Today I will be talking about our focus for the next three years. Every three years the CDPHE in coordination with the CDC establishes a general focus. While we still do a lot of other things this is kind of our overarching goal. The next three years, and our grant year begins in August so we just technically are moving into 20010, but the focus will be resiliency.
I would like to start with the slide that I have ended with in my last two presentations. I felt very strongly that becoming recognized for our efforts in EP by NACCHO and PPHR would be very important. It has been primarily because we turned in such a strong application. Because of this leadership we were awarded the only extra position in the state last year. This position primarily supports other counties who are now going through that application process, but she is housed here and works on other projects with us as well. Surveillance has grown considerably over the last year with our continuing relationship with infection control at Lutheran, and the school surveillance project that we did last year. And now food defense is taking off in private industry. Just the other day a great community partner Miller Coors talked about how they are working very hard on their food defense plans. Food defense is basically assuring that you have the controls in place to prevent intentional contamination of your product, there is even a checklist of things that make you more vulnerable and what you can do to reduce those vulnerabilities. So we were pretty much on the mark with where we thought a lot of our focus should be.
It is nice to see that they are trying to bring things together at the national level and create a system that works. I can tell you, regardless of your political perspective, that from my perspective I have seen some movement towards more coordination throughout government.
The trend here that is relevant is the resiliency piece. Response occurs in sort of a cycle, preparedness, response, and recovery. In looking at my slide of the future we have focused a lot on planning and preparedness, now we need to focus on the final piece which is recovery. I can tell you from personal experience, ittook us over a year from the first H1N1 case to finally get back to a point where we aren’t dealing with H1N1. I thought a lot about the long term implications of our response and I knew it would drag on but we did not have a recovery plan done, this will be one of our top priorities. Of course after a year, how resilient will our staff be if we have another hard influenza year? How resilient will the community be? We need to think about that.
These are some of the challenges that come up, I found these while doing a Google search on this subject just to see what would come up. Obviously a lot of it comes back to the mental health issues that people deal with following disasters. These issues are a problem but on the bright side there is such a foundation of work related to this already that applying it to EP is a small step. Also, we have focused a lot on the individual because each person obviously deals with disaster is different ways, this allows us to take a broader approach to community resiliency.
We have talked a lot about how having a plan, developing a kit and making sure that you have extra batteries, meds, etc on hand is important. Do you have copies of important paperwork or documents? Do you have at least some of the things that you rely on to create a sense of normalcy. But we have not focused a lot about how being healthy can help you be more resilient following a disaster. As my friend says “health is the first wealth”. If you are generally in good health following an event you can do more to help yourself and your family or community to recover. This sense of self reliance, this ability to begin to move your life back to normalcy, has been shown to reduce the incidence of stress and other issues related to traumatic events. But if you are in poor health and unable to reestablish a routine or do certain things for yourself, it could create more stress.
I think there has been a lot of discussion over the last several years surrounding healthcare debate regarding how we tend to deal with problems after they happen. This is important but I think we are slowly seeing a shift towards more prevention based activities, that of course is our job. At the NACCHO conference this year there was a lot of talk about this resiliency focus and one of the themes that came out of this was that a health community is a resilient community. So I think you can start to see how encouraging departments to focus on this can truly integrate EP with everything else that public health does. We will still be there for mass clinics, for distributing meds, working with all of our partners on all hazards response, but when the excitement dies down from all of the effort and work we still have to remember that some of our communities may not fully recover for a long time. Look at LA five years after Katrina, we can look at the new homes, we can look at the rebuilding, but is there any research out there about how the community is coping? Is there anything that we could learn from that to make sure that if we have a bad flu year, if SARS reappears, can we be doing anything now that will help our communities bounce back faster? Even a major snowstorm or a large fire if you have been following what is going on is Russia where people have to shelter in place or are exposed to harmful smoke; the healthier they are the easier it will be on all response organizations.
Another thing we can do is a staff inventory, this was initially done right before the DNC. The goal of this is to capture any skills that staff might have related to resiliency that they don’t use in their current role or that we might not know about.
So what do we do for this or how do we go about integrating a resiliency approach into what we do? Now that our funding has dropped back to more traditional levels its not like we can just keep doing more. Our saving grace is the partnerships that we have both within the organization and the county. We are going to have to rely on the people in the organization to help us out. And before I get to many people upset with me this does not mean asking them to do more work, it means us working with them on what they already do and translating that into EP plans. So many of our staff are out in the community everyday working and educating people on what we do. If we can support this work and make sure it is coordinated than we are building resilient communities by just doing our daily work. To give one great example of how this would work is through the advocacy group that grew out of strategic planning. This group came up with I think 8 slides that could be added to any presentation that anyone in the department does. These slides give a quick overview of JCPH and what we do. Adding one more slide about resiliency can help get this going.
Data collection and community health assessments are specifically discussed in the NHS as a way to effectively collect information to identify risk which will be used to determine workforce shortages and invest in building capacity. This makes me excited as well. I had made a push to include H1N1 evaluation as part of the upcoming health assessments required by SB 194. I felt at the time that this assessment could be used to bring this all together. Fortunately someone saw the wisdom in that and it is now going to be a part of the national health strategy.
