Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages.

Yesterday, NPR reported that business owners near the blast site are beginning to return and reopen their doors.

"They fled in a panic last week and returned both eager and anxious," said NPR reporter Tovia Smith. The piece describes how business owners returned to find food left half-eaten and rotting, because so many left in such a hurry, and blood splattered in some spots from those who were injured.

To help make sure businesses get the help they need to reopen safely, public health inspectors played a role in visiting every building on every block. "They also stood ready with trauma counselors, pro-bono attorneys and clean-up crews," said Smith.

But the public health response to any disaster goes beyond helping to restore normalcy in the immediate aftermath. An earlier interview with John Lumpkin, director of the Health Care Group at the Robert Wood Johnson Foundation, about the sustained response to Hurricane Sandy also applies here:

We saw with Katrina and are seeing again now with Sandy, [public health officials] are not only concerned with food, air, and water during and immediately after an emergency, but also with ensuring that services related to health care delivery and mental health are provided when and where they’re needed. It’s an interesting statistic, for instance, that the demand for mental health services was higher five years after Hurricane Katrina than it was immediately after the hurricane hit.

The Boston Public Health Commission announced this week, for example, that the organization has opened a new drop-in center to continue to provide emotional support to anyone affected by the Boston Marathon attack.

"While the physical injuries and destruction that resulted from the bombings might be the most visible signs of trauma, many people experience serious emotional distress based on what they saw, heard, and felt during and after the attack. Sometimes these symptoms do not surface immediately," according to the Commission release. "Understanding the deep impacts of this emotional distress, city officials opened the drop-in center as a safe place for people to come together and talk about their experiences over the past week."

>>Read more about building community resilience to recover from disaster.

NewPublicHealth is speaking with directors of several health departments who recently were accredited by the Public Health Accreditation Board. Eleven health departments received the credential so far. We recently spoke with Mary Selecky, director of the Washington State health department, one of the first two state health agencies receive national accreditation status. Ms. Selecky recently announced her plans to retire from the health department.

>>Also read our interview with Terry Cline, health commissioner of Oklahoma, which also was recently accredited by PHAB.

NPH: How do you think accreditation will improve delivery of public health services and care in Washington State? Now that the health department is accredited, do you feel as though you are leaving the department in even better shape than it was?

Mary Selecky: Accreditation is really a quality improvement tool, and the standards that have been set by the Public Health Accreditation Board force you to examine whether you have the right processes in place for continuous, sustained quality improvement. And if you have found that you are not quite up to par in an area, then the processes help you ask what you will do to improve your performance in that area? The process helps you increase your performance, your effectiveness, and your accountability.

Public health touches people every single day—everybody in the state, from the moment they get up until they go to bed at night and even while they’re sleeping. This credential shows us that we have effective programs and measures in place to meet the needs of our communities. Drinking water systems are a good example. We regulate 16,000 drinking water systems, and I have a lot of drinking water engineers who are out in communities checking on water systems. I have to know that they’ve got a common set of operating procedures to assure the public that we’re looking out for their interests and when they turn on their tap from a municipal water system, that the water’s safe to drink. You can only do that when you have some procedures in place and that goes for the engineers, for laboratories or programs to make sure they are operating well in the community. Accreditation touches every part of the department.

NPH: How will you be promoting and explaining accreditation to policymakers?  

A constant theme of this year’s Keeneland Conference is the emergence of the discipline of public health systems and services research (PHSSR) from strict research and evaluation to results that are beginning to be used by public health departments and agencies. So who better a dinner speaker than Joe Selby, MD, MPH, head of the Patient-Centered Outcomes Research Institute (PCORI), authorized by Congress under the Affordable Care Act. PCORI’s role is to conduct research and provide information about the best available evidence to help patients and health care providers make more informed decisions. The Institute's goals include:

• Substantially increase the quantity, quality, and timeliness of useful, trustworthy information available to support health decisions.
• Speed the implementation of patient-centered knowledge into practice.
• Influence clinical and health care research funded by others to be more patient-centered.

NewPublicHealth spoke with Dr. Selby about PCORI’s work so far and the critical goal of disseminating scientific research to improve health.

NewPublicHealth: Tell us about your talk at the Keeneland Conference.  

Dr. Selby: I’ll start by talking about the historical trends that led to PCORI’s formation. I think that these trends are bringing what we do, which is called comparative clinical effectiveness research, together with quality improvement and with public health systems and services research. There is a convergence of interests between what the conference attendees do as public health practitioners and public health researchers and systems-based researchers and what the quality improvement world is doing and what we’re trying to do at PCORI. There are many common bonds and a new appreciation for that.

It has suddenly dawned on everyone that you’ve got to put your patients or, in the case of public health, your communities, at the center of the research activity. And I know that in the public health world, they are involving communities and patients within communities and clients and consumers in their planning and intervention activities. That is one of the bonds that ties us together and that leads to enhanced productivity whether we’re doing clinical research like PCORI does, whether we’re doing quality improvement, or whether we’re doing public health.

