Conceptualizing and defining public health emergency preparedness

Apr 7 2007

A panel of experts convened by the RAND Corporation has recommended actions that communities around the United States should take to be better prepared to deal with bioterrorist attacks, pandemic flu outbreak and other large-scale public health emergencies.

The recommendations announced by RAND, a nonprofit research organization, consist of 16 actions listed under three broad categories. They call for communities to:

• Have a coordinated rapid-response capability. This should include well-defined roles and responsibilities for officials and the public; a clear command structure; strong public communications; the ability to provide emergency health care to large numbers of people; and the ability to monitor the spread of a public health emergency.
• Develop and maintain adequate numbers of operations-ready public health workers and volunteers.
• Engage in a continuous process of testing, improvement and maintenance of systems for tracking and reporting information on readiness to decision-makers and the public.

"The panel's work provides a clear, new definition of public health emergency preparedness and describes the critical ingredients that constitute a prepared community," said Christopher Nelson, lead author of the report that was produced by RAND Health's Center for Domestic and International Health Security. "This will not only help communities and government agencies figure out where the gaps are, but also where future investments should be made."

The panel defined public health emergency prepardness as: "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."

The proposed RAND definition emphasizes that responsibility for public health preparedness lies not only with governmental agencies but also with active, engaged and mobilized community residents, businesses, and non-governmental organizations.

The definition also states that preparedness should build upon day-to-day public health systems and be regularly tested.

"If you ask public health and government officials, 'What is a public health emergency?' no two people will give you the same answer," said Nicole Lurie, MD, co-director of the RAND Center for Domestic and International Health Security. "Without a clear definition of what a public health emergency is and how to prepare for one, communities and states cannot assess whether or not they are prepared."

"It's not enough to just have a plan for public health emergencies," Nelson said. "Communities need to have tested all the elements to make sure these plans will work in a time of crisis."

"The conceptualization and definition of public health preparedness proposed in this editorial is concise, clear and to the point," said Paul E. Jarris, MD, executive director of the Association of State and Territorial Health Officials. "The authors provide a framework to guide the development of performance metrics and continuous improvement of our nation's public health readiness."

The report from the RAND Health panel, chaired by former Virginia Gov. James Gilmore III, appears online as an editorial in the Public Health Preparedness supplement to the April issue of the American Journal of Public Health. It is titled "Conceptualizing and Defining Public Health Emergency Preparedness." The report was funded by the U.S. Department of Health and Human Services.

Since the terrorist attacks of Sept. 11, 2001, the U.S. government has invested more than $5 billion to increase the country's ability to prepare for and respond to public health emergencies.