From the immense flooding of Hurricane Harvey in my new state of Texas to the eruption of Kilauea in my former home in Hawaii, we are reminded daily of the potential for natural and man-made disasters to strike our communities at any time. The public health impacts of disasters are diverse and far-reaching, from the immediate loss of life due to physical trauma, to intermediate effects including cholera and increased mosquito-breeding sites, and to long-term effects including the spread of contamination from Superfund sites to neighboring communities. Mitigation of these negative outcomes requires development of evidence-based practices and programs, translation into appropriate formats for end users, dissemination to state and local public health entities and other partners, and implementation by these groups.
Meeting these goals is a challenging proposition. The United States is vast, with more than 9000 miles separating the US Virgin Islands and Guam. Our loose collection of national, state, and local public health agencies operates fairly independently. The National Association of County and City Health Officials has more than 13 000 members serving in 1500 local health departments.
In reality, the public health system can be characterized as a loosely coupled system, where each component has limited knowledge of other parts of the system. In this milieu, the Centers for Disease Control and Prevention (CDC) and its funded partners have been using an all-hazards approach to improve public health preparedness and response. Funding of schools of public health started in 2008 with the funding of Preparedness and Emergency Response Learning and Research Centers. These centers created 30 preparedness toolkits, 800 learning products, and more than 200 scientific articles.
The focus of this special issue is on the seven sites that received funding for translation, dissemination, and implementation. In many ways, this is the more difficult challenge. How do you ensure use of evidence-based practices by a diverse, diffuse workforce? This has proven to be difficult in evidence-based medicine, where every physician is trained as either a doctor of medicine (MD) or a doctor of osteopathic medicine (DO) and is licensed by his or her state.
For evidence-based public health preparedness and response, the public health workforce differs greatly, given the much wider array of job descriptions, educational requirements, and experience, which are not standardized across health departments. To make this more complicated, the grantees are not only working with traditional public health agencies but across a variety of organizations with public health functions, including tribal health departments, health care organizations, and a national organization for voluntary emergency responders. Each of these organizations has its own culture and communication channels.
The projects discussed in this supplement contain a variety of different approaches and areas of focus, including mental health, public health law, and public health in prisons and jails. Not surprisingly, several projects focused on online materials and searchable databases. In reading the articles, one is impressed by the magnitude of the problem and the scope of solutions that are needed. These articles present a strong step toward integrating evidenced-based practice vis-à-vis public health preparedness into the public health system, but there is still much work to be done. It is imperative that the CDC and schools of public health continue to work with their partners to create a truly functioning system for public health preparedness and response. People’s lives literally depend on it.
11 Years Ago
Defining Public Health Emergency Preparedness
[P]ublic health emergency preparedness (PHEP) is the capability of the public health and health care systems, communities, and individuals to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities. . . . [This] definition can provide a sound footing upon which to develop the kind of clear and coherent standards and metrics required . . . for public health systems to be accountable to the public. Simply put, the definition can help ensure that in the future we can answer the question on everyone’s mind: “Are we prepared and, if so, for what?”
From AJPH, September 2007 (Suppl 1), pp. S9–S11
14 Years Ago
The Pitfalls of Preparedness
In light of the daily toll of thousands of deaths from illnesses and accidents that could be prevented with even modest increases in public health resources here and around the world, we believe that the huge spending on bioterrorism preparedness programs constitutes a reversal of any reasonable sense of priorities. While some still believe that bioterrorism preparedness will protect us from catastrophe, we . . . [believe] that these programs represent a catastrophe for American public health, and we hope it is not too late to change this dangerous direction.
From AJPH, October 2004, p. 1670
Biography
