Building Community Disaster Resilience: Perspectives From a Large Urban County Department of Public Health

An emerging approach to public health emergency preparedness and response, community resilience encompasses individual preparedness as well as establishing a supportive social context in communities to withstand and recover from disasters. We examine why building community resilience has become a key component of national policy across multiple federal agencies and discuss the core principles embodied in community resilience theory—specifically, the focus on incorporating equity and social justice considerations in preparedness planning and response. We also examine the challenges of integrating community resilience with traditional public health practices and the importance of developing metrics for evaluation and strategic planning purposes. Using the example of the Los Angeles County Community Disaster Resilience Project, we discuss our experience and perspective from a large urban county to better understand how to implement a community resilience framework in public health practice.BUILDING COMMUNITY resilience to disasters—the ability to mitigate and rebound quickly—has received increased attention in the relatively new field of public health emergency preparedness and is now a central focus and a required activity for all public health departments that are recipients of Centers for Disease Control and Prevention (CDC) Public Health Emergency Preparedness (PHEP) grants.1 Critical lessons from Hurricane Katrina in 2005, the H1N1 pandemic of 2009, and, most recently, Hurricane Sandy continue to demonstrate that underlying issues of lack of trust and the absence of sustainable engagement with community-based organizations, faith-based organizations, and other neighborhood-level organizations create significant disparities in population health outcomes following emergencies and disasters. This situation hampers public health interventions in both everyday public health work and emergency response.2,3 As a theory and approach, community resilience provides a framework that embraces principles of equity and social justice with a focus on developing the core capacities of populations both to mitigate disasters and to rebound from them.4 The challenge is to clearly and operationally define community resilience, develop principles and practices that expand and enhance current community-based activities, and, through these changes, better align and integrate traditional public health and public health emergency preparedness.Although the term community resilience is relatively new to emergency preparedness, the emerging operational frameworks embrace many of the core components of effective community-based public health practice and, in many ways, represent a reframing of long-standing approaches to improve community well-being that have not been incorporated in preparedness programmatic activities.5We review the origins of the community resilience framework in the multidisciplinary research on individual resilience and assess how community resilience and related frameworks are shaping federal policies in all agencies involved in disaster and public health emergency response. We describe how the community resilience framework augments public health preparedness and reinforces longer-standing public health approaches to improving community health by examining a multiyear process developed by the Los Angeles County Department of Public Health (LACDPH) to implement this approach. The strategy consists of operationalizing community resilience through the following steps:

• Improving the community engagement skills of health department staff and building sustainable community engagement processes;
• Developing a resilience tool kit that can be used by community organizations to build coalitions and coordinated neighborhood strategies to increase community preparedness and specific mitigation skills; and
• Identifying metrics so that systematic interventions that can improve the abilities of communities to promote resilience and mitigate disaster impacts can be measured and evaluated.

     

Community health planning from an interorganizational perspective.

Planning agencies do not have control over health care resources in the community. Resources are concentrated in a number of provider organizations, associations, and government agencies, which have common goals as well as a diversity of individual objectives, and therefore enter into networks of relationships to accomplish their overlapping service missions. Interorganizational research shows that it is important to enhance the interdependence and benefits of cooperation between organizations and at the same time maintain the identity and distinctive qualities of each organization. Thus, in addition to the important role to provide information for decisions, planners have a role to manage the interdependencies and identities among organizations in the health system. Research shows that in situations where only methods, data, and analysis were emphasized by health planners, they had less impact on community decisions than in situations where planners also emphasized the development of the interorganizational system of decision-making. In a neutral position with respect to competing forces, planners can more effectively use their leverage from their information processing role and from their regulatory powers to facilitate the balancing of interorganizational interests and to enhance cooperative benefits to the community.     

