Hot Out of Obama’s Office

What moves us?

The nation’s first National Prevention Strategy came out today and it’s a step forward for creating a disaster resilient nation.  What moves us towards a healthier nation moves us towards greater resilience.

Where did the distinguished authors and advisors place disaster resilience in their thinking?  High up.  They specifically mentioned it in the first paragraph:

The strength and ingenuity of America’s people and communities have driven America’s success. A healthy and fit nation is vital to that strength and is the bedrock of the productivity, innovation, and entrepreneurship essential for our future. Healthy people can enjoy their lives, go to work, contribute to their communities, learn, and support their families and friends. A healthy nation is able to educate its people, create and sustain a thriving economy, defend itself, and remain prepared for emergencies. 

While it might instead have said “…and demonstrate resiliency to emergencies,” I am glad the issue of preparedness got such prominent mention.

The Strategy promotes resilience again in the section on “Healthy and Safe Community Environments” which is the first of four Strategic Directions. “Healthy and safe community environments are able to detect and respond to both acute (emergency) and chronic (ongoing) threats to health.” (p.14) Strengthening public health departments to provide essential services is a key recommendation in this section with which we all agree (p.15). Many of the activities that the Strategy states the Feds should do under this Strategic Direction do promote resilience and the one that most directly does is for the Feds to “support state, tribal, local, and territorial partners in strategic health security planning efforts for pandemics, biological and chemical attacks, incidents affecting food and agriculture, natural disasters, and other catastrophic events.”  Still, this lukewarm statement is further evidence that we must work at hyper-local levels to improve resilience.

A word search for “resilience” finds it only once in the text (“Supportive relationships, such as family connections, long- term friendships, and meaningful connections between youth and adults including students and teachers or coaches, build resilience and well-being.”) (p.48)

Missed opportunities for mentioning resilience IMHO:

  • The text accompanying the recommendation to strengthen health departments focuses on laboratory capacity and quality improvement with no mention specifically of their leadership role in building resilient communities.
  • The Key Indicator of success for the goal of strengthening public health departments is the, “proportion of state public health agencies that can convene, within 60 minutes of notification, a team of trained staff who can make decisions about appropriate response and interaction with partners”.

I guess we had no better indicators to use?

But resilience is a “latent” concept—it’s not measured directly but rather by other indicators that we think underlay resilience.  So, here are some Indicators that I’d say are directly related to a resilient community:

  • Proportion of children and adults who are vaccinated annually against seasonal influenza (child target = 80; 65+ target = 90%)
  • Proportion of adults reporting that they receive the social and emotional support they need (target = 88%)
  • Proportion of adults (from racial/ethnic minority groups) in fair or poor health (target = 8.8%, the baseline for non-Hispanc Whites)

Oh, the Feds will “support research and evaluation studies that examine health literacy factors in the study of other issues (e.g., patient safety, emergency preparedness, health care costs).”  Now that’s an RFA I can respond to.


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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