Article

Using a community-based approach for prevention and mitigation of national health emergencies

Authors:
  • DisasterDoc LLC
To read the full-text of this research, you can request a copy directly from the author.

Abstract

Disaster management is most effective when developed at the community level. Community based planning, prevention, mitigation, and emergency response all engage the population to make choices that are commensurate with local needs and resources. Community based disaster management also offers a force multiplying effect by increasing the number of potential participants and leaders. This discussion of key community based developmental activities is meant to provide a primer for the public health practitioner beginning the study of emergency preparedness and response.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... Such effects are frequently poorly understood and even less so concerning long-term repeated exposures to a contaminated environment resulting from a disaster. Epidemiologic studies of EPHDs resulting from accidental or intentional releases of hazardous contaminants provide important information on long-term toxic health effects1234, though methodological challenges such as mitigating selection biases, exposure assessment, and community mistrust present important obstacles to comprehensively evaluating these long-term health effects. The purpose of this paper is to share some practical lessons learned during the public health recovery work after four EPHDs (Table 1). ...
Article
Full-text available
Background: Environmental public health disasters involving hazardous contaminants may have devastating effects. While much is known about their immediate devastation, far less is known about long-term impacts of these disasters. Extensive latent and chronic long-term public health effects may occur. Careful evaluation of contaminant exposures and long-term health outcomes within the constraints imposed by limited financial resources is essential. Methods: Here, we review epidemiologic methods lessons learned from conducting long-term evaluations of four environmental public health disasters involving hazardous contaminants at Chernobyl, the World Trade Center, Bhopal, and Graniteville (South Carolina, USA). Findings: We found several lessons learned which have direct implications for the on-going disaster recovery work following the Fukushima radiation disaster or for future disasters. Interpretation: These lessons should prove useful in understanding and mitigating latent health effects that may result from the nuclear reactor accident in Japan or future environmental public health disasters.
... Partnerships among public entities (government) and the private sector are critical for usual emergency preparedness activities. 46 In difficult financial times, these public-private collaborations are critical because they optimize the resources of both entities by decreasing administrative hassles, creating new revenue streams in communities, and developing sustainable plans for ongoing community revitalization. 47,48 Public-private and private-private (eg, nonprofit to for-profit) partnerships can be used to build ongoing capacity that ultimately improves a community's resilience to disasters, including mitigating vulnerabilities of the population and infrastructure. ...
Article
Nongovernmental organizations (NGOs) are important to a community during times of disaster and routine operations. However, their effectiveness is reduced without an operational framework that integrates response and recovery efforts. Without integration, coordination among NGOs is challenging and use of government resources is inefficient. We developed an operational model to specify NGO roles and responsibilities before, during, and after a disaster. We conducted an analysis of peer-reviewed literature, relevant policy, and federal guidance to characterize the capabilities of NGOs, contextual factors that determine their involvement in disaster operations, and key services they provide during disaster response and recovery. We also identified research questions that should be prioritized to improve coordination and communication between NGOs and government. Our review showed that federal policy stresses the importance of partnerships between NGOs and government agencies and among other NGOs. Such partnerships can build deep local networks and broad systems that reach from local communities to the federal government. Understanding what capacities NGOs need and what factors influence their ability to perform during a disaster informs an operational model that could optimize NGO performance. Although the operational model needs to be applied and tested in community planning and disaster response, it holds promise as a unifying framework across new national preparedness and recovery policy, and provides structure to community planning, resource allocation, and metrics on which to evaluate NGO disaster involvement. (Disaster Med Public Health Preparedness. 2012;0:1-8).
Book
Full-text available
Estrategias comunitarias y familiares de prevención orienta procesos de observación e intervención barrial centrados en la parentalidad, el funcionamiento de las familias en su entorno socio-comunitario, y el potencial formativo, protector y participativo de las comunidades de adultos responsables. Se trata de una mirada sobre los recursos familiares, que no se agota en el ámbito familiar específico sino que se abre a todos las prácticas comunitarias que fortalecen las funciones parentales y permiten un vínculo intergeneracional enriquecedor.
Article
A disaster is a serious disruption of the functioning of a community or a society causing widespread human, material, economic, or environmental losses which exceed the ability of the affected community or society to cope using its own resources. Over 96% of all deaths from natural disasters occur in developing countries. Natural disasters kill one million people around the world each decade and leave millions more homeless each year. Disaster preparedness and management refers to measures taken to prepare for and reduce the effects of disasters. That is, to predict, prevent, and mitigate their impact on vulnerable populations, and respond to their consequences. Disaster preparedness is a continuous and integrated process resulting from a wide range of activities and resources rather than from a distinct activity by itself. It requires the contributions of many different areas ranging from training and logistics, to health care to institutional development.
