After a disaster, a community must focus on recovery and returning to normal – or what will become its “new normal” – as quickly as possible. This new normal may be similar to, better than, or worse than the state of the community before the event. The community’s ability to return to this new normal is called resilience – the capacity to withstand, respond positively to, and recover from a crisis.
The impacts of a disaster on a community are not necessarily determined by the scale of the event but are significantly influenced as well by the preparedness of the organizations, institutions, families, and individuals that comprise the community and enable it to thrive and grow. In an increasingly interconnected world of rapidly advancing technological change and diverse threats, resilience – particularly health resilience – has emerged as a major priority in communities around the world.
Creating community health resilience depends on several critical components, specifically including the following:
- Developing and implementing a whole community framework approach to response and recovery after a health incident or event;
- Developing a common operating picture;
- Using current research, best-practices, technological tools, workshops, and training events not only to increase and improve response, recovery, and resilience capabilities but also to strengthen the whole community framework;
- Addressing critical findings and lessons learned from the framework development processes and pilot programs; and
- Charting a path forward to support community health resilience even more effectively in the future.
Developing & Implementing the Whole Community Framework A systematic approach is needed to determine the actions required to improve community and broader societal capabilities to withstand events that significantly impact community health and safety. This approach involves the development of a holistic health-resilience framework by a broad group of stakeholders, including government agencies, utilities, businesses, and non-profit organizations.
The framework should not only articulate the risk management, mitigation, and continuity strategies agreed upon but also serve as the foundation for a sustainable ongoing process – centered on a public/private/non-profit partnership – to incrementally move communities toward health resilience.
The framework’s development should consist of a multi-step process that builds upon various regional initiatives and uses the lessons learned from both past and current efforts by several organizations. This process also enables stakeholders to: (a) develop working public/private/non-profit partnerships; and (b) conduct collective and coordinated hazard analyses, risk and capabilities assessments, educational workshops, and various model and simulation exercises.
Developing a Common Operating Picture Community health resilience requires improved preparedness, response, and recovery capabilities – all of which depend in large part on the timeliness, validity, and availability of information. Moreover, as the focus by state and local authorities on community health resilience has increased, so has the interest in information operations generated among healthcare, public health, and other government, business, and community organizations. As a result, this community of interest has sought out and invested in the development of cost-effective and robust information-sharing and data-exchange capabilities.
Several states already have invested in the development and application of electronic health information systems to streamline, accelerate, and make more cost-effective the reporting of laboratory information, the record keeping of patient-related data, and the analysis of recent healthcare trends.
The lessons learned from recent health-related events – e.g., the H1N1 pandemic response and several food-borne disease outbreaks – continue to emphasize the need for shared situational awareness. Communities can make informed decisions on health-related issues during an emergency situation only through the development of a common operating picture. These better-informed decisions should help to facilitate and expedite future response and recovery operations.
Using All of the Data & Resources Available Until recently, the development of health resilience frameworks has been carried out on an ad hoc basis, and the frameworks developed had not been implemented or assessed in any holistic or rigorous manner. The potential for the application of such frameworks to the preparedness and response continuum existed, therefore, but had not been rigorously explored. However, the focus of these frameworks has now shifted to the continuity and sustainment of health services during a crisis, and that shift has resulted in a significant health impact – i.e., health resilience.
There is now additional focus on how the resilience of health systems contributes to and ultimately affects the overall resilience of a community. The Office of Health Affairs (OHA) of the U.S. Department of Homeland Security (DHS) and other important stakeholders have sponsored pilot projects and national workshops that allowed implementation and refinement of “the framework approach” as an initial step toward creating a model holistic approach to health resilience that could be used anywhere.
The pilot projects mentioned above ranged in length from one year to several years and were carried out in various states throughout both the northwest and southwest areas of the United States.
Addressing the Critical Findings & Lessons Learned A wide range of critical observations and lessons learned wereentified during the course of the pilot projects and the workshops. Among the most significant lessons learned were the following:
- It is critical to engage and empower the whole community in partnership – private/public sector and non-profits, including social service organizations.
- Community health resilience must include mental as well as physical health, and should address such topics as behavioral needs, children and families, and the nation’s “at-risk” populations.
- There are many useful and innovative health information exchange (HIE) and resilience initiatives and capabilities that can be leveraged – and, therefore, provide a valuable starting point for an information-sharing and situational-awareness framework. HIE and broader resilient and secure information-sharing systems must be part of the framework process.
