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The Future of Public Health Preparedness

March 9, 2009

midwayIt’s been several weeks since the Public Health Preparedness Summit in San Diego, so please accept my apologies for being so late with this update.

First of all, there were some really great sessions. There were some clunkers. Most were about what you’d expect: intelligent, best practices, good tips. My favorite was the keynote by Amanda Ripley. Her message about integrating the public into the planning process–or at least giving them some credit to act appropriately in a disaster–resonated throughout the huge room and hopefully caused some planners to re-evaluate how they approach disaster planning. I also have to give shouts out to the folks at the Cambridge APC and Seattle-King County Health Department for a really great session on pictograph and comic design.

But, I’d really like to talk about the clunker session, the opening plenary. The presenters were academics from across the country describing research they’d recently been funded to undertake on preparedness issues. Lots of acronyms, lots of academic-speak about systems design and experimental design and cross-disciplinary study development–bo-ring. But I stayed! Lo, I stayed. Then I got lots of drinks at the kickin’ reception on the USS Midway to make up for it.

While I was at the reception, Jack Hermann and I talked about the plenary. I called it dry, and he laughed. He understood. But he made a really great point about the session, and indeed the whole summit. He said that it’s needed in the field. It’s the next step to making sure that our field doesn’t get swallowed up by the better and better funded EMAs, as our funding dries up because the world has forgotten that the work we do is important.

The more I thought about it, the more I agreed with him. Everybody loves coming to these things and picking up all the free swag and meeting old friends and not being in work for a week, but there’s only so much trading of best practices that can happen.

The reason for this isn’t that there isn’t some really great work being done, it’s that our stuff never really gets practiced. I’ve been told that Pennsylvania’s pandemic flu plan is pretty good, but I can’t tell you the last time it was implemented and all the tiny things that could go wrong were pointed out and fixed in the next version. Because that can’t happen. Sure, they can exercise it, but if you’ve ever planned an exercise or attended one, you know about the “artificialities.” You can’t really replicate the press of bodies at the last grocery store that’s got food stocked, or the way that a thousand bodies move through a POD in an hour, or the exhaustion you’d feel after giving eleven thousand vaccinations during your shift.

In every other field, one of two things happen. Either you implement those plans (send the 5th Brigade over the ridge, call in the SWAT Team to establish a recon position, build a car), or you do research to make sure they work. Real, boring, academic research (coincidentally, that’s a great tag-line for a consulting firm). Sure, our HSEEP-certified exercises look great and our CDC-sponsored TAR reviews get into the plans, but there’s just no evidence that this stuff actually works. And maybe that’s what is needed to ensure that our work is valid and evidence-based. No more of this, “let’s review the pandemic flu plans of every state, and maybe in a couple of years we’ll publish some sort of review” business.

Maybe I’m just spouting off, but I see a field that’s rapidly losing funding and importance in the eyes of the folks who supply that funding, while our mission gets bigger and bigger. Something needs to be done to ensure that the folks in public health preparedness can continue to do what they do best.

One more note about Jack Hermann. Ladies, he is as ruggedly handsome as they say.

Photo credit: dunechaser

UPDATE: a post from my buddy Joel, on the Summit can be found here.

5 Comments leave one →
  1. Jack Herrmann permalink
    March 10, 2009 10:19 am

    Thank you for the follow up on the Summit. I’ve received great feedback from attendees, especially regarding the research plenary. As stated, I do believe that it is imperative that we highlight the importance of research in validating (or not) the work that we are doing in the field. While I believe that introducing the work of the new CDC Preparedness and Emergency Response Research Centers (PERRCs) in a plenary session goes toward raising the visibility of the important missions of these centers, the response and feedback I’ve received from the audience suggests that we have more to do to bridge the cultural divide of how academics speak the language of public health practitioners in the field and vice versa. Thank you again for your support of the Summit (and of me, though I’m not sure I agree with the last line of your blog..but do appreciate it:)

    • March 15, 2009 2:48 pm


      Thanks so much for stopping by. I think you guys pulled together a great summit and I look forward to making it again next year.


  2. March 10, 2009 9:35 pm

    Your post reminded me of conversations I had with one of my professors/mentors when working on my MPH. He made the point repeatedly that health departments (and all non-EMA preparedness/response entities) should make sure their preparedness efforts also work to improve the day-to-day operations. Things like improving COOP by streamlining processes and the like. That obviously doesn’t help with the big/specifically tasked projects like pandemic or CRI, but it is a way to argue for continuing the preparedness programs.

    And I agree 100% that something needs to be done to make sure that there is continued support for preparedness efforts and personnel.

    • March 15, 2009 2:53 pm


      I’m a huge advocate for not separating out preparedness efforts. I would argue that if your preparedness group is not doing stuff that directly supports the functioning of traditional public health sections, it needs some real tweaking. Pandemic planning is, to some degree, communicable disease control and continuity of government. CRI planning can be used for things like Hepatitis A outbreaks and meningitis outbreaks. Vulnerable populations planning should be done hand-in-hand with traditional outreach services. It makes no sense for a local health center to only know the prep folks, but not the maternal & child health folks and the lead abatement folks and the food protection folks.

      Friends, please meet my dead horse, now excuse me as I continue to beat that thing into submission.



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