Article
Effective methods of communication are vital to preparing the public for emergency events. Hurricane Katrina was an unfortunate example of the devastating consequences that can occur from inadequate communication prior to and during emergency events. The presence of health disparities exacerbates these consequences for vulnerable populations such as low-income minorities. To address the need for more research within this realm of public health, the Morgan State University School of Public Health and Policy implemented the Special Populations Bioterrorism Initiative to assess the experiences and needs of low income minorities affected by natural disasters in Maryland. As an extension of this initiative, a content analysis of web-based emergency preparedness risk communication materials collected from the 26 county and municipal emergency management offices in Maryland was conducted to determine their appropriateness in reaching low income African Americans and Latinos. The results illustrated a significant disparity in the amount of culturally tailored information available for these populations, as well as the need for improvement in developing and disseminating culturally appropriate emergency risk communication designed to reach low income minorities.
Article
Community resilience (CR)-ability to withstand and recover from a disaster-is a national policy expectation that challenges health departments to merge disaster preparedness and community health promotion and to build stronger partnerships with organizations outside government, yet guidance is limited. A baseline survey documented community resilience-building barriers and facilitators for health department and community-based organization (CBO) staff. Questions focused on CBO engagement, government-CBO partnerships, and community education. Most health department staff and CBO members devoted minimal time to community disaster preparedness though many serve populations that would benefit. Respondents observed limited CR activities to activate in a disaster. The findings highlighted opportunities for engaging communities in disaster preparedness and informed the development of a community action plan and toolkit. (Am J Public Health. Published online ahead of print May 16, 2013: e1-e9. doi:10.2105/AJPH.2013.301270).
Article
Local health departments are among the first agencies to respond to disasters or other mass emergencies. However, they often lack the ability to handle large-scale events. Plans including locally developed and deployed tools may enhance local response. Simplified cluster sampling methods can be useful in assessing community needs after a sudden-onset, short duration event. Using an adaptation of the methodology used by the World Health Organization Expanded Programme on Immunization (EPI), a Microsoft Access-based application for two-stage cluster sampling of residential addresses in Louisville/Jefferson County Metro, Kentucky was developed. The sampling frame was derived from geographically referenced data on residential addresses and political districts available through the Louisville/Jefferson County Information Consortium (LOJIC). The program randomly selected 30 clusters, defined as election precincts, from within the area of interest, and then, randomly selected 10 residential addresses from each cluster. The program, called the Rapid Assessment Tools Package (RATP), was tested in terms of accuracy and precision using data on a dichotomous characteristic of residential addresses available from the local tax assessor database. A series of 30 samples were produced and analyzed with respect to their precision and accuracy in estimating the prevalence of the study attribute. Point estimates with 95% confidence intervals were calculated by determining the proportion of the study attribute values in each of the samples and compared with the population proportion. To estimate the design effect, corresponding simple random samples of 300 addresses were taken after each of the 30 cluster samples. The sample proportion fell within +/-10 absolute percentage points of the true proportion in 80% of the samples. In 93.3% of the samples, the point estimate fell within +/-12.5%, and 96.7% fell within +/-15%. All of the point estimates fell within +/-20% of the true proportion. Estimates of the design effect ranged from 0.926 to 1.436 (mean = 1.157, median = 1.170) for the 30 samples. Although prospective evaluation of its performance in field trials or a real emergency is required to confirm its utility, this study suggests that the RATP, a locally designed and deployed tool, may provide population-based estimates of community needs or the extent of event-related consequences that are precise enough to serve as the basis for the initial post-event decisions regarding relief efforts.
Article
Full-text available
Disasters are becoming more frequent. The US is experiencing a dramatic increase in the number of natural disasters, many involving a catastrophic number of related deaths. Despite billions of dollars being spent on the development of national, state and local interventions, there has been no significant change in the rate of disaster-related mortality among US populations over the past 50 years. As such, we evaluate strategies for reducing disaster-related mortality in the US in comparison to that associated with motor vehicle crashes. In doing so, a multi-faceted strategy is proposed for reduction of disaster-related mortality, based upon a sustained record of effectiveness involving transportation-related incidents.
Article
Full-text available
BACKGROUND Quantifying the effect of natural disasters on society is critical for recovery of public health services and infrastructure. The death toll can be difficult to assess in the aftermath of a major disaster. In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64. METHODS Using a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016. RESULTS From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial. CONCLUSIONS This household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate. (Funded by the Harvard T.H. Chan School of Public Health and others.)
