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Roadmaps Out of Fantasyland: RWJF’s Outbreaks Report and the National Health Preparedness Security Index

Jan 30, 2015, 5:47 PM, Posted by Susan Dentzer

Outbreaks 2014

“When you hear hoofbeats, think of horses, not zebras,” the late Theodore Woodward, a professor at the University of Maryland School of Medicine, cautioned his students in the 1940s. Woodward’s warning is still invoked to discourage doctors from making rare medical diagnoses for sick patients, when more common ones are usually the cause.

And while many Americans have worried about contracting Ebola—in viral terms, a kind of “zebra”—more commonplace microbial “horses,” such as influenza and measles viruses, continue to pose far greater threats. For instance, a large multistate measles outbreak has been traced to Disneyland theme parks in California—while this year’s strain of seasonal flu has turned out to be severe and widespread.

One obvious conclusion is that many microbes remain a harmful health menace, expected to kill hundreds of thousands of Americans this year. Another—speaking of Disneyland—is that much of America appears to live in a kind of fantasyland, thinking that it is protected against infectious disease.

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The Best Defense is a Strong Offense: Strengthening Our Nation’s Outbreak Preparedness

Dec 22, 2014, 5:08 PM, Posted by Paul Kuehnert

Outbreaks 2014

In the shadow of this year’s Ebola outbreak, the Trust for America’s Health and the Robert Wood Johnson Foundation released a new report, Outbreaks: Protecting Americans from Infectious Diseases.

The report finds that while significant advances have been made in preparing for, responding to, and recovering from emergencies, gaps in preparedness remain and have been exacerbated as resources have been cut over time.

On the eve of the report’s release, I spoke with Jeffrey Levi, PhD, executive director of the Trust for America’s Health to get his thoughts on today’s preparedness landscape—think, Ebola—what to do about shrinking budgets and growing infectious disease threats, and where to go from here.

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Building Back Better: New Jersey as a Case Study for Improving Preparedness

Nov 11, 2014, 1:12 PM

In recent years, the state of New Jersey has found itself at the center of high-profile emergencies and public health scares—from the disaster wrought by Superstorm Sandy in 2012 to a controversial plan in recent weeks to quarantine individuals identified as at risk for contracting Ebola. As the 11th-most populous state—and a major hub of international travel and commerce—New Jersey’s public health leadership serves as a case study for the nation.

NewPublicHealth recently spoke with New Jersey Health Commissioner Mary O’Dowd. She has been sharing New Jersey’s preparedness and recovery lessons nationally as a member of the preparedness policy committee of the Association of State and Territorial Health Officials and implementing them as the state addresses potential exposure to Ebola in returning volunteers.

NewPublicHealth: Looking back, what worked well in the health department’s response before, during and after Sandy?

Mary O’Dowd: I think one of the things that really worked well in that immediate response phase was that we employed our lessons learned from Hurricane Irene the year before, in 2011. For example, we used the Emergency Management Assistance Compact, which is an agreement among states to assist each other in times of crisis or emergency, and we specifically used it to bring additional ambulances into New Jersey for our EMS system to enhance our capability, but we didn’t make the request until after the storm. So for the first day or two, we didn’t have the resources on hand.

We learned from that shortfall. The next year, before Sandy made its way to New Jersey, we had already put out the request via the EMAC system and had ambulances from Indiana on the ground before the storm hit. And that was really critical in our ability to immediately respond in particular with Sandy, because with the flooding we had several areas of the state where ambulances actually were flooded out and were no longer available for us. We were very lucky that we had learned that lesson from the year before. 

Watch a NewPublicHealth video about the public health response to Hurricane Sandy featurining Mary O'Dowd and other public health officials.

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Global Health in a Time of Ebola

Oct 21, 2014, 2:44 PM, Posted by Paul Kuehnert

Nelson Mandela's cell on Robbens Island Nelson Mandela's cell on Robbens Island (photo by Paul Kuehnert)

I returned from Cape Town, South Africa a week ago and want to share some reflections on my trip and my participation in the Third Global Symposium on Health Systems Research, in Cape Town September 30-October 3, with the theme “Science & Practice of People-Centred Health Systems.”