- State HIE programs and activities are currently fragmented across the nation; they also vary significantly in goals, focus, and technical capabilities, and possess little or no coordination. Standards are needed for information sharing, and helpful guidelines also are needed to determine what community characteristics or functions are critical to support community health resilience.
- Emergency managers and public health officials must ensure that critical messages reach all populations, including special needs populations – more specifically, persons with physical or mental disabilities, suffering from various medical conditions, and/or those with limited language proficiency – who may require assistance in planning for or responding to an emergency.
In the preceding context, it should be emphasized that different constituencies not only need different types of information but also use different communications mechanisms, including trusted information sources. Social media are for that reason rapidly becoming an important element in health resilience information-sharing, but they also pose certain challenges – partly because they vastly increase the number of communicators involved, any of which can dilute or alter the message. Also, many groups (e.g., the elderly, the homeless, and the impoverished populations) may not have access to or be able to operate a computer or smartphone – in addition to which, internet connectivity may be interrupted during a crisis.
Charting a Path Forward The initial results from pilot projects and workshops have been promising. However, efforts must be expanded to further develop, refine, and assess the whole community framework approach and adapt the model created for regional, multi-state, and even national application.
Moreover, stakeholders at all levels of government should work, more diligently as well as more effectively: (a) to address the research areas and lessonsentified during these pilot projects and workshops; and (b) to ensure that the solutions created are implemented into framework development efforts – and then reassessed for efficacy. Finally, a toolkit also should be developed to enable state, local, tribal, and territorial stakeholders to scale and implement their own whole community frameworks.
DHS OHA, working in partnership with federal agencies and other interested stakeholders, is currently exploring how best to initiate and carry out these activities – and then move forward with development and implementation of an improved framework that will better prepare communities across the nation not only to withstand a health-related disaster but also to thrive in its aftermath.
________________________ Jeffrey Stiefel, Ph.D., is a Senior Health Threats Advisor within the Department of Homeland Security’s (DHS) Office of Health Affairs (OHA), Health Threats Resilience Division. Prior to assuming that role, he served as Director of the National Biodefense Architecture (NBA) and Director of the Early Detection Division and Program Executive for BioWatch at OHA. He retired from the U.S. Army in 2004 after 31 years of service. Previously, he served as: Research Scientist, Virology Division, U.S. Army Medical Research Institute of Infectious Diseases; Assistant Professor, Chemistry, U.S. Military Academy at West Point; Installation Commander, U.S. Army Materials Directorate at Watertown, MA; and Director, Chemical, Biological, Radiological, and Nuclear Systems Support, Joint Program Executive Office – Chem Bio Defense (JPEOCBD). He holds: a B.A. in Biology, Hood College; an M.S. in Microbiology, University of Alabama; and a Ph.D. in Biology (Molecular Genetics), Boston College.
Additional contributions for this article were made by: Paula Scalingi, Ph.D., is Executive Director of the Bay Area Center for Regional Disaster Resilience and President of The Scalingi Group. Previously, she served as: Director, Center for Regional Disaster Resilience for the Pacific Northwest Economic Region; Director, U.S. Department of Energy’s Office of Critical Infrastructure Protection; Director, Decision and Information Sciences Division for the Infrastructure Assurance Center at Argonne National Laboratory; Senior Strategic Affairs Advisor and Director of Public Information, U.S. Arms Control and Disarmament Agency; Staff Member, U.S. House of Representatives Permanent Select Committee on Intelligence; and analyst, Central Intelligence Agency. She is also a Board Member of both The Infrastructure Security Partnership (TISP) and the San Francisco Community Agencies Responding to Disasters, and Adjunct Associate Professor at Georgetown University.
William B. Anderson is Director and Chief Operating Officer for The Infrastructure Security Partnership (TISP). Before TISP, he served as Director of Transportation Operations and Program Assessment for the Intelligent Transportation Society of America (ITS America), where directed program development and project management for numerous forums, including the Homeland Security and Public Safety Forum, and managed various tasks in cooperation with the departments of Homeland Security and Transportation. Prior to that, he worked as a Program Analyst, Infrastructure Security and Regulatory Coordination, for the Transportation Security Administration. He currently holds a master’s degree from the University of Maryland and a bachelor’s degree from Roger Williams University in Rhode Island.