NGA: Integrate public health in homeland security
NGA: Integrate public health in homeland security
The National Governors Association (NGA) Center for Best Practices says during the last half of the 20th century, public health often was considered less than an integral part of disaster and emergency response. And as emergency management and homeland security evolved, public health officials frequently found themselves at the periphery of preparedness and response efforts.
"This lack of integration into homeland security structures has been further hindered by a public health culture sometimes at odds with decision-making approaches favored by other first response agencies and a public health infrastructure that has lagged behind other response agencies in terms of involvement," says NGA policy analyst Jeff Mitchell, who wrote an issue brief highlighting four recommendations for better integrating public health into homeland security.
Mr. Mitchell tells State Health Watch that for virtually any disaster that states will face, public health needs to be a part of the response, and it's much better to have those arrangements in place before they're needed, rather than exchanging business cards in the emergency operations center.
According to Mr. Mitchell, responding to disasters was once considered the sole province of emergency managers, law enforcement officers, and firefighters. To many Americans, he says, the term "first responder" calls forth images of the National Guard airlifting hurricane victims from rooftops or firefighters digging through the wreckage of structures searching for victims.
"It is rare to think of first responders as latex-gloved officials inoculating the elderly and children against diseases spawned by fetid flood waters, or lab officials quietly monitoring the incidence of West Nile virus in local bird populations," he says. "And that's because during the latter half of the 20th century, public health officials found themselves at the periphery of preparedness and response efforts. Primary public health activities such as lead hazard abatement, reduction of tobacco use, and education about sexually transmitted diseases have seemed to have little to do with natural or man-made disasters within mass populations. And the committee approach to decision making favored by public health personnel often placed them at odds with the command and control philosophy in the emergency management community."
Infrastructure deteriorating
Adding to the culture clash has been a deteriorating public health infrastructure. Mr. Mitchell quoted testimony given Oct. 9, 2001, by American Public Health Association executive director Mohammad Akhter on the state of public health, which noted that on entering the 21st century, half of all states lacked an epidemic intelligence service officer, only 32 states employed a designated public health veterinarian, and some 10% of U.S. health departments lacked e-mail.
"If a bioterrorist attack occurred on a Friday afternoon, there would be no report of it until Monday morning under the current staffing profile of most health departments," he said.
That all changed when events in 2001 triggered a reexamination of the role of public health in all types of disasters.
"As states upgraded their own homeland security structures," Mr. Mitchell says, "many began examining ways to upgrade the assets of public health for emergencies. While bioterrorism and emerging infectious diseases are the most obvious triggers for these efforts, state homeland security directors also realize that, after responding to almost any natural or man-made disaster in their state, they may face a second wave of disease-related deaths that amplify the human toll of an emergency. During an epidemic, access to information about patient health and treatment could prove to be as critical as access to information about terrorist intentions. Indeed, disease surveillance may be the most important type of intelligence available to authorities of any type during an emergency with public health implications. Furthermore, in many states public health authorities — not law enforcement, emergency management, or fire-fighting personnel — are the only entities empowered to enforce compliance with medical treatments, to shut down institutions to prevent the spread of disease, and to issue quarantine and isolation orders."
While public health's role in homeland security continues to grow, he says, in most cases it is not yet fully integrated. Mr. Mitchell makes four "generic recommendations" for areas to be focused on:
1. Fully integrate public health in the state homeland security governance structure. Efforts to include public health within state homeland security structures must start at the top, Mr. Mitchell says, and most states have recognized this and have included public health in the new governance structures. One way to place public health within homeland security structures is to ensure representation within central homeland security decision-making committees at the highest level of state government, he says. Another approach in addition to integrating public health into homeland security decision-making at the top levels of government is a regional model in which the public health discipline is represented in regional decision-making bodies as well as the statewide committees overseeing regional efforts.
2. Include public health in homeland security planning. Whether preparing to distribute the medicines to end an epidemic or preserving the health of evacuees after an initial disaster, states are now beginning to include public health in a wide variety of planning activities, according to Mr. Mitchell's analysis. "The most obvious place for planning to become integrated," he says, "would be by correlating state public health and overall state homeland security strategic plans. States can accomplish this by giving public health a defined role in preparedness and response and by requiring public health and other agencies to work together." In addition, some disaster scenarios call for widespread distribution of drugs and public health must play a large role in this process. As the lead agencies for planning and response for bioterrorism and other public health emergencies, state public health organizations are required to work with other agencies. Another timely opportunity to integrate public health into homeland security is to develop a state plan for potential pandemic flu.
3. Incorporate public health in state and local exercise and training activities. Mr. Mitchell says it isn't enough to pursue integration at government's senior levels. States seeking to integrate public health into their overall homeland security structure should also view disaster exercising and training as an opportunity to pursue a multidisciplinary approach because it gives workers from public health and other homeland security agencies the chance to get to know and understand each other's expertise, authority, and culture before a disaster strikes.
4. Include public health in homeland security intelligence and analysis. The first sign of a biological attack or the emergence of a deadly infectious disease would come from the health care community, Mr. Mitchell notes. Doctors and nurses would report an increase in particular maladies or emergence of a strange new disease. While the signs for some biological agents such as smallpox, anthrax, or pneumonic plague can be subtle, the best hope of containing an outbreak is to recognize it early and take appropriate measures. "Public health disease surveillance systems need to be incorporated into statewide homeland security efforts to inform any state responses to disasters," he says. "In addition, states should include public health representatives in state intelligence fusion centers. These centers and other state intelligence sharing entities seek to avoid the 'information silo' phenomenon in which individual agencies, for a variety of reasons, tightly refused to share their own intelligence products. Public health experts can inform the work of those centers through their medical and disease tracking expertise, infectious disease surveillance systems, and epidemiological capabilities."
Mr. Mitchell tells State Health Watch that because many states have been working to integrate public health into their homeland security structure, the issue brief has been well received and there has been a lot of interest in various states.
One reason the recommendations have been well received, he says, is that they came from a number of conference calls with state homeland security and public health officials.
[The issue brief is available on-line at www.nga.org. Contact Mr. Mitchell at (202) 624-5312 or e-mail [email protected].]
The National Governors Association (NGA) Center for Best Practices says during the last half of the 20th century, public health often was considered less than an integral part of disaster and emergency response.Subscribe Now for Access
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