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US Governmental Spending for Disaster-Related Research, 2011–2016: Characterizing the State of Science Funding Across 5 Professional Disciplines
Abstract and Figures
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.
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... A research-practice gap exists across all fields of public health, including disaster-related health science. 10,11 Public health has moved forward in recent years to bridge this gap. Evidence-based public health calls for knowledge of the determinants and consequences of disease, as well as the efficacy, effectiveness, and costs of interventions. ...
Objective
This study compared 2019 values for the National Health Security Preparedness Index (NHSPI) with rates of coronavirus disease 2019 (COVID-19)-related mortality as reported by the 50 US states and Puerto Rico during the first six months of the US pandemic (March 1 - August 31, 2020).
Methods
Data regarding provisional death counts and estimates of excess deaths for COVID-19 according to state and territory were downloaded from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website. Reporting included the six-month-long period of March 1 - August 31, 2020. Excess mortality rates were calculated as the number of excess deaths per 100,000 persons in each state population using 2019 US Census Bureau data. Mean values for state and territorial NHSPI domain indices were compared to state and territorial rates of COVID-19-related excess mortality using multiple linear regression, including analysis of variance. Correlations between the 51 state and territorial NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson’s correlation coefficient.
Results
These calculations revealed a high degree of variance (adjusted r square = 0.02 and 0.25) and poor correlation (P = .16 and .08) among values for the overall NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.
There was also a high degree of variance (adjusted r square = 0.001 and 0.03) and poor correlation (P values ranging from .09 to .94) for values for the six individual domains of the NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.
Conclusion
The NHSPI does not appear to be a valid predictor of excess COVID-19 mortality rates for 50 US states and Puerto Rico during the first six months of the pandemic.
... 7 Public health has a long history of community-based participatory research and interventions for managing health risks due to a range of hazardous exposures. 7 However, a research-practice gap exists across all fields of public health and medical practice, including disaster-related health science: 8,9 "Our inability or unwillingness to apply what is known to improve health results in significant health deficits and persistent inequalities." 8 In fact, there is no evidence of significant change in US disaster-related mortality rates over the past 50 years despite billions of dollars in public outlays. ...
Objective
The efficacy is measured for a public health intervention related to community-based planning for population protection measures (PPMs; ie, shelter-in-place and evacuation).
Design
This is a mixed (qualitative and quantitative) prospective study of intervention efficacy, measured in terms of usability related to effectiveness, efficiency, satisfaction, and degree of community engagement.
Setting
Two municipalities in the Commonwealth of Puerto Rico are included.
Participants
Community members consisting of individuals; traditional leaders; federal, territorial, and municipal emergency managers; municipal mayors; National Guard; territorial departments of education, health, housing, public works, and transportation; health care; police; Emergency Medical Services; faith-based organizations; nongovernmental organizations (NGOs); and the private sector.
Intervention
The intervention included four community convenings: one for risk communication; two for plan-writing; and one tabletop exercise (TTX). This study analyzed data collected from the project work plan; participant rosters; participant surveys; workshop outputs; and focus group interviews.
Main Outcome Measures
Efficacy was measured in terms of ISO 9241-11, an international standard for usability that includes effectiveness, efficiency, user satisfaction, and “freedom from risk” among users. Degree of engagement was considered an indicator of “freedom from risk,” measurable through workshop attendance.
Results
Two separate communities drafted and exercised ~60-page-long population protection plans, each within 14.5 hours. Plan-writing workshops completed 100% of plan objectives and activities. Efficiency rates were nearly the same in both communities. Interviews and surveys indicated high degrees of community satisfaction. Engagement was consistent among community members and variable among governmental officials.
Conclusions
Frontline communities have successfully demonstrated the ability to understand the environmental health hazards in their own community; rapidly write consensus-based plans for PPMs; participate in an objective-based TTX; and perform these activities in a bi-lingual setting. This intervention appears to be efficacious for public use in the rapid development of community-based PPMs.
