Presented at The International Association of Emergency Managers (IAEM) 2010 Annual Conference with Nicole Errett, Baltimore City Mayor\'s Office of Emergency Management
Public Health 101: What Every Emergency Manager Needs to Know
1. Public Health 101 - What Every
Emergency Manager Needs to Know
International Association of Emergency Managers Conference
November 2nd, 2010
Nicole Errett
Baltimore City Mayor’s Office of Emergency Management
Brian Spendley
Hagerty Consulting
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2. Define Public Health and its core concepts
Describe the U.S. Public Health Preparedness
Infrastructure
Discuss
H1N1
Identify funding opportunities
Identify implications of PPACA (Health Reform) on
emergency planning assumptions
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4. “…assuring conditions in which people can be
healthy.”
Goals (the three P’s)
Prevent Disease
Promote Health
Prolong Life
Two major defining characteristics
Deals with prevention instead of curative aspects of health
Focuses on population-level interventions, not individual
level
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6. Primary Prevention
Prevent the outcome before it occurs (e.g. vaccination)
Secondary Prevention
Early detection (e.g. screenings)
Tertiary Prevention
Prevent the outcome from getting worse (e.g.
treatment)
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7. Primary Prevention
Prevent the outcome before it occurs (e.g. planning,
hazard mitigation, gap analysis, training and exercises)
Secondary Prevention
Early detection (e.g. surveillance)
Tertiary Prevention
Prevent the outcome from getting worse (e.g.
emergency management operations)
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9. You’re not alone!
Most public health professionals in the United
States are not formally trained:
Health department personnel
Clinic workers
Public health consultants
Emergency managers
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10. Core Concepts
What are the major
components of a public
health education?
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11. Biostatistics
Epidemiology
Health Policy and Management
Environmental Health
Social/Behavior Health Sciences
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12. Creates and applies methods for quantitative
research in health sciences (JHSPH).
Science of obtaining, analyzing and interpreting
data in order to understand and improve human
health (UNC).
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13. How can we apply past incidents to accurately
predict future events?
Statistical significance
Methods
Example: Baltimore City Code Red
Does Energy Assistance Program enrollment correlate
with the impact of a Code Red day or a Code Red
season?
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14. The study of the distribution and determinants of
health and disease in human populations to
enable health services to be planned rationally,
disease surveillance to be carried out, and
preventative and control programs to be
implemented and evaluated (World Health
Organization).
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15. Identifying disease clusters and priority
populations
Where are your vulnerable populations located?
Example: H1N1
Initial confusion over disease severity and mode of
transmission
Strategically placing H1N1 – novel influenza
immunization clinics
Quality assurance
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16. Addresses all the physical, chemical, and biological
factors external to a person, and all the related
factors impacting behaviors. It encompasses the
assessment and control of those environmental
factors that can potentially affect health (World
Health Organization).
Includes occupational health, risk assessment and
toxicology
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17. Risk assessment and toxicology
Hazard mitigation planning
Risk = Probability * Severity
Risk is relative
Hospital Hazard Analysis (required by the Joint Commission)
takes advantage of Public Health risk assessment strategies
HAZMAT
PPE
Building materials
Implications of 9/11 on air quality
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18. Health policy
Study of the policy process as it related to health
Identify the problem
Determine magnitude
Analyze the problem
Propose solutions
Evaluate solutions
Health management
Study of health administration and leadership,
including application of quality assurance and
leadership strategies to the health arena
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19. Policies
PAHPA
NHHS
PPACA
Emergency Plans
Quality Assurance and Improvement
HSEEP compliance
Grant guidance
Training and exercises
Management
NIMS
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20. Addresses the behavioral, social and cultural
factors related to individual and population health
and health disparities over the life course. (ASPH)
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21. Health communications
How do we get people to listen to us?
Preparedness planning, immunizations, evacuations
Health Belief Model
Cues to actions, perceived barriers
Theory of Reasoned Action
Behavioral intention is the most important predictor of
actual behavior
How can we change that?
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22. Public Health in the United States
Research, Practice, and
Infrastructure
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23. Where is public health researched?
Academia
Schools of Public Health
“Community Health”
Health departments
Private and Public Sector
Where is public health practiced?