The sixth annual Keeneland Conference begins today in Lexington, Kentucky. Each year hundreds of public health researchers and practitioners meet to share research and translation strategies at the annual conference, is sponsored by the National Coordinating Center for Public Health Services and Systems Research, which is based at the University of Kentucky. This year’s keynote speakers include Paul Kuehnert, MS, RN, senior program officer and director for the Public Health team at the Robert Wood Johnson Foundation; Lisa Simpson, president and CEO of AcademyHealth; and Joe V. Selby, MD, MPH, the first executive director of the Patient-Centered Outcomes Research Institute authorized by Congress.

In advance of the conference, NewPublicHealth spoke with Glen Mays, PHD, MPH, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health. Mays is also the co-PI of the National Coordinating Center for PHSSR at the University of Kentucky, which is funded by the Robert Wood Johnson Foundation.

NewPublicHealth: What will be some of the key issues at the Keeneland conference this year, both from the plenary podiums and in hallway conversations?

Glen Mays: One area involves looking at the changing roles and responsibilities of health care organizations in the public health enterprise, especially the changing roles of hospitals in helping to deliver public health activities, in part because of new tax incentives for hospitals to be involved and to play a larger role in delivering community benefit services. We have a number of studies taking a look at that issue, as well as other elements of health care reform such as the accountable care organizations that hospitals are playing an important role in and that are part of new health delivery systems. The hospitals are playing roles and engaging public health activities as part of their health care delivery strategy. So there will be a number of studies looking at various angles of hospital and health care system involvement in public health delivery and the larger issue of integration of public health into new health care delivery strategies under health reform, which is a big area.

NPH: How much discussion do you expect about the Affordable Care Act?

Yesterday, New York State Health Commissioner Nirav R. Shah, MD, MPH, released the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State. The plan is a blueprint for local community action to improve health and address health disparities.

Dr. Shah was joined by New York City Health Commissioner Thomas Farley, MD, MPH, and representatives from leading health care and community organizations at the Charles B. Wang Community Health Center in Manhattan. Among the other speakers were Jo Ivey Boufford, MD, president of The New York Academy of Medicine, and Daniel Sisto, president of the Healthcare Association of New York State.

 >>Read a related Q&A with Commissioner Nirav Shah.

“We’ve all heard the adage—an ounce of prevention is worth a pound of cure,” said Commissioner Shah. “We need to fundamentally change the way we think about achieving better health in our society.”

That fundamental shift toward prevention, said Dr. Shah, requires setting clear goals, promoting active collaborations, and identifying policies and strategies that create opportunities for everyone to live a healthy life.

The Prevention Agenda identifies five priority areas:

• Prevent chronic disease
• Promote healthy and safe environments
• Promote healthy women, infants and children
• Promote mental health and prevent substance abuse
• Prevent HIV, STDs, vaccine-preventable diseases, and healthcare-associated infections

A health improvement plan like the one released by the New York Department of Health is a critical prerequisite for public health department accreditation. Recently, the Public Health Accreditation Board awarded five-year accreditation to 11 public health departments. Those 11 are the first of hundreds currently preparing to become accredited, including New York state.

"Completing the accreditation application, which includes our Prevention Agenda 2013-17, provides the Department of Health a valuable opportunity to engage partners and community stakeholders in our ongoing efforts to improve public health, evaluate the effectiveness of our services and showcase our successes," Commissioner Shah said.

Hurricane Sandy devastated much of the East Coast last fall, with sea communities in New York and New Jersey such as Ocean County bearing a disproportionate share of the damage. In Ocean County alone, 40,000 buildings were damaged by the storm’s monstrous gusts and floodwaters and the county suffered nearly half the damage recorded throughout New Jersey, according to the Federal Emergency Management Agency.

>>A new video produced by the Robert Wood Johnson Foundation about the public health response to Hurricane Sandy features health department officials including Dan Regenye, coordinator of the Ocean County Public Health Department, and New Jersey Health Commissioner Mary O’Dowd. Watch the video:

For more than a week after the storm ended, more than 250 employees of the public health department worked day and night to help the county’s 576,000 residents. The county provided medical needs sheltering for more than 1,000 residents, three times the number expected. And many shelters that housed displaced residents were also able to shelter their pets­–a critical need for many people who might not have evacuated otherwise.

This week at the annual Public Health Preparedness Summit hosted by the Centers for Disease Control and Prevention and the National Association of County and City Health Officials, the Ocean County Health Department will present a poster on response to and recovery from disaster. Follow NewPublicHealth coverage of the conference and other preparedness news.

In advance of the conference, NewPublicHealth spoke with Dan Regenye.

NewPublicHealth: How is your community doing?

Dan Regenye: I think it’s going to take a long time for total recovery to happen, and the reality is that it’s never going to be what it was. Some things will be better, some things will be worse. Our residents are dealing with their own personal issues and circumstances on a case-by-case basis. I think it’s the navigation part that’s so difficult for so many people between all the different agencies—local, state and federal—and private organizations. They need to look at FEMA (Federal Emergency Management Agency) maps and have to interact with insurers, contractors and others. It’s challenging.

