limits of human psychology under conditions of unequal globalization.

So let’s see if this framework can hold up to what is happening in the States, again as only one case study.

 

APPLYING THIS FRAMEWORK TO WHAT IS HAPPENING IN THE STATES

Civil society is perpetually unstable because it presses against the limits of human social psychological capacity in a globalised world of deep interdependence and unequal impacts. Participation in global civil society requires restraint, tolerance of ambiguity, and commitment to distant others under conditions where benefits and burdens are unevenly distributed. Some individuals, groups, and institutions can manage this strain, at least intermittently. Others cannot.

What distinguishes our present globalised and highly interdependent moment is not that this limit has suddenly appeared. It is that those who experience global commitment as intolerable are increasingly able to shape political agendas, institutional trajectories, and public narratives.

This capacity does not reside in leaders and elites alone – who often benefit massively from globalisation. In most of the global West, political authority operates through negotiated ordering: what leaders can do, sustain, or get away with is constrained by what those they govern will tolerate, endorse, ignore, or quietly accept.

Everyday social psychological thresholds therefore matter.

Civil society weakens not only when leaders undermine institutions, but when large numbers of people withdraw their willingness to sustain demanding commitments in daily life—through indifference, compliance, selective outrage, or active support for narrowing obligation.

Seen this way, current conflicts around civil society are not well captured by simple stories of democracy versus authoritarianism. What we are witnessing instead is a struggle over how much commitment can reasonably be demanded, and who gets to decide when that demand has gone too far. This struggle plays out unevenly, often within the same societies and institutions, producing patterns that appear contradictory only if we assume civil society is a single, shared object rather than a social psychologically uneven demand.

In the United States, the Trump administration’s 2025–2026 challenges to NATO and the United Nations, alongside proposals treating Greenland’s sovereignty as negotiable, have been widely contested. But they have also found significant pockets of tolerance—and occasional enthusiasm—because they resonate with an already present scepticism toward multilateral obligation and alliance commitments. For those citizens in support, the United States’ responsibilities within global civil society have come to be experienced as onerous obligations imposed in the name of others’ interests: a system of restraint perceived as serving a distant transnational elite rather than the national in-group. Under these conditions, pushing back against multilateral institutions does not register as destabilising global order so much as resisting repression.

What matters analytically is not the accuracy of this picture, but its social psychological plausibility. Europe is not a unified liberal bloc, nor are its states interchangeable. The United Kingdom’s withdrawal from the European Union, Denmark’s initial hesitations over military support for Ukraine, and persistent domestic conflicts over immigration, welfare, and sovereignty all point to internal fractures that sit uneasily with any image of a coherent ‘transnational elite.’ Yet these complexities do little to disrupt the underlying resentment narrative. From a social-psychological perspective, such narratives function not to describe reality, but to simplify it—to compress heterogeneous actors and institutions into a single external force against which resistance feels justified.

In this context, challenges to NATO, scepticism toward the United Nations, and gestures that treated territorial norms as flexible operated as outward-facing expressions of a deeper social psychological withdrawal from global commitment. They signal a refusal of restraint framed as self-defence: a reclaiming of agency against obligations that now felt excessive, moralising, and asymmetrically distributed. That these moves risk undermining institutions from which the United States also benefits did not weaken their appeal. On the contrary, it reinforces their symbolic power as acts of release from a global order increasingly experienced as psychologically oppressive. As Freud long noted, such contradictions are not incidental: under conditions of perceived constraint, individuals and groups will often accept—even embrace—self-damage if it promises release from an order experienced as asymmetrically benefiting others.

This logic also applies domestically. One prominent example in 2025–2026 lies in domestic practices associated with U.S. Immigration and Customs Enforcement (ICE), which relies heavily on in-group/out-group distinctions to normalise harsh enforcement, detention, and sanctioned force. Policies that inflict harm on refugees, minorities, or marginalised groups are rarely defended as cruelty. They are justified as realism, protection, or necessity. Once participation in civil society is experienced as an unreasonable psychological burden, limiting compassion and narrowing responsibility can feel not like moral failure but like common sense. Support for such measures is sustained not only through coercion, but through widespread accommodation.