Parish nursing and hospitals

Parish nursing is an emerging area of specialized professional nursing practice that focuses on health maintenance and health promotion for parishioners and the community. Health care occurs across a continuum along which hospitals provide a key function. There is a role for hospitals in relation to parish nursing and faith-based health care organizations have a greater obligation than secular ones to partner with parish nursing programs. Faith-based health care facilities, like secular ones, are institutions that bring health care professionals together to apply their knowledge, judgment, and skills to provide care for those in need of such services. But faith-based facilities differ from others in sharing a holistic perspective of health intended to benefit the individual and society, particularly those who are marginalized. This obligation to serve enables God's work because caring for those in need is essential for a just and beneficent society. It seems reasonable to assume that partnering with parish nurse programs is a fitting role for faith-based hospitals. In such circumstances, the facility may choose to introduce the parish nurse concept to the community by hosting a town hall meeting or a workshop with community partners. The facility may also fund parish nursing exhibitions at community events and conferences. The notion of "partnering with," although it carries no theological implications, is in the health care context somewhat akin to the Catholic notion of "sponsorship." The church's sponsorship of health care facilities should be seen as a ministry in itself, and such an approach would "shift the focus from preservation to enhancement, from being a guardian to being a creator, from a sense of diminishment to one of empowerment." Faith-based health care organizations have a responsibility to focus on holistic health for both the individual and society at large, particularly the health of people who are marginalized. It is not only logical that faith-based health care organizations should partner with parish nursing programs--it is imperative that they do so.     

A Community and Medical Library Collaboration to Address Senior Caregivers Barriers to Health Services Access

This describes an outreach program to improve access to community resources and online health information for the lay public and professionals engaged in caregiving to seniors. An academic health sciences library and a coalition of community organizations collaborated to develop an authoritative, web-enabled clearinghouse that consolidated access to regional and national health and social service resources and online health information. Findings from a mixed-methods approach of roundtable discussions, key informant structured interviews, and surveys of professionals involved in senior care planning and discharge management were used to develop, pilot test, and evaluate the project. The website was promoted through a series of webinars outlining the range of services and resources available as well as engagement with a variety of community health care organizations. This project advanced understanding of the needs of seniors and their caregivers and created mechanisms to improve access to authoritative health care information supporting senior care. Community feedback on the website launch highlights its value for the lay public and professional caregivers. It also provided a platform for volunteerism and service learning through which individuals can have a collective impact on their community.     

Cardiovascular disease prevention in Ghana: feasibility of a faith-based organizational approach

ObjectiveTo examine the feasibility of using community health workers (CHWs) to implement cardiovascular disease (CVD) prevention programmes within faith-based organizations in Accra, Ghana.MethodsFaith-based organization capacity, human resources, health programme sustainability/barriers and community members’ knowledge were evaluated. Data on these aspects were gathered through a mixed method design consisting of in-depth interviews and focus groups with 25 church leaders and health committee members from five churches, and of a survey of 167 adult congregants from two churches.FindingsThe delivery of a CVD prevention programme in faith-based organizations by CHWs is feasible. Many faith-based organizations already provide health programmes for congregants and involve non-health professionals in their health-care activities, and most congregants have a basic knowledge of CVD. Yet despite the feasibility of the proposed approach to CVD prevention through faith-based organizations, sociocultural and health-care barriers such as poverty, limited human and economic resources and limited access to health care could hinder programme implementation.ConclusionThe barriers to implementation identified in this study need to be considered when defining CVD prevention programme policy and planning.     

The public and public health organizations: issues for community engagement in public health

Deliberative processes are beginning to take effect in the public health sector. Public health organizations have a critical role in fostering local deliberation during the planning and implementation of community health efforts. The chief executive officer (CEO) of eight national public health constituent organizations were provided background readings about deliberation and its potential role in community public health planning. They were then interviewed about their prior knowledge of public health deliberation, impressions and thoughts about deliberation's role in public health, whether they could identify constituents using the approach, and the best method of disseminating information on deliberation. Information provided by stakeholders was analyzed to gauge the understanding and implementation of public deliberation. Four main themes emerged from the interviews including: general awareness and attitudes about public deliberation, barriers to deliberation, words of caution when using the deliberative approach, and dissemination of deliberation. Each of the CEOs interviewed favored deliberative approaches in public health planning that would ensure that the community's voice is present in the decision-making process. However, there are certain limitations to the approach that must be addressed before the full benefits of public engagement can be obtained in public health.     

Benefits of standardized diabetes and hypertension screening forms at community screening events

The objectives of this project were to (a) assess hypertension and diabetes screening data collection practices and guidelines and (b) develop and test standardized screening forms for use at minority community- and faith-based screening events. Project Phase I involved resource assessment and the development of a set of screening forms and guidelines containing a core data set for both hypertension and diabetes. These were then tested during Phase II at predetermined community based screening events throughout the United States. Community- and faith-based health screening programs are important in reaching and informing individuals in selected communities about their health and health risks. This study demonstrated the development of a standard tool that was effective in conducting African American community-based screening programs for hypertension and diabetes by community-based organizations. These activities are effective to obtain standardized information on individuals within the communities served.     

