Public health and terrorism preparedness: cross-border issues

On December 15, 2003, the Centers for Public Health Preparedness at the University of Minnesota and the University of Iowa convened the "Public Health and Terrorism Preparedness: Cross-Border Issues Roundtable." The purpose of the roundtable was to gather public health professionals and government agency representatives at the state, provincial, and local levels to identify unmet cross-border emergency preparedness and response needs and develop strategies for addressing these needs. Representatives from six state and local public health departments and three provincial governments were invited to identify cross-border needs and issues using a nominal group process. The result of the roundtable was identification of the needs considered most important and most doable across all the focus groups. The need to collaborate on and exchange plans and protocols among agencies was identified as most important and most doable across all groups. Development of contact protocols and creation and maintenance of a contact database was also considered important and doable for a majority of groups. Other needs ranked important across the majority of groups included specific isolation and quarantine protocols for multi-state responses; a system for rapid and secure exchange of information; specific protocols for sharing human resources across borders, including emergency credentials for physicians and health care workers; and a specific protocol to coordinate Strategic National Stockpile mechanisms across border communities.     

Vaccine advance-purchase agreements for low-income countries: practical issues

There are strong theoretical arguments for the creation of advance-purchase agreements to increase incentives for the development and production of vaccines for diseases concentrated in low-income countries. A Center for Global Development working group recently concluded that such agreements could be implemented successfully. We consider the practical economic and legal arrangements for such advance-purchase commitments. We identify several practical issues that we believe the public health and policy community should consider further in the design of an advance-purchase commitment.     

Surveying linguistically challenged Southeast Asian American populations: use of a community-partnered methodology

Southeast (SE) Asians suffer from health disparities often caused by lack of preventive care, exacerbated by linguistic barriers which exclude many from surveys that fail to include minorities. This survey of linguistically-challenged SE Asians captured health status indicators, behaviors and access. Items were based upon Public Health Management Corporation's Household Health Survey. Participants were recruited by a community-based organization serving SE Asians; interviews were conducted in nine languages. Data were weighted to match age-sex distributions of Asians in Philadelphia. Of 527 interviews completed, 57% were U.S. citizens, 48% uninsured, 23% had gone without care due to cost. English was the main language at home for 3%, yet 53% reported their primary health care site did not have an interpreter. Nearly half reported health as fair/poor, and 22% had a chronic health condition. This community survey illuminates the need to profile the health care needs of these immigrant populations.     

Disaster preparedness for limited English proficient communities: medical interpreters as cultural brokers and gatekeepers

Current disaster and emergency response planning does not adequately address the needs of limited English proficient (LEP) communities. The complexities of language and cultural differences pose serious barriers to first responders and emergency providers in reaching LEP communities. Medical interpreters are potential key cultural and linguistic linkages to LEP communities. This project established a collaborative partnership with the Interpreter Services department of Harborview Medical Center in Seattle, Washington. In summer 2004, a pilot assessment of the training background and work experiences of medical interpreters was conducted that focused on training needs for disaster/emergency situations. Overall, medical interpreters identified a need for disaster preparedness training and education. Medical interpreters further reported that LEP communities are not prepared for disasters and that there is a need for culturally appropriate information and education.     

Locating and communicating with at-risk populations about emergency preparedness: the vulnerable populations outreach model

Vulnerable populations tend to have the worst health outcomes during and after disasters; however, these populations are rarely included in the emergency planning process. In Philadelphia, the Department of Public Health and the Office of Emergency Management have reached out to community-based organizations that serve vulnerable populations to include these key stakeholders in emergency planning. In this article, we outline strategies for locating, engaging, and communicating with vulnerable populations about both organizational and personal emergency preparedness. Such strategies include creating a method for bidirectional communication via a free quarterly health newsletter that is distributed to community-based organizations serving vulnerable populations. We also note successes and next steps from engaging vulnerable populations in the planning process in Philadelphia.     

Disaster preparedness among families of older adults taking oral medications

This study aimed to examine factors influencing disaster preparedness among families caring for older adults who take oral medications. Fifty-eight family caregivers completed anonymous self-administered questionnaires. Binomial logistic regression analysis with the storage of the care recipient’s medications as the dependent variable revealed that caregivers’ disaster-related information-seeking behavior (e.g., considering appropriate methods to collect such information), and recognition of disaster risks in their communities strongly influenced their storage of emergency medication.     

