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Public Health System Response to Extreme Weather Events

Hunter, Mark D. MPH; Hunter, Jennifer C. MPH, DrPH; Yang, Jane E. MPH; Crawley, Adam W. MPH; Aragón, Tomás J. MD, DrPH

Journal of Public Health Management and Practice: January/February 2016 - Volume 22 - Issue 1 - p E1–E10
doi: 10.1097/PHH.0000000000000204
Original Articles

Context: Extreme weather events, unpredictable and often far-reaching, constitute a persistent challenge for public health preparedness.

Objective: The goal of this research is to inform public health systems improvement through examination of extreme weather events, comparing across cases to identify recurring patterns in event and response characteristics.

Design: Structured telephone-based interviews were conducted with representatives from health departments to assess characteristics of recent extreme weather events and agencies' responses. Response activities were assessed using the Centers for Disease Control and Prevention Public Health Emergency Preparedness Capabilities framework. Challenges that are typical of this response environment are reported.

Setting: Forty-five local health departments in 20 US states.

Results: Respondents described public health system responses to 45 events involving tornadoes, flooding, wildfires, winter weather, hurricanes, and other storms. Events of similar scale were infrequent for a majority (62%) of the communities involved; disruption to critical infrastructure was universal. Public Health Emergency Preparedness Capabilities considered most essential involved environmental health investigations, mass care and sheltering, surveillance and epidemiology, information sharing, and public information and warning. Unanticipated response activities or operational constraints were common.

Conclusions: We characterize extreme weather events as a “quadruple threat” because (1) direct threats to population health are accompanied by damage to public health protective and community infrastructure, (2) event characteristics often impose novel and pervasive burdens on communities, (3) responses rely on critical infrastructures whose failure both creates new burdens and diminishes response capacity, and (4) their infrequency and scale further compromise response capacity. Given the challenges associated with extreme weather events, we suggest opportunities for organizational learning and preparedness improvements.

This study aims at presenting a detailed, largely quantitative, account of local health department responses to weather events.

Center for Infectious Diseases & Emergency Readiness/Cal PREPARE, School of Public Health, University of California, Berkeley (Drs Jennifer Hunter and Aragón, Ms Yang, and Messrs Mark Hunter and Crawley); Health Services and Policy Analysis, University of California, Berkeley (Mr Mark Hunter); and City & County of San Francisco, and Department of Public Health, Population Health Division, San Francisco, California (Dr Aragón).

Correspondence: Mark D. Hunter, MPH, Center for Infectious Diseases & Emergency Readiness, 1918 University Ave, Fourth Floor, Berkeley, CA 94720 (

This study was supported by a Preparedness and Emergency Response Research Center (PERRC) grant from the Centers for Disease Control and Prevention, under FOA RFA-TP-08-001, to the University of California, Berkeley (grant number 5P01TP000295). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The Cal PREPARE Sm(all)-Hazards Preparedness team thanks the following research partners: our local health department research participants, the Cal PREPARE Advisory Committee, the National Association of County & City Health Officials, and Cal PREPARE Staff, especially: Karen Shiu, Julia Dysart, Michael Dysart, Carissa Gutierrez, and Jeannie Balido.

The authors declare no conflicts of interest.

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