Natural Experiments on the Public Health System: Q&A with Lainie Rutkow

Oct 10, 2012, 11:20 AM

Public health has experienced major economic, environmental, and technology upheavals in recent years. A new round of research supported by the Robert Wood Johnson Foundation (RWJF) will examine how recent dramatic changes in the operation of the nation’s public health system impact its effectiveness in such critical roles as emergency preparedness and reporting of disease outbreaks.

Seven new research awards are part of an initiative on “natural experiments” in public health delivery developed by the National Coordinating Center for Public Health Services and Systems Research (PHSSR), a RWJF-funded center housed at the University of Kentucky College of Public Health. The awards of $200,000 each are being administered by the National Network of Public Health Institutes.

NewPublicHealth spoke with Lainie Rutkow, PhD, JD, MPH, assistant professor at the Johns Hopkins Bloomberg School of Public Health, about her award to assess whether state laws influence the public health workforce’s willingness to respond in emergencies. The award will include collaboration with the National Registry of Emergency Medical Technicians; Butler County Health Department in Missouri; and the Multnomah County Health Department in Oregon. Rutkow, a member of the Eastern Region of the Network for Public Health Law, will also be presenting about some of her other emergency preparedness work at the Public Health Law Conference in Atlanta this week.

>>Follow NewPublicHealth coverage of the Public Health Law Conference, with speaker interviews, session coverage and more.

NewPublicHealth: Tell us about natural experiments and the opportunity they offer to better understand how the public health system can operate more effectively.

Lainie Rutkow: Natural experiments really capitalize on variations that already exist, particularly within the public health system, and as researchers we can analyze the public health impacts of a natural experiment over time and also in different settings. I see natural experiments as an opportunity to compare populations who are exposed to a particular policy with populations that have not been exposed to that policy. It would be very difficult or impossible to do that kind of thing in a controlled research setting. 

NPH: What is your particular award designed to look at?


Lainie Rutkow: We are going to be examining whether certain types of laws at the state level influence willingness to respond to emergencies among members of the public health workforce. And because each of the 50 states has passed—or in some cases has not passed—different types of emergency preparedness laws, we can take advantage of a natural experiment. We are planning to use that to better understand how certain laws may influence the public health workforce in terms of their willingness to respond and thus the broader public health system.

NPH: So your award is going to look at states across the country?

Lainie Rutkow: The first part of our award will involve a legal mapping study and that will look at laws in all 50 states.

NPH: Can you give us an example of some of the state policies that you expect to see?

Lainie Rutkow: Sure, one type of law that we are interested in looking at is whether or not states have legislatively created a mechanism to officially declare a public health emergency. That is something that would often be given to the governor as a power. We know for certain that some states simply do not provide the ability to declare a public health emergency while other states do. That is exactly the type of natural experiment that we will be able to capitalize on with this research.

NPH: What is the public health workforce role in emergencies and how do you expect that it might change because of a state law that is in place or not?

Lainie Rutkow: The public health workforce does all kinds of things during emergencies but some specific examples are before an emergency occurs, engaging directly in the disaster planning process, participating in response to the presence of hazardous materials, liaising with local health departments during an actual emergency and shortly thereafter, and managing health resources. But for our particular award, we are focusing on whether the presence or absence of particular laws might make the public health workforce more likely to respond during an emergency and then carry out their emergency work responsibilities.

NPH: How do you expect that you will use the results of your research?

Lainie Rutkow: Well, the biggest goal is to be able to use the results of our work to assist state level policy-makers to prioritize the passage and subsequent implementation of particular emergency preparedness laws that are associated with greater willingness to respond among the public health workforce. Of course we won’t know what those laws are until we have actually conducted our research. 

But the idea behind this whole study was that if states adopt laws that have demonstrated effectiveness in terms of willingness to respond for their public health workforce, that should strengthen the state’s public health system and allow the public health system to sustain high quality and effective emergency response efforts.

NPH: What else are you working on?

Lainie Rutkow:  I just started working on a project with colleagues that’s funded by the National Science Foundation. It’s an interdisciplinary project to develop tools for modeling the vulnerability of certain critical infrastructures—things like hospitals—relative to natural disasters. We are focusing on concerns about physical infrastructure, so that’s the engineering perspective, as well as emergency preparedness, and law and public policy.  So I am the person that brings the law and public policy perspective. I think that’s going to be a really great project. It’s just starting.

NPH: What are you presenting on at the Public Health Law Conference?

Lainie Rutkow:  The work that I will be presenting comes from a CDC funded project in its fifth year. And my part of the project is to look at legal issues that arise relative to individuals’ mental and behavioral health during emergencies. That has been a really fun project to work on because, while much work has been done relative to law and emergency preparedness, not a whole lot has been done looking at law, preparedness, and mental and behavioral health. We are so used to looking at emergencies and thinking about physical health.

The nice thing for me, and why I am so excited about this new PHSSR award, is that it really brings together a lot of dimensions of my work. And ultimately it has a very practical goal of helping to ensure that the public health system will effectively protect and promote the public’s health.

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