Article
Full-text available
The gap between discovery of public health knowledge and application in practice settings and policy development is due in part to ineffective dissemination. This article describes (1) lessons related to dissemination from related disciplines (eg, communication, agriculture, social marketing, political science), (2) current practices among researchers, (3) key audience characteristics, (4) available tools for dissemination, and (5) measures of impact. Dissemination efforts need to take into account the message, source, audience, and channel. Practitioners and policy makers can be more effectively reached via news media, social media, issue or policy briefs, one-on-one meetings, and workshops and seminars. Numerous "upstream" and "midstream" indicators of impact include changes in public perception or awareness, greater use of evidence-based interventions, and changes in policy. By employing ideas outlined in this article, scientific discoveries are more likely to be applied in public health agencies and policy-making bodies.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Article
Full-text available
The guest editors of this special issue thank the reviewers and all authors for providing important contributions in this issue.
Article
Full-text available
This paper describes the innovative use information technology for assisting disaster planners with an easily-accessible method for writing and improving evidence-based emergency operations plans. This process is used to identify all key objectives of the emergency response according to capabilities of the institution, community or society. The approach then uses a standardized, objective-based format, along with a consensus-based method for drafting capability-based operational-level plans. This information is then integrated within a relational database to allow for ease of access and enhanced functionality to search, sort and filter and emergency operations plan according to user need and technological capacity. This integrated approach is offered as an effective option for integrating best practices of planning with the efficiency, scalability and flexibility of modern information and communication technology.
Article
Full-text available
The 2010 World Exposition in Shanghai China (Expo) was the largest mass gathering in world history, attracting a record 72 million visitors. More than 190 countries participated in the Expo, along with more than 50 international organizations. The 2010 Expo was six months in duration (May 1 through October 30, 2010), and the size of the venue site comprised 5.28 square kilometers. Great challenges were imposed on the public health system in Shanghai due to the high number and density of visitors, long duration of the event, and other risk factors such as high temperatures, typhoon, etc.As the major metropolitan public health agency in Shanghai, the Shanghai Municipal Center for Disease Control and Prevention (SCDC) implemented a series of actions in preparing for, and responding to, the potential health impact of the world's largest mass gathering to date, which included partnerships for capacity building, enhancement of internal organizational structure, risk assessment, strengthened surveillance, disaster planning and exercises, laboratory management, vaccination campaign, health education, health intervention, risk communication and mass media surveillance, and technical support for health inspection. The clear-cut organizational structures and job responsibilities, as well as comprehensive operational and scientific preparations, were key elements to ensure the success of the 2010 World Exposition. H Yi, Y Zheng'an, W Fan, G Xiang, D Chen, H Yongchao, S Xiaodong, P Hao, M Mahany, M Keim. Public health preparedness for the world's largest mass gathering: 2010 World Exposition in Shanghai, China. Prehosp Disaster Med. 2012;27(6):1-6.
Article
Full-text available
Usability is an important concept that seems to receive less attention than it deserves outside of the core Human–Computer Interaction community. The reason for this apparent lack of interest may stem from an overly instrumental orientation towards usability that does not appeal to more socially oriented researchers. Three central criteria for usability, as reflected in the contemporary literature, are the effectiveness, efficiency and satisfaction with which users can achieve specified goals. These criteria are often expressed in terms of achieving goals, which, at least tacitly, seem to be restricted to goals related to an instrumental view on the use of IT. To broaden this view, the paper elaborates on how the concept of usability can be understood and used within a social action context. How social goals are related to the effectiveness, efficiency and satisfaction criteria is addressed specifically. It is argued that in order truly to understand usability, we must consider both instrumental and social goals since their combination constitute a fundamental part of the social action context in which systems are used. Both instrumental and social goals affect the way systems and use-situations are designed and conceived. Interpreting usability from this broad social action perspective may be a way to make the concept more accepted throughout the wide variety of areas dealing with the design of IT systems.Journal of Information Technology (2006) 21, 24–39. doi:10.1057/palgrave.jit.2000055 Published online 29 November 2005
Article
Full-text available
The leadership in each jurisdiction of the world has been described as legally, morally, and politically responsible for ensuring that necessary and appropriate actions are taken to protect people and property from the consequences of emergencies and disasters. As emergencies often evolve rapidly and become too complex for effective improvisation, a government can successfully discharge its emergency management responsibilities only by taking action beforehand. This requires preparedness in advance of the disaster event. Accordingly, preparedness measures should not be improvised or handled on an ad hoc basis.
