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Dynamics of Preparedness: Systems and Impacts

Potter, Margaret A. JD, MS

Journal of Public Health Management and Practice: September/October 2013 - Volume 19 - Issue - p S1–S2
doi: 10.1097/PHH.0b013e31829edb0e

Center for Public Health Practice, Department of Health Policy and Management, and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

Correspondence: Margaret A. Potter, JD, MS, Center for Public Health Practice, Graduate School of Public Health, University of Pittsburgh, A728 Crabtree Hall, 130 DeSoto St, Pittsburgh, PA 15261 (

The author declares no conflicts of interest.

This issue of the Journal of Public Health Management and Practice presents articles from a conference on emergency preparedness research held October 22-24, 2012, in Pittsburgh. The participants heard about innovative methods and novel approaches to measure and evaluate public health systems in emergencies. They critiqued the rigor and quality of research output and flagged issues for which a better base in evidence was needed. They considered whether and how research in preparedness would be sustainable in the future.

“Dynamics” is an evocative word with several meanings. The Greek root is dynamikos meaning power or strength. As a field of mechanical physics, dynamics explores how force acts on bodies or systems in motion or at equilibrium. In music, dynamics denotes relative changes in volume, with loudness conveying perhaps urgency, power, or energy and softness suggesting peacefulness, passivity, or introspection. In common parlance, a system called dynamic is meant to contrast interactive change versus static or linear behavior of components.

All these nuances of meaning are apt for the preparedness research presented in this journal issue. The field itself was forced into prominence in the decade after 2001 by domestic terror attacks, floods, hurricanes, tornadoes, and pandemics (both threatened and actual). The resulting investments in preparedness have provoked thinking about how research contributes to decision making (Burke and Grefenstette) and how policy, practice, and evaluation are mutually supportive (Stoto; Potter et al). In preparedness policy making, cause and effect are nonlinear: a decision to extend Medicaid benefits to an out-of-state evacuee population gives rise to other problems (Quast et al). Analyzing such decisions either prospectively or after action requires a broad, sociopolitical perspective.

The problems addressed in preparedness research call for novel interactions. In this issue, there are works showing interdisciplinary collaborations by infectious disease specialists and industrial engineers (Luangkesorn et al; Lee et al), by infectious disease specialists and geospatial modelers (Everette et al); by social scientists and computationalists (Behr et al; Lewis et al); and by political scientists and statisticians (Comfort et al). Other articles in this issue study the numerous interacting agents of preparedness systems with, as in measures of community resilience (Uscher-Pines et al), risk assessment (Dean et al) and performance evaluation (Klaiman et al). The larger preparedness system has smaller internal systems, as explored in the article on metrics of adaptivity for local health departments (Potter, Schuh et al) and another on emergency training for hospitals (Agboola et al). An approach to learning from past critical incidents is drawn from established practice of transportation agencies (Piltch-Loeb et al).

How well the voice of preparedness research resonates with policy makers and practitioners might depend less on its loudness and more on its calibration. If the topics of research inquiry are relevant, chances are that research outputs will be heard. The commentaries in this issue (Smith et al; Berg et al; Hupert) provide expert advice on topics and their audiences as a guide to future studies.

The Pittsburgh conference of October 2012 succeeded in reaching its stated goals. Goal 1 was to compile research on public health systems supporting preparedness, specifically highlighting innovative methods and novel approaches. The content of this special issue of the Journal of Public Health Management and Practice attests to success with this goal. The challenge ahead is to sustain and build capacity to pursue interdisciplinary work. Goal 2 was to critique the rigor and quality of output from this research arena, noting the findings and insights with implications for public policy and practical application. The conference presentations were selected by peer-review and those published in this issue underwent further review and revision. Those processes justify a conclusion that articles here fully and fairly represent the best of what preparedness research in public health has to say at this time. Goal 3 was to catalog the issues and assess the evidence base for preparedness policy and practice. Conference participants—including policy makers, practitioners, and researchers—spent time considering policy and practice applications, and the commentaries in this issue well represent their thinking.

Taking an editor's license to opine, I believe that preparedness research has come a long way in 10 years but surely needs more time and resources to mature. The dynamics of interdisciplinary research collaborations are challenging: having now invested in forming them, it's time to invest in sustaining them. The dynamics of voice among of practitioners, policy makers, and researchers need ongoing attention because risks, political priorities, and the evidence base for decision making will always be in flux.

Finally, I want to acknowledge and thank the University of Pittsburgh's MIDAS Center of Excellence for its support of both the Dynamics of Preparedness Conference and this special issue of the Journal of Public Health Management and Practice.

© 2013 Lippincott Williams & Wilkins, Inc.