Joys and tribulations of faith-based youth tobacco use prevention: a case study in Mississippi

Faith-based health promotion initiatives are resurging in popularity among health promoters and providers, but few programs are systematic, large-scale, and funded at the state level. One exception is an initiative by the Partnership for a Healthy Mississippi (PHM), a nonprofit organization funded by tobacco settlement monies. PHM funded churches and other faith-based organizations to implement a grassroots youth tobacco use prevention program to coincide with other community- and school-based efforts. In the 2-year evolution of this faith-community health partnership, PHM experienced both successes and challenges. This article outlines the history of tobacco use prevention and control programs within Mississippi's faith community, provides a brief case study of two churches, and makes 10 recommendations based on lessons learned.     

Using social network analysis to understand Missouri's system of public health emergency planners

OBJECTIVES: Effective response to large-scale public health threats requires well-coordinated efforts among individuals and agencies. While guidance is available to help states put emergency planning programs into place, little has been done to evaluate the human infrastructure that facilitates successful implementation of these programs. This study examined the human infrastructure of the Missouri public health emergency planning system in 2006. METHODS: The Center for Emergency Response and Terrorism (CERT) at the Missouri Department of Health and Senior Services has responsibility for planning, guiding, and funding statewide emergency response activities. Thirty-two public health emergency planners working primarily in county health departments contract with CERT to support statewide preparedness. We surveyed the planners to determine whom they communicate with, work with, seek expertise from, and exchange guidance with regarding emergency preparedness in Missouri. RESULTS: Most planners communicated regularly with planners in their region but seldom with planners outside their region. Planners also reported working with an average of 12 local entities (e.g., emergency management, hospitals/ clinics). Planners identified the following leaders in Missouri's public health emergency preparedness system: local public health emergency planners, state epidemiologists, the state vaccine and grant coordinator, regional public health emergency planners, State Emergency Management Agency area coordinators, the state Strategic National Stockpile coordinator, and Federal Bureau of Investigation Weapons of Mass Destruction coordinators. Generally, planners listed few federal-level or private-sector individuals in their emergency preparedness networks. CONCLUSIONS: While Missouri public health emergency planners maintain large and varied emergency preparedness networks, there are opportunities for strengthening existing ties and seeking additional connections.     

Best of ARM: Evaluating engagement in multisector community health networks: The case of tribal organizations

ObjectiveTo quantify variation in public health system engagement with tribal organizations across a national sample of communities and to identify predictors of engagement.Data SourcesWe used 2018 National Longitudinal Survey of Public Health Systems data, a nationally representative cohort of the US public health systems.Study DesignSocial network analysis measures were computed to indicate the extent of tribal organization participation in public health networks and to understand the sectors and social services that engage with tribal organizations in public health activities. Two‐part regression models estimated predictors of tribal engagement.Data CollectionA stratified random sample of local public health agencies was surveyed, yielding 574 respondents. An additional cohort of oversampled respondents was also surveyed to include jurisdictions from the entire state upon the request of their respective state health departments (n = 154). Analyses were restricted to jurisdictions with a nearby American Indian and Alaska Native (AI/AN) serving health facility, yielding a final sample size of 258 local public health systems.Principal FindingsWhen an AI/AN serving health facility was present in the region, tribal organizations participated in 28% of public health networks and 9% of implemented public health activities. Networks with tribal engagement were more comprehensive in terms of the breadth of sectors and social services participating in the network and the scope of public health activities implemented relative to networks without tribal engagement. The likelihood of tribal engagement increased significantly with the size of the AI/AN population, the presence of a tribal facility with Indian Health Service funding in the region, and geographic proximity to reservation land (p < 0.10).ConclusionsThe vast majority of public health networks do not report engagement with tribal organizations. Even when AI/AN serving health facilities are present, reported engagement of tribal organizations remains low.     

