National Academy of Science Comments

Some of you have asked what I said today to the National Academy of Sciences/National Research Council.  They originally asked Alonzo Plough to speak and he, who was not in town today, asked me to represent him.  Here are my comments to them:

Thank you to the National Academy of Science and the National Research Council for inviting the Los Angeles County Department of Public Health to address this distinguished panel.  Dr. Alonzo Plough, the Director of the Emergency Preparedness and Response Program, regrets he is unable to address the panel today.  It is my honor to represent him today, with the assistance of Ms. Brittney Weissman, Public-Private Partnership Manager for the Emergency Preparedness and Response Program, who sits in the audience.

I am going to describe how our public health department is putting resilience into practice.  By way of background, CDC’s 15 Public Health Preparedness Capabilities are national standards for health departments to plan for resilience.  Two of the 15 Capabilities address community resilience.  Capability One is “Community Preparedness” and Capability 2 is Community Recovery. Los Angeles County Department of Public Health (LACDPH) is directly addressing Capability 1 and Capability 2 in its community resilience efforts.  During the next 5 minutes I will describe how LACDPH is implementing its community resilience plans both externally, in its relations to the community, and internally within the Department of Public Health.

Externally, LACDPH is developing its public-private partnerships.

In the Los Angeles County Community Disaster Resilience Project project (www.laresilience.org), LACDPH aims to engage community-based organizations in providing leadership and partnership to promote community resilience in the face of public health emergencies .  The key goal is to develop an active network of community agencies that work consistently with the Los Angeles County Department of Public Health and the Emergency Network of Los Angeles (ENLA) to develop resilience in communities in the context of public health disasters. ENLA is the Los Angeles County VOAD (Voluntary Organizations Active in Disasters), and is recognized as the networking agency for community based organizations that provide assistance to individuals, families, and organizations following emergencies and disasters.

Through community organization meetings, surveys, and workgroups this project aims to identify what agencies and CBOs are doing, what leadership they could provide, and what it would take to build more resilient communities in Los Angeles County.

Three community resilience workgroups are now working to engage community partners more fully in resilience.  The three workgroups have different and intersecting aims and share the same aim of identifying existing social networks, services and resources that can be dually used for improving resilience or otherwise leveraged to this goal.

For instance, the purpose of the Vulnerable Populations Workgroup is to identify the specific populations in Los Angeles County that are vulnerable to public health emergencies and to identify strategies that will enhance their integration into plans to build community resilience.   Initial workgroup discussion questions:

· What resources can be used for the dual purposes of preparedness and building healthier communities?

· What are new ways to engage all vulnerable populations in building the resilience of a community?

· How can the Los Angeles County Department of Public Health work with community-based organizations including social service organizations, schools, businesses, and faith-based organizations to meet the goals of reduced vulnerability and increased community resilience?

In this context, it is worth mentioning that LACDPH is advising UCLA investigators on a related project the aim of which is to determine how local health departments work effectively with community-based organizations and faith-based organizations to enhance preparedness.  One likely lesson we are learning from these two projects combined is about VOADs generally.  The Voluntary Organizations Active in Disasters (VOAD) model can greatly enhance linkages between health departments and CBO’s.  Also, variations in VOAD effectiveness appear to be related to variations in funding, staffing, membership requirements, and the quality of their relationships with local government counterparts.  Enhancing VOAD effectiveness and linkages to public health departments may be one way that community resilience can be fostered in other communities.

Second, we are very excited about a new media campaign that LACDPH  is rolling out in August that publicly announces the paradigm shift from individual preparedness to community resilience.  Community sufficiency will be the theme.  A focus on “we” is replacing the focus on “me”.  No longer will billboards exhort citizens to get prepared by making a plan or kit, though that’s certainly still important.  At the heart of this campaign is the question of how do you get people to trust each other, to know each other, so that they can work together in the midst of a disaster before government help arrives. LAC DPH will also revamp its website to support the community resilience theme and will encourage community folks and organizations to connect with each other before, during and after disasters.

Third, LACDPH performs regular population assessments that include sections on preparedness and resilience markers; and analysis informs LACDPH programs and campaigns.  These are always random-digit-dialed telephone survey of the Los Angeles County population, conducted in 6 languages English, Spanish, Mandarin, Cantonese, Korean, or Vietnamese.  For instance, my team’s analysis of recent data has lead to the conclusion that low literacy materials will be particularly important and to include multiple languages with saturation in minority communities.  Determining risks to the health of the jurisidiction is a core function of the CDC Capabilities which these population surveys address.

Fourth, is the ROADMAP project.  The UCLA Schools of Medicine and Public Health, Los Angeles County Department of Public Health (LACDPH) and the City of Los Angeles Department of Aging (DOA) are collaborating on this project, a resiliency intervention that aims to build capacities for staff at the City of Los Angeles DOA Senior Centers to work with their senior consumers around safety and preparedness.  This is building new community partnerships to support preparedness by, one, linking across government agencies and, two, linking LACDPH with community resources, in this case the Senior Centers that are privately owned and contract to provide services.

This project is supplementing our understanding of how to convey preparedness messages effectively to various vulnerable communities. Our approach adopts the evidence-based approach of using a train-the-trainer model to disseminate preparedness lessons into the community.  Lay workers and volunteers are provided brief training in preparedness.  They hold community meetings and classes at public venues.  Meetings are participatory and hands-on; for instance everyone walks out with some part of their emergency plan completed.  Seniors leave with their medications written down onto an emergency card.  Social networks are leveraged to improve participation and adoption.  The content and processes are targeted and slightly adapted for different audiences.  For example, promotoras can lead “platicas” at community centers, libraries and churches; peer mentors can assist developmentally disabled adults who are living independently in the community to gather their supplies. Always the core Methods are evidence-based and straight out of the public health playbook.  Understand the whole community.  Engage the community in an authentic manner.  Meet people where they are. Build on what already works on a daily basis. Empower local action.  Evaluate.  Disseminate.

The above are examples of LAC-DPH facing outwards, developing external linkages and partnerships with the community.  All of this is complemented by LAC-DPH’s inward facing efforts to develop linkages and partnerships within the Department that support and maintain the external resilience work.  Indeed, if community resilience is also concerned with the more common adverse events and problems then LAC-DPH is infusing resilience as a fundamental concept into all the programs at DPH – Community Health Services, Health Education Administration, Health Assessment, Organizational Development and Training etc.  Dr. Plough and Brittney Weissman are undergoing a series of “Meet and Greets” with the heads of the other sections of DPH.  With the support of Dr. Fielding, the Commissioner of Public Health, slowly, the internal structure of the DPH is being infused with an understanding of resilience, to support the goal of community resilience, and community coalitions and partners that are currently linked with departments in LAC-DPH will be infused with resilience ideas, training and tools.  In sum, LACDPH will be connecting preparedness activities with other health promotion and public health prevention activities across department programs.

One last example:  LACDPH continues to develop 8 emergency preparedness public health nurses from the Community Health Services Department to engage communities and develop partnerships.  Nurses from the divisions of Maternal Child Health, Substance Abuse Prevention and Control and the Office of AIDS Program and Policy are being trained in emergency preparedness and community resilience work.  Several resilience-related trainings for all staff are slated to occur between now and the end of August including: social media tools for preparedness, response and recovery, and psychological first aid.  These trainings will be part of a broader resilience-related training curriculum implemented in partnership with the DPH training program for staff throughout the Department.

Thank you.

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About David Eisenman

I'm a physician and public health/health services researcher. I want to bring these perspectives to understanding disaster resilience.
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