System Preparedness Research Articles

Assessment of Primary Laboratory Facilities for Rural Health Care Preparedness in Osmanabad District, India

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centres (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services, and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most, followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in the form of laboratory services is essential in primary health care facilities.

The impact of the COVID-19 pandemic on HIV treatment gap lengths and viremia among people living with HIV British Columbia, Canada, during the COVID-19 pandemic: Are we ready for the next pandemic?

The SARS-CoV-2 (COVID-19) pandemic has impacted the care of people living with HIV (PLWH). This study aims to characterize the impact of the pandemic on the length of HIV treatment gap lengths and viral loads among people living with HIV (PLWH) in British Columbia (BC), Canada, with a focus on Downtown Eastside (DTES), which is one of the most impoverished neighbourhoods in Canada. We analyzed data from the HIV/AIDS Drug Treatment Program from January 2019 to February 2022. The study had three phases: Pre-COVID, Early-COVID, and Late-COVID. We compared results for individuals residing in DTES, those not residing in DTES, and those with no fixed address. Treatment gap lengths and viral loads were analyzed using a zero-inflated negative binomial model and a two-part model, respectively, adjusting for demographic factors. Among the 8982 individuals, 93% were non-DTES residents, 6% were DTES residents, and 1% had no fixed address during each phase. DTES residents were more likely to be female, with Indigenous Ancestry, and have a history of injection drug use. Initially, the mean number of viral load measurements decreased for all PLWH during the Early-COVID, then remained constant. Treatment gap lengths increased for all three groups during Early-COVID. However, by Late-COVID, those with no fixed address approached pre-COVID levels, while the other two groups did not reach Early-COVID levels. Viral loads improved across each phase from Pre- to Early- to Late-COVID among people residing and not residing in DTES, while those with no fixed address experienced consistently worsening levels. Despite pandemic disruptions, both DTES and non-DTES areas enhanced HIV control, whereas individuals with no fixed address encountered challenges. This study offers insights into healthcare system preparedness for delivering HIV care during future pandemics, emphasizing community-driven interventions with a particular consideration of housing stability.

Swedish crisis preparedness planners' understanding and sense‐making of preparedness work in a public organisation: Implications for future development

AbstractThe sometimes rapid development of (new) threats and extraordinary events calls for a robust, flexible, and well‐equipped civil crisis preparedness system to respond and limit the damage of crisis events. To achieve this, Swedish municipalities and regions are required by law to regularly perform and report risk and vulnerability analysis ‘bottom up’ to governmental agencies. When performed in large and complex public organisations, crisis preparedness planning activities require negotiation, coordination, and cooperation among large numbers of people. Crisis preparedness planners facilitate and produce this proactive crisis preparedness work. However, research has revealed that preparedness planners face organisational and practical challenges when performing their work.This study aims at increasing the knowledge of crisis preparedness planners' understandings and sense‐making of their work in one Swedish region when fulfilling the requirements set by the Swedish national regulations. The objectives of this paper are to present findings on (1) how the preparedness planners understand and make sense of their crisis preparedness work; (2) which major enablers and barriers that affect their work; and, based on the results, (3) forward possibilities for improvement.Semi‐structured interviews were conducted with the 10 crisis preparedness planners. A narrative stepwise analysis approach was applied. The analysis results revealed challenges in the crisis preparedness work due to uncommitted managers, unclear goalsetting, and the planners' sometimes limited skills in crisis preparedness work. It also report on managers' autonomy and varying focus on crisis preparedness, planners' unclear individual work space, and many different and sometimes strong voices about the work performance and content. This raises the question whose interest that in practice sets the agenda for crisis preparedness planning in the organisation.The study demonstrates needs for increased organisational sense‐making on the concept of crisis preparedness and how it should be performed, and for conceptual and technical skills to perform the preparedness work. To increase sense‐making and strengthen generic subjectivity on crisis preparedness work, further discussions are needed about enablers and barriers in preparedness work and an increased joint focus on possible internal and external threats. There are also needs for increased manager‐coworker‐planner cooperation when developing the preparedness work, and strategic changes in the organisational development involving goalsetting for crisis preparedness ‘top‐down’ as well as ‘bottom‐up’.