Domestically, what is at stake is not immigration alone. For those drawn toward nostalgic retreat, nationalism, or similar defensive orientations, civil society itself comes to be experienced as an intolerable social psychological burden—an overextended demand for restraint, pluralism, and global obligation. In response, civil society is rewritten not as a shared space of negotiation and restraint, but as a legitimate source of coercive power: a means of enforcing order against those who insist on maintaining commitments that now feel unbearable. In this context, the rights of immigrants, refugees, and citizens engaging in nonviolent protest are no longer recognised as upholding civil society but are recast as obstacles to order. Sanctioned force is thus redirected inward, not as an aberration, but as a social psychologically intelligible attempt to resolve the strain of global and civic commitment by narrowing who and what civil society is for.

This helps explain why undermining civil society can focus on empowering a defiant social psychology. Commitment can be narrowed without being disavowed. Obligations can be reinterpreted rather than rejected. Restraint can be recast as naivety, care as overreach, and solidarity as self-harm. These shifts matter not because they are rhetorically clever, but because they align with what many people can psychologically carry. Leaders articulate these framings, but their durability depends on whether they resonate with everyday experiences of strain, loss, and resentment.

Crucially, these dynamics do not produce uniform retreat. Survey evidence across the United States and Europe consistently shows divided publics: support for humanitarian values and democratic norms often coexists with endorsement of restrictive or coercive domestic policies, particularly around migration, protest, and security. The point is not moral inconsistency, but psychological management. Commitment strain is negotiated across domains, narrowed where tolerance is exceeded, and maintained where demands remain bearable. However, many people experience the erosion of restraint itself as intolerable. As defiance bleeds out across society, in this case the States, resistance reappears in the form of protest, institutional defence, and demands for civility and humanity to be restored. These responses emerge from the same negotiated order. They signal that withdrawal has gone too far, that the social costs of undermining now exceed the psychological relief it provides.

 

COMING FULL CIRCLE TO WHY THIS ARGUMENT MATTERS GLOBALLY 

What this perspective ultimately clarifies is why the present moment in the States (and more globally, across a lot of the world) feels both volatile and unresolved. Civil society is not collapsing in a single direction, nor stabilising through consensus. It is being stretched, resisted, defended, and narrowed all at once as individuals and institutions confront the psychological limits of global commitment. Even under more equitable forms of globalization, the demands of global interdependence and global civil society would remain psychologically taxing; the issue is not whether strain exists, but whether it becomes corrosive or manageable. Those who find these limits intolerable now have greater capacity to drive agendas that reduce obligation and legitimise withdrawal—because enough people, in everyday life, are prepared to live with the consequences. 

The task, then, is not to imagine a world without resistance to civil society, but to recognise that its instability is structural, negotiated, and ongoing—and that how societies manage these limits will determine whether commitment is contained, distorted, or progressively undone. 

 

CONCLUSION 

In summary, this analysis shows how social-psychological limits on commitment can be traced across countries and regions—not by attributing outcomes to national character, ideology, or leadership, but by examining how obligations are experienced, negotiated, resisted, and narrowed under specific structural conditions. Offered as a starting point, the United States case examined here warrants careful comparative extension to other national and regional contexts where global commitments are being renegotiated under different institutional, cultural, and historical conditions.

 

 

Working for Health 2030 2025 – 2026 WHO and NHS Seminar Series: Embracing Complexity: Systems Thinking for Health Workforce Strengthening

I would like to thank the WHO and NHS for the opportunity to be part of this panel and to present on the value of the complexity sciences for healthcare workforce strengthening.

 

I would like to specifically thank Cris Scotter, (Unit of Health Workforce and Health Services) and Danielle Mason and team in Global Health Partnerships, NHS England for the opportunity to present.

 

I would also like to thank my colleagues who presented, for an excellent discussion: Leila Reid, Malixole Percy Mahlathi, Naja Hulvej Rod with Wendy Reid.

 

 

OVERVIEW OF MY KEYNOTE

My  WHO–NHS session introduction to the complexity sciences was based on The Atlas of Social Complexity. It rested on a claim that still meets resistance in workforce policy circles: many of the most persistent failures in health workforce planning are not technical problems waiting for better optimisation, but systemic mis-specifications that optimisation cannot fix.

