America’s preparedness for managing health emergencies is improving, yet progress is slow and regional inequities persist. Miami-Dade County shows us that actively engaging communities is key to improving local health security.
Hurricanes and tornados, Zika and Ebola, wildfires and flash floods, terrorist attacks and tainted water systems. Threats to American health security are on the rise and could hit U.S. communities at any time. The responsibility for preparing for potential threats and keeping people safe doesn’t fall on any one official or institution but on diverse and diffuse government agencies, health care organizations, public health, non-profit organizations, business leaders and community members.
Since 2013, the Robert Wood Johnson Foundation (RWJF) has been measuring how ready our nation is to face emergencies that threaten health and well-being through the National Health Security Preparedness Index (Preparedness Index).
Originally developed by the Centers for Disease Control and Prevention (CDC), and overseen by our partners at the University of Kentucky, the Preparedness Index analyzes more than 130 measures in each of the states and across the nation. Measures include things like hazard planning in public schools, food and water safety monitoring, wireless 9-1-1 capabilities, flu vaccination rates, and access to paramedics and hospitals.
This year, on a scale from one to 10, the United States as a whole scored 6.8. That’s an improvement of 6.3 percent since the Preparedness Index launched and 1.5 percent over last year. Yet our nation’s health security remains less than optimal.
Gaps persist in how well people are protected in different parts of the country.
In many parts of the nation, we’re just not doing well enough on some basic measures that are important not only in emergencies but for long-term health and well-being overall. Of the six broad categories the measures fall into (community planning and engagement, incident and information management, health care delivery, countermeasure management, and environmental and occupational health), the nation’s lowest score is in health care delivery (5.3 out of 10). This means that hospitals in many regions would be hard-pressed to manage the level of trauma a widespread health emergency might entail.
In their overall scores, the least-prepared states lag 31 percent behind the best-prepared states, which include Vermont, Maryland, Virginia, Maine, Nebraska, New York and Wisconsin. In particular, people who live in states in the Deep South and Mountain West regions have much lower health security than those in other parts of the country. They are also more likely to have low or moderate incomes or live in rural areas, and therefore have fewer personal and community resources to draw upon in the event of an emergency.
Health security is possible when communities come together and plan in advance.
Historically, it’s been a struggle for communities to foster supportive relationships among government agencies, community organizations and individual residents in the interest of responding to emergencies in a coordinated way. But in this regard, things are changing for the better: The national score for community planning and engagement has improved 16.3 percent over the last four years.
That’s a great sign. It tells us that improving health security really is possible when communities come together.
A 2016 RWJF Culture of Health Prize winner, Miami-Dade County, is a strong example of proactive collaboration for health security. Last year, as panic over the Zika virus gripped the Western Hemisphere, all eyes turned to Miami. Given its proximity to Central and South American countries with active Zika transmission, it was one of the places where the disease was expected to surface in the United States.
Miami-Dade public health officials had strong existing relationships and coalitions to engage in preparing for this potential onset and response to emerging cases of Zika. Rather than waiting for an emergency, officials had been proactively meeting and maintaining contact with mayors, police and fire departments, hospital administrators, educators, social service providers, business leaders, and others.
"This ongoing effort made coordinating among 34 municipalities, 35 hospitals, and the nation’s fourth-largest school system much easier than it might have been," says Lillian Rivera, administrator of the Florida Department of Health in Miami-Dade County.
Before emergency strikes, she says, “It’s important that people trust and understand what we do and how public health affects them. You can’t wait until an event to do that.”
These existing relationships across the Miami community, as well as with state government and the CDC, enabled Rivera’s department to work quickly, tracking cases and educating the public through presentations within the community. They visited universities, public schools and private businesses to explain how Zika is transmitted, the importance of wearing clothing that protects the arms and legs, and using mosquito repellant to prevent bites. They asked the public to take precautions while traveling abroad and to wear repellant for three weeks after returning. This way, they would be less likely to transmit the disease to others.
The strong systems and planning Miami-Dade County had in place also prepared them for other health threats that came their way. For instance, "they were able to effectively respond to Hurricane Matthew which hit right in the midst of the Zika crisis," says Natasha Strokin, public health preparedness director at the Florida Department of Health in Miami-Dade County.
“When Matthew was approaching, we erased all things Zika from our dry erase board and put in the hurricane response,” she says, emphasizing that the county’s Zika response continued even as the hurricane took priority. “Then as soon as the hurricane shelter shut down, we erased the board again and put Zika back up.”
This year, the Department of Health in Miami-Dade will be at summer camps, parks, and at town halls to continue educating the public about how to stay safe from Zika and other insect-borne diseases. They are holding town hall meetings to keep the public informed about what will happen in case of an outbreak, and Rivera is regularly meeting mayors and county leaders. Mayors are working with the county’s code enforcers to remove mosquito breeding grounds, and the county will roll out a new public health campaign, “Fight the Bite.”
Miami’s experience with Zika is a good reminder that though health security prepares us for emergencies, it’s not something that happens on the spot. It’s an intentional and continuous process that we’re never done with.