Article
Full-text available
Despite the many accomplishments of public health, a greater attention to evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about a decade ago. Key components of EBPH include making decisions on the basis of the best available scientific evidence, using data and information systems systematically, applying program-planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Three types of evidence have been presented on the causes of diseases and the magnitude of risk factors, the relative impact of specific interventions, and how and under which contextual conditions interventions were implemented. Analytic tools (e.g., systematic reviews, economic evaluation) can be useful in accelerating the uptake of EBPH. Challenges and opportunities (e.g., political issues, training needs) for disseminating EBPH are reviewed. The concepts of EBPH outlined in this article hold promise to better bridge evidence and practice.
Article
Full-text available
Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.
Article
Full-text available
Randomized controlled trials (RCTs) are essential for evaluating the efficacy of clinical interventions, where the causal chain between the agent and the outcome is relatively short and simple and where results may be safely extrapolated to other settings. However, causal chains in public health interventions are complex, making RCT results subject to effect modification in different populations. Both the internal and external validity of RCT findings can be greatly enhanced by observational studies using adequacy or plausibility designs. For evaluating large-scale interventions, studies with plausibility designs are often the only feasible option and may provide valid evidence of impact. There is an urgent need to develop evaluation standards and protocols for use in circumstances where RCTs are not appropriate.
Article
Objective Disaster-related research funding in the United States has not been described. This study characterizes Federal funding for disaster-related research for 5 professional disciplines: medicine, public health, social science, engineering, emergency management. Methods An online key word search was performed using the website, www.USAspending.gov , to identify federal awards, grants, and contracts during 2011–2016. A panel of experts then reviewed each entry for inclusion. Results The search identified 9145 entries, of which 262 (3%) met inclusion criteria. Over 6 years, the Federal Government awarded US $69 325 130 for all disaster-related research. Total funding levels quadrupled in the first 3 years and then halved in the last 3 years. Half of the funding was for engineering, 3 times higher than social sciences and emergency management and 5 times higher than public health and medicine. Ten (11%) institutions received 52% of all funding. The search returned entries for only 12 of the 35 pre-identified disaster-related capabilities; 6 of 12 capabilities appear to have received no funding for at least 2 years. Conclusion US federal funding for disaster-related research is limited and highly variable during 2011–2016. There are no clear reasons for apportionment. There appears to be an absence of prioritization. There does not appear to be a strategy for alignment of research with national disaster policies.
Article
Public health is what we do together as a society to ensure the conditions in which everyone can be healthy. Although many sectors play key roles, governmental public health is an essential component. Recent stressors on public health are driving many local governments to pioneer a new Public Health 3.0 model in which leaders serve as Chief Health Strategists, partnering across multiple sectors and leveraging data and resources to address social, environmental, and economic conditions that affect health and health equity. In 2016, the US Department of Health and Human Services launched the Public Health 3.0 initiative and hosted listening sessions across the country. Local leaders and community members shared successes and provided insight on actions that would ensure a more supportive policy and resource environment to spread and scale this model. This article summarizes the key findings from those listening sessions and recommendations to achieve Public Health 3.0.
Article
Background: Sub-Saharan Africa is vulnerable to several natural and man-made disasters. We used the CDC Automated Disaster and Emergency Planning Tool (ADEPT) to develop all-hazards disaster management plans at district level in three eastern African countries. Methods: During July 2008-February 2011, we used the automated disaster and emergency planning tool to conduct training on disaster planning and management in the three east African countries namely Kenya, Tanzania and Uganda. We trained district disaster teams per country. We held 7 trainings in Tanzania, 8 in Uganda and 10 in Kenya respectively. The district disaster management teams trained comprised five district administrative personnel and a national Red Cross officer. The training took 5 days. Results: A total of 100 districts teams (40 in Uganda and 35 in Kenya and Tanzania respectively) were trained using the ADEPT and consequently 100 district disaster response plans were developed during 2008-2011. A total 814 district disaster team members from these districts were trained. Our experience has shown that the Automated Disaster Emergency Planning Tool is a relatively quick, easy, practical, participatory and inexpensive approach to developing emergency operating plans at the sub-national (district) level. Conclusions: The ADEPT can be used relatively easily, quickly and inexpensively at the sub-national levels to develop emergency operating procedures to improve disaster management. Although the ADEPT enables district disaster response teams to generate their disaster response plans, the use of the ADEPT may be hampered by lack of computer skills and knowledge of MS computer programme by district personnel in resource limited settings.
