Barbara Ferrer, Ph.D., MPH, M.Ed Executive Director Boston Public Health Commission

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1 Barbara Ferrer, Ph.D., MPH, M.Ed Executive Director Boston Public Health Commission

2 Public health emergency preparedness is the capability of the public health and health care systems, communities, and individuals, to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities. Preparedness involves a coordinated and continuous process of planning and implementation that relies on measuring performance and taking corrective action. Conceptualizing and Defining Public Health Emergency Preparedness Christopher Nelson, PhD, Nicole Lurie, MD, MSPH, Jeffrey Wasserman, PhD, and Sarah Zakowski, BA, AJPH, 2007

3 What does a LHD need to do to support public health preparedness? Coordinate with local, state, federal, and international partners (public & private); develop integrated set of priorities Train public/private workforce Develop infrastructure and agreements that allow for efficient collection, analysis, and sharing of data (across public and private sector) Build effective communication strategies Establish metrics for assessing impact and performance Secure sustained funding

4 Coordination of Efforts -- Challenges Federal Lack of coordination among federal agencies results in competing priorities for funding and systems development at the local level ex: emergency management activities (DHS/FEMA) vs. public health preparedness activities (HHS/CDC) Boston Local issues often not well represented in state/federal planning documents ex: Distribution of flu vaccine during H1N1 epidemic

5 Developing cross-disciplinary PH teams (expertise in emergency preparedness, epidemiology, informatics, behavioral health, communications, environmental health, biology, law, and medicine) Adapting existing academic programs to address emerging training needs and support workforce development Securing infrastructure dollars/resources at the local level to support personnel costs of maintaining a highly trained team and training other public and private sector employees and residents (ex: DelValle Institute)

6 Securing infrastructure support from federal and state to develop health IT capacity of local health departments (including integrating siloed systems and adopting technologies that facilitate real time data collection and reporting) Adopting agreements that address issues related to ownership of information and responsibilities for follow-up (public health practice needs) Standardizing data collection and reporting across jurisdictions Developing systems that work to manage routine tasks as well as emergency situations associated with public health preparedness (Dual Purpose)

7 Securing clarity on restrictions on release of information and standard for data sharing Developing infrastructure that permits two-way communication, particularly when receiving and/or sharing information with residents Presenting data in a manner that is understandable and actionable Ensuring cultural and language competency Enhancing the incorporation of social media in communication strategies Educating trusted community partners on public health preparedness so they can communicate with members of the community not reached by traditional communication methods

8 Complying with the various metrics used by different federal funders Incorporating local priorities/unique situations in standardized evaluation metrics Strengthening alignment of public health and healthcare capabilities (PHEP and HPP) Including metrics that not only assess data management, early detection, situational awareness and effective communication, but also include response outcomes

9 Evaluation Metrics Challenges Example Public Health Preparedness Capabilities Community Preparedness Community Recovery Emergency Operations Coordination Emergency Public Information and Warning Fatality Management Information Sharing Mass Care Medical Countermeasure Dispensing Medical Materiel Management and Distribution Medical Surge Non-pharmaceutical Interventions Public Health Laboratory Testing Public Health Surveillance and Epidemiological Investigation Responder Safety and Health Volunteer Management Healthcare Preparedness Capabilities Healthcare System Preparedness Healthcare System Recovery Emergency Operations Coordination NONE Fatality Management Information Sharing NONE NONE NONE Medical Surge NONE NONE NONE Responder Safety and Health Volunteer Management

10 Federal funding has decreased while infrastructure and response needs have increased States differ dramatically in how they distribute federal grants to local jurisdictions Health emergencies occur regularly at the local level, depleting resources, and requiring constant replenishing of funding (investments are not all one-time costs)

11 Sustained Funding Challenges Example

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13 Opportunities Patient Protection & Affordable Care Act Emphasis on prevention offers an opportunity to align medical care and public health; this may make it easier to share data and resources Focus on workforce training and retention State allocations for surveillance and health IT can be leveraged to support local needs and integration across jurisdictions National Level Grant Realignment Efforts ASPR/Hospital Preparedness Program + CDC/Public Health Emergency Preparedness + DHS/Grants and Cooperative Agreements (SHSP, CCP, MMRS, UASI) Emphasis on strengthening community resilience All-of-nation /whole community approach Capabilities-based approach Identification of state and local preparedness gaps Requirement for risk assessment Demonstration of ROI through performance measures

14 Incorporate: Stabilized federal funding to support increased infrastructure and response needs Application of risk-based allocation approach to all grants to ensure states allocate adequate funding to jurisdictions with the highest risk Opportunities