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The Local Health Department Mandate and Capacity for Community Engagement in Emergency Preparedness: A National View Over Time

Schoch-Spana, Monica, PhD; Nuzzo, Jennifer, DrPH, SM; Ravi, Sanjana, MPH; Biesiadecki, Laura, MSPH; Mwaungulu, Geoffrey, Jr, JD, MPH

Journal of Public Health Management and Practice: July/August 2018 - Volume 24 - Issue 4 - p 350–359
doi: 10.1097/PHH.0000000000000680
Research Reports: Research Full Report

Context: Local health departments (LHDs) perform the highly valued, yet time- and staff-intensive work of community engagement in public health emergency preparedness (CE-PHEP) when the Great Recession has had lingering effects on their organizational capacity.

Objective: Track the extent to which LHDs still embrace collaborative, whole community approaches to PHEP in a historically low resource environment.

Design: National survey in 2015 of LHDs using a self-administered online questionnaire regarding LHD practices and resources for CE-PHEP first fielded in 2012 (“The Community Engagement for Public Health Emergency Preparedness Survey”). Differences in 2015 survey responses were reviewed, and comparisons made between 2012 and 2015 responses.

Setting: Randomized sample of 811 LHDs drawn from 2565 LHDs that were invited to participate in the 2010 National Profile of LHDs and participated in the 2012 CE-PHEP survey. Sample selection was stratified by geographic location and size of population served.

Participants: Emergency preparedness coordinators reporting on the LHDs they serve.

Main Outcome Measure: Community engagement in public health emergency preparedness intensity as measured by a scoring system that valued specific practices on the basis of the community capacity and public participation they represented.

Results: Survey response was 30%; 243 LHDs participated. The CE-PHEP activities and intensity scores remained unchanged from 2012 to 2015. Local health departments that reported having an explicit CE-PHEP policy and experienced CE-PHEP staff member-–2 of the top 3 predictors of CE-PHEP intensity-–have dropped between 2012 and 2015. The numbers of LHDs with a CE-PHEP budget, also an important predictor of intensity, have not increased in a statistically significant way during that same period.

Conclusions: Local health departments appear to be in a CE-PHEP holding pattern, presumably pushed forward by the doctrinal focus on partner-centered preparedness but held back by capacity issues, in particular, limited staff and partner support. Local health departments operating in low-resource environments are encouraged to formalize their CE-PHEP policy to advance performance in this arena.

Johns Hopkins Center for Health Security, Baltimore, Maryland (Drs Schoch-Spana and Nuzzo and Ms Ravi); and Public Health Preparedness Program, National Association of County & City Health Officials, Washington, District of Columbia (Ms Biesiadecki and Mr Mwaungulu).

Correspondence: Monica Schoch-Spana, PhD, Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 (

This work was funded through a grant from the de Beaumont Foundation. The authors thank foundation staff including Brian Castrucci, Melissa Monbouquette, Theresa Chapple, and Catherine Patterson for their support and feedback on the survey instrument, sampling strategy, and study findings. The authors also thank Tanna Liggins, who helped with survey administration. The findings are those of the authors and do not necessarily represent the views of the funders.

The authors declare no conflicts of interest.

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