Road to Recovery After Disaster: Q&A with Alonzo Plough

Jun 4, 2014, 2:30 PM


Recovery after a disaster can take years or even decades—but what most people don’t realize is that recovery starts even before the disaster occurs. Resilience is about how quickly a community bounces back to where they were before a public health emergency—and only a healthy community can do that effectively.

NewPublicHealth recently spoke with Alonzo Plough, PhD, MPH, Vice President, Research-Evaluation-Learning and Chief Science Officer at the Robert Wood Johnson Foundation, about taking steps toward recovery even before a disaster occurs.

NewPublicHealth: What are some important aspects of preparedness that help prepare responders and the community for recovery from a disaster?

Alonzo Plough: Connectivity between organizations, between neighbors, between communities and formal responder organizations is absolutely critical to building community disaster resilience. This allows recovery to go more smoothly because the partners who have to work together in recovery have been working together and connecting to communities prior to a disaster event. Managing the long tail of recovery is easier if there has been recovery thinking in the preparedness phase.

NPH: One of the issues for the panel at the 2014 Preparedness Summit is the impact of the news spotlight when a disaster occurs, and then the impact of that spotlight turning off. How does that focus impact recovery?

Plough: Often the initial media frames are to wonder why there weren’t preventive mechanisms. In the case of the mudslides in Washington State, for example, why weren’t there zoning restrictions or regulatory restrictions? That initial media frame often will point a finger to ask why houses were allowed to be built in an at-risk location. Why were building permits given at all?

But none of that really addresses the long-term issues of communities working toward recovery, regardless of the specific event. There is a disruption of life as people know it in a disaster that goes on for a long, long period of time. The media doesn’t really capture the complexity of that while they’re focused on the short-term outcomes. When the media focus goes away, the appropriate agencies and organizations who need to be engaged continue their engagement.

The really critical thing in disaster response is the emergent support and resources from local organizations, large and small, who are not traditional or designated disaster response organizations—like FEMA—who step up in innovative and community nuanced ways to support long term recovery.

NPH: What issues can most impact the pace of recovery?

Plough: There is a disparity in the pace at which recovery happens. Communities with a lot of assets are able to bounce back and recover very quickly. That’s a function often of the socioeconomic status of those communities. In other communities that do not start with those kinds of assets the pace of recovery could be much slower and the community voice to engage with and demand attention to that long tail of recovery may not be as powerful or persuasive. And so you see great inequities that exacerbate the underlying health-related disparities.

Additional longer-term impacts of a community disaster are mental health and economics, and the two are related. Particularly in communities that are economically marginal without adequate mental health resources, a disaster exacerbates that lack of resources.

In Los Angeles we made a great effort to provide an easy-to-learn approach to what’s called psychological first aid. It’s the mental health analogue of bystander CPR so that non-professional folks—neighbors, teachers, coaches or friends—understand some of the principles of psychological first aid, psychological triage and support. This provides more community capacity to deal with at least some part of the continuum of mental stress that goes with disasters. It’s an important approach that public health has been taking. There are inadequate mental health capacities even in non-disaster times and so that system has a very difficult time ramping up to meet the long-term mental health needs of individuals who go through and survive a disaster.

A community resilience framework is key to effective preparedness and response.

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