Guide to 

Expanding Mitigation

MAKING THE CONNECTION TO PUBLIC HEALTH
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Cover Photo: Couple riding bicycles by river bank 

Photo: Ambulance driving on winding remote road 

Photo: Turn around don t drown sign 

One aim of hazard mitigation is to reduce the vulnerability of health and social 

systems, networks of relationships between individuals and groups, while promoting 

equity. During and following a disaster, public health professionals, first responders, 

and community officials work together to minimize death and injuries, prevent disease 

outbreaks and illnesses, and ensure safe housing and facilities for individuals and 

families. Public health has become increasingly focused on disaster preparedness, to 

prevent potential impacts on health care related facilities and services. 

Community officials use a hazard mitigation plan to identify resiliency goals, risks and 

potential mitigation projects. Though public health issues have not historically been 

addressed through mitigation projects, people in the health field also plan proactively 

to make populations more resilient. By bringing public health and community officials 

together, they can work together toward the common goal of minimizing the impacts 

of disasters. Public health experts can offer important insights in areas such as: 

• Physical and mental health challenges, 

• Environmental hazards and communicable disease, and, 

• Public health data. 

This Guide to Expanding Mitigation explores how community 

officials can work with the public health sector to support 

hazard mitigation, including the planning process. This guide 

can help community officials initiate a conversation about 

mitigation investments that also address public health goals. 

This Guide to Expanding 

Mitigation is part of a series 

highlighting innovative 

and emerging partnerships 

for mitigation. 

Cover Photo: Couple riding bicycles by river bank 
Photo: A floodwall protected the Lourdes Hospital in Binghamton, N.Y., from damage during a historic flood in 2011 

PUBLIC HEALTH IN YOUR COMMUNITY 

Disasters can disrupt health services, pollute the environment, cause food 

shortages, and affect survivors’ emotional health and well-being. For example, 

flooding can damage sewer systems. If untreated sewage enters drinking water 

systems, widespread gastrointestinal illness could occur. Flooding can also cause 

mold which thrives in damp environments. Unless the mold is removed quickly, its 

presence can lead to respiratory illnesses. This is especially true for the elderly 

and people with disabilities. In addition to the more visible damage to property 

and infrastructure, disasters can disrupt vital health services like dialysis and 

breathing machines. 

When mitigation plans are not developed holistically, disasters can have greater 

impacts. Some of those affect local health. For example, urban growth 

that does not consider the ecology can result in: 

• More destructive fires and poor air quality when 

development is allowed in high-risk fire zones 

or does not use fire management principles. 

• Increased flood risk when buildings and 

roads replace green space that filters 

rainwater. Higher and faster runoff can 

add to the damage and danger. 

• Changes in biodiversity that can increase the 

number of and exposure to disease-carrying 

insects when land cover patterns shift. 

Public health workers can identify these and 

many other patterns, yet they are infrequently 

engaged during the mitigation planning process. 

For successful mitigation, we must understand 

local risks, address problems, and invest in 

long-term resilience. By including public health in mitigation planning, community 

officials can find projects that both reduce risk and help the larger community. 

WHAT IS 

PUBLIC HEALTH? 

Public health is a science 

that seeks to protect and 

improve the health of 

people and communities. 

Through policy advice, health 

education, outreach, and 

research, public health 

workers seek to understand 

and address the root causes 

of health issues. 

Photo: Man takes samples of soil and groundwater for environmental research 

Photo: A floodwall protected the Lourdes Hospital in Binghamton, N.Y., from damage during a historic flood in 2011 
Photo: Southern California brush fire near houses Photo: Couple restoring their home after a disaster Photo: Evacuation route sign in Florida 

A PLACE FOR PUBLIC HEALTH AT THE TABLE 

Hazard mitigation is usually led by emergency management agencies. Their 

organization and focus are different from those of public health agencies. But 

local health officials can share community-specific information or introduce experts 

from the broader field of public health. Public health experts can add insights 

to hazard and impact analyses, as well as identifying projects that protect 

health. When discussing structural mitigation projects, 

they can help identify public health co-benefits. 

Collaboration between emergency managers, community 

planners, and public health officials can lead to: 

• Identifying toxic sites within the floodplain or near 

potable and well water sources. 

• Sharing insight into how vulnerability to hazards 

varies across populations, and the ways that 

children, older adults, low-income communities, 

public housing residents and some communities 

may be disproportionately affected. 

• Identifying resiliency or preparedness investments 

that address the unique vulnerabilities across these populations. 

• Identifying health services and mental health providers that are not listed 

as critical facilities. 

• Identifying critical records stored in hazardous areas, that should be relocated 

and digitized. 

• Combining risk awareness and emergency preparedness campaigns with 

existing public health campaigns and engaging with health officials as part 

of their planning process. 

• Launching successful engagement 

strategies and building social 

capital by partnering with community 

organizations. 

• Sharing ideas for turning post-buyout 

or floodwater storage areas into 

recreational areas. These areas 

support physical activity, improve 

mental health, and create space 

for social gatherings. 

• Identifying locations to invest in 

and promote active modes of travel 

that do not rely on fuel. 

• Brainstorming locations for regional 

distribution of medicine during and 

after a disaster. These are known 

as Points of Dispensing, or PODs. 

• Analyzing key issues and challenges 

by reviewing the root causes of 

complex public health challenges and 

considering how mitigation projects 

and investments can be leveraged 

to address them. 

DID YOU KNOW? 

The past 23 years of 

federally funded natural 

hazard mitigation is 

estimated to have 

prevented 4,000 cases 

of Post-Traumatic 

Stress Disorder. 