Analysing health system capacity and preparedness for climate change

Analysing health system capacity and preparedness for climate change

Public Health System's Preparedness to Address Polycystic Ovarian Syndrome: A Rapid Assessment Survey of Health-care Providers in India.

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders largely affecting women of reproductive age group. This study aimed to understand the Indian public health-care systems' preparedness in addressing PCOS. A multicentric rapid assessment cross-sectional study was undertaken among 173 health-care providers serving across various public health-care facilities in India. This study was a component of a larger task force study that aimed to estimate the community-based prevalence of PCOS in India. Information on PCOS cases reported that knowledge about PCOS diagnosis, management practices, availability of diagnostic facilities, and drugs was explored. Irregular menstrual cycle was the most commonly reported PCOS symptom. Most of the health-care providers (HCPs) lacked correct knowledge about diagnostic criteria and investigation needed for the diagnosis of PCOS. Diagnostic facilities and drugs were inadequate. However, some facilities had access to investigations through public-private partnerships. Awareness programs on PCOS in the community were negligible, and PCOS cases were not documented. Training HCPs on PCOS along with the availability of specialists and strengthening diagnostic facilities were some major demands from the HCPs. Results suggest the need for training HCPs, strengthening infrastructure with good referral linkages, and adequate supply of drugs to help improve PCOS management at public health-care facilities in India. There is a need to develop national technical and operational guidelines to address PCOS using a multidisciplinary approach across all levels of care. Creating demand for services and advocating healthy lifestyles through community awareness can help early diagnosis and prevention of complications.

Knowledge of non-communicable diseases and access to healthcare services among adults before and during COVID-19 pandemic in rural Tanzania.

The COVID-19 pandemic significantly affected access to healthcare services, particularly among individuals living with Non-Communicable Diseases (NCDs) who require regular healthcare visits. Studies suggest that knowledge about a specific disease is closely linked to the ability to access services for that condition. In preparation for the future, we conducted the study to assess knowledge of NCDs and access to healthcare services among adults residing in rural areas before and during the COVID-19 pandemic. We conducted a community-based cross-sectional study in rural Tanzania in October 2022, a few months after the end of the third wave of the COVID-19 pandemic. A total of 689 community residents participated in the study. The level of knowledge of NCDs was assessed using an 11-item Likert questionnaire, which was later dichotomized into adequate and inadequate levels of knowledge. In addition, access to healthcare was assessed before and during the pandemic. We summarized the results using descriptive statistics and logistic regression was applied to determine factors associated with adequate levels of knowledge of NCDs. All statistical tests were two-sided; a p-value <0.05 was considered statistically significant. All data analyses were performed using SPSS. Among 689 participants, more than half 369 (55%) had adequate knowledge of whether a disease is NCD or not; specifically, 495 (73.8%), 465 (69.3%), and 349 (52%) knew that hypertension, diabetes mellitus, and stroke are NCDs while 424 (63.2%) know that UTI is not NCD. Of the interviewed participants, 75 (11.2%) had at least one NCD. During the COVID-19 pandemic the majority 57 (72.2%) accessed healthcare services from nearby health facilities followed by traditional healers 10 (12.7%) and community drug outlets 8 (10.1%). Residence and education level were found to be significantly associated with knowledge of NCDs among participants. The study revealed that the community has a moderate level of knowledge of NCDs, and during the COVID-19 pandemic outbreaks, people living with NCD (s) relied on nearby health facilities to obtain healthcare services. Health system preparedness and response to pandemics should take into account empowering the community members to understand that NCD care is continuously needed even during pandemic times. We further advocate for a qualitative study to explore contextual factors influencing the knowledge of NCDs and access to healthcare services beyond the big domains of education and residence.

Lessons learned from health system rehabilitation preparedness and response for disasters in LMICs: a scoping review.

