# Presentation: 505043

## Community Engagement inPublic Health Emergency Planning

- Monica Schoch-Spana
- FEMA Higher Education Conf – June 2007

**Notes:**
THANKS

OPENING ANECDOTES
 In September 2001, the Independence Plaza North Tenants Association helped direct people running away from the collapsing World Trade Center towers (only blocks away); formed “urgent needs” teams to canvass homebound residents; and volunteered at local businesses to maintain resident access to food and medicine when paid employees could not get in. 
 Plaquemines parish = southeastern-most parish in Louisiana. After the emergency services leadership evacuated the area, a Plaquemines employee took charge by phoning around the south parish to locate people stranded by the Hurricane Katrina storm surge and to commandeer boats, keys, and gasoline for a search-and-rescue “Cajun Navy.” 
 During the SARS outbreak of 2003, the Infectious Diseases Society of America issued a virtual plea for members to consider volunteering in Toronto-area hospitals where health-care workers were in short supply due to personal illness or home-quarantine; 1,000 said yes.
WHAT STATUS TO CONFER ON THESE ANECDOTES?
 Human interest stories that populate news reports on extreme events?
 Inspirational acts of heroism sprinkled throughout immense human suffering?
 Recurrent social phenomena that officials should recognize in emergency planning?

## Working Group on Civic Engagement in Health Emergency Planning – Overview

**Problem** – Does volunteerism plus stockpiled basements equal citizen preparedness?
**Process** – What do scholarly research and practical experience today suggest?
**5 Principal Findings**:
- Extreme events compel citizen action & judgment
- Civic infrastructure yields remedies at all stages of disasters
- Communication, consultation, & community engagement (CE) are tools for leaders to mobilize civic infrastructure
- Decision makers gain wisdom & influence thru CE
- Certain ingredients are necessary for genuine CE

**Notes:**
WG Purpose:  Advise government leaders and response professionals on the feasibility and value of more active collaboration with individual citizens and civil society institutions in preparing for, responding to, and recovering from an extreme health event. 

## WG Process

- Interdisciplinary body w/ breadth of knowledge & experience
- Review of relevant literatures
- Social rsch into hazards, disasters, epidemics
- Public participation theory & practice
- Medical/public health emergency management
- Group deliberation of evidence & advice
- May ’06 Summit: *Disease, Disaster, & Democracy*
- July & Nov ’06 meetings; iterative drafts & review

**Notes:**
Working Group = multi-disciplinary approach to help address a pressing public matter
 Members = scholars, policymakers, practitioners (emergency mgmt, public health, infectious diseases, public participation)
 Experience and professional judgment of working group members
 Evidence obtained by the review of relevant literatures, including:
   -- Social and behavioral research into hazards, disasters, epidemics; 
   -- Theory and practice of public participation and deliberative democracy; 
   -- Medical and public health management of extreme events including pandemic influenza
 Group deliberation of basic concepts, scientific evidence, contexts for practical application

Running conversations May ’06 thru Feb ’07 to produce set of consensus recommendations for governors, mayors, health and safety officers, and national decision makers with homeland security and health emergency-related responsibilities 

“Community Engagement: Leadership Tool for Catastrophic Health Events” scheduled for release in the March 2007, 5(1), issue of Biosecurity & Bioterrorism 

## WG Members (e.g.)

- CDC Coordinating Ofc for Terrorism Preparedness & Emergency Response
- Center for Minority Health, Univ of Pittsburgh (PA)
- City Manager’s Office, Berkeley (CA)
- Disaster Interfaith Services (NYC)
- Grand Bayou Families United (LA)
- James Lee Witt Associates (DC)
- Montgomery County Health Dept (MD)
- Natural Hazards Center (CO)
- Seattle & King County Public Health (WA)
- Tulsa Partners, Project Impact, & Citizen Corps (OK)

**Notes:**
WG on Civic Engagement in Health Emergency Planning
 Decision makers at local and national levels of government; 
 Public health practitioners who have responded to high-profile events; 
 Heads of community-based partnerships for public health and disaster mitigation; 
 SMEs in civic engagement, community development, risk communication, public health preparedness, disaster management, health disparities, and infectious diseases

## 1. Disasters & Epidemics Compel Citizen Judgment and Action

**Shock-producing damages **– ruptured expectations about physical survival, social order, meaning of life
**Response system overload** – high-volume &/or widely dispersed demands; functional disabilities
**Improvised solutions** – unforeseen situations demand creative problem solving & break w/ routine
**Disproportionate impacts** – chances for greater victimization are unevenly distributed in society
**History-in-the-making** – political after effects, transformed social expectations, indelible memories

**Notes:**
Principal Finding #1:  Disasters and epidemics – and acts of terrorism – are immense and shocking disturbances that necessitate the moral courage, judicious action, and practical innovations of large numbers of people, not simply those who serve in an official capacity.

Shock-Producing Damages
 Many  human deaths, grotesque injuries, broken buildings, blazing fires, and/or deformed landscapes, along with the abrupt or dramatic interruption of everyday routines, erode people’s basic sense of safety and the proper order of things. 
 Members of technologically advanced societies may also feel betrayed by institutions and individuals charged with controlling risk. 

Improvised Solutions: 
 Successful remedies and recovery for communitywide disasters are neither conceived nor implemented solely by trained emergency personnel, nor confined to pre-authorized procedures. 
 Family members, friends, coworkers, neighbors, and strangers who happen to be in the vicinity often carry out search and rescue activities and provide medical aid before police, fire, and other officials even arrive on the scene. 
 In epidemics, volunteers have helped conduct mass vaccination campaigns, nurse homebound pts, & meet broad social needs of the sick & their families. 