Consider collaborating with these 

or other health-related groups during 

hazard mitigation planning: 

• Senior care organizations. 

• Faith-based organizations. 

• Community-based organizations. 

• Public housing agencies 

or authorities. 

• Dialysis centers. 

• Community health centers. 

• Hospitals. 

• Health emergency 

preparedness coalitions. 

• Public Health and Emergency 

Preparedness Coordinators. 

• Local departments of health. 

• U.S. Department of Health 

and Human Services. 

• Academic institutions. 

Photo: Southern California brush fire near houses Photo: Couple restoring their home after a disaster Photo: Evacuation route sign in Florida 
Photo: Alcoa East Superfund Site, a former aluminum smelter on the Grasse River near Massena, N.Y. 

OVERCOMING BARRIERS TO COLLABORATION 

The first step to bridging the gap is to reach out to local and state health 

departments. Health departments and staff from the public health sector can 

identify champions who understand risks and have ideas to minimize those 

risks through mitigation actions. Being connected with others in the public 

health sector, these champions can help increase awareness of the importance 

of joining the mitigation planning process. For example, Public Health and 

Emergency Preparedness Coordinators (affiliated with the Centers for Disease 

Control and Prevention, or CDC) and local public health officers often work 

at the intersection of these two fields. 

Ideally, stakeholders will work together to develop a shared approach to mitigation. 

They will agree on common terms, identify a greater variety of funding sources 

for projects, and begin building a base of shared skills. In Monmouth County, 

New Jersey, for example, the emergency management department meets regularly 

to review hospital emergency management plans, has an ongoing commitment 

to communicate health care preparedness information, and collaborates with the 

planning department to include public health and pandemics in the mitigation 

planning process. 

Public health agencies are responsible for preventing disease, protecting people 

from environmental hazards, responding to disasters, and helping communities 

recover. Their work and that of mitigation and hazard experts naturally overlaps. 

More cooperation and collaboration between these two fields can improve 

community resilience. 
 

RESOURCES 

Guides to Expanding Mitigation 

https://www.fema.gov/mitigation-risk-reduction 

Link to all available Guides to Expanding Mitigation. 

FEMA Hazard Mitigation Planning 

https://www.fema.gov/emergency-managers/risk-management/hazardmitigation-planning 

Review standards and guidance for the planning process. 

Emergency Support Function #8: Public Health and Medical Services 

https://www.fema.gov/sites/default/files/2020-07/fema_ESF_8_ 

Public-Health-Medical.pdf 

Learn which health agencies may provide more resources for mitigation efforts. 

U.S. Department of Health and Human Services (HHS), 


Office of the Assistant Secretary for Preparedness and Response
 

https://www.phe.gov 

Learn how HHS supports disaster response and builds public health 

capabilities for preparedness. 

Fourth National Climate Assessment, Human Health 

https://nca2018.globalchange.gov/chapter/14/ 

Learn how climate change affects the health and well-being of the 

American people, and how adaptation reduces risks and improves health. 

Funding Opportunities 

https://toolkit.climate.gov/content/funding-opportunities 

Learn about a range of government and private financing for climate 

adaptation and resilience projects. 

ENGAGE WITH US 

Are you a state, local, tribal or territorial official interested 

in making the connection between public health and hazard 

mitigation? Are you a public health worker interested in 

connecting with local officials to reduce risk from hazards? 

Please contact us at FEMA-ExpandingMitigation@fema.dhs.gov. 

REFERENCES 

CDC. 2018. “Introduction to Public Health.” Public Health 101 Series. 

https://www.cdc.gov/publichealth101/public-health.html 

Chow NA, et al. 2019. “Hurricane-Associated Mold Exposures Among Patients 

at Risk for Invasive Mold Infections After Hurricane Harvey — Houston, Texas, 

2017.” MMWR Morbidity and Mortality Weekly Report 68(21): 469-473. 

https://www.ncbi.nlm.nih.gov/pubmed/31145717 

Greenough, Gregg, et al. 2001. “The Potential Impacts of Climate Variability and 

Change on Health Impacts of Extreme Weather Events in the United States.” 

Environmental Health Perspectives 109(2). https://doi.org/10.1289/ehp.109-1240666 

Lo, Sharon Tsoon Ting, et al. 2017. “Health Emergency and Disaster Risk 

Management (Health-EDRM): Developing the Research Field within the Sendai 

Framework Paradigm.” International Journal of Disaster Risk Science 8(145). 

https://doi.org/10.1007/s13753-017-0122-0 

Lowe, Sarah R, et al. 2019. “Cumulative Disaster Exposure and Mental and 

Physical Health Symptoms Among a Large Sample of Gulf Coast Residents.” 

Journal of Traumatic Stress 32(2). https://doi.org/10.1002/jts.22392 

National Institute of Building Sciences. 2019. “Natural Hazard Mitigation Saves: 2019 

Report.” https://www.nibs.org/reports/natural-hazard-mitigation-saves-2019-report 

Workman A, et al. 2018. “The Political Economy of Health Co-Benefits: Embedding 

Health in the Climate Change Agenda.” International Journal of Environmental 

Research and Public Health. https://www.ncbi.nlm.nih.gov/pubmed/29617317 

ACKNOWLEDGEMENTS 

We thank the following organizations, whose staff contributed their time toward 

advancing our understanding of mitigation and public health: FEMA Region 2; 

Lifespan Rochester; Monmouth County Office of Emergency Management; 

Monmouth County Planning Department; New York City Housing Authority; 

New York Department of Health and Human Services; New York State 

Department of Health; New York University; and Rogosin Institute Woodside.