Public health professionals fill vital roles in homeland security preparedness. One of these roles is to ensure that government decision makers are well informed on issues that may affect the life and health of – perhaps not all, but at least most of – their community members.
When referring to public health preparedness efforts, the need for a deeper understanding of the political knowledge of efforts, successes, and future challenges is paramount. Webster’s defines the word “politics” as “any activities that relate to influencing the actions and policies of a government or getting and keeping power in a government.” A working definition of this word should encompass a range of situations. In other words, the meaning of politics should reflect what it is for each person, in terms of his or her own agenda, and the agenda he or she purports to pursue. Thus, politics – and the elected officials involved in the political world – are fundamentally variable as opposed to constant.
Public health, on the other hand, is based on the concept of doing the greatest good for the greatest number of people. This means that, on occasion, elected officials and decision makers need to be informed about initiatives and programs that may not benefit all, but rather most, of their constituents. A panel of experts in 2007 defined public health emergency preparedness (PHEP) – a subset of public health – as:
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. Preparedness involves a coordinated and continuous process of planning and implementation that relies on measuring performance and taking corrective action.
Any preparedness program that readies a community could potentially have a positive effect, even if the program has yet to be tested in a true emergency. However, the inherent difficulty working in a field such as public health preparedness is that, although there are dedicated professionals with significant awareness and even operational experience, there are other elected or appointed officials without the same subject matter expertise, who must be rapidly educated. Additionally, policy goals have been overshadowed by politics in public health preparedness on numerous occasions.
The State of Readiness & Other Successes There have been multiple successes in public health preparedness efforts, least of which is the overall state of readiness achieved since the post-9/11 Anthrax attacks. In the time period prior to these events, the United States experienced a degradation of public health preparedness infrastructure and capacity including a lack of laboratory readiness and appropriately trained personnel.
Since then, with the assistance of multiple federal funding streams – including the PHEP, Cities Readiness Initiative, and Hospital Preparedness Program grants – the strengthening of the public health infrastructure includes qualified professionals performing the following tasks:
Conducting surveillance for pathogens;
Practicing mass prophylaxis distribution;
Safe-guarding the food supply;
Engaging in cross-jurisdictional training and communication efforts;
Participating in media training;
Keeping first responders healthy;
Creating volunteer opportunities and community outreach; and
Consistently training in incident management.
On a daily basis, these improvements in the public health infrastructure have assisted during everyday occurrences – including environmental, food-based, and terrorism-related incidents – and have also been augmented to handle large-scale bioterrorism attacks or other emergencies affecting the public’s health. The knowledge of these successes was solidified during the 2009-2010 H1N1 pandemic and the recent Ebola situation when, moving rapidly, the federal government released funds to state and local partners to strengthen response efforts for the specific situations.
The conundrum of public health preparedness efforts is that many community members and elected officials understand response efforts, but not readiness efforts. They fail to understand that well-trained responders responding to an emergency situation are an element of overall preparedness. The fact that experts have been trained and educated about myriad public health emergencies, conducted various drills and exercises based on relevant scenarios, and stand at the ready is not easily understood. Therefore, without seeing an incident occur, the need to have grant funding for readiness efforts may not be apparent.
Another area of success is the establishment of well-developed, operationally sound emergency plans for the wide variety of public health-specific emergencies that call for health departments to respond. Although these plans are primarily related to health emergencies, they can also include other incidents, such as weather emergencies, where the health department plays a tangential role. The National Response Framework, the National Disaster Recovery Framework, and the National Preparedness Goal all highlight the key roles that the field of public health plays in community preparedness and resilience, specifically in the planning process.
At best, it can be difficult to get elected officials to attend necessary drills and exercises in order to understand their distinct roles in an emergency. At worst, they may be so removed from the incident that they actually hamper agencies’ efforts in an emergency and provide news media with inaccurate information.
Budgets, Planning & Other Challenges Politics, budgets, and long-term planning are dynamically intertwined in the public health preparedness context. The electoral process may impact preparedness in significant ways. Representatives’ thinking about preparedness leads to adjustments in budgets and policies. Elected officials who are aware of preparedness efforts may choose to funnel resources to this area, whereas others might elect to trim budgets and focus more narrowly on specific strategic priorities. These shifts may alter, or even undermine, long-term efforts. Below are some points to keep in mind:
At times, public health representatives must be proactive in making elected officials aware of specific community successes at the city, regional, and state levels.
Forward-leaning politicians – local, state, or even national representatives –understand the “lay of the land” when it comes to preparedness efforts. However, for those who do not understand, local, regional, or state-based agencies must relay to elected officials that public health preparedness is a long-term issue that is affected by the term-to-term fluidity of politics.
Subject matter experts must be able to clearly explain complex public health-specific terms such as quarantine, isolation, and patient screening realities to elected officials of all levels. This optimally should be done in a proactive manner, but may be required during an emergency.
State and local health officials traditionally receive guidance, as well as incident-specific resources such as vaccines, from the federal government. Ensuring that elected officials understand dispensing practices and priorities before distributing antivirals or antibiotics could prevent a public relations debacle.
Public health preparedness programs need buy-in from all levels of government in order to build upon current successes. A strong commitment must be made at the federal, state, and local levels to maintain and improve local public health preparedness capacities and to make this effort a national priority. Without such a commitment, public health will continue to fail in its primary functions and lack the capacity to meet homeland security preparedness goals.
Raphael M. Barishansky, MPH, MS, CPM is director of the Connecticut Department of Public Health’s Office of Emergency Medical Services (OEMS). Before establishing himself in this position, he served as chief of public health emergency preparedness for the Prince George’s County (Maryland) Health Department. A frequent contributor to the DomPrep Journal and other publications, he can be reached at firstname.lastname@example.org