Jan 8 2013
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Impact of Hurricane Sandy: NewPublicHealth Q&A with Irwin Redlener

Irwin Redlener Irwin Redlener, New York State Ready Commission and Columbia University National Center for Disaster Preparedness

Just several weeks after Hurricane Sandy hit the New York City area, New York State Governor Andrew Cuomo appointed Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health, to co-chair the New York State Ready Commission. The role of the Commission is to determine ways to ensure that critical systems and services are in place to respond to future natural disasters and other emergencies.

The specific areas for which the commission was asked to make recommendations include:

  • Addressing vulnerabilities in the state’s health care, energy, transportation, communications and other systems
  • Ensuring that new, modified and existing construction is resilient
  • Ensuring the availability of adequate equipment, fuel, food, water and other emergency supplies
  • Ensuring that first responders and other critical personnel are able to communicate efficiently and have access to adequate resources
  • Ensuring the availability of reliable real-time information for decision-makers
  • Ensuring that lines of authority are clear and officials have the authority to react rapidly to emergency situations

Both the Ready Commission and the 2100 Commission, which was tasked with finding ways to improve the resilience and strength of the state’s infrastructure in the face of natural disasters and other emergencies, submitted their reports to the governor earlier this week. Recommendations of the Ready Commission included:

  • Create a statewide network of unified emergency training, coordination, protocols and communication
  • Update the New York State Building Code
  • Expand use of Vulnerable Populations Databases so first responders; outreach workers; and health care and human services personnel can find and serve those who may need assistance
  • Require that gas stations in strategic locations have access to onsite back-up power capacity

NewPublicHealth spoke with Dr. Redlener about the Commission and the storm’s impact on New York residents.

>>Read about the 2012 edition of its Ready or Not? report from Trust for America’s Health, which looks at strengths and vulnerabilities in each state’s emergency preparedness status.

NewPublicHealth: You were appointed to co-chair the Ready Commission by Governor Cuomo in November. What is the specific focus of the Commission?

Redlener: What we are going to do is assess the current resilience of the city in terms of its preparedness efforts. Are we ready? Are we prepared? What are the missing elements right now in trying to make us more prepared for the next events than we were for this one? Some of this is not all that complicated and unfortunately these are problems that we have seen in prior disasters. Some of the things that we are seeing here were basically exactly what we saw in the Gulf and in New Orleans after Katrina. It isn’t like we haven’t been thinking about these things. I think that is why we were able to provide some reasonable recommendations, because these are not altogether new problems or challenges.

NPH: How strong is disaster preparedness training at schools of public health and within governmental public health?

Redlener: Well I think we have a lot of work to do. The federal government has been funding disaster training programs for public health professionals and that funding has been cut to the bone or eliminated. The schools of public health are very interested in the topics generally speaking, but again there is not much support financially from the federal government to continue and enhance the programs that need to be supported in order to make graduating public health students able to take on jobs that have to do with disaster readiness and response. And there’s an even bigger context for the problem: Between 2008 and now there have been more than 50,000 jobs lost in the public health arena nationally, because of cutbacks and the reduced flow of dollars from the federal government to support local and state health departments. And in the areas of public health emergency preparedness and hospital preparedness programs around the country—these have been drastically cut by between 25 and 35 percent since 2005.

This recent history of drastic program cuts has resulted in real fragility in the system of planning and response. We just don’t have the money available anymore to deal with the necessary levels of testing and emergency response. And the planning ability of health departments has been really undermined by these funding cuts. These funding cuts have been pretty much under the radar because nobody quite has this in mind in-between the disasters. We are thinking about this today in the immediate aftermath of Sandy. We have a lot of challenges and it has been quite difficult time.

NPH: How should we use Hurricane Sandy to improve the response of public health before, during and after a disaster?

Redlener: We don’t learn very well from experience, in large part because too often we are reactive rather than proactive. That said, it is true that we are improving in terms of emergency response skills—individuals and local response teams are generally innovative and effective with plenty of examples of heroic acts of rescue by courageous men and women. But our ability to learn from previous situations, to develop forward-thinking policies and more effective planning based on data analysis and careful scientific studies remains extremely limited. That is really to our own detriment because we end up repeating the same mistakes over and over again with subsequent disasters.

>>Read more on this topic in a book Redlener wrote post-Katrina, Americans at Risk: Why We Are Not Prepared for Megadisasters and What We Can Do Now.

Whether it is the tsunami in Indonesia or Katrina or the earthquake in Haiti or the Gulf oil spill, we see a lot of drama and public attention through the media, which is entirely understandable. And inevitably each catastrophe is called a “wake-up call,” the implication being that—finally—we’ll learn our lesson and change the way we plan and respond to major disasters. But the resources invariably are not identified and nothing much changes. We simply slip back into a state of complacency. So these wake-up calls ultimately end up more resembling a “snooze alarm.” Being the eternal optimist, I am very much hoping that this time we will actually take the lessons of Sandy to heart.

NPH: What are the big issues to focus on right now?

Redlener: The affected states have knocked on doors in Washington, D.C., seeking money to rebuild, but we also need them knocking on doors demanding that we restore some of the basic public health infrastructure and, perhaps more importantly, demand that we invest in fixing some of the underlying problems that make us so vulnerable. The two big challenges right now are the continuing consequences of rapidly evolving climate change and the fragility of U.S. infrastructure. Both of those challenges must be addresses and solved. And we may have to invest in the mitigation strategies such as sea walls and upgrading the electrical grid infrastructure. We have a lot of work to do and hopefully we’ll have the good sense to stick with it this time.

NPH: It has been a little more than two months since the hurricane and there have been quite a few summits. There was one at the New York Academy of Medicine and one at the Institute of Medicine in Washington, D.C., as well as others. How do you get from a summit to the attention of the policymakers? How do we move from summit to action?

Redlener: Academic summits are actually important. For too long we have permitted a dysfunctional disconnect between science and policy. We need to focus on translating science and research into public policy and public priorities.

NPH: In any disaster—war, hurricane, a building collapse—there are going to be people left behind. How do we better help those who are most vulnerable?

Redlener: In my opinion it is immoral to even consider the fact that we might have acceptable loss in a disaster that might have been prevented if we had planned properly or had invested sufficient resources. In a disaster we need a “no room for error” policy just as we say to a surgeon or a pilot. Having just an occasional airplane crash is not okay. And I think that is the case with disasters. We are talking about human needs that we are experienced with and should be able to do better.

The most important point is that I believe the measure of our effectiveness is how well we have taken care of the most vulnerable: how we have cared for them, protected them and provided for them and organized recovery around their needs. I am talking about people who are frail or elderly; children in low-income families; and people with medical conditions or disabilities. The point is if we can’t plan to keep those folks safe before, during and after a major disaster, then we are really failing in our overall mission.

>>Bonus Link: View presentations by the New York State Ready Commission and 2100 Commission that show some of the key recommendations presented to New York State Governor Andrew Cuomo.

Tags: Emergency preparedness and response, Hurricane Sandy, New York (NY) MA, Preparedness, Public Health , Public health, Public health schools