Chronically unprepared: emergency preparedness status among US medically vulnerable populations

Journal of Public Health - The prevalence of large-scale natural and biological disasters has increased in recent years and can have detrimental impacts on health. Some populations are more...     

Ethical issues in obesity interventions for populations

Beyond the usual technical and evidentiary considerations, there are ethical questions that we must consider in the justification of our obesity interventions in the name of expected population health gains. These relate to the types of health identities that are permitted in society, the possible unintended consequences of preferencing certain health identities over others, and the manner in which public health policies and interventions are justified. The prevalence of overweight and obesity in Australia highlights some of the areas of uncertainty and identifies some important ethical questions that arise as a result of this uncertainty. I propose that the Australian obesity prevention strategy could be evaluated using the Nuffield Council on Bioethics stewardship model of public health to assess whether any current approaches exceed recommended intervention constraints or limits. My aim is to prompt further debate on this topic.     

Critical issues in bioterrorism preparedness: before and after September 2001.

The Bioterrorism Preparedness and Response Survey (BPRS) was a survey of Ohio local health departments' capacity to respond to bioterrorism. Soon after completion of the BPRS, the events of September 11 occurred, followed by the human cases of anthrax. The Ohio Response to Bioterrorism 2001 Survey (ORB) identified bioterrorism preparedness issues related to the suspected anthrax incidents. The BPRS measured capacity before September 11, 2001, and the ORB measured Ohio communities' response to white powder incidents. The BPRS and ORB provided independent and outcome measures related to the 2001-bioterrorism events. The significant bioterrorism response issues were: monitoring critical or unexplained deaths and clusters or symptoms; training on bioterrorism agents; integration of medical and criminal investigations of bioterrorism incidents; development of bioterrorism emergency response plans to include agencies to be contacted, management strategies for implementing mass vaccination, prophylaxis, treatment distribution and administration; and participation in a bioterrorism field or tabletop exercise. These results are confirmed and extended by studies by the US General Accounting Office, the Rand Corporation, Trust in the Future of America's Health foundation, and a follow-up survey of issues during a simulated covert smallpox attack.     

Disaster preparedness among families of children with special health care needs

Families with children with special health care needs may present a challenge for disaster responders. This study examined the level of personal disaster preparedness among this at-risk population in relation to the general population, and explores whether special health care needs or perception of disaster risk affects preparedness levels. A convenience sample of 145 families presenting to an urban tertiary care children's hospital was surveyed using a previously validated instrument to gather information on levels of preparedness and factors influencing preparedness. In spite of significant special health care needs and concern about disasters, families remain unprepared for a disaster event. Health care and psychosocial support workers are in a unique position to increase preparedness levels in this at-risk population.     

The burden and management of dyslipidemia: practical issues

Abstract The objective of this study is to describe briefly the burden of dyslipidemia, and to discuss and present strategies for health professionals to improve dyslipidemia management, based on a review of selected literature focusing on interventions for dyslipidemia treatment adherence. Despite the availability of effective lifestyle and pharmaceutical therapies for dyslipidemias, they continue to present a significant economic burden in the United States. Adherence to evidence-based guidelines for the treatment of dyslipidemias is unsatisfactory. The reasons for medication nonadherence are complex and specific to each patient. The lack of progress in achieving optimal lipid targets is caused by many factors: patient (medication adherence, cost of medication, literacy), medication (adverse effects, complexity of regimen), provider (lack of adherence to evidence-based practice guidelines, poor communication), and the US healthcare system (being focused on acute care rather than prevention, lack of continuity of care, general lack of use of an electronic health record). Combined interventions that target each part of the system have been effective in improving treatment adherence and achieving lipid goals. Patients, providers, pharmacists, and employers all play a role in management of dyslipidemia. No single approach will solve the complex issue of improving dyslipidemia management. The required lifestyle changes are known and effective medications are available. The challenge is for all interested parties-including nurses, nurse practitioners, doctors, pharmacists, other health care professionals, employers, and health plans-to help patients achieve behavioral changes. (Population Health Management 2012;15:302-308).