(Re-) conceptualising vulnerability as a part of risk in global health emergency response: updating the pressure and release model for global health emergencies

Global health emergency response often treats risk as a simple probability of an event occurring, frequently overlooking the underlying social and structural factors that make populations susceptible to disease. The authors ask how concepts from disaster studies and hazard geography can be adapted to create a more robust, theory-driven understanding of vulnerability and risk in global health emergencies.

The study adapts the classic Pressure and Release (PAR) model, a foundational framework in disaster research. The original PAR model explains how root causes (e.g., political and economic systems) lead to dynamic pressures (e.g., lack of infrastructure), which in turn create unsafe conditions (e.g., overcrowding, poor sanitation) that, when combined with a hazard, result in a disaster. The authors tailor this model to global health by identifying specific health-related root causes, dynamic pressures, and unsafe conditions, arguing that this framework allows for more effective, sustainable risk mitigation.

The authors demonstrate that what are traditionally labeled as simple 'risk factors' in epidemiology are actually components of a deeper, progressive system of vulnerability. By mapping these factors onto the PAR model, the authors show that risk is not just a function of the hazard (the pathogen) but is fundamentally shaped by structural violence, inequality, and institutional failures. This conceptual shift allows for better identification of intervention points—such as addressing food insecurity or lack of government services—that can reduce risk even when the specific hazard is unknown or difficult to eliminate. The model also provides a common language to bridge the gap between medical professionals and disaster response actors.

By grounding global health emergency response in a more comprehensive theoretical framework, this model encourages a shift from reactive, hazard-focused interventions to proactive, sustainable strategies that address the root causes of vulnerability. It offers a pathway for more effective adaptive management in rapidly changing, uncertain environments, ultimately fostering greater resilience in populations at risk.