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Community Health Resilience: The Need to Build Trust to Keep Trust

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
September 25, 2015

On April 23, 2014, the National Biodefense Science Board, an advisory group to the Assistant Secretary for Preparedness and Response (ASPR), voted to approve their final recommendations to promote improved community health resilience in the U.S. The board noted that the National Health Security Strategy in 2009 had defined community resilience as “the sustained ability of communities to withstand and recover – in both the short-term and long-term—from adversity.”

The board’s first recommendation was to create a comparable definition of community health resilience. The report offered additional recommendations to:

  1. Promote community health resilience to a wide range of stakeholders.
  2. Provide interagency support in the form of guidance, tools, and technical assistance to aid communities trying to improve their level of health resilience.
  3. Link community health resilience policy to other initiatives.
  4. Promote coordinated research regarding community health resilience.

The relevance of recommendation 4, linking “community health resilience policy to other national preparedness or health initiatives…” is of particular relevance as the U.S. prepares for its next public health challenge.

Among the strategies included under the recommendation is the need to coordinate preparedness grant and cooperative agreement programs to bring private, public, nonprofit and civic organizations together into sustainable governance structures. Having all of these stakeholders actively engaged before, during and after a major public health event would be essential in a community’s successful recovery.

A report from a statewide tabletop exercise simulating a major pandemic influenza outbreak noted the strain that such an event would have on all essential services and systems, even at the earliest stage. This makes it imperative that organizations in all sectors coordinate on continuity of operations plans, create assessments regarding fitness for duty, and encourage cross training. Staffing plans for periods of limited personnel need to be developed along with plans to provide first responders with appropriate medical protection. Mutual aid agreements should also be negotiated in advance to codify resource sharing. Another important consideration is to have the appropriate personnel and equipment in place to deliver clear, consistent and accurate information.

Based on projections from the tabletop exercise, at the worst stage of the outbreak about one-third of the population may be infected, a similar percentage of health care workers will be ill and unavailable and hospitals may be over capacity. Law enforcement may experience challenges protecting health care facilities and other community institutions. Other first responders may face similar challenges. Food and other goods could be in short supply, while many are afraid to venture out of their homes.

The exercise determined that it would be important for a community at this stage to have plans in place to continue to distribute vaccine and other available countermeasures, which would include providing security at distribution sites. Agreements should also be made with local mortuaries to see that the deceased are attended to and altered standards of care should be established, with health care workers clearly aware of expectations and legal protections.

An incident command center needs to be activated and staffed to oversee the coordination of communitywide activities. Citizens must be given clear information about what services are still available and those messages should be reinforced. Consideration must also be given to those with special needs, the mentally ill and those suffering emotional and psychological stress. The federal government may need to be contacted at this point to request additional countermeasures from the Strategic National Stockpile.

The degree to which the community in question addresses the challenges in the first two stages will determine how quickly the community will return to normal operations after the event deescalates. Particularly for small, rural communities, there is a high likelihood that their systems will be severely taxed during a virulent public health emergency. However, strained but functioning is much different from total collapse.

A key issue in terms of recovery will be whether institutions charged with managing the crisis have kept the trust of the public. If, in the wake of the event, citizens see the institutions they counted on for protection as unprepared and disorganized, it may take quite some time before the community can truly recover. However, if citizens see that these institutions were severely challenged but had prepared to the best of their ability and performed the best they could with the resources available, public trust is less likely to be a long-term issue.

The tabletop exercise simulating a pandemic influenza outbreak illustrates the importance of coordinated policy, established relationships and a sustainable system of collaborative governance to community health resilience. There is no guarantee during such an emergency that those who would normally be engaged in strategic thinking will be available, so plans must be well-established and widely disseminated so they can be implemented by others if necessary. Issues of protection, communication, medical distribution and other logistical issues must be considered.

In order to preserve public trust in the wake of an outbreak, trust must be built among all the key stakeholders. As suggested by the National Biodefense Safety Board, the federal government should align policy to help facilitate that.


Author: Nathan Myers is an assistant professor in the political science and public administration program at Indiana State University.

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