The 2009 novel H1N1 epidemic identified the critical need for the emergency managers‟ knowledge of the US public health infrastructure and core concepts. The core concepts of public health - epidemiology, environmental health, health policy/administration, health behavior and biostatistics - that comprise most health departments and influence emergency planning assumptions and response mechanisms will be discussed. With over $1.35 billion in CDC administered PHER grant funding to date, the 2009 National Health Security Strategy‟s perspective that preparedness programs are not coordinated or efficient and significant disparities in breadth and quality of preparedness programming exist highlights a huge area for emergency management improvement and involvement. The current US public health preparedness infrastructure and grant programs will be outlined to identify areas for local and State EM coordination and interaction. The health reform bill‟s impact on emergency planning assumptions, including shifts in insurance structure and health paradigms, will also be presented. Public Health 101: What Every Emergency Manager Needs to Know Level: Intermediate  Brian Spendley, Associate, Hagerty Consulting  Nicole Errett, Emergency Management Planner, City of Baltimore Mayor's Office of Emergency Management

1. Public Health 101 What Every
Public Health 101 ‐ What Every
Emergency Manager Needs to Know
Partners in Emergency Preparedness Conference
April 27, 2011
p ,
Nicole Errett
Baltimore City Mayor s Office of Emergency Management
Baltimore City Mayor’s Office of Emergency Management
Brian Spendley
Hagerty Consulting
1
PIEP 2011

2.  Define Public Health and its core concepts
 Describe the U.S. Public Health Preparedness
Infrastructure
 Video and Discussion
 H1N1
 Identify implications of PPACA (Health Reform) on
emergency planning assumptions
l i i
2
PIEP 2011

3. Public Health Definition
Public Health Definition
Public health definition and
Public health definition and
prevention
3
PIEP 2011

4. Definition:
Is there one?
Is there one?
4
PIEP 2011

5.  Definition: “Public health emergency preparedness
(PHEP) is the capability of the public health and
health
h lth care systems, communities, and individuals, t
t iti d i di id l to
prevent, protect against, quickly respond to, and
recover from health emergencies, particularly those
whose scale, timing or unpredictability threatens to
overwhelm routine capabilities. Preparedness
involved a coordinated and continuous process of
planning and implementation that relies on measuring
performance and taking corrective action.”
 Source: Nelson, C., Lurie, N., Wasserman, J., and Zakowski, S. (2007) Conceptualizing and Defining Public Health Emergency
Preparedness. American Journal of Public Health, 97(S1), S9-S11.
5
PIEP 2011

6. 6
PIEP 2011

7.  3 Core Functions
 Assessment
 Policy Development
 Assurance
7
PIEP 2011

8.  Primary Prevention
 Secondary Prevention
 Tertiary Prevention
8
PIEP 2011

9.  Primary Prevention
 Prevent the outcome before it occurs (e.g. planning,
hazard mitigation, gap analysis, training and exercises)
h d iti ti l i t i i d i )
 Secondary Prevention
Secondary Prevention
 Early detection (e.g. surveillance)
 Tertiary Prevention
 Prevent the outcome from getting worse (e.g.
emergency management operations)
i )
9
PIEP 2011

10. 1
0 PIEP 2011
Picture: http://mickmaurer.com/DrillsAndExercises.html

11. …. Saving lives, millions at a time.
…. Saving lives, millions at a time.
1
1 PIEP 2011
Picture: http://www.iaem.org and http://www.jhsph.edu

12.  Undergraduate Degree Programs
 Master Degree Programs
 Doctoral Degree Programs
1
2 PIEP 2011

13.  You’re not alone!
1
3 PIEP 2011
Picture: http://www.accessrx.com/blog/current‐health‐news/hand‐washing‐and‐hand‐sanitizer‐study‐a914/

14. Core Concepts
p
What are the major
components of a public health
t f bli h lth
education?
1
4 PIEP 2011

15.  Biostatistics
 Epidemiology
 Health Policy and Management
 Environmental Health
 Health Policy and Management
 Social/Behavior Health Sciences
1
5 PIEP 2011

16. 1
6 PIEP 2011
Picture: http://www.njit.edu/features/images/sceneandheard/ms‐biostatistics.jpg

17. 1
7 PIEP 2011
Picture: http://scienceblogs.com/effectmeasure/2009/10/why_the_epidemiology_of_swine.php

