Public Health Preparedness

"Preparedness is a process, not a destination," states the authorof one of the papers in this special issue of Health Affairs.Indeed, public health preparedness in the United States hasa long history of flow/reaction/action, taking various twistsand turns as the unknown unfolds. Preparedness increasinglyhas become a priority alongside public health’s other,more traditional priorities. For instance, the Centers for PublicHealth Preparedness (CPHP) program of the Centers for DiseaseControl and Prevention (CDC) was initiated in 2000 to strengthenpreparedness for terrorism and emergencies by linking academicexpertise to state and local health agencies. And the preparednessprocess continues to morph as the country reacts to and takesaction on terrorist acts and bioterrorist threats, the hurricanedisasters of 2005, the threat of flu pandemics—and, ofcourse, whatever else awaits us. The following papers explorethe current state of U.S. public health preparedness from threediffering vantage points: the evolving effect on public healthagencies, the collaborative role with emergency response systems,and the government’s roles when issuing mandatory evacuationorders.

First, RAND authors Nicole Lurie, Jeffrey Wasserman, and ChristopherNelson examine how integrating public health practice with emergencypreparedness is helping the public health system respond moreeffectively and economically to broader challenges. The evolutionarypace of this integration is slow, they note, and there are challengingbarriers, such as inadequate accountability systems and littleconsensus on who should be responsible for what. It will takesome revolutionary thinking—and action—to move thepublic health system sufficiently forward, they conclude.

Next, Aaron Katz, Andrea Staiti, and Kelly McKenzie, all affiliatedwith the Center for Studying Health System Change, narrow thefocus to look at what’s happening with emergency preparednessin communities. They find that collaborative relationships developedfor bioterrorism preparedness also have been useful in addressingother threats, such as natural disasters and infectious diseases.But they find, too, that there is a need for sizable fundingincreases if the United States is to have a public health infrastructurethat improves community preparedness.

When it comes to mandatory evacuation during an emergency ordisaster, public health practices have a unique, historicalperspective on legal, practical, and ethical issues, write AmyFairchild, James Colgrove, and Marian Jones. These ColumbiaUniversity authors state that in mandatory evacuations, thegovernment has a responsibility to decide what needs to be donewhen, as well as to provide a wide range of assistance. Theythen outline a number of these dual responsibilities, includingenforcing mandatory evacuation orders (with penalties for refusing)and establishing and updating registries of special-needs peoplewho would need help in an emergency.

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