Disasters such as earthquakes, conflict, or landslides result in traumatic injuries creating surges in rehabilitation and assistive technology needs, exacerbating pre-existing unmet needs. Disasters frequently occur in countries where existing rehabilitation services are underdeveloped, hindering response to rehabilitation demand surge events. The primary aim of this scoping review is therefore to synthesize the evidence on rehabilitation and assistive technology preparedness and response of health systems in LMICs to the demand associated with disasters and conflict situations. A secondary aim was to summarize related recommendations identified in the gathered literature. A scoping review was conducted using the Arksey and O'Malley framework to guide the methodological development. The results are reported in accordance with PRISMA-ScR. Four bibliographic databases were used: CINHAL, Cochrane, Pubmed, Scopus and. Key international organisations were also contacted. The search period was from 2010-2022. Eligible publications were categorized for analysis under the six World Health Organization health systems buildings blocks. The findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMICs. Of the 27 studies included in the scoping review, 14 focused on service delivery, 6 on health workforce, 4 on health information systems and 3 on the leadership and governance building block. No study focused on financing nor assistive technology. This review found the most frequently referenced recommendations for actions that should be taken to develop rehabilitation services in disasters to be: the provision early and multi-professional rehabilitation, including the provision of assistive technology and psychological support, integrated community services; disaster response specific training for rehabilitation professionals; advocacy efforts to create awareness of the importance of rehabilitation in disasters; and the integration of rehabilitation into disaster preparedness and responseplans. Findings of this scoping review suggest that rehabilitation is poorly integrated into health systems disaster preparedness and response in LMIC's, largely due to low awareness of rehabilitation, undeveloped rehabilitation health systems and a lack of rehabilitation professionals, and disaster specific training for them. The paucity of availableevidence hinders advocacy efforts for rehabilitation in disaster settings and limits the sharing of experiences and lessons learnt to improve rehabilitation preparedness and response. Advocacy efforts need to be expanded.

What makes health systems resilient? An analytical framework drawing on European learnings from the COVID-19 pandemic based on a multitiered approach

IntroductionThe COVID-19 pandemic posed an unprecedented challenge, which caught many health systems widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience...

Health System Preparedness, Response, and Incidence of Dengue in District Mianwali

Dengue is a mosquito-borne viral infection caused by the dengue virus. It has 4 different serotypes and is mainly spread by Aedes mosquitoes. The disease is a significant public health problem worldwide. Objective: Assess district health system preparedness for Dengue outbreaks, identify gaps, strengthen surveillance, and determine incidence post-preventive measures. Methods: The study was a mixed-method design, using both qualitative and quantitative approaches. A cross-sectional design was used to assess the incidence of dengue. Results: A total of 118 participants were selected for questionnaire-based interviews out of which 47.9% were male and 51.3% were females. The average age of the participants was 38.58 ± 9.63 with a minimum age of 24 years and minimum age of 55 years was observed. Overall 8.4% of the participants belonged to the Supervisor cadre, 5.9% were entomologists, 32.8% were CDC supervisors and 52.1% were clinical doctors. Most healthcare professionals find it easy to diagnose and report a case of dengue fever. Only 0.85% of the participants felt it very difficult to diagnose and report a dengue case, 45.76% felt somewhat easy and 44.07% felt very easy in reporting a dengue case. Some of the participants 9.32% neither felt it easy nor difficult to report dengue cases. Conclusions: Punjab, Pakistan's dengue surveillance system has improved but needs further enhancements in case detection, reporting, communication, and stakeholder collaboration. The province has established dengue monitoring units and implemented a comprehensive reporting system.

Politics and implications on the health systems preparedness to COVID-19 pandemic response: The Malawian experience.

The spread of the COVID-19 disease to Africa has raised concerns around the resultant effects on the fragile and non-resilient health systems. Malawi reported its first COVID-19 cases in early April 2020 at the time of the country's political turmoil, as the courts ruled for a re-run of presidential elections in July 2020 due to irregularities observed in the May 2019 elections. Therefore, assessing the implications of politics on the COVID-19 health systems preparedness is critical to design health systems strengthening efforts during the pandemic. We applied the WHO health systems framework to assess the implications of politics on the COVID-19 on the Malawi health systems preparedness. There was the population's lack of trust in government hampering government efforts, which posed as a huge concern for Malawi to navigate through the pandemic including the health systems preparedness for the pandemic. This, coupled with mass demonstrations by the public disagreeing with the Lockdown and health service providers put across their COVID-19 related demands. The political environment and the trust people have in the government determines a country's response to a pandemic. In a pandemic situation like COVID-19, the government's ability to coordinate the various key stakeholders while instilling trust in people remain critical in strengthening health systems to contain and mitigate the pandemic. However, the Malawi political turmoil highlighted in this paper derailed the process and efforts to contain the and timely prepare the health systems to manage the pandemic whilst maintaining its core functions of delivering essential health services. Therefore, governments should consider the effects of political challenges in supporting a country's health system to prepare for pandemics.

