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Centers for Disease Control and Prevention, & Centers for Disease Control and Prevention. (2011). Public health preparedness capabilities: National standards for state and local planning. Atlanta, GA: Centers for Disease Control and Prevention.‏

Abstract:

In 2011, CDC established 15 capabilities that serve as national standards for public health preparedness planning. Since then, these capability standards have served as a vital framework for state, local, tribal, and territorial preparedness programs as they plan, operationalize, and evaluate their ability to prepare for, respond to, and recover from public health emergencies.

Public health departments have made progress since 2001, as demonstrated in CDC’s state preparedness reports (http://www.cdc.gov/phpr/reportingonreadiness.htm).

However, state and local public health departments continue to face multiple challenges, including an ever-evolving list of public health threats.  Regardless of the threat, an effective public health response begins with an effective public health system with robust systems in place to conduct routine public health activities.

The resulting body of work, Public Health Preparedness Capabilities: National Standards for State and Local Planning, hereafter referred to as public health preparedness capabilities, creates national standards for public health preparedness capability-based planning and will assist state and local planners in identifying gaps in preparedness, determining the specific jurisdictional priorities, and developing plans for building and sustaining capabilities. These standards are designed to accelerate state and local preparedness planning, provide guidance and recommendations for preparedness planning, and, ultimately, assure safer, more resilient, and better prepared communities.  

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Centers for Disease Control and Prevention (U.S.) (2018). Public Health Preparedness and Response 2018 National Snapshot. Pp 1-57.Available at:https://www.cdc.gov/phpr/pubs-links/2018/documents/2018_Preparedness_Report.pdf.‏

Abstract:

"An emergency can happen at any moment, and the U.S. must be ready to respond to pandemics, natural disasters, or chemical or radiological threats. Our actions in this area directly serve to protect the health of the American people and is a matter of national security. The terrorist and anthrax attacks of 2001 revealed critical gaps in our nation's preparedness and our ability to connect around response efforts. Emerging diseases like H7N9, MERS [Middle East Respiratory Syndrome], Ebola, and Zika continue to show us that we cannot let our guard down. Preparedness demands constant vigilance and investment to keep up with public health threats as they evolve."

The Snapshot highlights preparedness activities and investments at the federal, state, and local levels, and features stories that demonstrate the impact of these activities. There are two sections to this report: the Narrative and PHEP Program Fact Sheets. The Narrative describes CDC preparedness and response activities in 2016 and 2017 and demonstrates how investments in preparedness enhance the nation’s ability to respond to public health threats and emergencies. The PHEP Program Fact Sheets provide information on PHEP funding from 2015 to 2017 and trends and progress related to the 15 public health preparedness capabilities defined in the PHEP Cooperative Agreement

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Federal Emergency Management Agency (2016). Protection Federal Interagency Operational Plan. Available at: https://www.fema.gov/federal-interagency-operational-plans.‏

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Gesser-Edelsburg, A., Stolero, N., Mordini, E., Billingsley, M., James, J. J., & Green, M. S. (2015). Emerging infectious disease (EID) communication during the 2009 H1N1 influenza outbreak: Literature review (2009-2013) of the methodology used for EID communication analysis. Disaster medicine and public health preparedness, 9(2), 199-206.  

Abstract:

This year alone has seen outbreaks of epidemics such as Ebola, Chikungunya, and many other emerging infectious diseases (EIDs). We must look to the responses of recent outbreaks to help guide our strategies in current and future outbreaks or we risk repeating the same mistakes. The objective of this paper was to conduct a systematic literature review of the methodology used by studies that examined EID communication during the 2009 H1N1 pandemic outbreak through different communication channels or by analyzing contents and strategies. This was a systematic review of the literature (n=61) studying risk communication strategies of H1N1 influenza, published between 2009 and 2013, and retrieved from searches of computerized databases, hand searches, and authoritative texts by use of specific search criteria. Searches were followed by review, categorization, and mixed qualitative and quantitative content analysis. Of 41 articles that used quantitative methods, most used surveys (n=35); some employed content analyses (n=4) and controlled trials (n=2). The 16 articles that employed qualitative methods relied on content analyses (n=10), semi-structured interviews (n=2) and focus groups (n=4). Four more articles used mixed-methods or nonstandard methods. Seven different topic categories were found: risk perception and effects on behaviors, framing the risk in the media, public concerns, trust, optimistic bias, uncertainty, and evaluating risk communication. Up until 2013, studies tended to be descriptive and quantitative rather than discursive and qualitative and to focus on the role of the media as representing information and not as a medium for actual communication with the public. Several studies from 2012, and increasingly more in 2013, addressed issues of discourse and framing and the complexity of risk communication with the public. Formative evaluations that use recommendations from past research when designing communication campaigns from the first stages of crises are recommended. Research should employ diverse triangulation processes based on representatives from different stakeholders. Further studies should address the potential offered by social media to create dialogue with individuals and the public at large.

