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.

What key role does public health play when it comes to natural disasters?

PK: In emergency or disaster management, we think about three phases: preparedness, response and recovery.  Public health has distinct roles within each of these three components, with the common thread that public health is bringing its science base and its responsibility for protecting and promoting the health of the entire population to this work.

For example, in terms of natural disasters, in the preparedness phase, public health would have responsibility for making sure that community disaster plans include shelters for those with special medical needs, plans for getting insulin or other critical medications to people with chronic illnesses, and oversight of shelter sanitation, including food preparation and distribution.

During a disaster response, for example, public health is coordinating efforts among hospitals to manage surges of injured or ill community members.

During disaster recovery from, say, flooding, public health has the responsibility to assure that rebuilding the physical environment—housing, business districts, recreational areas—is done in ways that enhance health by implementing approaches that enhance walkability and other forms of physical activity, while mitigating the risks of future disasters.

What have we learned since the Johnstown Flood about the health impacts of events like these? How has the thinking evolved?

PK: I think we have learned a great deal! At the time of the Johnstown Flood, the germ theory of disease was not uniformly accepted and understood, so you had great potential for spread of communicable diseases from a variety of human and animal sources. The system of coordinated planning and response that we know as the Incident Command System had not been invented, so each disaster required reinventing the wheel, so to speak, in figuring out everything that needed to be done—and by whom.

Further, we did not have an appreciation or understanding of psychological trauma as a result of disasters—so, again, nothing was in place to systematically support survivors and responders, no system of providing mental health first aid. These are just a few of the areas in disaster response and public health that have been addressed since that terrible event 125 years ago.

Where does public health fit in with other agencies, both before and after events like the tornadoes in Joplin and Moore?

PK: Prior to the first grants to states and large cities in the late 1990s, public health was really not “at the table” in a systematic manner as far as emergency preparedness and response. This really changed significantly, of course, after the anthrax attacks in the fall of 2001, when Congress recognized that public health agencies across all levels of government were not adequately prepared to respond to emergent population health threats, whether natural or man-made.

Over the past dozen or so years, the value of public health has been clearly established as part of the unified community, state and national efforts to prepare for, respond to, and recover from population-level emergencies and disasters. Public health has the direct responsibility for health-related sections of community plans and, during events, for marshaling necessary resources for response and recovery. 

In addition, it has responsibility for early detection of threats to population health—for example, influenza or foodborne illnesses. This early detection and response responsibility blends into public health’s routine efforts to monitor for threats and protect the community, but it also extends beyond that to have the knowledge and expertise necessary to detect potential bio-, chemical or radiological terrorist events.

Let’s talk about the National Health Security Preparedness Index. How will this help change the way we think about and plan for natural (and man-made) disasters?

PK: We need to understand, first of all, that preparedness, response and recovery are not a “one and done” type of effort. In other words, you can’t simply write a plan for a generic disaster in your community or state and then sit back and wait for something to happen and then use the plan! Threats change. Resources come and go. Trained staff members come and go. There must be an ongoing commitment to keeping plans updated and fresh; to test them through drills and exercises; to train staff; to update equipment and technique; and to communicate with and educate policymakers, business leaders and members of the general public.

So, the National Health Security Preparedness Index is a tool to keep our readiness for disasters in front of us. It is an organized method for looking at key parts of public health (and soon, health care and other sectors vital to our health security) systems, takes measures of them in each and every state, and gives a set of scores organized by important functional areas or domains for each state. This helps to identify areas that need improvement and areas in which a state is doing well.  In short, the Index can help health officials, elected policymakers and the public understand how prepared we are and how we can improve our public health preparedness capabilities.

If you could wave a magic wand and fix one thing about how we, as a nation and as individual communities, deal with natural disasters, what would it be?

PK: I would love to have the magic wand increase our awareness of how much we are connected to each other in our communities, our country, and ultimately, the globe. I believe that this awareness would influence our decisions and would foster our connections with each other in big and small ways that would, in turn, benefit our health as individuals, families, and communities. This sense of connectedness empowers us to meet the challenges we face with resilience—whether they are the day-to-day challenges in our relationships and our families, or the huge challenges of a flood, hurricane, or tornado. We need to live as if our lives depend on each other—because they do!