Two things about this slide: When I first started doing this work having public health mentioned before homeland security or many of these other disciplines was rare. So public health is rising in visibility. The next paragraph in the Health Security Strategy goes on to talk about how shortages are projected in key workforce areas the primary one being public. So they are doing a gap analysis and risk assessment as we speak related to how to improve the PH workforce, what the outcome will be I do not know but I have already e-mailed HHS and asked for 2 million dollars.
One final note on the NHS related to PH. One of the last concepts they present in the interim plan is that they need to find ways to integrate NHS into routine PH programs. I talked about that a little bit from the perspective of resiliency but the plan talks about it from the perspective of health security in general. This is what we have been talking about for years, EP has the same mission as the rest of public health, and because this is the program that health security is being driven through we can be the doorway to introduce health security into routine programs.
I know I got away from the specific focus of resiliency but I started putting the presentation together before I read the guidance and I was very pleasantly surprised with how much the yare trying to integrate public health into the big picture. So we will be starting with resiliency but will be doing a lot more with the overall health security strategy if our resources allow.
A healthy community is a resilient community boh 2010
A Healthy Community is AA Healthy Community is A
Resilient CommunityResilient Community
Public Health Preparedness Focus
2010 - 2013
EP Three Year CyclesEP Three Year Cycles
• 2004 – 2007 Mass Prophylaxis
• 2007 – 2010 Hospital/Medical Surge
• 2010 – 2013 National Health Security
National Health Security StrategyNational Health Security Strategy
• The purpose of the National Health Security Strategy
(NHSS) is to refocus the patchwork of disparate public
health and medical preparedness, response, and
recovery strategies in order to ensure that the nation is
prepared for, protected from, and resilient in the face of
health threats or incidents with potentially negative
health consequences. This refocusing will strengthen
the community, integrate response and recovery
systems, generate a framework for accountability and
continuous quality improvement, and create seamless
coordination between all levels of the medical system.
The resulting NHSS will provide a common vision for
how the nation will achieve national health security.
National Health SecurityNational Health Security
• National health security is a state in which
the nation and its people are prepared for,
protected from, and resilient in the face of
health threats or incidents with potentially
negative health consequences.
Strategic ObjectivesStrategic Objectives
1. Foster informed, empowered individuals
2. Develop and maintain the workforce
3. Ensure situational awareness
4. Foster integrated, scalable healthcare
5. Ensure timely and effective
Strategic ObjectivesStrategic Objectives
6. Promote an effective countermeasures
7. Ensure prevention or mitigation of
environmental and emerging threats
8. Incorporate post-incident health recovery
into planning and response
9. Work to enhance national health security
10.Ensure all systems are based on good
science and quality improvement
When something goes wrong, do you tend to
bounce back or fall apart? When you have
resilience, you harness inner strengths and
rebound more quickly from a setback or
challenge, whether it's a job loss, an illness, a
disaster or the death of a loved one.
In contrast, if you lack resilience, you tend to
dwell on problems, feel victimized, become
overwhelmed and turn to unhealthy coping
mechanisms. You may even be more inclined to
develop mental health problems.
Because disaster disrupts so many aspects
of daily life, many problems for disaster
survivors are immediate and practical in
nature. People may need help locating
missing loved ones; finding temporary
housing, clothing, and food; obtaining
transportation; applying for financial
assistance, unemployment insurance,
building permits, income tax assistance;
getting medical care, replacement of
eyeglasses or medications; obtaining help
with demolition, digging out and clean-up.
Health and ResiliencyHealth and Resiliency
Self Sufficiency Good Health
Next StepsNext Steps
• Staff Inventory
• Continued work with special needs
• Continued work with other programs
• Encouraging community preparedness
Staff InventoryStaff Inventory
• Mental health training
• Community organizations/neighbors
• Health promotion
• Gardening skills
• Mechanical/trade skills
Special NeedsSpecial Needs
• Nursing homes
• Assisted living
JCPH Program IntegrationJCPH Program Integration
• Produce Fairs/Food Security
• Tobacco Cessation
• Environmental Health/Community Plans
• Community Health Assessment
– Special Needs
• Health Promotions
• Emergency Preparedness
– Plans & Training
Community PreparednessCommunity Preparedness
• Stay healthy
• Maintain supplies and plans
• Know your neighbors/community
• Understand your needs
• Good data to drive all of our programs
• Community health assessment
• What services we provide and how
An adequately sized, capable, and diverse
workforce is a key ingredient of health
security systems. The workforce for
national health security includes but is not
limited to employees in public health,
health care, homeland security, pre-
hospital emergency medical systems,
volunteers and others.
During National Preparedness Month, we
stress the importance of strengthening the
security and resiliency of our Nation
through systematic preparation for the full
range of hazards threatening the United
States in the 21st century, including
natural disasters, cyber attacks, pandemic
disease, and acts of terrorism
Proclamation - President Barack Obama,