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Gesser-Edelsburg, A., Shir-Raz, Y., Walter, N., Mordini, E., Dimitriou, D., James, J. J., & Green, M. S. (2015). The public sphere in emerging infectious disease communication: recipient or active and vocal partner?. Disaster medicine and public health preparedness, 9(4), 447-458.‏

Abstract:

Recent years have seen advances in theories and models of risk and crisis communication, with a focus on emerging epidemic infection. Nevertheless, information flow remains unilateral in many countries and does not take into account the public's polyvocality and the fact that its opinions and knowledge often "compete" with those of health authorities. This article addresses the challenges organizations face in communicating with the public sphere. Our theoretical approach is conceptualized through a framework that focuses on the public sphere and that builds upon existing guidelines and studies in the context of health and pandemics. We examine how health organizations cope with the public's transformation from recipients to an active and vocal entity, i.e., how and to what extent health organizations address the public's anxiety and concerns arising in the social media during outbreaks. Although international organizations have aspired to relate to the public as a partner, this article identifies notable gaps. Organizations must involve the public throughout the crisis and conduct dialogues free of prejudices, paternalism, and preconceptions. Thereby, they can impart precise and updated information reflecting uncertainty and considering cultural differences to build trust and facilitate cooperation with the public sphere.  

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Gesser-Edelsburg, A., Shir-Raz, Y., Bar-Lev, O. S., James, J. J., & Green, M. S. (2016). Outbreak or epidemic? How Obama’s language choice transformed the Ebola outbreak into an epidemic. Disaster medicine and public health preparedness, 10(4), 669-673.  

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Our aim was to examine in what terms leading newspapers' online sites described the current Ebola crisis. We employed a quantitative content analysis of terms attributed to Ebola. We found and analyzed 582 articles published between March 23 and September 30, 2014, on the online websites of 3 newspapers: The New York Times, Daily Mail, and Ynet. Our theoretical framework drew from the fields of health communication and emerging infectious disease communication, including such concepts as framing media literacy, risk signatures, and mental models. We found that outbreak and epidemic were used interchangeably in the articles. From September 16, 2014, onward, epidemic predominated, corresponding to when President Barack Obama explicitly referred to Ebola as an epidemic. Prior to Obama's speech, 86.8% of the articles (323) used the term outbreak and only 8.6% (32) used the term epidemic. Subsequently, both terms were used almost the same amount: 53.8% of the articles (113) used the term outbreak and 53.3% (112) used the term epidemic. Effective communication is crucial during public health emergencies such as Ebola, because language framing affects the decision-making process of social judgments and actions. The choice of one term (outbreak) over another (epidemic) can create different conceptualizations of the disease, thereby influencing the risk signature

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Green, M. S., Pri-or, N. G., Capeluto, G., Epstein, Y., & Paz, S. (2013). Climate change and health in Israel: adaptation policies for extreme weather events. Israel journal of health policy research, 2(1), 23.  

Abstract:

Climatic changes have increased the world-wide frequency of extreme weather events such as heat waves, cold spells, floods, storms and droughts. These extreme events potentially affect the health status of millions of people, increasing disease and death. Since mitigation of climate change is a long and complex process, emphasis has recently been placed on the measures required for adaptation. Although the principles underlying these measures are universal, preparedness plans and policies need to be tailored to local conditions. In this paper, we conducted a review of the literature on the possible health consequences of extreme weather events in Israel, where the conditions are characteristic of the Mediterranean region. Strong evidence indicates that the frequency and duration of several types of extreme weather events are increasing in the Mediterranean Basin, including Israel. We examined the public health policy implications for adaptation to climate change in the region, and proposed public health adaptation policy options. Preparedness for the public health impact of increased extreme weather events is still relatively limited and clear public health policies are urgently needed. These include improved early warning and monitoring systems, preparedness of the health system, educational programs and the living environment. Regional collaboration should be a priority.

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Khan, Y., Fazli, G., Henry, B., de Villa, E., Tsamis, C., Grant, M., & Schwartz, B. (2015). The evidence base of primary research in public health emergency preparedness: a scoping review and stakeholder consultation. BMC public health, 15(1), 432.‏

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Background - Effective public health emergency preparedness and response systems are important in mitigating the impact of all-hazards emergencies on population health. The evidence base for public health emergency preparedness (PHEP) is weak, however, and previous reviews have noted a substantial proportion of anecdotal event reports. To investigate the body of research excluding the anecdotal reports and better understand primary and analytical research for PHEP, a scoping review was conducted with two objectives: first, to develop a thematic map focused on primary research; and second, to use this map to inform and guide an understanding of knowledge gaps relevant to research and practice in PHEP.