 

Health workforce systems are complex socio-ecological systems. They are case-based rather than law-like; adaptive rather than stable; shaped by power, inequality, governance, and psychology as much as by headcounts and demand curves. They evolve, self-organise, and operate within nested structures—from teams and organisations to national policy regimes and global labour markets.

 

When these conditions are treated as noise rather than structure, linear causality, average effects, and single “best” projections do not merely simplify reality—they mislead.

 

The value of the complexity sciences, as I argued, is not that they replace existing methods or offer panaceas—they do neither—but that they provide a grammar for working with systems as they actually behave.

 

Case-based complexity foregrounds configurational causality (equifinality, multifinality, causal asymmetry), trajectory thinking, and cross-scale analysis, making visible why similar pressures produce divergent outcomes, or why very different contexts converge on the same failures. It also destabilises categories that workforce models routinely naturalise—roles, professions, demand assumptions—showing how these shift under political, institutional, and ecological strain.

 

For workforce planning, this means abandoning the fiction of a single correct forecast. Health systems are better understood as ensembles of situated cases, where responses must be assembled rather than imposed. Complexity, in this sense, is not an analytic complication to be managed away; it is a place-based, contextual truth that policy must learn to work with or continue reproducing the problems it seeks to solve.

 

 

 LINKS

 

Here is a link to my PowerPoint Presentation

 

Here is a link to the paperback version of The Atlas of Social Complexity

Here is a discount code until the end of 20255

The code is TASC15, and it offers a 15% discount.

Here is a link to the map of the complexity sciences

Here is a link to PRSM (Online Participatory Systems Mapping) Platform

Here is a link to Barbrook-Johnson and Penn’s Open-Access Systems Mapping Book

Here is a link to COMPLEX-IT, the online R-Studio platform allowing non-experts in computational modelling access to these tools, all through a social complexity framework.

 

Mapping inequality in power law and exponential distributions

We’ve just published a new paper that advances our longer-running programme on inequality, entropy, and structure. The core move is simple but consequential: instead of collapsing inequality into a single number (Gini, Theil, entropy), we show how to locate inequality inside a distribution. Using an entropy-based decomposition, we turn inequality into a multiscale map that identifies which parts of a system are more uniform, which are more concentrated, and how those contrasts intensify as you move across the distribution.

Applied to two foundational cases—power-law and exponential distributions—we derive closed-form, analytic cutoffs that replace heuristic rules (e.g. “80/20”) with principled thresholds. For power laws, this shows precisely how inequality concentrates along heavy tails. For exponentials (including the Boltzmann distribution), the entropy-defined cutoff turns out to equal the conditional mean, giving it a clear physical interpretation as a balance point between concentration and dispersion. More broadly, the paper pushes our work from global inequality summaries toward a structural, diagnostic view: inequality not as a single score, but as something layered, ordered, and navigable across a system.

Using Complexity Science to (Re)think Resilience in Public Administration: Keynote at Vaasa University Public Admin Conference 2025

I would like to thank Patrik Nordin, Ville-Pekka Niskanen, and the rest of my colleagues/friends at Vaasa University, Finland for the chance to provide the Keynote for this year’s Hallinnon ja kuntatutkimuksen tiedepäivät HKTP 2025 Vaasassa (Administration and Municipal Research Science Days HKTP 2025.

OVERVIEW OF MY KEYNOTE

Resilience has become a central concept in public administration, planning, and urban governance. Yet its popularity risks masking its conceptual ambiguity and methodological complexity. As argued in The Atlas of Social Complexity, resilience is not a stable property of systems, but a dynamic process shaped by coevolving social, institutional, and environmental constraints. It involves adaptation, transformation, and at times rupture.

 

The Helsinki-Uusimaa Climate Resilience Roadmap offers a powerful illustration. Rather than a top-down blueprint, the roadmap represents a distributed, multi-level strategy — integrating regional authorities, municipalities, civil society, and the private sector to address climate risk. Its emphasis on systemic interdependence, adaptive governance, and inclusive stakeholder engagement reflects a complexity-informed approach to planning. Such efforts reflect a broader shift that public administration and planning must embrace – moving beyond static models of control toward adaptive governance, polycentric coordination, and iterative planning.