... 7 Public health has a long history of community-based participatory research and interventions for managing health risks due to a range of hazardous exposures. 7 However, a research-practice gap exists across all fields of public health and medical practice, including disaster-related health science: 8,9 "Our inability or unwillingness to apply what is known to improve health results in significant health deficits and persistent inequalities." 8 In fact, there is no evidence of significant change in US disaster-related mortality rates over the past 50 years despite billions of dollars in public outlays. ...
Guest Lecturer for day-long workshop
Johns Hopkins University Bloomberg School of Public Health
Health Emergency for Large Populations (HELP) Course
Title: Planning for Community-based Disaster Risk Reduction
Baltimore, MD January 16, 2014
... 7 Public health has a long history of community-based participatory research and interventions for managing health risks due to a range of hazardous exposures. 7 However, a research-practice gap exists across all fields of public health and medical practice, including disaster-related health science: 8,9 "Our inability or unwillingness to apply what is known to improve health results in significant health deficits and persistent inequalities." 8 In fact, there is no evidence of significant change in US disaster-related mortality rates over the past 50 years despite billions of dollars in public outlays. ...
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.
Ecologists are increasingly becoming interested in disasters, reflecting growing recognition that disasters can present exceptional opportunities to advance fundamental knowledge and appreciation for how ecological research can aid affected communities. Attempts to achieve both objectives can, however, create fractious tensions that result in unfavorable opinions about ecologists and diminish the perceived value of ecological research. Here we outline the merits and perils of "disaster ecology." We first examine how ecologists have engaged in the disaster cycle, focusing on trends in training and education, research funding, and the prevalence of community engagement in ecological research. We illustrate the global asymmetries in educational opportunities, how funding of opportunistic pursuits can engender discord, and how the discipline has not yet widely embraced approaches that foster community engagement. We then provide a prospectus for improving best practices to advance knowledge and support humanitarian missions. Pathways toward improvement and innovation begin with taking steps to increase interdisciplinary coursework and trainings that prepare ecologists to work with first responders and stakeholders. Expanding the base of funding sources and supporting research spanning the disaster cycle would foster broader integration of ecological expertise into decision making. Greater adoption of community-engaged research approaches also would better address community and stakeholder concerns as well as strengthen the discipline by broadening representation and participation.
Research conducted in the context of a disaster or public health emergency is essential to improve knowledge about its short- and long-term health consequences, as well as the implementation and effectiveness of response and recovery strategies. Integrated approaches to conducting Disaster Research Response (DR2) can answer scientific questions, while also providing attendant value for operational response and recovery. Here, we propose a Concept of Operations (CONOPS) template to guide the collaborative development and implementation of DR2 among academic public health and public health agencies, informed by previous literature, semi-structured interviews with disaster researchers from academic public health across the United States, and discussion groups with public health practitioners. The proposed CONOPS outlines actionable strategies to address DR2 issues before, during, and after disasters for public health scholars and practitioners who seek to operationalize or enhance their DR2 programs. Additional financial and human resources will be necessary to promote widespread implementation of collaborative DR2 programs.
Background:
In 2008, the Institute of Medicine released a letter report identifying 4 research priority areas for public health emergency preparedness in public health system research: (1) enhancing the usefulness of training, (2) improving timely emergency communications, (3) creating and maintaining sustainable response systems, and (4) generating effectiveness criteria and metrics.
Objectives:
To (1) identify and characterize public health system research in public health emergency preparedness produced in the United States from 2009 to 2015, (2) synthesize research findings and assess the level of confidence in these findings, and (3) describe the evolution of knowledge production in public health emergency preparedness system research. Search Methods and Selection Criteria. We reviewed and included the titles and abstracts of 1584 articles derived from MEDLINE, EMBASE, and gray literature databases that focused on the organizational or financial aspects of public health emergency preparedness activities and were grounded on empirical studies.
Data collection and analysis:
We included 156 articles. We appraised the quality of the studies according to the study design. We identified themes during article analysis and summarized overall findings by theme. We determined level of confidence in the findings with the GRADE-CERQual tool.