Health departments and agencies
Emergency management offices and agencies
Government agencies
Private Sector
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24. What is the foundation?
Pandemic and All Hazards Preparedness Act (PAHPA)
National Health Security Strategy (NHSS)
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25. The purpose of the Pandemic and All-Hazards
Preparedness Act is to “improve the Nation’s
public health and medical preparedness and
response capabilities for emergencies, whether
deliberate, accidental, or natural.
Ratified in December 2006.
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26. Amended the Public Health Service Act to
establish a new Assistant Secretary for
Preparedness and Response (ASPR)
Called for a quadrennial National Health Security
Strategy (NHSS)
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27. Major Program Areas
Biomedical Advanced Research and Development Authority
(BARDA) and Medical Countermeasures
Emergency Support Function (ESF) #8: Public Health and
Medical Response: Domestic Programs
Emergency Support Function (ESF) #8: Public Health and
Medical Response: International Programs
Grants
At-Risk Individuals
National Health Security Strategy (NHSS)
Situational Awareness: Surveillance, Credentialing, and
Telehealth
Education and Training
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28. What is it?
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 with potentially negative
consequences.
Two Goals
Build community resilience
Strengthen and sustain health and emergency response
systems.
No unfunded mandates; aligns with the NRF and NSS.
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29. Department of Health and Human Services
(DHHS)
Food and Drug Administration (FDA)
National Institute of Health (NIH)
Assistant Secretary for Preparedness and Response
(ASPR)
Center for Disease Control and Prevention (CDC)
Environmental Protection Agency (EPA)
Department of Homeland Security (DHS)
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30. Created under PAHPA
Lead the nation in preventing, preparing for, and
responding to the adverse health effects of public
health emergencies and disasters.
Focus:
Preparedness planning and response;
Building federal emergency medical operational capabilities;
Countermeasures research, advance development, and
procurement;
Grants to strengthen capabilities of hospitals and health care
systems in public health emergencies and medical disasters.
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31. Mission: Collaborating to create the expertise,
information, and tools that people and
communities need to protect their health –
through health promotion, prevention of disease,
injury and disability, and preparedness for new
health threats.
emergency.cdc.gov
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32. WIDELY varied structures and authorities
ME: 5 state agencies, 2 city health departments, 5 tribal
agencies, 492 municipal health officers
MA: 6 state agencies, 1 county health department, 4
regional health districts, 351 municipal boards of health
NY: 2 state agencies, 58 city/county health departments
MD: 6 state agencies, 24 local county health
departments
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34. Now show me the money!
Federal grant opportunities in
emergency management and
public health preparedness
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35. Federal Funding
Fiscal Year (October 1st – September 30th)
Funding announcements can occur at any time
throughout the fiscal year and often notifications to the
State Single Point of Contact (SPOC)
Two forms:
Discretionary Grants
Formula / Block Grants
Approval can take 3-9 months
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36. Department of Homeland Security
FEMA Administered
Health and Human Services
ASPR
CDC
Department of Defense (limited PH impact)
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37. American Recovery & Reinvestment Act (ARRA)
Buffer Zone Protection Program (BZPP)
Citizen Corps Program National Emergency Technology Guard (NET Guard) Pilot Program
Commercial Equipment Direct Assistance Program (CEDAP)
Competitive Training Grants Program (CTGP)
Driver's License Security Grant Program (DLSGP)
Emergency Management Performance Grant (EMPG)
Emergency Operations Center (EOC) Grant Program
Freight Rail Security Grant Program (FRSGP)
Homeland Security Grant Program (HSGP)
Interoperable Emergency Communications Grant Program (IECGP)
Intercity Passenger Rail (Amtrak)
Intercity Bus Security Grant Program (IBSGP)
Nonprofit Security Grant Program (NSGP)
Port Security Grant Program (PSGP)
Regional Catastrophic Preparedness Grant Program (RCPGP)
Tribal Homeland Security Grant Program
Transit Security Grant Program (TSGP)
3 Trucking Security Program (TSP)
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38. Purpose: to assist state and local governments in
enhancing and sustaining all-hazards emergency
management capabilities
State Administrative Agency (SAA) or State’s EMA
are eligible to apply
FY 2010: $329.8 Million
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39. Purpose: to build capabilities at state and local levels
and to implement goals/objectives in state homeland
security strategies and initiatives in State Homeland
Security Preparedness Report
25% dedicated towards law enforcement terrorism
prevention
Funds allocated based on
Minimum amounts legislatively mandated
Risk Methodology
Effectiveness
FY 2010: $842 Million
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40. Purpose: enhance regional preparedness in 64
major metropolitan areas
25% dedicated towards law enforcement terrorism
prevention
FY 2010: $823.5 million
10 highest risk (Tier I) eligible for $524,487,600
Remaining 53 (Tier II) eligible for $308,032,400
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41. Purpose: Supports integration of emergency
management, health, and medical systems into a
coordinated response to all hazard mass casualty
incidents
Augmented existing local operational response
systems before the incident occurs
124 MMRS jurisdictions
FY 2010: $39.36 Million
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42. Purpose: bring community and government
leaders together to coordinate community
involvement in emergency preparedness,
planning, mitigation, response and recovery.