Flood preparedness and utilization of early warning systems among households in selected flood-prone areas in Tagum City, Davao Del Norte

Flooding presents a significant threat to infrastructure, property, and lives worldwide, with Barangay San Miguel in Tagum City, Davao Del Norte, standing out as particularly vulnerable. Therefore, assessing household preparedness and early warning system effectiveness is vital. A survey sampled 99 respondents using the Slovin formula. Household preparedness was evaluated based on indicators like first aid kit readiness, evacuation plans, food supplies, and participation in seminars. Early warning systems' effectiveness was assessed through indicators such as localized flood warnings, electronic systems, flyers, and direct communication. Results showed commendable overall preparedness (mean: 3.75), but shortcomings in seminars (2.74) and flyers (2.06). Policymakers should prioritize enhancing knowledge via targeted training and allocate resources to improve warning systems. This approach aims to strengthen resilience and reduce vulnerability to flooding in Barangay San Miguel and similar areas.

Neonatal Transport Network Services: Preparedness of healthcare systems in Southern Nigeria.

Nigeria remains a major contributor to neonatal deaths worldwide, yet little consideration has been given to intra/inter health facility transfer of sick neonates. The dearth of Neonatal Transport Network Services (NNTS) is probably an underappreciated driver of the abysmally high national neonatal mortality indices. This study aimed to evaluate neonatal transport services and the healthcare workers' preparedness among health facilities in Port Harcourt Metropolis, Rivers State, Nigeria. Twenty-eight selected health facilities (tertiary, private hospitals Primary Health Centers] were assessed on the availability, modality and practice of NNTS. Data was analyzed using SPSS Version 23. Routine transfer of high-risk pregnant mothers to higher levels of care occurred always in 14 (50%) and sometimes in 6 (21.4%) facilities; Private cars and taxis were the most common mode of transport in 24 (85.7%) facilities. Two facilities (7.2%) had ambulances equipped with transport incubators. Nurses and nurse attendants with no formal training in NNTS accompanied referred neonates in 2 (7.2%) facilities. Most referring facilities (78.6%) neither rarely or never contacted receiving centres before the arrival of neonates and most nor gave back referrals after offering neonatal care. None (100%) of the facilities had a trained emergency transport team. Health facilities in Southern Nigeria lack a standardized Neonatal Transport Network and are characterized by poor communication between health facilities and inadequately trained personnel for inter-facility transfer of sick neonates. Urgent action is required to address these gaps, including training of healthcare workers on neonatal transport and sharing findings with relevant stakeholders/policymakers to establish a functional neonatal transport network among health facilities.

Scoping Review of International Experience of a Dedicated Fund to Support Patient Access to Cancer Drugs: Policy Implications for Thailand.

Access to high-cost cancer drugs is an unsolved problem globally. The dedicated drugs fund is attractive and feasible. This study reviewed currently implemented dedicated drugs fund worldwide to inform policy implications for Thailand. A scoping review was conducted to identify countries currently implementing dedicated funds for cancer drugs. We searched electronic databases, PubMed and Embase, from 2010 to May 2021, Google and Google Scholar in August 2021, and government websites up to April 2022. The structure, management, cost containment strategies, and impact of dedicated funds were summarized and compared across the identified countries and Thailand. Out of 218 nations, Hong Kong, England, and Italy have established dedicated cancer drugs fund, primarily funded by their governments. Funds in England and Italy operate within annual budget limits. Hong Kong relies on an endowment fund. In England and Italy, pharmaceutical companies contribute proportionally to cover overspending as per risk-sharing agreements, while cost-sharing is not required. Hong Kong implements cost-sharing based on a patient's family income. England and Italy employ a parallel pathway, utilizing the same drug selection committee to determine whether innovative drugs belong in the regular pharmaceutical benefits package or the dedicated drugs fund. Hong Kong follows a sequential pathway, allowing drugs to be considered for the dedicated funds after a negative decision. These countries use the fund for 5-11 years, making administrative adjustments to ensure sustainability. The dedicated drugs fund is an effective strategy to improve access to non-reimbursable high-cost drugs in Thailand. Robust evaluation of the fund itself and funded drugs are recommended for policymakers' better decision-making. Learning from other countries can offer promising solutions. Health insurers need to balance providing cancer treatments with overall system preparedness.