Comprehending an immense tragedy and recovering a sense of security are, at once, highly personal and public affairs. 

## 2. Civic Infrastructure (CI) Yields Remedies thru out Disaster Cycle

**Communications network** w/ trusted channels that reach dispersed, diverse, & wary populations
**Collective wisdom** to help set priorities & inform values-laden decisions
**Local knowledge** to improve reliability & acceptability of disaster plans
**Support for responders** during response & recovery
**Self-organized, innovative solutions** for unforeseen circumstances
**Rooted-ness in place** the personalizes communitywide recovery & amasses resilience

**Notes:**
Principal Finding #2: The civic infrastructure—the public’s collective wisdom and ability to solve problems; voluntary associations that arise from shared interests or a public good, and that meet on-line or face-to-face; and social service organizations that look out for the well-being of various groups—is essential to managing a mass health emergency. 

The CI can perform valuable functions during the entire disaster cycle:

Preparedness 
 Prior to an event, the civic infrastructure can transmit educational and awareness-raising information, energize social trust between authorities and communities at-large, and thus help coordinate the response and recovery roles of government, business, civic groups, and individuals. 
 Allegheny County’s (PA) predominantly white emergency officials met with the local black community for the very first time at a disaster preparedness forum co-hosted by the Urban League of Pittsburgh and The Healthy Black Family Project, a University of Pittsburgh health promotion and disease prevention project with 4,600 enrollees.

## 3. Leaders’ Tools to Tap Civic Infrastructure Are Unevenly Applied 

- Communication
- Typically one-way w/ intent of educating & informing public
- Pamphlets, press releases, public meetings, websites like *ready.gov*
- Consultation
- Solicitation of opinions thru surveys, polls, focus groups, advisory panel
- Citizen input can inform policy decision & implementation, but is one factor among many
- Community Engagement
- Structured dialogue, joint problem solving, & collaborative action among formal authorities, citizens at-large, & local opinion leaders

**Notes:**
Principal Finding #3: Leaders have a range of techniques for mobilizing the civic infrastructure for disaster preparedness, response, and recovery ends. Mass communication approaches are the most familiar, while community engagement methods remain largely unused. 

Communication: 
 An official or agency conveys information to members of the public in one-way fashion, often with the intent of educating and informing the populace. Public feedback is not required or specifically sought out. 
 Disaster/epidemic context: pamphlets, press releases, public meetings, and websites like ready.gov and pandemicflu.gov  -- how to prepare a family communication plan, gather an emergency supply kit, and recognize characteristic features (or health signs) of a specific hazard. 

Consultation: 
 Leaders solicit opinions thru surveys, polls, focus groups, advisory panels. Again, communication is one-way, from citizens to decision makers. 
 The public’s points of view, criticisms, and constructive advice may inform policy options and their implementation, but comprise only one factor among others for a decision maker’s consideration. 
 Polling citizens’ beliefs, attitudes, and behaviors in relation to disaster preparedness, as well as surveying their crisis communication needs, fall into this category. 

## 4. Decision Makers Gain Wisdom & Influence thru Community Partners

- Greater ability to govern & maintain trust during a crisis
- More citizen responders who ease burdens on health & safety agencies
- Fiscal probity thru fewer disaster-related losses & expenditures, more tax revenue
- Feasible emergency plans that reflect collective values & judgments
- Constituents interested in success of public health/safety & emergency mgmt agencies

**Notes:**
Principal Finding #4:  Leaders who embrace, implement, and continuously improve ways for the public to collaborate in health emergency policy making and implementation can anticipate immediate and longer-term rewards, such as:

Greater ability to govern and maintain trust during a crisis
 Decision makers who proactively solicit community partners prior to a crisis may be better equipped to govern effectively during an actual event: first, by commanding greater public confidence in their decisions, and second, by exercising better judgments in the context of uncertainty and evolving circumstances. 
 Political scientific research suggests that Americans care about policy outcomes as well as the policy-making process; they want decision-making to be a balance between elected officials and ordinary people.

More citizen responders to ease burdens on health and safety agencies
 Leaders can tap the civic infrastructure to support agencies during response and recovery by way of pre-event protocols for volunteer integration and partnerships with community-based organizations that can mobilize their own networks. 
 Grassroots organizations may reach certain populations more easily and effectively than official channels or the mass media. This informal communications network can circulate information from citizens to leaders about specific communities’ needs and from leaders to citizens about what government assistance is possible. Such exchanges can help keep expectations realistic on both sides. 

## 5. Certain Ingredients Are Necessary for Genuine CE 

- Commit the administration; identify agency champion(s)
- Assess civic infrastructure; build on prior foundations
- Define top issues with community partners
- Allocate sufficient resources to sustain CE
- Reach out to groups typically absent from policy-making table
- Listen to unresolved trauma & grief from past

## WG Materials Available On-Linewww.upmc-biosecurity.org

- May ’06 - Disease, Disaster, & Democracy: The Public’s Stake in Health Emergency Planning (summit proceedings)
- Mar ’07 - Community Engagement: Leadership Tool for Catastrophic Event (consensus report)
- May ’07 - How to Work with Community Partners to Prepare for Health Emergencies (leadership handbook)

## Acknowledgements

- WG was funded by the U.S. Department of Homeland Security through the National Center for the Study of Terrorism and Responses to Terrorism (START), grant number N00140510629, and The Alfred P. Sloan Foundation, award number 2004-6-13.
- Any opinions, findings, and conclusions or recommendations in this document are those of the WG and do not necessarily reflect views of the U.S. Department of Homeland Security or the Sloan Foundation.

## Thank you.