# Presentation: 320224

## Building Community Preparedness:Local Public Health’s Role

**Medical Reserve Corps Leadership Conference**
**Baltimore, MD – July 7****th****, 2004**
**Michael Fraser, PhD**
**Deputy Director**
**National Association of County & City Health Officials**
**Washington, DC**

## Thank you!

**Thank ****you!**

***#1***

## Overview

- Snapshot of local public health agencies nationwide
- What’s the public health role in community preparedness?
- NACCHO resources

## The view from 35,000 feet

## Diverse LPHA Nationwide

**Diverse LPHA Nationwide**

## Diverse LPHA Nationwide

**Diverse LPHA Nationwide**

## Over 2,800 LPHAs nationwide

Various LPHA types nationwide including county, city, city-county, regional, township 

Range from large county or metropolitan area LPHAs with complex staffing patterns to small agencies with volunteer health officer

- Over 2,800 LPHAs nationwide
- Various LPHA types nationwide including county, city, city-county, regional, township
- Range from large county or metropolitan area LPHAs with complex staffing patterns to small agencies with volunteer health officer

## LPHA Characteristics

- Majority of LPHAs serve small population jurisdictions in non-metro areas
- Median staff size is 13 FTEs
- Average staff size is about 65 FTEs
- Most common services provided include communicable disease control, environmental health, child health &  home health

*Source: NACCHO 2001*

## LPHA Characteristics

- Most frequent staff categories: administrative, public health nurses, environmental specialists
- Most common partners: other local public health agencies, state public health agencies, hospitals, community-based organizations
- Future challenges: workforce recruitment & retention, stable funding, changing LPHA mission

*Source: NACCHO 2001*

## Where we do our work

- Hospital and traditional medical care

- Primary medical care and prevention

- Classic public health functions and advocacy

- Social determinants of health
- (housing, education, economy)

- Individual

- Community

- Institutions

- National

- Illness

- Health

**Intervention**

**Targets of Intervention **

*Source: Boufford 2002*

## LPHAs & Primary Care

- Not all LPHAs have clinical capacity (i.e., nurses or physicians on staff)
- Focus to date has been on assuring health services, not providing them
- Relationship with hospitals and primary care sector is strained in many areas

## The Public Health System

**Business, Media, Schools, Churches & Community Groups**

**Nongovernmental Health Sector**

**Governmental Public Health Agencies**

*Source: Boufford 2002*

## The Public Health System

**Business, Media, Schools, Churches & Community Groups**

**Nongovernmental Health Sector**

**Governmental Public Health Agencies**

*Source: Boufford 2002*

- Volunteers!

## Surge capacity in many areas

Community expertise

Flexible, adaptable

- Community expertise
- Flexible, adaptable

**Need for Volunteers**

## Slide 15

## Slide 16

## Slide 17

## The Need for Surge Capacity

- For every one person hospitalized there are six to ten individuals experiencing psychological effects
- Main role in an emergency may not be primary care, but rather triaging the “worried well”

*Source: Hutton, 2004*

## Importance of Volunteer Leaders

**Importance of Volunteer Leaders**

**Demand for Preparedness**

**State & Local Funding ($)**

**Volunteers**

**Time**

**Resources**

- Anthrax

- 9/11/01

**Notes:**
CDC sent recommendations on this scenario Friday – 11/1/02. Recommend remove 1-page Word document and insert comments about the call from the State Epi Dept and the cases in other states only on the  Assumptions ppt slide . ...

## No lack of volunteers

- Issue with World Trade Center Incident was TOO MANY volunteers, not lack of volunteers
- Over-burdened the emergency management system

## Psycho-Social Impact

- 90% of New Yorkers reported psychological distress two weeks after 9-11; 62% a year later
- 43% of Oklahoma City residents reported four or more stress symptoms four months after the bombing

*Source: Hutton, 2004*

## The Worried “Well”?

- Iraqi Scud Missile attacks on Israel (1991)
-  40% of civilians in immediate vicinity of the first attack had physical symptoms (difficulty breathing, sweating, tremors)
- About 75% of those reporting to an emergency department had no physical injury
- Tokyo Subway Sarin Gas Attack (1995)
- 4,000 of 5,510 (75%) seeking treatment had no or minimal injuries
- Goiania, Brazil (1987) Radiation Event
-  244 exposed to radiation (20 severe cases)
-  10% of the population (100,000) sought medical advice

*Source: Hutton, 2004*

## ?

**?**

## Slide 24

## Slide 25

## Slide 26

## Slide 27

## Preparedness is a Local Activity

- “Where the rubber hits the road...”
- “Where the needles hits the arm...”

**Notes:**

(NIMS draft, page 9)

## Other Agency Involvement

**Other Agency Involvement**

**Local**
- Neighboring LPHAs
- Environmental agencies
- Local emergency management agencies
- Fire, police, EMS
- Local 911
- Hospitals, health plans
- Managed care organizations
- Individual physicians
- Local laboratories
- School officials
- Elected officials
- Local media
- Area businesses

**State**
- State health agency
- State EMA
- American Red Cross
- Other groups
**Federal**
- DHHS/CDC
- FDA
- DOJ
- FEMA/Homeland Security
- Dept of Agriculture
- EPA
- DOD

**Notes:**
CDC sent recommendations on this scenario Friday – 11/1/02. Recommend remove 1-page Word document and insert comments about the call from the State Epi Dept and the cases in other states only on the  Assumptions ppt slide . ...

## Response is a Local Activity

- 	“The vast majority of domestic incidents are handled at the local level, with local entities... participating as appropriate to the incident.”
- National Incident Management System, *Initial System, Draft June 25**th**, 2003*

**Notes:**

(NIMS draft, page 9)

## Response is a Local Activity

**Notes:**

(NIMS draft, page 9)

## Local Public Health Preparedness 

- Local public health agency is the “on the ground” presence; not state or Federal agencies
- NACCHO working to build LPHA capacity and infrastructure nationwide
- Work with LPHAs contributes to national efforts in many ways

## Preparedness Tensions

- Facing “the usual” while preparing for the unusual
- Growing preparedness programs while simultaneously cutting other programs
- Being held accountable for a system to which partners are not accountable
- Spotlight on public health versus the invisibility of public health success

## The Columbus Factor

**The Columbus Factor**

- Didn’t know exactly where he was going
- Didn’t know where he was when he got there
- Did it with someone else’s money!

**Notes:**
CDC sent recommendations on this scenario Friday – 11/1/02. Recommend remove 1-page Word document and insert comments about the call from the State Epi Dept and the cases in other states only on the  Assumptions ppt slide . ...

## Broad Strategies

- Develop systems that have multiple uses
- Enhance competencies, promote workforce development
- Forward programs that make public health visible, “teachable moments”
- Develop programs that foster partnerships across disciplinary lines

## Broad Strategies

- BtCREATE
- BtPREP
- BtTOOLBOX
- Stockpile Guidance
- Advanced Practice Centers
- Incident Command System
- Research, Policy & Advocacy

- www.naccho.org