 

From a social complexity perspective, resilience is not about returning to normal but enabling systems to reorganise meaningfully under stress. This requires new transdisciplinary methods and tools for tracing feedback loops, greater tolerance for uncertainty, and participatory approaches that draw on local knowledge. It demands what is called the social complexity imagination: the ability to see policy not as a linear solution but as part of a living system. Resilience, then, is less about stability and more about the capacity to evolve.

 

LINKS

Here is a link to the paperback version of The Atlas of Social Complexity

Here is a discount code until the end of 20255

The code is TASC15, and it offers a 15% discount.

Here is a link to my PowerPoint Presentation

Here is a link to the map of the complexity sciences

Here is a link to PRSM (Online Participatory Systems Mapping) Platform

Here is a link to Barbrook-Johnson and Penn’s Open-Access Systems Mapping Book

Here is a link to COMPLEX-IT, the online R-Studio platform allowing non-experts in computational modelling access to these tools, all through a social complexity framework.

An Invitation to Re-Imaging Public Administration and Policy from a Social Complexity Framework

I would like to thank Patrik Nordin and colleagues at Vaasa University, Finland for the chance to run a pre-conference workshop, based on the Atlas of Social Complexity. The focus of the workshop was, ‘An Invitation to Re-Imaging Public Administration and Policy from a Social Complexity Framework.’

 

Here is a link to the paperback version of The Atlas of Social Complexity

Here is a link to the Overview of the Complexity Sciences and Atlas PowerPoint

Here is a link to the map of the complexity sciences

Here is a link to PRSM (Online Participatory Systems Mapping) Platform

Here is a link to Barbrook-Johnson and Penn’s Open-Access Systems Mapping Book

Here is a link to COMPLEX-IT, the online R-Studio platform allowing non-experts in computational modelling access to these tools, all through a social complexity framework.

From Assemblages to Tangles - A Public Lecture at Nelson Mandela University

On 17 September 2025, I gave a public lecture at Nelson Mandela University, reflecting on three decades of experimentation in visual complexity — from early assemblages and the OneBigMob cartoon world to entangled portraitures and AI art.

The event was hosted through the Chair in Identities and Social Cohesion, Nelson Mandela University, South Africa. Much thanks to Andrea Hurst and Harsheila Riga and colleagues for providing the space to do this work.

For me, art is not just practice but method: a way of researching how we live in ecological crisis, emotional life, and social conflict. I shared this journey, screened a short piece from Entangled 2025, and invited colleagues and communities to join me in building new collaborations. Complexity is not only studied — it’s also lived, felt, and created.

 

CLICK HERE to see my Art Website where you can learn more about this work 

 

HERE IS A LINK to the PowerPoint of my presentation

Social Complexity Retreat at Nelson Mandela University

On 17 September 2025 we held our second Social Complexity Retreat, this time at Nelson Mandela University – hosted through the Chair in Identities and Social Cohesion, Nelson Mandela University, South Africa. Much thanks to Andrea Hurst and Harsheila Riga and colleagues for providing the space to do this work.

 

Building on the first retreat at Durham, we gathered a transdisciplinary mix of scientists, social scientists, artists, and philosophers.

A retreat is not a workshop and is, most certainly, 180 degrees opposite of a conference. It is a space to step back, slow down, and think more creatively—without the pressure of constant presentations or finished work. Organised around The Atlas of Social Complexity, participants brought their own projects, questions, and challenges, working individually and in small groups.

Through discussion, writing, and creative exercises, we built a collective imagination for how complexity might be advanced in both practice and research, making real progress together.

 

HERE IS A LINK to the PowerPoint for the day

CLICK HERE for Cillier’s article on system boundaries

CLICK HERE for the complexity sciences map

Improving the resilience of health and public health systems to the impact of climate change: learning from Japan and the UK

Resilience Reframed: Notes from the JSPS–AMS Policy Workshop

In October 2024, I joined a UK–Japan policy workshop hosted by JSPS and the UK Academy of Medical Sciences. The question set before us was: what does it mean to make health systems resilient in the face of converging shocks e.g., climate extremes, pandemics, inequality, technological disruption? As part of the Workshop I presented on the value of social complexity and complex systems thinking to address such a question.

 

CLICK HERE to read the full report. 