Methods - A scoping review was conducted based on established methodology. Multiple databases of indexed and grey literature were searched based on concepts of public health, emergency, emergency management/preparedness and evaluation/evidence. Inclusion and exclusion criteria were applied iteratively. Primary research studies that were evidence-based or evaluative in nature were included in the final group of selected studies. Thematic analysis was conducted for this group. Stakeholder consultation was undertaken for the purpose of validating themes and identifying knowledge gaps. To accomplish this, a purposive sample of researchers and practicing professionals in PHEP or closely related fields was asked to complete an online survey and participate in an in-person meeting. Final themes and knowledge gaps were synthesized after stakeholder consultation.

Results - Database searching yielded 3015 citations and article selection resulted in a final group of 58 articles. A list of ten themes from this group of articles was disseminated to stakeholders with the survey questions. Survey findings resulted in four cross-cutting themes and twelve stand-alone themes. Several key knowledge gaps were identified in the following themes: attitudes and beliefs; collaboration and system integration; communication; quality improvement and performance standards; and resilience. Resilience emerged as both a gap and a cross-cutting theme. Additional cross-cutting themes included equity, gender considerations, and high risk or at-risk populations.

Conclusions - In this scoping review of the literature enhanced by stakeholder consultation, key themes and knowledge gaps in the PHEP evidence base were identified which can be used to inform future practice-oriented research in PHEP.

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Markiewicz, M., Bevc, C. A., Hegle, J., Horney, J. A., Davies, M., & MacDonald, P. D. (2012). Linking public health agencies and hospitals for improved emergency preparedness: North Carolina's public health epidemiologist program. BMC Public Health, 12(1), 141.‏

Abstract:

Background - We describe the specific services public health epidemiologists provide to local health departments, the North Carolina Division of Public Health, and the hospitals in which they are based, and assess the value of these services to stakeholders.

Methods - We surveyed and/or interviewed public health epidemiologists, communicable disease nurses based at local health departments, North Carolina Division of Public Health staff, and public health epidemiologists' hospital supervisors to 1) elicit the services provided by public health epidemiologists in daily practice and during emergencies and 2) examine the value of these services. Interviews were transcribed and imported into ATLAS.ti for coding and analysis. Descriptive analyses were performed on quantitative survey data.

Results - Public health epidemiologists conduct syndromic surveillance of community-acquired infections and potential bioterrorism events, assist local health departments and the North Carolina Division of Public Health with public health investigations, educate clinicians on diseases of public health importance, and enhance communication between hospitals and public health agencies. Stakeholders place on a high value on the unique services provided by public health epidemiologists.

Conclusions - Public health epidemiologists effectively link public health agencies and hospitals to enhance syndromic surveillance, communicable disease management, and public health emergency preparedness and response. This comprehensive description of the program and its value to stakeholders, both in routine daily practice and in responding to a major public health emergency, can inform other states that may wish to establish a similar program as part of their larger public health emergency preparedness and response system.

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Murthy, B. P., Molinari, N. A. M., LeBlanc, T. T., Vagi, S. J., & Avchen, R. N. (2017). Progress in public health emergency preparedness—United States, 2001–2016. American journal of public health, 107(S2), S180-S185.‏

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Objectives. To evaluate the Public Health Emergency Preparedness (PHEP) program’s progress toward meeting public health preparedness capability standards in state, local, and territorial health departments.

Methods. All 62 PHEP awardees completed the Centers for Disease Control and Prevention’s self-administered PHEP Impact Assessment as part of program review measuring public health preparedness capability before September 11, 2001 (9/11), and in 2014. We collected additional self-reported capability self-assessments from 2016. We analyzed trends in congressional funding for public health preparedness from 2001 to 2016.

Results. Before 9/11, most PHEP awardees reported limited preparedness capabilities, but considerable progress was reported by 2016. The number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had the largest increase, almost 200%, by 2014. However, more than 20% of jurisdictions still reported underdeveloped coordination between the health system and public health agencies in 2016. Challenges and barriers to building PHEP capabilities included lack of trained personnel, plans, and sustained resources.

Conclusions. Considerable progress in public health preparedness capability was observed from before 9/11 to 2016. Support, sustainment, and advancement of public health preparedness capability is critical to ensure a strong public health infrastructure.

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