The hurricane season and reports of disease outbreaks – domestically and abroad – serve as reminders that there are threats that communities face at the same time. Creating resilient communities requires an understanding that communities contend with competing priorities, and must find ways to harness their existing strengths to improve their preparedness and response capabilities.
In addition to the upcoming Hurricane Season, there are several additional potential threats to which the public health and emergency management community must respond, including the potential spread of the Zika virus in the United States and U.S. territories. There are often multiple priorities to be managed during a single event. As emergency responders already know, disasters and disease outbreaks do not occur in silos. At the systemic level, every event involves multiple components of critical infrastructure – including telecommunications, healthcare, financial systems, and a host of other sectors. At the patient level, events are normally accompanied by other concerns – for example, managing the care of loved ones, dealing with the complexities of evacuation, or even managing chronic disease. Resilience requires balancing the needs of both the systemic and individual to create plans that sustain public health during crises and through recovery.
Visible & Invisible Disasters
At its very core, resilience relies on people to make it work. The ability for a community to rebound after a disaster is more dependent on the cohesion and sense of interconnectedness that is shared throughout that community, more so than the infrastructure that is in place. Every disaster, global or local, leaves behind a community to clean up and rebuild. The more “visible” disasters – for example, tornadoes, earthquakes, hurricanes, floods – leave tangible reminders of the damage done, so rebuilding focuses on improving the physical and visible evidence that the community has been affected. These rebuilding efforts may involve construction and repair of infrastructure like bridges and roads, reopening schools, and rebuilding workforces.
On the other hand, chemical and biological events are less tangible and are almost “invisible” disasters – such as infectious disease outbreaks. Although these disasters do not often leave the same fragmented physical infrastructure, they still can cause significant damage. The strain of a pandemic on healthcare infrastructure can be measured in hospital system recovery, impacts to public health first receivers and responders, and efficiency of the public health community’s response and recovery efforts.
One of the most important measures of recovery is the rebuilding of the community linkages that must occur. There is a need to measure and respond to the social cohesion, including the mental and emotional strain on the community, as community linkages are a critical part of a population’s health and well-being. Rebuilding community networks and re-establishing cohesion are components of disaster recovery that are as important as built infrastructure. Often, community connections and social norms that reinforce those linkages can be crucial factors that help control or exacerbate an event.
The Ability to Strain or Strengthen Communities
During the Ebola outbreak of 2014, cultural norms of expressing care played a major role in disease transmission. The responders realized that the process of caring for loved ones and preparing them for burial was responsible for a significant amount of the transmission. In West Africa, the preparation for burial incorporating an extensive process of preparing the body exposed the preparers to body fluids filled with the Ebola virus. It would have been almost impossible to stop the spread of the virus without addressing cultural norms, which resulted in major changes in community dynamics in order to get the epidemic under control. However, the same measures necessary to contain the spread of the virus also fragmented the community by creating stigmas and other negative reactions at the exact time when a sense of community needed to be restored after the pandemic subsided. This is just one of many examples of the strain communities experience after events.
On the other hand, there are events that are able to strengthen community culture and bring them together. Media coverage of the August 2016 flooding in Baton Rouge, Louisiana, showed devastation and families that had lost everything, but alongside those stories were snapshots of local heroes who worked to rescue neighbors and get them to shelters (see Figure 1). Also in 2016, while news coverage of the Baltimore uprising focused on civil unrest, residents made sure that elderly patients were able to get medicines they needed and that community programs continued.
In the emergency management and healthcare spaces, there has been an increased focus on building resilience within local communities. As more catastrophic events and disasters occur, there is an obvious need to ensure that healthcare operations are able to withstand the threats posed by these events.
A Need for More Than Just “Grit”
A term rising in popularity and usage within this space is “grit.” Although the term recognizes the positive trait that some individuals and communities have the capacity to fight back against their circumstances, focusing on “grit” as a quality that communities need to be successful or vibrant misses the point – the reality is that communities need resource gaps plugged and systems failures addressed to be successful in any crisis. To suggest that some communities are more resilient and better at bouncing back because of “grit” ignores the determination and togetherness even the most vulnerable communities already possess and demonstrate as they work to survive. That determination is a core component of what holds these communities together and exactly what makes them resilient.
Community resilience is about more than roads and bridges, it is about the fabric of the community being strengthened and healed after an event. Pivoting away from infrastructure and toward a people-centered approach to resilience may help decision makers determine the best measures to protect communities from disasters and ensure they quickly recover. When instituted and nurtured correctly, community can be a system as powerful as any other.
Nicolette Louissaint, Ph.D., is the interim executive director at Healthcare Ready. Previously, she served as a foreign affairs officer at the U.S. Department of State in the Bureau of Economic and Business Affairs as the lead officer for health intellectual property and trade issues. During the height of the Ebola Epidemic of 2014, she served as the senior advisor to Ambassadors Nancy J. Powell and Steven A. Browning, the State Department’s special coordinators for Ebola. She holds degrees in Chemical Engineering and Biological Sciences from Carnegie Mellon University, as well as a Ph.D. in Pharmacology and Molecular Sciences from Johns Hopkins University School of Medicine.