In the opening session, Professor Thandika Mkandawire from the London School of Economics made two remarks that resonated with me, and that were referred to by other speakers throughout the conference. First, referencing Napoleon’s quote that “War is too important to leave to the generals,” Mkandawire said that “health is too important to leave to health specialists.”  Instead, there is a need for multiple disciplines and sectors to create health and devise health policy. He went on to address the policy issues related to the most vulnerable populations, saying that “policies targeting the poor are poor policies”, arguing for the importance of social solidarity, not charity.

The current Ebola epidemic highlights the gaps in public health in many nations, as well as the erosion of public health emergency preparedness and response at WHO and many other nations, including the US.. This is putting our health at risk from all kinds of infectious and emerging diseases (e.g., MERS, polio) and threatens progress in health in other areas.

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Public Health Campaign of the Month: Know Where to Meet Your Family in an Emergency

Sep 2, 2014, 2:09 PM

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Averting Disaster with a Pillowcase

Jun 6, 2014, 2:15 PM

file Courtesy: American Red Cross

This commentary originally appeared on the RWJF New Public Health blog.

When Springtime Turns Ugly: Public Health and Disaster Preparedness

Jun 6, 2014, 11:24 AM, Posted by Beth Toner

MOYER_110506_13128 EMOTIONAL AFTERMATH: A resident of Alabama, overwhelmed by the sight of her ruined home after tornadoes struck at the end of April, 2011.

Ah, springtime: especially welcome for those of us who experienced a particularly harsh winter. Spring often conjures up images of blossoming trees and blue skies, freshly cut grass and picnics.

Yet in May, several anniversaries of devastating natural disasters reminded us that springtime can also bring with it some of nature’s most violent weather phenomena:

  • On May 20, Moore, Okla., marked the first anniversary of the devastating tornado that killed 24, including seven children at an elementary school. It was the second EF-5 tornado to strike the city in 15 years; the May 3, 1999, tornado left 46 dead.
  • In Joplin, Mo., residents remembered the May 22, 2011, EF-5 tornado that killed 161 people.
  • On May 31, Johnstown, Pa,., observed the 125th anniversary of the devastating flood that leveled the entire city and killed 2,209.

While improved warning systems and 21st century technology have certainly played a role in reducing the number of lives Mother Nature’s temper tantrums claim, the fact remains that these events have a substantial impact on our health as a nation.

We recently talked to Paul Kuehnert, director, Bridging Health and Health Care portfolio—as well as a pediatric nurse practitioner and longtime state and local health official—to get his thoughts about the role public health plays in helping us prepare for, cope with, and learn from natural disasters.

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Emergency Care: A Story of Extraordinary Success and Lingering Challenge

May 23, 2014, 8:43 AM

Brendan Carr, MD, MA, MS, directs the Emergency Care Coordination Center and is on the faculty of the Perelman School of Medicine at the University of Pennsylvania. He is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program (2008-2010).

Brenda Carr

Human Capital Blog: The Emergency Care Coordination Center (ECCC) was created in 2006 by presidential directive in response to pressing needs in the nation’s emergency medical care system. Can you describe those needs?

Brendan Carr: I’ll try my best. While the landmark Institute of Medicine (IOM) report on the future of emergency care really brought much of this into focus in 2006, the story of the emergency care system’s struggles extends back well before that. The IOM reports on the health care system’s response to injuries (Accidental Death and Disability in 1966 and Injury in America in 1985) really foreshadowed the shortcomings of acute care delivery. At the time, we understood that rapid intervention in trauma was lifesaving and that our delivery system wasn’t keeping pace with the science of emergency care. 

