Abstract
As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. While each incident is unique, the number and type of response activities are finite; therefore, through comparative analysis, we can learn about commonalities in the response patterns that could improve predictions and expectations regarding the resources and capabilities required to respond to future acute events. In this study, we interviewed representatives from more than 120 local health departments regarding their recent experiences with real-world acute public health incidents, such as infectious disease outbreaks, severe weather events, chemical spills, and bioterrorism threats. We collected highly structured data on key aspects of the incident and the public health response, particularly focusing on the public health activities initiated and community partners engaged in the response efforts. As a result, we are able to make comparisons across event types, create response profiles, and identify functional and structural response patterns that have import for future public health preparedness and response. Our study contributes to clarifying the complexity of public health response systems and our analysis reveals the ways in which these systems are adaptive to the character of the threat, resulting in differential activation of functions and partners based on the type of incident. Continued and rigorous examination of the experiences of health departments throughout the nation will refine our very understanding of what the public health response system is, will enable the identification of organizational and event inputs to performance, and will allow for the construction of rich, relevant, and practical models of response operations that can be employed to strengthen public health systems.
Highlights
As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses
Adopting the maxim that ‘‘all emergencies are local,’’ we focused this research on describing the public health response systems from the perspective of the local health department
We examine three domains through structured interviews with public health authorities involved in response efforts, including: (1) key characteristics of the acute event context, (2) the number and type of public response activities initiated using the CDC Public Health Preparedness (PHEP) Capabilities as an organizing framework, and (3) the number and type of organizations contributing to the public health response activities
Summary
As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. A number of challenges have been cited as barriers to research advancement in this field, including: the infrequent nature of large-scale public health emergencies [3,5,6,7], the heterogeneity of emergency events and of public health delivery structures [3,6], the challenges with access to incident leadership during real-world emergencies [7], the limited ability for standardized surveys to measure complex agency and system processes [6], and the difficulty of identifying a comparison group or constructing a counterfactual of what might have occurred if particular public health interventions had not taken place [8,9]. Simulated emergencies introduce artificialities that do not reflect real-world response situations [12]
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