Mar 27 2013
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RWJF’s John Lumpkin on Sustained Response to Public Health Emergencies: NewPublicHealth Q&A

At this month’s Public Health Preparedness Summit, John Lumpkin, MD, MPH, senior vice president and the director of the Health Care Group at the Robert Wood Johnson Foundation, presented about the National Health Security Preparedness Index. The Index, when completed, will be a single annual measure of health security and preparedness at the national and state levels. The Index will help inform decisions about how to prioritize investments and continual quality improvement of public health preparedness, and will also identify and highlight strengths and novel approaches. With input from many stakeholders, the Association of State and Territorial Health Officials, in partnership with the Centers for Disease Control and Prevention, is coordinating development of the Index.

Prior to joining the Foundation in 2003, Dr. Lumpkin served as director of the Illinois Department of Public Health for 12 years. In an interview at the Summit, Dr. Lumpkin described how the Index will help improve the quality of public health preparedness. He also shared his insights from his first-hand experience in coordinating a sustained response to public health emergencies that extends well beyond the initial response.

NPH: In the aftermath of a disaster such as Hurricane Sandy, how can public health agencies balance their focus on immediate needs such as shelter, food and emergency services, with longer-term challenges such as mental health, housing solutions and resilience?

Dr. John Lumpkin: While the immediate impact of homes being destroyed, people being forced to relocate and lives being lost, is devastating—there is also an ongoing public health impact of a disaster such as Hurricane Sandy, which is tremendous.

>>Watch a video on the ongoing public health response to Hurricane Sandy.

The public health agencies in New Jersey and New York are just beginning to deal with their response to the longer-term effects. Public health impacts peoples’ lives in ways they don’t recognize every single day of their life. So after a flood, for instance, when can a restaurant open? Public health has to come in and do the inspections. Is the water in the public water system safe to drink?  And for people who live outside of cities and rely on water wells for their drinking water, they need to know if the water safe to drink. Public health has to be involved in both. What happened in homes that were damaged—is there need for major rehabbing to prevent exposure to mold and mildew? Was there paint on the walls that may have had lead in it?

And we saw with Katrina and are seeing again now with Sandy, they 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.

All these issues are public health issues. And they continue to have impact for many years after the disaster has faded from the news headlines.

NPH: What approach has the Foundation taken looking at the longer-term impact of disasters such as Hurricane Sandy and Hurricane Katrina? 

Dr. Lumpkin: The nature of philanthropy and giving in the United States is special. Immediately after Katrina, immediately after Hurricane Sandy, after 9/11, the outpouring of volunteers, of people giving money, was absolutely amazing. But what we’ve learned about these disasters is that outpouring lasts while it’s in the public’s eyes. Within six months, the donations for relief and recovery essentially dry up. Yet the need for a community to rebuild and address the impact on the infrastructure that protects food, water and air, and the mental health challenges – these all linger for years. Our approach at the Foundation is that though we make significant donations up front, we also reserve funds for that later part of the recovery phase to address that long-term impact. That’s the approach we took during Hurricane Katrina, where within the first week we contributed over a million and a half dollars, and over a period of years we contributed more than $20 million. With Hurricane Sandy we made an immediate donation to the New Jersey Red Cross, and we’ve allocated the remainder of the $5 million to provide relief in the long term so that we are still giving when some others may have stopped.

NPH: How has your preparedness experience in your role as a state health director informed your work in preparedness at the Foundation?

Dr. Lumpkin: I started out my career in emergency medicine and got into emergency response planning very early in my career. Working in public health took it to a new level. One of the things I learned early on was that when a disaster happens, it’s not a good time to be exchanging business cards. In Illinois, by working closely with the state emergency management agency, we were able to bring in fire, police, emergency medical services, so we all thought through a response plan together.

NPH: So that approach to integrating efforts and collaborating sectors has to be happening all year long, not just during an emergency?

Dr. Lumpkin: Right. The public health system has to think about how to respond, working in a coordinated fashion with other emergency response agencies like the Red Cross, the state and local emergency management agencies, relief organizations like the Salvation Army, and volunteer organizations.

And it has to be practiced. We have to go through drills. In the first disaster drill I participated, before I was with the Illinois state health department when I was practicing emergency medicine at the University of Chicago hospital, we’d we set up a process where there were a couple hundred mock-injured patients. The disaster was supposed to kick off at 8 a.m. We’re sitting in the emergency department and 8 a.m. came and went. 9 a.m. came and went. Finally we get a call from the hospital operator that there was a disaster. When we debriefed we realized that she had a call-up list, and the last on the list was the emergency room. If this had been a real mass-casualty event, the people who should’ve been notified first would have been notified last. If we had never drilled that, we would not have known that. That’s why it’s so important to constantly learn where there might be holes in the system, where there might be gaps that people can fall through.

NPH: How will the National Health Security Preparedness Index help foster quality improvement in public health preparedness?

Dr. Lumpkin: That’s exactly why the Preparedness Index is so important. Prior to the Index, we had a measure of performance in laboratories, and a measurement of other aspects in infectious disease. But nothing brought it all together. This Index is the attempt to bring together an assessment of preparedness at the state and local level into one measure. It will give tools not only to determine where things are going well, but also to enable a process of continuous quality improvement. It also gives some perspective to where the priorities might be.

NPH: What are the next steps with the Preparedness Index?

Dr. Lumpkin: The process included representatives from more than 25 stakeholder organizations and 75 people in coming up with first draft. The Index now has been approved by steering committee as a beta version. It will be rolled out over the next months to states and the preparedness and public health community, and we’ll be asking them to comment. The Index will become a living thing. The goal is to make sure it gives us the best view of preparedness and health security.

>>Bonus Link: Visit NHSPI.org to learn more and provide your feedback to help shape the future of the Index.

Tags: Emergency Preparedness and Response, Hurricane Sandy, Preparedness, Public and Community Health, Q&A