External collaboration and performance: North Carolina local public health departments, 1996

OBJECTIVES: This study examined the extent to which local public health departments in North Carolina collaborated with other groups and organizations, the health problems on which they worked together, and the effect of external collaboration on health departments' performance on core public health functions. METHODS: The author mailed a questionnaire asking about interactions with city and county government agencies, boards of health, schools, nonprofits, physicians/private clinics, community health centers/migrant clinics, community members, citizens' groups, state and federal agencies, and universities to all of the directors of local public health departments in North Carolina. Sixty-four directors returned the questionnaire, for a response rate of 74.4%. RESULTS: Local public health departments most frequently interacted with boards of health, state agencies, community members, schools, city and county government agencies, and nonprofit agencies. Large majorities reported productive relationships with boards of health, state agencies, city and county government agencies, schools, nonprofit agencies, and hospitals. Greater frequency of interaction with several types of partners was associated with better performance. CONCLUSIONS: While questions exist about whether performance on core functions improves the community's health status, the results suggest that it is important for local public health departments to continue to build relationships with other organizations in the community.     

Hospital and community health: going from stakeholder management to stakeholder collaboration

Leaders of hospitals and other health service organizations often use stakeholder management capabilities to analyze, understand, and transact business with their stakeholders in order to achieve organizational goals. When these leaders and their organizations become involved in community health improvement, they have new and different types of stakeholders than for traditional medical care. In the community health domain, these leaders should modify their approach toward stakeholders so that they collaborate with stakeholders rather than try to manage them. Recommendations for how to do this include giving up some control, building trusting relationships, and emphasizing community goals.     

The delivery of health care in faith-based organizations: parish nurses as promoters of health

This research report examines the role of faith-based organizations in the delivery of health care. Special emphasis is given to parish nurse programs and the unique relationship between parish nurses and faith members. Parish nurses attend not only to the physical needs of faith members, but also to needs associated with emotional and spiritual wellness. Parish nurses (N = 25) responded to questions about health ministries in faith-based organizations, their role as nurses, and the benefits of partnering with these organizations to promote health care. The nurses described the delivery of care through educational clinics, viewed themselves as promoters of health, and described the benefits of a holistic approach to health that includes emotional and spiritual dimensions. The discussion addresses themes that emerged from the results as well the ethical implications of incorporating health ministries into faith-based organizations.     

Health Communication: A Multicultural Perspective. By Snehendu B. Kar and Rina Alcalay,with Shana Alex

This research report examines the role of faith-based organizations in the delivery of health care. Special emphasis is given to parish nurse programs and the unique relationship between parish nurses and faith members. Parish nurses attend not only to the physical needs of faith members, but also to needs associated with emotional and spiritual wellness. Parish nurses (N = 25) responded to questions about health ministries in faith-based organizations, their role as nurses, and the benefits of partnering with these organizations to promote health care. The nurses described the delivery of care through educational clinics, viewed themselves as promoters of health, and described the benefits of a holistic approach to health that includes emotional and spiritual dimensions. The discussion addresses themes that emerged from the results as well the ethical implications of incorporating health ministries into faith-based organizations.     

States' implementation of the Section 510 abstinence education program, FY 1999

CONTEXT: As part of its reworking of the nation's welfare system in 1996, Congress enacted a major new abstinence education initiative (Section 510 of Title V of the Social Security Act), projected to spend $87.5 million in federal, state and local funds per year for five years. The new program is designed to emphasize abstinence from sexual activity outside of marriage, at any age, rather than premarital abstinence for adolescents, which was typical of earlier efforts. The actual message and impact of the program, however, will depend on how it is implemented. METHODS: Program coordinators in all 50 states, the District of Columbia and Puerto Rico were surveyed concerning implementation of the Section 510 abstinence education program in FY 1999. The questionnaire asked about expenditures and activities performed, about policies established for a variety of specific situations and about how the term "sexual activity" is defined and what specific components of the federal definition of "abstinence education" are emphasized. RESULTS: Forty-five jurisdictions spent a total of $69 million through the Section 510 program in FY 1999. Of this total, $33 million was spent through public entities, $28 million was spent through private entities and $7million (in 22 jurisdictions) was spent through faith-based entities. Almost all jurisdictions reported funding school-related activities, with 38 reporting in-school instruction and presentations. Twenty-eight jurisdictions prohibited organizations from providing information about contraception (aside from failure rates), even at a client's request, while only six jurisdictions prohibited information about sexually transmitted diseases. Few reported having a policy or rendering guidance about providing services addressing sexual abuse, sexual orientation or existing pregnancy and parenthood. Only six respondents said they defined "sexual activity" for purposes of the program, and 16 reported focusing on specific portions of the federal definition of "abstinence education." CONCLUSIONS: More than one in 10 Section 510 dollars were spent through faith-based entities. Programs commonly conducted in-school activities, particularly instruction and presentations, not only through public entities, but also through private and faith-based entities. Most jurisdictions prohibited the provision of information about contraception, about providers of contraceptive services or about both topics, even in response to a direct question and when using other sources of funding. Most also left definitions of "abstinence" and "sexual activity" as local decisions, thus not clearly articulating what the program is designed to encourage clients to abstain from.     