Main results:
Thirty-one studies provided evidence on how to enhance the usefulness of training. Results demonstrated the utility of drills and exercises to enhance decision-making capabilities and coordination across organizations, the benefit of cross-sector partnerships for successfully implementing training activities, and the value of integrating evaluation methods to support training improvement efforts. Thirty-six studies provided evidence on how to improve timely communications. Results supported the use of communication strategies that address differences in access to information, knowledge, attitudes, and practices across segments of the population as well as evidence on specific communication barriers experienced by public health and health care personnel. Forty-eight studies provided evidence on how to create and sustain preparedness systems. Results included how to build social capital across organizations and citizens and how to develop sustainable and useful planning efforts that maintain flexibility and rely on available medical data. Twenty-six studies provided evidence on the usefulness of measurement efforts, such as community and organizational needs assessments, and new methods to learn from the response to critical incidents.
Conclusions:
In the United States, the field of public health emergency preparedness system research has been supported by the US Centers for Disease Control and Prevention since the release of the 2008 Institute of Medicine letter report. The first definition of public health emergency preparedness appeared in 2007, and before 2008 there was a lack of research and empirical evidence across all 4 research areas identified by the Institute of Medicine. This field can be considered relatively new compared with other research areas in public health; for example, tobacco control research can rely on more than 70 years of knowledge production. However, this review demonstrates that, during the past 7 years, public health emergency preparedness system research has evolved from generic inquiry to the analysis of specific interventions with more empirical studies. Public Health Implications: The results of this review provide an evidence base for public health practitioners responsible for enhancing key components of preparedness and response such as communication, training, and planning efforts.
Recent high-profile activations of the US Centers for Disease Control and Prevention (CDC) Emergency Operations Center (EOC) include responses to the West African Ebola and Zika virus epidemics.
Within the EOC, emergency responses are organized according to the Incident Management System, which provides a standardized structure and chain of command, regardless of whether the EOC activation occurs in response to an outbreak, natural disaster, or other type of public health emergency. By embedding key scientific roles, such as the associate director for science, and functions within a Scientific Response Section, the current CDC emergency response structure ensures that both urgent and important science issues receive needed attention. Key functions during emergency responses include internal coordination of scientific work, data management, information dissemination, and scientific publication.
We describe a case example involving the ongoing Zika virus response that demonstrates how the scientific response structure can be used to rapidly produce high-quality science needed to answer urgent public health questions and guide policy. Within the context of emergency response, longer-term priorities at CDC include both streamlining administrative requirements and funding mechanisms for scientific research.
The need for high quality and timely disaster research has been a topic of great discussion over the past several years. Recent high profile incidents have exposed gaps in knowledge about the health impacts of disasters or the benefits of specific interventions-such was the case with the 2010 Gulf Oil Spill and recent events associated with lead-contaminated drinking water in Flint, Michigan, and the evolving health crisis related to Zika virus disease. Our inability to perform timely research to inform the community about health and safety risks or address specific concerns further heightens anxiety and distrust. Since nearly all disasters, whether natural or man-made, have an environmental health component, it is critical that specialized research tools and trained researchers be readily available to evaluate complex exposures and health effects, especially for vulnerable sub-populations such as the elderly, children, pregnant women, and those with socioeconomic and environmental disparities. In response, the National Institute of Environmental Health Science has initiated a Disaster Research Response Program to create new tools, protocols, networks of researchers, training exercises, and outreach involving diverse groups of stakeholders to help overcome the challenges of disaster research and to improve our ability to collect vital information to reduce the adverse health impacts and improve future preparedness.
Effective preparedness, response, and recovery from disasters require a well-planned, integrated effort with experienced professionals who can apply specialized knowledge and skills in critical situations. While some professionals are trained for this, others may lack the critical knowledge and experience needed to effectively perform under stressful disaster conditions. A set of clear, concise, and precise training standards that may be used to ensure workforce competency in such situations has been developed. The competency set has been defined by a broad and diverse set of leaders in the field and like-minded professionals through a series of Web-based surveys and expert working group meetings. The results may provide a useful starting point for delineating expected competency levels of health professionals in disaster medicine and public health.
( Disaster Med Public Health Preparedness . 2012;6:44–52)
At present, many administrators lack a theoretical guide to build management systems to cope with public health emergencies. This study developed a detailed function list for public health emergency management to help building the management systems scientifically.