Data-Driven Interventions for an Emergency Preparedness System: A National Experience in Australia.

Natural disasters and health emergencies disproportionally affect vulnerable populations causing disruptions to usual care and increasing chronic disease burden. Data and digital technologies are important tools to identify and mitigate indirect effects of emergencies. In this paper, we describe the methods used in the development of a series of digital emergency preparedness interventions to mitigate the direct and indirect consequences of the COVID-19 pandemic in the veteran community in Australia. The case studies demonstrate the use of data for surveillance, patient phenotyping, data-driven decision support and stakeholder communication in primary care. The intervention successfully increased appropriate healthcare use by vulnerable individuals and could be expanded to other populations.

Contributing to health system resilience during pandemics via purchasing and supply strategies: an exploratory system dynamics approach

BackgroundHealth systems worldwide struggled to obtain sufficient personal protective equipment (PPE) and ventilators during the COVID-19 pandemic due to global supply chain disruptions. Our study’s aim was to create a proof-of-concept model that would simulate the effects of supply strategies under various scenarios, to ultimately help decision-makers decide on alternative supply strategies for future similar health system related crises.MethodsWe developed a system dynamics model that linked a disease transmission model structure (susceptible, exposed, infectious, recovered (SEIR)) with a model for the availability of critical supplies in hospitals; thereby connecting care demand (patients’ critical care in hospitals), with care supply (available critical equipment and supplies). To inform the model structure, we used data on critical decisions and events taking place surrounding purchase, supply, and availability of PPE and ventilators during the first phase of the COVID-19 pandemic within the English national health system. We used exploratory modelling and analysis to assess the effects of uncertainties on different supply strategies in the English health system under different scenarios. Strategies analysed were: (i) purchasing from the world market or (ii) through direct tender, (iii) stockpiling, (iv) domestic production, (v) supporting innovative supply strategies, or (vi) loaning ventilators from the private sector.ResultsWe found through our exploratory analysis that a long-lasting shortage in PPE and ventilators is likely to be apparent in various scenarios. When considering the worst-case scenario, our proof-of-concept model shows that purchasing PPE and ventilators from the world market or through direct tender have the greatest influence on reducing supply shortages, compared to producing domestically or through supporting innovative supply strategies. However, these supply strategies are affected most by delays in their shipment time or set-up.ConclusionWe demonstrated that using a system dynamics and exploratory modelling approach can be helpful in identifying the purchasing and supply chain strategies that contribute to the preparedness and responsiveness of health systems during crises. Our results suggest that to improve health systems’ resilience during pandemics or similar resource-constrained situations, purchasing and supply chain decision-makers can develop crisis frameworks that propose a plan of action and consequently accelerate and improve procurement processes and other governance processes during health-related crises; implement diverse supplier frameworks; and (re)consider stockpiling. This proof-of-concept model demonstrates the importance of including critical supply chain strategies as part of the preparedness and response activities to contribute to health system resilience.

Influence of Planning Tools on the Performance of a Disaster Management Project in Rwanda. A Case of Strengthening National and Local Disaster Risk Management Capacity, Resilience and Enhancing Preparedness and Early Warning System Project in Musanze District

Influence of Planning Tools on the Performance of a Disaster Management Project in Rwanda. A Case of Strengthening National and Local Disaster Risk Management Capacity, Resilience and Enhancing Preparedness and Early Warning System Project in Musanze District

Effectiveness of an E-learning System for Emergency Signs and CPR Emergency Preparedness in Marathon Events: A Comparative Study