Responses of HMO Medical Directors to Trust Building in Managed Care

Managed care organizations (MCOs) are facing intense criticism at national, state, and local levels and battling initiatives that would impose stricter regulation. Medical directors of HMOs were surveyed regarding their organizations' strategies of communication, the programs they have instituted to build trust, and their commitment to sponsoring family and patient support groups. The responses obtained from 252 directors indicate that nonprofit and free-standing organizations are more likely than either for-profitHMOs or organizations that are part of a chain to sponsor community activities and programs and to offer family and patient support groups. Staff- and group-model HMOs are more likely than other organizational configurations to initiate many types of "trust programs." The results indicate that more dispersed and "virtual-type" organizations must explore ways to respond meaningfully to community concerns–and to public health, prevention, and health promotion needs as well–while continuing to improve their practice patterns.     

"Do good and talk about it". A CHRISTUS health study emphasizes the importance of telling our stories to the public

In a time of public scrutiny, it is paramount that Catholic health care organizations examine their commitments to their communities and effectively communicate community benefit activities to stakeholders-employees, physicians, patients, and the public. CHRISTUS Academy, a leadership development program at CHRISTUS Health, Irving, TX, conducted two studies regarding community benefit. The first researched community benefit practices at more than 20 highly respected, tax-exempt CHA- and VHA-member organizations, comparing them with the practices of about 40 publicly traded, for-profit organizations. The primary conclusion was that community benefit is not just about measuring the numbers-it is also about "telling the story." Unlike the for-profit organizations, tax-exempt health care organizations tend to struggle with adequately measuring and reporting their community contributions. In a second study, the academy surveyed CHRISTUS Health's employees and physicians regarding their knowledge of the system's commitment vis-à-vis identifying and meeting community needs. The vast majority said the system is important to the community and is actively involved in understanding and meeting the needs of the community. However, they also ranked the system lower in terms of working with other community organizations, being a leader in community health, and being known for sponsoring volunteer activities. These lower rankings indicate that the community benefit activities are not well publicized or known within the organization. Catholic health organizations must take an active approach in communicating their work to the public, the media, and each other. In doing so, they fulfill an integral part their mission.     

An International Survey of the Public Engagement Practices of Health Technology Assessment Organizations

ObjectivesMany jurisdictions are moving toward greater public involvement in health technology assessment (HTA) processes. This study aims to provide a broad, cross-sectional indication of the extent and methods of public engagement in HTA, with a focus on which public are engaged, by what mechanisms, and the purpose of public engagement.MethodsAn international Web-based survey of 217 organizations involved in HTA was undertaken. Contact e-mail addresses for targeted organizations were identified from the Internet.ResultsIndividuals from 39 (18%) of the contacted organizations completed a survey. The majority (67%) of responding HTA organizations undertake public engagement activities, predominantly involving lay representatives of organized groups (81%), and to a lesser extent individual patients/consumers (54%) or citizens/community members (54%). For organizations undertaking public engagement, mechanisms based on communication or consultation were the most common, although some organizations have used or intend to use participatory approaches, particularly the Citizens’ Jury (8%) or Consensus Council (20%) methods. Respondents identified with a number of rationales and barriers for undertaking public engagement.ConclusionsThis survey provides further insight into the public engagement approaches that are used by HTA organizations in practice. In particular, it suggests a limited adoption of participatory methods to date, and interest in the use of social media. Study findings require further confirmation, due to limitations related to survey response. There is considerable opportunity for further research into pragmatic, robust, and meaningful approaches to public engagement to strengthen HTA policy and decision-making frameworks. An agenda for future research evolving from the survey responses is proposed.