NPH: What is the health department’s role in the recovery?

Time to vote! The U.S. Department of Health and Human Services (HHS) has announced the start of public voting for the People’s Choice Award in the HHSinnovates Program, which rewards outstanding projects led by HHS employees to solve critical health issues.

The public is invited to cast their votes for finalists who submitted ideas that have proven to be scalable, replicable and uniquely innovative. The finalist with the highest number of votes will win the “People’s Choice” award, which will be announced March 19 in Washington, D.C.

Vote for your favorite finalist here. The top contenders include:

• Connecting to Combat Alzheimer’s
• FDA-iRISK
• The Body Weight Simulator
• Portal System: Linking Health Care Clinics
• Counterfeit Detector Device
• The Weight of the Nation Campaign

Read the full post for a detailed description of each.

The most recent update on flu activity in the U.S. from the Centers for Disease Control and Prevention finds 47 states showing widespread activity, down from 48 states the week before. “Widespread” means that more than half of the counties in a state are reporting flu activity. While the Western part of the country will likely see more cases, flu seems to be slowing some in the South, Southeast, New England and the Midwest—though still packing a punch in terms of illness, deaths, emergency room visits and hospital admissions.

NewPublicHealth spoke with Paul Etkind, MPH, DrPH, MPH, DrPH, Senior Director of Infectious Diseases at the National Association of County and City Health Officials about the role local health departments play in educating communities about flu prevention and helping to facilitate treatment.

NewPublicHealth: What, if anything, is different about the flu this year?

Paul Etkind: The flu severity that’s being experienced, which we haven’t seen for several years now, has gotten the public’s attention and they’re really heeding the public health urgings, communication and education that’s been going on all along saying hey, get your flu shots, protect yourself. So now, within a relatively short period of time, there’s a very large demand for flu shots.

During the H1N1 outbreak of a few years ago, there was much greater funding for what the health departments were doing. I saw some magic happening then. They had the funds to hold clinics in very unusual places, such as local baseball stadiums and airports. They went to places where people are most comfortable.

Three months have passed since Hurricane Sandy hit the East Coast. And while the number of people displaced by the storm has gone down from tens of thousands to the hundreds in different communities, some people are still without power or a permanent place to live. Others face the daunting task of rebuilding businesses and homes while protecting against mold and dust, which can cause or exacerbate respiratory problems. For many, the stress has rekindled mental health issues that might have been at bay, or created new ones or just made tough times even worse.

NewPublicHealth spoke with Patricia Yang, DrPH, Chief Operating Officer and Executive Deputy Commissioner at the New York City Department of Health and Mental Hygiene.

NewPublicHealth: Hurricane Sandy hit just over two months ago. How’s the city doing now?

Dr. Yang: There are people in parts of the city for whom the storm is a distant memory, and their daily lives are virtually unaffected apart from what they might hear on the news or read in the papers. But in the areas that were most directly affected by the hurricane, life for many is far from normal and may never return to what it was pre-storm. Those areas in particular are parts of the Rockaways and Coney Island and Staten Island. So there are still thousands of people who don’t have basic utilities and for whom grid power and heat have not returned. And we’re heading into the coldest winter months.

NPH: What’s the role of the public health department both now to help people deal with the aftermath, and looking ahead to prepare for the next disaster?

The Public Health Accreditation Board (PHAB) recently celebrated the one year anniversary of the launch of national public health accreditation.

Over 100 health departments have engaged with the Public Health Accreditation Board on their accreditation journey, according to PHAB CEO Kaye Bender in an email exchange with NewPublicHealth, and more health departments enter the system each week. “One year post launch of voluntary national public health department accreditation, PHAB is excited about the progression of health departments through the process,” Bender wrote. “The first site visits began last month, and more are scheduled. We expect to announce the first accredited health departments in early 2013!”

At the recent APHA 2012 conference, representatives from California’s state and local health departments led a session offering their peers a first look at the accreditation process underway in California. As PHAB states, “the goal of national public health accreditation program is to improve and protect the health of the public by advancing the quality and performance of all health departments in the country – state, local, territorial and tribal.” All of the California representatives made a case for why accreditation is a priority for their respective departments.

“Accreditation equals opportunity,” said Dr. Ron Chapman, California Department of Public Health director. “Quality improvement is about problem solving. Infuse quality into what you do every day and you will see transformation.”

>>Watch a VIDEO with Ron Chapman about new opportunities to transform public health by making quality improvement a way of life.

Dr. Alonzo Plough, Emergency Preparedness and Response Program director for the Los Angeles County Public Health Department, said accreditation’s quality improvement standards align well with the “triple aim” goals of: improving patients’ experience of care, improving the health of populations and reducing the cost of health care.

Plumas County Public Health Agency director, Mimi Hall, talked about how building relationships with local hospitals and community and business leaders can help meet public health goals.

“We have to redefine the role of public health and work with outside organizations to get the best benefit for the community,” said Hall. “Accreditation pulls it all together.”