This study investigates the implementation, effectiveness, and impact of a unique e-learning system designed specifically for emergency signs and cardiopulmonary resuscitation (CPR) emergency preparedness in marathon events. Our approach introduces the first e-learning system specifically designed for marathon events. It delivers engaging content, including infographic stories, expert lectures, and interactive modules, to provide registered runners with comprehensive knowledge of first aid and emergency signs for CPR. To evaluate the e-learning application, we conducted a comparative experiment during the CMU (Chiang Mai University) marathon with 9,761 participants. We used pre- and post-tests, as well as a survey questionnaire. The results showed significant improvements in participants’ CPR knowledge across all educational backgrounds. The integration of e-learning into the registration process contributed to a safer marathon environment, as participants felt more confident in handling emergencies. Approximately 85% of participants expressed a willingness to recommend the e-learning system. This increased confidence among participants in handling emergencies benefits both runners and marathon organizers by enhancing safety measures and emergency response during events. In conclusion, our findings strongly support the integration of e-learning into the registration process for marathon events. Recommendations based on our research include providing comprehensive guidelines for other marathon events, instilling stakeholder confidence, and emphasizing the suitability of e-learning for medium- to largescale events. However, caution is advised for smaller events due to potential complexities and costs. Additionally, we suggest limiting the validity of e-certificates to ensure that participants have up-to-date CPR knowledge.

Humanitarian-Development Nexus: strengthening health system preparedness, response andresilience capacities to address COVID-19 inSudan-case study ofrepositioning external assistance model andfocus.

The advent of the COVID-19 pandemic and the establishment of a new transitional government in Sudan with rejuvenated relations with the international community paved the way for external assistance to the EU COVID-19 response project, a project with a pioneering design within the region. The project sought to operationalize the humanitarian-development-peace nexus, perceiving the nexus as a continuum rather than sequential due to the protracted nature of emergencies in Sudan and their multiplicity and contextual complexity. It went further into enhancing peace through engaging with conflict and post-conflict-affected states and communities and empowering local actors. Learning from this experience, external assistance models to low- or middle-income countries (LMICs) should apply principles of flexibility and adaptability, while maintaining trust through transparency in exchange, to ensure sustainable and responsive action to domestic needs within changing contexts. Careful selection and diverse project team skills, early and continuous engagement with stakeholders, and robust planning, monitoring and evaluation processes were the project highlights. Yet, the challenges of political turmoil, changing Ministry of Health leadership, competing priorities and inactive coordination mechanisms had to be dealt with. While applying such an approach of a health system lens to health emergencies in LMICs is thought to be a success factor in this case, more robust technical guidance to the nexus implementation is crucial and can be best attained through encouraging further case reports analysing context-specific practices.

Mass Casualty Incident Preparedness for Airport Emergencies: Report From an Aeroplane Crash Simulation at Guglielmo Marconi Airport, Bologna (Italy).

Airport emergencies are rare but potentially catastrophic; therefore, system preparedness is crucial. Airport emergency plans include the organization of emergency drills on a regular basis, including full-scale exercises, to train and test the entire rescue organization. This report describes a full-scale simulation at Bologna International Airport, Italy, in October 2022, involving local EMS resources. A full-scale aeroplane crash was simulated on the airport ground, activating the Airport emergency plan, and requiring the intervention of supplementary resources (ambulances, medical cars, and other emergency vehicles). Twenty-seven simulated patients were evaluated by EMS: START triage assessment was correct for 81.48% of patients; 11.11% were over-triaged and 7.41% were under-triaged. All patients were transported to the hospitals of the area. The simulation ended 2 hours and 28 minutes after the initial alarm. The response time proved a good response. Triage accuracy was correct in more than 80% of simulated patients. The availability of a trauma centre within 6 kilometres allowed the transportation of a quota of patients directly from the event, without affecting transportation times. Areas for improvement were identified in the communication within the different agencies and in moving ambulances within the airport runway without airport personnel guidance.

Deadly yet Preventable? Lessons From South Korea's Halloween Crowd Crush.

Avoidable disasters are both saddening and baffling. In 2022, 159 people, mostly in their 20s, and 30s were crushed to death in Itaewon's narrow alleyway amid South Korea's first pandemic-restrictions-free Halloween celebration. What is particularly sobering about this tragedy is that although many people called police hotlines as crowds became cramped and static, their calls went unheeded for hours. Rather than order independent investigations into the catastrophe (as of January 2024), the President of South Korea at the time focused on superficial issues such as asking the public to refer to the disaster as an "accident" (which it was not, it was an avoidable disaster) and the casualties as "the dead" (who are casualties indeed, instead of victims of a preventable tragedy). In this paper, we examine how officials' complacency about public health and safety dangers, ineffective disaster prevention, and preparedness systems, as well as the government's chronic lack of prioritization of public health and safety may have contributed to the disaster. Furthermore, we discuss the importance of creating integrated public health and safety protection systems to prevent similar tragedies from happening.