Article
Background: The Eastern Africa region is regularly affected by a variety of disasters ranging from drought, to human conflict and population displacement. The magnitude of emergencies and response capacities is similar across the region. In order to strengthen public health disaster management capacities at the operational level in six countries of the Eastern Africa region, the USAID-funded leadership project worked through the HEALTH Alliance, a network of seven schools of public health from six countries in the region to train district-level teams. Objectives: To develop a sustainable regional approach to building operational level capacity for disaster planning. Methods: This project was implemented through a higher education leadership initiative. Project activities were spear-headed by a network of Deans and Directors of public health schools within local universities in the Eastern Africa region. The leadership team envisioned a district-oriented systems change strategy. Pre-service and in-service curricula were developed regionally and district teams were formed to attend short training courses. Project activities began with a situational analysis of the disaster management capacity at national and operational levels. The next steps were chronologically the formation of country training teams and training of trainers, the development of a regional disaster management training curriculum and training materials, the cascading of training activities in the region, and the incorporation of emerging issues into the training curriculum. An evaluation model included the analysis of preparedness impact of the training program. Results: The output from the district teams was the creation of individual district-level disaster plans and their implementation. This 4-year project focused on building operational level public health emergency response capacity, which had not previously been part of any national program. Use of the all-hazard approach rather than a scenario-based contingency planning led to the development of a standardized curriculum for training both in-service and pre-service personnel. Materials developed during the implementation phases of the project have been incorporated into public health graduate curricula in the seven schools. This systems-based strategy resulted in demonstrable outcomes related to district preparedness and university engagement in disaster management. Conclusion: University partnerships are an effective method to build district-level disaster planning capacity. Use of a regional network created a standardized approach across six countries.
Article
The authors review lessons learned from several recent public health emergencies and argue that we must conduct research during emergencies to improve our capacity to prevent illness and injury. They propose policies to facilitate timely research.
Article
Climate change, although a natural phenomenon, is accelerated by human activities. Disaster policy response to climate change is dependent on a number of factors, such as readiness to accept the reality of climate change, institutions and capacity, as well as willingness to embed climate change risk assessment and management in development strategies. These conditions do not yet exist universally. A focus that neglects to enhance capacity-building and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks. Reducing vulnerability is a key aspect of reducing climate change risk. To do so requires a new approach to climate change risk and a change in institutional structures and relationships. A focus on development that neglects to enhance governance and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks.
Article
Over the past few decades, four distinct and largely independent research and policy communities--disaster risk reduction, climate change adaptation, environmental management and poverty reduction--have been actively engaged in reducing socio-economic vulnerability to natural hazards. However, despite the significant efforts of these communities, the vulnerability of many individuals and communities to natural hazards continues to increase considerably. In particular, it is hydro-meteorological hazards that affect an increasing number of people and cause increasingly large economic losses. Arising from the realisation that these four communities have been largely working in isolation and enjoyed only limited success in reducing vulnerability, there is an emerging perceived need to strengthen significantly collaboration and to facilitate learning and information exchange between them. This article examines key communalities and differences between the climate change adaptation and disaster risk reduction communities, and proposes three exercises that would help to structure a multi-community dialogue and learning process.
Article
Reducing losses to weather-related disasters, meeting the Millennium Development Goals and wider human development objectives, and implementing a successful response to climate change are aims that can only be accomplished if they are undertaken in an integrated manner. Currently, policy responses to address each of these independently may be redundant or, at worst, conflicting. We believe that this conflict can be attributed primarily to a lack of interaction and institutional overlap among the three communities of practice. Differences in language, method and political relevance may also contribute to the intellectual divide. Thus, this paper seeks to review the theoretical and policy linkages among disaster risk reduction, climate change and development. It finds that not only does action within one realm affect capacity for action in the others, but also that there is much that can be learnt and shared between realms in order to ensure a move towards a path of integrated and more sustainable development.
Environmental Health from Global to Local. Third Ed
  • M Keim
Keim M. Environmental Disasters. In: Frumkin H, (ed). Environmental Health from Global to Local. Third Ed. San Francisco, California USA: John Wiley and Sons; 2016:667-692.
A map of the US cities and states under lockdown -and those that are reopening. Business Insider
  • Hwa Secon
Secon HWA. A map of the US cities and states under lockdown -and those that are reopening. Business Insider. May 8, 2020. https://www.businessinsider.com/us-mapstay-at-home-orders-lockdowns-2020-3. Accessed August 2, 2020.