The five steps in this study including literature review, semistructured interviews with experts, focus group, Delphi study and focus group were conducted to develop the detailed list of functions.
An initial list of 25 functions with 188 items was formed through literature review. The list was reduced to 10 functions with 57 items by semistructured interviews with experts and focus group. Next, all these 57 items reached the consensus through one-round Delphi study. Some revisions of the consensus were done by the same focus group.
The final 10 functions with 57 items could be used as a guide for most countries during their building of a public health emergency management system.
Disaster Medicine is a relatively new discipline. Understanding of the current status of its science is needed in order to develop a roadmap for the direction and structure of future studies that will contribute to building the science of the health aspects of disasters (HADs). The objective of this study was to examine the existing, peer-reviewed literature relevant to the HADs to determine the status of the currently available literature underlying the science of the HADs. A total of 709 consecutive, peer-reviewed articles published from 2009-2014 in two disaster-health-related medical journals, Prehospital and Disaster Medicine (PDM) and Disaster Medicine and Public Health Preparedness (DMPHP), were examined. Of these, 495 were disaster-related ( PDM , 248; DMPHP , 247). Three major categories defined these disaster-related research articles: (1) Epidemiological studies comprised 50.5%; (2) Interventional, 20.3%; and (3) Syntheses, 26.9%. Interventional studies were sub-categorized into: (a) Relief Responses, 23.0%; (b) Recovery Responses, 2.0%; or (c) Risk-Reduction Interventions, 75.0%. Basically, the inventories were consistent within the two journals. Reported indicators of outcomes related to the responses were constrained to achievement indicators (numbers accomplished). Syntheses articles were sub-categorized into: (a) Literature Reviews, 17.6%; (b) Opinions, 25.2%; (c) Models, 24.4%; (d) Frameworks, 6.9%; (e) Guidelines, 13.0%; (f) Tools, 3.0%; (g) Protocols, Policies, or Criteria, 2.3%; or (h) Conference Summaries, 7.6%. Trend analyses indicated that the relative proportions of articles in each category and sub-category remained relatively constant over the five years. No randomized controlled trials (RTCs), non-randomized, comparative controlled trials (CCTs), or systematic reviews were published in these journals during the period examined. Each article also was examined qualitatively for objectives, study type, content, language, and structure. There was no common structure used for any category or sub-categories. In addition, the terminology used was inconsistent and often confusing. This categorization process should be applied to other peer-reviewed journals that publish research related to HADs. As evidenced in the current study, the evidence base for HADs is far from robust and is disorganized, making the development of scientific evidence on which to base best practices difficult. A stronger evidence base is needed to develop the science associated with the HADs. This will require a common structure and terminology to facilitate comparisons. Greater depth of reporting is needed in order to render the Epidemiological studies more useful in mitigating the negative health impacts of hazard-related events. Interventional studies must be structured and include outcomes, impacts, benefits, and costs with robust indicators. The outcomes and impacts of Risk-Reduction Interventions will require the evaluation of changes in the epidemiology documented in future events or exercises.
BirnbaumML , AdibhatlaS , DudekO , Ramsel-MillerJ . Categorization and analysis of disaster health publications: an inventory . Prehosp Disaster Med . 2017 ; 32 ( 5 ): 1 – 10 .
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.
The federal government plays a critical role in achieving national health security by providing strategic guidance and funding research to help prevent, respond to, mitigate, and recover from disasters, epidemics, and acts of terrorism. In this article we describe the first-ever inventory of nonclassified national health security-related research funded by civilian agencies of the federal government. Our analysis revealed that the US government's portfolio of health security research is currently weighted toward bioterrorism and emerging biological threats, laboratory methods, and development of biological countermeasures. Eight of ten other priorities identified in the Department of Health and Human Services' National Health Security Strategy-such as developing and maintaining a national health security workforce or incorporating recovery into planning and response-receive scant attention. We offer recommendations to better align federal spending with health security research priorities, including the creation of an interagency working group charged with minimizing research redundancy and filling persistent gaps in knowledge.
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