 

It was a great event and really to-the-moment in terms of what we are up against, presently, in terms of learning from cross-country comparisons on what, at a global level, we can do to address the impact climate change is having on health.

HERE IS THE EXECUTIVE SUMMARY

Through case study presentations, Q&As, breakout groups and plenary discussions participants identified several key themes relevant to resilient health and public health systems. A full agenda can be found in Annexe 1.

 

Key themes identified

To build resilience on a national scale, an interconnected approach with cross-government working and transdisciplinary research, which considers health in other policies such as housing and transport, is required. This, coupled with an enabling environment for the translation of research into evidence-based policy facilitates quick evaluation of new and current interventions to ensure they are fit for purpose.

 

Resilience on a national scale would also involve considering the health and public health system as something that extends beyond its traditional boundaries and out into communities. Increasing the resilience of communities in Japan and the UK was therefore seen as essential; this included reducing the deep-seated inequalities experienced by more vulnerable populations. Targeted communication around climate change and health emergencies was noted as a way to reduce the spread of mis- and disinformation and to gain public trust.

 

The impact of compound pressures on the health system – such as a pandemic occurring under climate extremes with a cost-of-living crisis – was identified as particularly challenging for resilience. Of particular note, the limited opportunity for the health system to ‘bounce back’ after the COVID-19 pandemic, and the impact of this on the mental health of healthcare workers. Developing clear response plans and prioritisation strategies was suggested as a way of managing these pressures. Integrated monitoring and analysis would also be needed, which could enable the system to rapidly respond to threats and ensure evidence-based actions.

 

Increasing the resilience of health systems was also seen as an opportunity to decrease its environmental impact. Adopting innovation and technology could aid decarbonisation, as well as increase the resilience of health systems. This opportunity was noted to be not without its risks, as new technologies such as artificial intelligence (AI) could lead to greater inequalities if not implemented carefully with the most vulnerable populations in mind.

 

Participants noted that education, training and research support underpinned a lot of the actions to increase resilience. Integrated training, both formally and informally, would be crucial in ensuring that the next generation of health professionals had the necessary knowledge and skills to respond to future threats. Whilst Japan and the UK have different political, social and cultural contexts, participants discussed that there were still many opportunities to learn and collaborate to address the key themes identified. As shared endeavours, both countries could:

 

·       Share future-proofing strategies between Japan and the UK, including lessons learned and best practice from each country’s deemed relative strengths. Participants noted that much could be learned from Japan’s experience of disaster response and from managing an ageing population. Similarly, lessons could be drawn from the UK’s actions to reduce the environmental impact of the NHS.

 

·       Identify pathways driving inequitable access to the health system and how the climate emergency exacerbates this for socially disadvantaged and physically vulnerable people. Share interventions targeting these pathways to reduce health inequalities.

 

·       Identify where cross-sector working nationally and internationally is needed, including transdisciplinary research and cross-government departments to bring together traditionally separated sectors, for example health systems research, climate expertise, evaluation experts and public health professionals.

 

·       Compare healthcare system evaluation methods and collaborate on finding the right indicators to monitor success of interventions and policies and develop responsive research infrastructure to study time-limited natural experiments, to improve rapid evidence-based policymaking.

 

·       Share lessons learned on how to implement integrated planetary health and health system monitoring and analysis, inclusive of developing a skilled workforce and collecting robust data to develop early warning systems.

 

·       Understand which communication strategies work well under different threat scenarios and with different populations within Japan and the UK. Share how best to target communication and engagement with the populations around health emergencies and climate change to lead to short- and long-term behaviour changes.

 

·       Exchange knowledge and best practice about how to co-design interventions with patients and the public to create people-centred resilient health systems. Share strategies to ensure communities who do not normally engage in health systems are reached.

 

·       Identify the pros and cons of using AI and tech-based transformations in health care systems. Understand how to mitigate the risks that AI could exacerbate health inequalities and contribute to climate change.

 

·       Enhance bilateral collaboration to develop integrated education programmes that include the impact of the climate emergency on human health, in particular for early career researchers and healthcare professionals.

 

Participants agreed that by drawing on each other’s strengths, both countries can invest in health systems that can better address immediate and long-term challenges, whilst promoting collaboration, innovation and inclusivity.