FY 2010: $12.48 Million
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43. Purpose: support target-hardening activities to
nonprofit organizations that are at high risk of a
terrorist attack and are located within one of the
UASI areas
Funds based on risk analysis, effectiveness, and
integration
FY 2010: $19 Million
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44. Purpose: Enhance catastrophic incident
preparedness in 11 high risk areas, support
regional coordination, including development of
plans, protocols and procedures, and share
deliverables
FY 2010: $33.6 Million
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45. Purpose: provides funding directly to help eligible
tribes prepare for risks associated with potential
terrorist attacks
FY 2010: up to $10 Million
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46. Public Health Emergency Preparedness Program
(PHEP)
Hospital Preparedness Program (HPP)
Preparedness and Emergency Response Research
Center (PERRC)
Centers for Public Health Preparedness (CPHP)
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47. Nearly 85% of CDC budget goes towards
grants/contracts
Awards ~$7 Billion annually
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48. Purpose: to support preparedness capability and
capacity in state, local, tribal and public health
departments
FY 2010: $690,259,211
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49. Purpose: support and enhance state and local public health
preparedness and response infrastructure
Goals
Strengthen and sustain PH workforce
Increase lab capability and capacity
Strengthen disease surveillance activities
Plan/implement mass vaccination
Develop effective risk communication
Develop effective communication mitigation
Purchase/protect PPE, antivirals and pandemic supplies for Public Health
workforce
Train/educate Public Health workforce
Address gaps, meet challenges of PH preparedness
New vaccination program guidance introduced September, 2010
To date: $1.35 Billion through 4 phases
CDC Administered
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50. Purpose: enhance ability of hospitals/health care
systems to prepare for and respond to
bioterrorism and other public health emergencies
Administered by ASPR
FY 2010: $390,500,000
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51. Administered by CDC to accredited Schools of
Public Health
PERRC includes research projects; many schools
apply to practice oriented research projects
CPHP are training oriented grants. Most trainings
are open to State/local EM and PH
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52. Health Reform: Patient Protection and
Affordable Care Act (PPACA)
What is it?
How does it affect planning
assumptions?
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53. Individual Mandate
By 2014, all Americans must have health insurance
$695 or 2.5% household income fine
Exceptions for financial hardship (income to cost ratio
>8%, earn too little pay for federal income tax, religious
objections, Native Americans, uninsured <3 months)
Employer Mandate
Employer with 50 or more employees must provide
minimum coverage or pay penalty
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54. Health Insurance Exchange
Subsidies
Transparency
Medicaid Expansion
133% Federal Poverty Line
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55. Minimum Coverage
Cannot deny coverage for pre-existing conditions
No lifetime caps on benefits allowed
Preventative services are not subject to co-pay and
deductibles
Mental health parity
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56. Reduces uninsured by 32 million in 2019 (CBO
Estimate)
Illegal aliens, individuals who think they cannot afford
the cost even with the subsidy, and those that would
rather pay the penalty remain uncovered
Decreases vulnerability
May decrease cost
Increases transparency
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57. Questions?
Nicole Errett
nicole.errett@baltimorecity.gov
Baltimore City Mayor’s Office of Emergency Management
Brian Spendley
brian.spendley@hagertyconsulting.com
Hagerty Consulting
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