Over the last few decades, we’ve really come face to face with this reality on a broader scale. Our growing appreciation for the importance of early diagnostics and intervention, combined with increased awareness about the importance of creating a patient-centered health care system, have highlighted the mismatch between the demand for care and the product that we deliver. The emergency care system’s crisis is really the health system’s crisis.  

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Faces of Public Health: Laura Howe, The American Red Cross

May 9, 2014, 3:05 PM

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The American Red Cross recently announced the opening of its second Digital Operations Center—the first one outside of its national headquarters in Washington, D.C.—in the organization’s North Texas Region. Both centers are funded by the Dell Computer Corporation. The new center, along with others to be opened in the next few years, expands the ability of the American Red Cross to engage in social media, especially during regional disasters.

The Center will “allow us to build a center of expertise through our digital volunteers who help provide social data for regional responses,” said Laura Howe, vice president of public relations at the American Red Cross. NewPublicHealth recently spoke with Howe about the impact of using social media to respond during disasters.

NewPublicHealth: How did the Red Cross social listening program begin?

Laura Howe: We started a social listening program for emergencies and disaster in a fulsome way after the Haiti earthquake. I walked out of my office and I had a bunch of staff members who were in tears. They were getting Twitter and Facebook messages from members of the Haitian diaspora community here in the United States giving them the exact locations of where people were trapped under rubble and where people needed help in Port au Prince. We were able to move that information to the U.S. Department of State and the U.S. Department of Defense to hopefully get people help on the ground. But, it showed us two things. It showed us the power of individuals to provide information that can help responders, but it also showed that there was a tremendous gap in the response system for being able to take in information and respond specifically to people who had an urgent emergency rescue need, and there really is no infrastructure to be able to do that.

But I do want to make clear that the Red Cross as an organization and Red Cross disaster workers are not going to be able to take in information off of social media and then send one of our people to come get you out of the rubble or to come rescue you. We are not acting as a 911 dispatch here. We are using social media platforms to provide people with preparedness information, emotional support and information that they can take action on. We’re also listening for information that can help us in our disaster response generally and help us better hone where we’re putting our resources during a disaster.

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NPH: What are the criteria for an optimal American Red Cross digital volunteer?

Laura Howe: We want someone who is comfortable in a social space; understands social media platforms and how social communities work; and is comfortable engaging with the public, having done that previously. Volunteers don’t necessarily have to have professional experience with social media, but do have to have a personal comfort level. Our training follows up on those prior skills about how to engage on behalf of the Red Cross. We train the digital volunteers about how we take in the information and then move it to our decision makers in order to make operational decisions.

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Faces of Public Health: Donna Levin, Network for Public Health Law

Apr 25, 2014, 12:53 PM

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The Network for Public Health Law recently named Donna Levin, formerly the general counsel at the Massachusetts Department of Public Health, as its new National Director.

The Network provides assistance and resources to public health lawyers and officials on legal issues related to public health, including health reform, emergency preparedness, drug overdose prevention, health information privacy and food safety. More than 3,500 public health practitioners, attorneys, researchers, policy makers and others have joined the Network since it was formed in 2010 as a national initiative of the Robert Wood Johnson Foundation (RWJF).

“We are delighted that Ms. Levin, an experienced leader in public health law, will be joining a stellar Network team,” said Michelle Larkin, JD, assistant vice president for RWJF. “Laws and policies that help people lead healthier lives are among the cornerstones for building a culture of health. Through Ms. Levin’s leadership, we look forward to continued growth in the Network—a strategic resource for state and local public health officials.”

NewPublicHealth recently spoke with Levin about her new position with the Network.

NewPublicHealth: How does your previous work as the general counsel for a state health department help inform your goals for the Network for Public Health Law?

Donna Levin: During my decades at the Massachusetts Department of Health I saw the responsibility of the state health department grow exponentially. We were trusted by the legislature and given many new initiatives. So public health grew and grew and public health law has grown alongside it. So what informs my view is that the range of issues is so incredibly broad. And so I really know firsthand how the availability of technical assistance from the Network is so valuable both to lawyers working in the field and to practitioners.

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