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States are challenged in responding to public health crises
For Colorado, it was several major snowstorms in a relatively short period of time; while for Rhode Island, it was the death of an elementary school student from encephalitis. In each instance, state and local officials were hard-pressed to deal with the challenges of responding to the crisis and communicating with their communities. Officials who were involved shared their experiences and lessons learned in a policy laboratory at a forum sponsored by the American Public Health Association as part of National Public Health Week. Federal officials also commented on what transpired and what has been learned about how things can be done better.
Denver director of public health Christopher Urbina, MD, MPH, said the most important thing he learned from the series of blizzards is that people in communities must get to know their neighbors. "In instances where the elderly were stranded or they didn't know how to get in and out, they had to know each other," he said. "People were walking around the streets of Denver during that period of time helping each other. People were helping each other dig out their cars and share food. Actually, that was pretty spectacular."
The second thing Dr. Urbina learned was the importance of having realistic expectations. He said people didn't realize that not everyone could expect to have suburban residential streets cleared when the effort was going to maintaining the major routes. Dr. Urbina's suggestion was that the public needs to become involved in planning much earlier. "If you only have this snowstorm once every 25 or 100 years, do you really want to buy all those snowplows?" he asked. "Do you really want to invest in all that effort if it's going to happen so rarely? I think the public has got to get involved in the debate, in terms of understanding what those expectations are."
From a government perspective, he said, familiarity also applies. All the various elements were able to work well together because they had already set up a plan and had practiced it. He also said governments must make the hard decisions of establishing priorities and sticking to them, no matter how many complaints come from the public. "I think governments need to think and involve the public in that prioritization," Dr. Urbina said. "I think the lessons we've learned from government and the public is that we need to practice and continue to practice."
Demonstrate what you believe
Rhode Island Department of Public Health director David Gifford, MD, MPH, spoke about the school health crisis that hit his state right after the Christmas break in 2006. An important lesson that was learned, he said, was that actions speak louder than words. As additional cases of illness were reported, he said, and the number of school districts potentially involved grew, people asked why schools were allowed to remain open. A positive message was sent, Dr. Gifford said, when he continued to send his son to school and people realized, "Look, he's sending his son to school, so it really must be more than just a government official trying to say something about this, but he really believes it."
Dr. Gifford also said when his department and the federal Centers for Disease Control & Prevention took blood samples and throat swabs from some people to better understand who had been infected and how widespread the problem was, people assumed it had something to do with treatment and demanded to be tested.
Dr. Gifford also stressed the importance of drilling and practicing, saying that if Rhode Island officials hadn't been practicing an incident command system, which had been put in place by the federal Department of Health and Human Services, they would not have done as well in this crisis. "All politics are local and all emergencies are local," he declared.
Department of Health and Human Services assistant secretary for health John Agwunobi, MD, MBA, MPH, an admiral in the U.S. Public Health Service, called attention to the need for what he called horizontal linkages in and between communities. He praised the utility companies for sending manpower and equipment from around the country to aid in restoring service when there are hurricanes, floods, and other major disruptions. "These horizontal obligations are more important than the vertical, in my humble opinion, when it comes to preparedness," he declared. "Snow plows from across the nation could converge on the place of a storm to help a local community as it seeks to clear snow."
On the state-to-state level, he said, the Emergency Management Assistance Compact allows people to move from one state to another to help in an emergency, and "it is as important as getting help from the federal government to the state, or from the state to the county. This notion of being able to rely on each other is critical."
Centers for Disease Control and Prevention director Julie Gerberding, MD, reminded the audience that when she toured the Katrina shelters, she was struck by the fact that she was seeing the poor, the disabled, the isolated, lonely, and forgotten people—society's most vulnerable people. They were, she said, those who are medically, socially, technologically, environmentally, mobility, and transportation challenged. "When we're thinking about preparedness for the urgent threats," she said, "we should start there first because those are the people that sustain the disproportionate burden of these kinds of events.
Dr. Gerberding also called attention to the current "crisis of complacency," saying she has been trying to nail down what the cause is. "Not knowing what to do is frustrating," she declared, "but not doing what you know is tragic. We are sitting here in a context where we know the things that people need to do, but they are not getting done. We really have to step back and say, 'Why is that? Why are we, as a society and as individuals, unable to sustain our efforts to prepare?'"
The reasons Dr. Gerberding has come up with are that people are too busy or are distracted by other threats. Also, some people are too frightened and some people are too isolated. Some people, she said, may be too confident.
"You can fight complacency with caring," Dr. Gerberding said, "but it's a special brand of caring that we need to focus on. We need to care enough to truly commit as family members, as a community, and as a nation to continuing to build that network of preparedness across all of our communities….We also need to care enough to connect, not just with our families, but with the other people in our community, the people that we might not normally come in contact with through our community organizations, through our churches, through the walks that we are hopefully taking in our neighborhoods, just thinking about the other person a little bit more and maybe having that person be a part of your own family preparedness plan."