Disasters and Public Health

Planning and Response

Bruce W. Clements, Julie Casani

• Publisher: Butterworth-Heinemann
• Year: 2016
• ISBN:
  9780128019894
• Edition: 2
• Topic: Politics & International Relations
• Subtopic: Public Affairs & Administration
• Index: Politics & International Relations

Disasters and Public Health: Planning and Response, Second Edition, examines the critical intersection between emergency management and public health. It provides a succinct overview of the actions that may be taken before, during, and after a major public health emergency or disaster to reduce morbidity and mortality.

Five all-new chapters at the beginning of the book describe how policy and law drive program structures and strategies leading to the establishment and maintenance of preparedness capabilities. New topics covered in this edition include disaster behavioral health, which is often the most expensive and longest-term recovery challenge in a public health emergency, and community resilience, a valuable resource upon which most emergency programs and responses depend.

The balance of the book provides an in-depth review of preparedness, response, and recovery challenges for 15 public health threats. These chapters also provide lessons learned from responses to each threat, giving users a well-rounded introduction to public health preparedness and response that is rooted in experience and practice.

• Contains seven new chapters that cover law, vulnerable populations, behavioral health, community resilience, preparedness capabilities, emerging and re-emerging infectious diseases, and foodborne threats
• Provides clinical updates by new MD co-author
• Includes innovative preparedness approaches and lessons learned from current and historic public health and medical responses that enhance clarity and provide valuable examples to readers
• Presents increased international content and case studies for a global perspective on public health

1

Public Health Preparedness History and Policy

Abstract

This chapter provides a historical overview of public health emergency preparedness. It summarizes major events influencing US policy on public health emergency preparedness and response, which has its roots in the establishment of maritime hospitals used to provide screening and care for sailors, merchants, and immigrants who carried diseases from around the world. The public health preparedness focus shifted from general sanitation and infectious disease control measures to concerns about biological warfare during World War II. Decades later, public health preparedness received renewed focus following the 2001 terrorist attacks and amid concerns about bioterrorism. An all-hazards approach was adopted following the 2005 Hurricane Katrina response and 2006 emerging avian influenza threat. This chapter describes how public health preparedness policies evolved throughout history, leading to the introduction of public health and medical preparedness programs and the establishment of preparedness as a specific public health discipline.

Keywords

Biological warfare; Bioterrorism; Pandemic and All Hazards Preparedness Act; Public health preparedness capabilities; Public health preparedness history; Public health preparedness policy; Public health preparedness program

Objectives

• Describe the roots of public health preparedness programs in early US history.

• Explain how war and terrorism have influenced public health preparedness.

• List key activities required by the 2002 CDC Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism.

• Explain the events influencing the expansion of the focus of public health preparedness from bioterrorism to all-hazards.

• Describe the significance of the 2006 Pandemic and All-Hazards Preparedness Act (PAHPA).

• List the major changes introduced by the 2013 Pandemic and All Hazards Preparedness Reauthorization Act (PAHPRA).

• Describe the components of the 2015 US National Health Security Strategy.

• List the public health preparedness capabilities shared with healthcare systems.

• Summarize the role of nongovernmental professional associations in public health preparedness policy development.

• List several key accomplishments in building public health preparedness infrastructure since the 2001 terrorist attacks in the United States.

The US public health preparedness policy journey provides a road map for other nations developing similar programs. The origins of public health preparedness go back to the earliest responses to infectious disease outbreaks. Today a wide range of sociopolitical factors serve as additional influences. This chapter provides a high-level summary of the history and events influencing current US policies related to public health preparedness.

The Early Years

Public health and healthcare preparedness programs are rooted in history, law, and policy development. The preamble to the US Constitution laid the groundwork for national preparedness initiatives when the framers of the Constitution stated the role of government is to “…insure domestic tranquility, provide for the common defense, promote the general welfare…”. All three of these requisite Constitutional values are supported by public health preparedness. In 1798, shortly after the Constitution was adopted, the second US president, John Adams, signed into law the “Act for Relief of Sick and Disabled Seamen.” This legislation established maritime hospitals to care for American merchant seamen and created the Marine Hospital Service. The greatest public health challenges of the 18th century (1700s) arrived on the shores of America through sailors, merchants, and immigrants carrying diseases from around the world. These public health threats placed the Marine Hospital Service at the forefront of public health emergency preparedness and response. The Marine Hospital Service became a national hospital system in 1870 and developed into a uniformed military service to coordinate the medical officers. It was led by a national senior official whose office eventually became the Office of the Surgeon General (USPHS, 2015; OSG, 2015). The Marine Hospital Service eventually became the Public Health Service. Throughout the 19th and early 20th centuries, Public Health Service officers served on the front lines against epidemics, including challenges such as smallpox and yellow fever.

As the US Public Health Service evolved on a national level, local and state health departments were established from the late 1700s through the 1800s. For example, in 1805 an ordinance was passed by New York City’s Common Council establishing the New York City Board of Health. The Board of Health was led by the mayor and comprised elected city officials. The creation of New York City’s Board of Health occurred in response to a series of yellow fever outbreaks over a 10-year period (1795–1805) in New York City (Jones, 2005).

Early public health agencies established policies to address sanitation issues. The sanitary movement started in Europe in the late 1700s. The early years of the industrial revolution ushered in a downward spiral in sanitation conditions across industrialized regions. This movement spread from Europe to the United States and became the primary focus of urban public health agencies throughout much of the 18th century. The movement was spurred on by the regular occurrence of major disease outbreaks, including cholera and yellow fever (Duffy, 1992). The progression of science and the increased understanding of infectious disease led to the bacteriological era (1875–1950) (Rosen, 1958). Public health infrastructure has its origins in this era, including establishment of the foundations of public health disciplines such as epidemiology, environmental health, and laboratory science. One example of the application of this infrastructure is shown in Fig. 1-1.

Figure 1-1 Health examination of immigrants at Ellis Island. Office of the US Public Health Service Historian.

Establishing Modern Public Health Infrastructure

President Franklin D. Roosevelt signed into law the “Public Health Service Act” on July 1, 1944. This legislation combined and markedly revised all existing legislation relating to the Public Health Service. A year prior to the Public Health Service Act, President Roosevelt had ordered the establishment of the US biological weapons program. A new era of state-sponsored biological warfare had begun, and the 1944 Public Health Service Act was considered a part of US defense.

In establishing a national program of war and postwar prevention, we will be making as sound an investment as any Government can make; the dividends are payable in human life and health.

US President Franklin D. Roosevelt at the signing of the 1944 Public Health Service Act (Roosevelt, 1944).

The growing biological warfare threat also prompted Great Britain to stockpile medical countermeasures, expand lab capacity, and initiate their own offensive program (Martin et al., 2007). Other nations, including Japan, were carrying out secret biological weapons programs during World War II. The war also prompted a boost in public health infrastructure. This would not be the last time an expansion of US public health infrastructure resulted from a national security threat. It would be seen again in 2002 following the 9/11 terrorist attacks on the United States during 2001 and the subsequent mailing of letters carrying Bacillus anthracis (anthrax) spores to US political leaders and news media.

The 1940s was a watershed decade for public health. The Centers for Disease Control (CDC) was established in Atlanta in 1946 and comprised mostly entomologists and engineers who assisted with malaria control in the Southeastern United States and World War II combat regions (CDC, 2013). Figs. 1-2 and 1-3 show the original and contemporary heaquarters locations of the CDC. Two years later, in 1948, the United Nation...