18. 1
8 PIEP 2011
Picture: http://www.moldremovalcincinnati.com/flood.htm

19. HAZARD AND VULNERABILITY ASSESSMENT TOOL
NATURALLY OCCURRING EVENTS
SEVERITY = (MAGNITUDE - MITIGATION)
PROBABILITY RISK
HUMAN IMPACT PROPERTY IMPACT BUSINESS IMPACT PREPARED-NESS INTERNAL RESPONSE EXTERNAL RESPONSE
EVENT
Community/ Mutual Aid staff
Likelihood this will occur Possibility of death or injury Physical losses and damages Interuption of services Preplanning Time, effectivness, resouces Relative threat*
and supplies
0 = N/A 1 = Low 0 = N/A 1 = Low 0 = N/A 1 = Low 0 = N/A 1 = Low 0 = N/A 1 = High 0 = N/A 1 = High 0 = N/A 1 = High
SCORE 2 = Moderate 3 = High 2 = Moderate 3 = High 2 = Moderate 3 = High 2 = Moderate 3 = High 2 = Moderate 3 = Low or none 2 = Moderate 3 = Low or none 2 = Moderate 3 = Low or none
0 - 100%
Hurricane 0%
Tornado 0%
Severe Thunderstorm 0%
Snow Fall 0%
Blizzard 0%
Ice Storm 0%
Earthquake 0%
Tidal Wave 0%
Temperature Extremes 0%
Drought 0%
Flood, External 0%
Wild Fire 0%
Landslide 0%
Dam Inundation
Volcano 0%
Epidemic
E id i 0%
AVERAGE SCORE 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0%
*Threat increases with percentage.
0
RISK = PROBABILITY * SEVERITY IAEM 2010 19
0.00 0.00 0.00
0

20.  Pictures of recent CSXT
2
0 PIEP 2011

21. 2
1 PIEP 2011

22. 2
2 PIEP 2011

23. 2
3 PIEP 2011

24. Public Health in the United States
Research, Practice, and
, ,
Infrastructure
2
4 PIEP 2011

25.  Where is public
health researched?
 Where is public
health practiced?
h lh d?
2
5 PIEP 2011

26.  What is the foundation?
 Pandemic and All Hazards Preparedness Act (PAHPA)
 National Health Security Strategy (NHSS)
2
6 PIEP 2011

27.  Amended the Public Health Service Act to
establish a new Assistant Secretary for
Preparedness an Response (ASPR)
P d R (ASPR)
 Called for a quadrennial National Health Security
Strategy (NHSS)
Strategy (NHSS)
2
7 PIEP 2011

28.  What is it?
 National Health Security is a state in which the nation and its
people are prepared for, protected from, and resilient in the
people are prepared for protected from and resilient in the
face of health threats with potentially negative
consequences.
 T G l
Two Goals
 Build community resilience
 Strengthen and sustain health and emergency response
Strengthen and sustain health and emergency response
systems.
 No unfunded mandates. Aligns with the NRF and NSS.
2
8 PIEP 2011

29. 2
9 PIEP 2011

30.  Created under PAHPA
 Lead in the nation in
preventing, preparing
for, and responding to
the adverse health
the adverse health
effects of public
health emergencies
health emergencies
and disasters.
3
0 PIEP 2011

31.  Mi i
Mission: Collaborating
C ll b ti
to create the expertise,
information, and tools
that people and
that people and
communities need to
protect their health –
through health
through health
promotion, prevention
of disease, injury and
disability, and
disability and
preparedness for new
health threats.
3
1 PIEP 2011

32. MA: 6 State
Agencies, 1 County
HD, 4 regional HD,
HD 4 i l HD
351 municipal
board of health
MD: 6 State
MD: 6 State
Agencies, 24 local
county health
departments
3
2 PIEP 2011

33. Video
H1N1 Flu in Review: The HHS
Response
3
3 PIEP 2011

34. Discussion
H1N1 Novel Influenza
H1N1 N l I fl
3
4 PIEP 2011

35. Health Reform: Patient Protection and
Affordable Care Act (PPACA)
Affordable Care Act (PPACA)
What is it?
How does it affect planning
assumptions?
3
5 IAEM 2010

36.  Individual Mandate
 Employer Mandate
Employer Mandate
 Health Insurance Exchange
Health Insurance Exchange
 Medicaid Expansion
Medicaid xpansion
 Minimum Coverage
g
3
6 IAEM 2010
Picture: http://www.deha.org/FedLegislation.html

37.  Reduces uninsured by
32 million in 2019
(CBO Estimate)
(CBO E ti t )
 Decreases
vulnerability
 May decrease cost
IIncreases
transparency
3
7 IAEM 2010