Community Preparedness: “It Takes a Village”

The phrase “It takes a village [to raise a child]” is a proverb attributed to several African cultures that appears to have no specific origin.¹ The phrase embodies the concept of a whole community interacting for the well-being, safety, and health of all, particularly vulnerable populations such as children. It is particularly relevant for those of us in public health, as we seek to foster communities that are prepared (especially to help the most underserved and vulnerable) and resilient in the face of natural or human-made emergencies. Today, in fact, the “village” is becoming global, and—as articulated by LeBlanc et al. in their editorial in this supplemental issue of AJPH—“The Virtual Village: A 21st-Century Challenge for Community Preparedness” (p. S258).

THE PUBLIC HEALTH PREPAREDNESS SUPPLEMENT

This third public health preparedness supplement (“Community Preparedness for Public Health Emergencies”) of AJPH was developed in collaboration with the Centers for Disease Control and Prevention. It provides a focus on communities’ ability to prepare for, respond to, and recover from domestic or international natural or intentional incidents that are public health emergencies. This supplement complements both the first special public health preparedness supplement, which emphasized the full spectrum of public health emergency management from preparedness to response and recovery, and the second special supplement, which provided insights into the challenges and successes of the evolution of the system for medical countermeasures.^2,3

WHAT IS COMMUNITY HEALTH RESILIENCE?

The Office of the Assistant Secretary for Preparedness and Response in the US Department of Health and Human Services defines community health resilience as “the ability of a community to use its assets to strengthen public health and health care systems and to improve the community’s physical, behavioral, and social health to withstand, adapt to, and recover from adversity.”⁴ The office notes that natural as well as human-caused public health emergencies are affecting greater numbers of people and becoming more complex, costly, and frequent because of such factors as climate change, travel and trade that interconnects local communities to the “global village” (i.e., globalization), and increased urbanization. Health, “meaning physical, behavioral, social, and environmental health and wellbeing . . . is a key foundation of resilience because almost everything we do to prepare for disaster and protect infrastructure is ultimately in the interest of preserving human health and welfare.”⁴ Specifically, “Community resilience focuses on enhancing the day-to-day health and wellbeing of communities to reduce the negative impacts of disasters.”⁴

WHY COMMUNITY RESILIENCE “TAKES A VILLAGE”

Although as individuals and families we should inform ourselves about actions and preparations we can undertake in our own homes before a disaster that is more likely in the area where we live (e.g., stocking up with at least a three-day supply of food and water for areas prone to earthquakes and flooding), there are some preparedness measures that go beyond individual preparation and involve the community. These measures include such things as preidentifying local shelters where people can go if they are displaced from their homes (e.g., local school gymnasiums for persons whose homes have been damaged or are in harm’s way because of wildfires) and cooling centers (e.g., local shopping malls or libraries for vulnerable senior citizens who have no air conditioning during the daytime for an extreme heat event).

The Office of the Assistant Secretary for Preparedness and Response noted specific strategies to strengthen community resilience, such as building “networks that include social services, behavioral health, community organizations, businesses, academia, at-risk individuals, and faith-based stakeholders in addition to traditional public health, health care, and emergency management partners” and “engaging individuals with potential vulnerabilities to take an active part in protecting their health and aiding their community’s resilience.”⁴

WHAT CAN COMMUNITIES DO?

Importantly, during an actual public health emergency, and before the arrival on scene of official first responders from the city, county, or even state level, it will be one’s neighbors and community that will be the first to render aid and assistance to their fellow community members. In anticipation of being able to provide such immediate assistance, communities can plan educational programs for their citizens so that basic lifesaving first aid (e.g., the “stop the bleed” campaign to “cultivate grassroots efforts that encourage bystanders to become trained, equipped, and empowered to help in a bleeding emergency before professional help arrives” [https://www.dhs.gov/stopthebleed]⁵) could be rendered—this is particularly critical in natural disasters (e.g., tornadoes) and human-made disasters (e.g., an explosive device or active shooter incident). Also, beyond identifying local shelters, communities can pre-position supplies for use by shelter occupants who may be cut off from assistance by official first responders from larger geopolitical areas for longer periods because of weather conditions or damaged infrastructure (e.g., roads).

WHAT IS THE INTERFACE?

It should be recognized that individuals, communities, and state, local, territorial, and governmental and nongovernmental entities should not be operating in isolation and that the interface between them is vital. Rather, each partner and level should understand the relative strengths and vulnerabilities of each other and work cooperatively to identify likely hazard scenarios, plan, and drill for actions to be taken by each in an actual public health emergency—for both response and recovery. This preparedness supplement contains several articles that cover these types of issues, such as “Community Assessments for Public Health Emergency Response (CASPERs)—US Virgin Islands, 2017–2018” by Schnall et al., (p. S303), “Top-Down and Bottom-Up Measurement to Enhance Community Resilience to Disasters (CASPERs)” by Schoch-Spana et al., (p. S265), and “Inclusive Public Health Preparedness Program to Promote Resilience in Rural Appalachia (2016–2018)” by Schroeder and Bouldin (p. S283).

THE FUTURE OF COMMUNITY PREPAREDNESS

The concept that “It takes a village” is a companion to my previous preparedness supplement editorials: “Public Health Disasters: Be Prepared”^{2(pS120–S121)} and “Medical Countermeasures: A Stitch in Time Saves Nine.”^{3(S177–S179)} These addressed such future-looking issues as novel approaches to medical countermeasures and how societies must weigh their perception of risk and the availability of funds to decide if a particular preparedness effort is financially and socially feasible and acceptable. They also discussed the levels—individual, community, and societal—at which specific preparedness and response actions should be planned for and taken.

The future of community preparedness depends on a full recognition of the vital role that communities play in increasing their own resilience and the degree to which individuals, in addition to their own preparedness activities at the individual and family level, embrace and wholeheartedly support the communities in which they live to become more prepared and resilient—because when the inevitable public health disaster strikes, the lives saved by quick and resourceful actions the community takes may well be their own.