Building Resilient Public Health Infrastructure

April 10th, 2015 by Christine Gentry

CHHS Extern Lisa Bowen also contributed to this blog


   noun re·sil·ience \ri-ˈzil-yən(t)s\
: the ability to become strong, healthy, or successful again after something bad happens
: the ability of something to return to its original shape after it has been pulled, stretched, pressed, bent, etc.

Several recent public health crises – Ebola, Measles, and the 2014-2015 Flu Season to name a few – make apparent the need for public health partners to develop and maintain resilient public health infrastructures.   These well-publicized incidents and others like them occur against the backdrop of the essential services provided by public health partners every day.   Local health departments (LHDs) provide a variety of services that contribute to creating and maintaining healthy communities, such as immunizations, food safety, and maternal/child services.

All of these public health functions require an infrastructure of resources and relationships, which is put under strain by both the recent trend of substantial budget cuts for public health programs and by providing for continued operations during emergency response activations.   In the face of this strain, resilient infrastructure bolsters the capacity of public health partners to withstand disruption, absorb disturbance, act effectively in a crisis, adapt to changing conditions, and grow stronger over time.

Building community resilience has been one of the major focuses of the U.S. Department of Health and Human Services’ (DHHS) National Health Security Strategy.  DHHS and other policy makers believe that resilience is a fundamental capability for disaster preparedness, response, and recovery.

According to DHHS’s National Health Security Strategy, the core components of community resilience are:

  1. Social connectedness for resource exchange, cohesion, response, and recovery;
  2. Effective risk communication for all populations, including at-risk individuals;
  3. Integration and involvement of government and non-governmental entities in planning, response, and recovery;
  4. Physical and psychological health of the population; and
  5. Social and economic well-being of the community.

When applying these core components to public health infrastructure, two categories emerge: resources and relationships.  Using the Incident Command System (ICS) definition of resources, this category refers to both the materials and the people needed to maintain public health functions.

In order to create a resilient community, materials and people need to be ready for deployment the moment an emergency happens. While it is not feasible to build a cache of supplies for every conceivable event, having response plans for a variety of events,  communication systems, and the laboratory capacity to rapidly test and confirm infectious agents can greatly improve the ability for health departments to efficiently respond and manage public health emergencies. Having a tiered list of cross-trained individuals and alternate people who could lead public health operational response efforts is also vital to maintaining public health functions and building a resilient community.

However, resilient public health infrastructure goes beyond the materials and people directly involved in the emergency response.  The core of resilient infrastructure is a strong healthcare system. A healthcare system that is capable of scaling up everyday operations during emergencies decreases the vulnerability of the impacted population.

An important part of community resilience is human resilience and social capital. Even during strictly public health emergencies, public health responders will receive assistance from police, fire/ems, emergency management, etc. Emergency responders must work together to build strong relationships among their different agencies and with the community.

FEMA recognizes a “whole community” approach to emergency management. Community engagement helps local governments understand the unique and diverse needs of their communities and builds social capital through community empowerment.

By investing in the relationships among individuals and organizations and having a public-private partnership that can address emergencies as a unified front, communities can build social capital through improved trust between government and citizens and can better overcome damage to infrastructure and lack of aid during emergencies.

Local governments can build resilient communities through efforts to build strong relationships and ensure resources are in place. By working together before an emergency occurs, public health infrastructure can withstand disruption and better respond when disaster strikes.






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