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Preparedness for Public Health

A Long Story, Short

Potter, Margaret A., JD, MS

Journal of Public Health Management and Practice: January/February 2019 - Volume 25 - Issue 1 - p 19–21
doi: 10.1097/PHH.0000000000000919
25 Years of Publication: Twelve Major Themes: Commentary

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

Correspondence: Margaret A. Potter, JD, MS, Public Health Management and Practice, University of Pittsburgh Graduate School of Public Health, 130 De Soto St, Pittsburgh, PA 15261 (

The author declares no conflicts of interest.

The 21st century started off with a series of unprecedented events for the public's health. Terrorist attacks, pandemics, both threatened and inflicted, and extreme natural disasters—one after another—startled the American public and, no less, their public health leaders. Threats and vulnerabilities had to be recognized and mitigated. Plans had to be created and tested. Response experience had to be documented and evaluated. Assets for resilience and recovery had to be assessed and built into communities wherever possible. Above all, metrics to measure and evaluate preparedness had to be developed and validated. Over nearly 2 decades, the Journal of Public Health Management & Practice documented relevant efforts among public health practitioners, researchers, and educators. The Journal's articles published since 2001 tell the story.

It begins with status evaluations and priority setting. In the early 2000s, the Journal reported on collaborations among state, local, and regional health agencies as they strove to improve preparedness for emergencies and bioterrorism.1–3 When federal preparedness funding in 2003 required a detailed program of capability targets for state and local public health systems, the Journal gave its readers a validated inventory tool to track progress.4 The need for research and training drew much attention from the Journal's contributors. Some reported on preparedness competencies to guide education and training,5 , 6 and another urged nationwide, interagency coordination of training and evaluation efforts.7 A critical review of research conducted from 2000 to 2008 found a predominance of nonempirical studies and argued for greater diversity of methods to yield useful guidance for policy makers and practitioners.8

The preparedness story continues with details about the use of public investments for capacity building, training, and research. Late in the post-9/11 decade, federal agencies launched research and training programs focused on the nation's emergency and disaster capabilities. Among the most important for public health were 3 such programs. The Centers for Disease Control and Prevention funded Preparedness and Emergency Response Research Centers (PERRCs) as well as Preparedness and Emergency Response Learning Centers (PERLCs). These centers were to fulfill needs identified by a 2008 letter report from the Institute of Medicine: developing training resources, improving communications, building and maintaining response systems, and providing metrics for effectiveness and efficiency—all with overarching emphases on protecting vulnerable populations and preparing the public health workforce.9 The National Institutes of Health funded the Models of Infectious Disease Agent Study (MIDAS) to understand and prepare for contagious disease outbreaks, simulate disease spread, evaluate alternatives for intervention, and support decision making by public health officials and policy makers.10

From the products of these major grant programs, the Journal published numerous articles and 2 supplemental issues. Articles in a 2013 supplemental issue featured contributors from the PERRC and MIDAS programs11 who focused on the challenges unique to preparedness research—such as the unique characteristics of each individual disaster12 and the difficulty of data gathering during an emergency response.13 Supplement articles described the data and metrics necessary for this research14 , 15 and featured innovative methods for modeling, simulation, and evaluation.16 One article reported on the use of geospatial analytics for a county's mass prophylaxis distribution plan.17 Another explored the computationally efficient use of agent-based modeling to assist local decision making during a pandemic.18 Yet, another showed the dynamic implications of multiple policies and interventions after an improvised nuclear detonation.19

The topics of community resilience and population vulnerability rose to the fore largely as a result of research on natural disasters including Hurricane Katrina in the Gulf region and Superstorm Sandy in the northeast. Articles in the Journal documented efforts toward community engagement by local health departments20; identified metrics for partnership, self-sufficiency, and social connectedness21; and reported on a model disaster recovery service program for a vulnerable population.22

Numerous articles, including those in a 2014 supplemental issue, reported on how the PERLCs provided innovations in training content, methods, and outcome evaluations.23 Articles on areas of specialization included psychological first aid24 and cultural and linguistic competencies.25 , 26 Methods articles described gaming simulation,27 large-scale exercises,28 and a training program based on digital storytelling.29 Articles on evaluation presented, among other studies, a standardized method for evaluating training resources30 and a validation of methods for hazard vulnerability and jurisdictional risk assessments to improve planning.31

To what ends did this extended period of data gathering, innovation, and rigorous evaluation eventually bring us? The preparedness story leads to “so-what” questions: What was achieved? What did we learn? Did the investments pay off? These are pressing questions at a time when the urgency of all-hazards preparedness among policy makers seems to have waned. And they are difficult questions to answer well. But there is at least one achievement clearly evident: the National Health Security Preparedness Index.32 Its purpose is “to provide an accurate portrayal of our nation's health security using relevant, actionable information.” With metrics from more than 50 sources that have been tested and validated, the 2018 Index documented a preparedness improvement of 11% over the preceding 5 years.33 It is fair to say that the index was built on investments in preparedness research and training since 2001. Thanks to the Journal for telling this story.

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