In coordination with National Public Health Week, April 2-8, the American Journal of Public Health will debut its first electronic-only supplement, entirely devoted to public health preparedness.
Each year, the American Public Health Association serves as the lead organizer of National Public Health Week (NPHW). This year’s theme is “Take the First Step! Preparedness and Public Health Threats: Addressing the Unique Needs of the Nation’s Vulnerable Populations.” Visit www.nphw.org for more information.
Preparedness Supplement Highlights:
- State pandemic flu plans fail to address important ethical issues
- Many Hurricane Katrina evacuees suffered psychologically, many for years
- Another lesson from Katrina: New Orleans blacks failed to evacuate for complex reasons
- States hampered in efforts to track, respond to non-communicable diseases
State pandemic flu plans fail to address important ethical issues
If the United States is threatened by an influenza pandemic in the near future, "we stand the risk of making many unjust and regrettable decisions," according to an analysis of state and federal preparedness plans that are surprisingly lacking in ethical language.
Federal pandemic preparedness plans as well as plans from all 50 states and the District of Columbia were searched for such ethical terms as accountability, autonomy, collaboration, confidentiality, privacy and many others. Many plans recognized the need to address ethical questions but simply stated they would eventually need to confer with an ethicist. The researchers note, however, that ethical questions should be anticipated and addressed before the urgency of a pandemic makes deliberation difficult. They recommend that people at every level of government should be trained to identify and address ethical issues arising in a public health emergency such as a pandemic.
The ethical issue most often addressed in the plans was the allocation of vaccines and antiviral medications. The researchers point out that a vaccine won’t be available until months after the pandemic begins and antivirals will be unavailable to most people. Meanwhile, other ethical questions were seldom addressed, including the diversion of resources from other public needs in order to anticipate or address the pandemic, acceptable compromises in skill levels if retired professionals are recruited to fill in for those struck by the pandemic, and preventing panic in communities and fear mongering by the media.
The plans are "opaque in their ethical reasoning," according to the analysis. "The implied messages are a combination of "trust us and do as we say" and "ethics are self-evident, just do what is needed to preserve lives." [From: "Ethics in a Pandemic: A Survey of State Pandemic Influenza Plans." Contact: James C. Thomas, MPH, PhD, University of North Carolina School of Public Health, Chapel Hill, firstname.lastname@example.org]
Many Hurricane Katrina evacuees suffered psychologically, many for years
It is not surprising that the majority of Hurricane Katrina evacuees suffered psychological distress. This study suggests that almost half of them will likely suffer from post traumatic stress disorder even two years after the hurricane hit the Gulf Coast.
Based on a survey conducted 12-19 days after Hurricane Katrina of evacuees at a major emergency shelter, 62 percent met the criteria for acute stress disorder, often a precursor to such problems as post traumatic stress disorder. Based on this data, researchers predicted that up to 49 percent of the evacuees would be suffering from post traumatic stress disorder two years after the disaster. Some risk factors that increased the likelihood of evacuees suffering from psychological problems after the hurricane were being black or female, having a prior history of psychological problems, or having sustained physical injury in the disaster.
Nearly all of the evacuees surveyed had waited several days before being evacuated, "resulting in high levels of traumatic exposure and loss," the study's authors said. Black evacuees were more likely to have waited longer before rescue and to have suffered financial hardships such as losing a job in the hurricane's wake. "The lack of an adequate mental health care structure, as was evident in New York after 9/11, continues to be a national problem."[From: "Trauma and Stress Response in Katrina's Evacuees." Contact: Mary Alice Mills, University of Connecticut Department of Psychology, email@example.com.]
Another lesson from Katrina: New Orleans blacks failed to evacuate for complex reasons
Inconsistent information coming from authorities, perceived racism and optimism about their ability to ride out the storm because of religious faith all affected many blacks’ decisions not to evacuate as Hurricane Katrina hit the New Orleans area.
A study based on focus groups of black New Orleans residents who were evacuated to Columbia, S.C., following the hurricane found that “culturally sensitive logistic planning for the evacuation of minority, low-income and underserved communities” is a key need for all future disaster preparedness planning. The study’s authors said federal, state and local disaster preparedness plans should specify criteria for timely evacuation orders as well as needed resources and how those resources should be allocated.
The report’s authors point out that disproportionate numbers of those seeking shelter in Katrina’s wake were black, as were three-fourths of the 2,300 reported missing and a majority of the 668 reported dead from Louisiana. Among the reasons the study participants gave for not evacuating: they had successfully ridden out a hurricane in the past; they had no money for gas to leave the city; they were afraid to leave their homes and have their valuables stolen; and a fear that police would stop them if they tried to evacuate through neighboring parishes.
In addition to better preparedness plans, the study’s authors said “It is very important as well that the perception of race-based inequities be explored in depth, to understand their contribution to the disproportionate casualties and suffering experienced by minorities in emergencies such as that created by Hurricane Katrina.” [From: “Why African Americans Did Not Evacuate Before Hurricane Katrina: A Qualitative Study of Evacuees From New Orleans.” Contact: Keith T. Elder, PhD, MPH, MPA, University of South Carolina, Columbia, firstname.lastname@example.org.]
States hampered in efforts to track, respond to non-communicable diseases
When it comes to tracking and responding to clusters of non-communicable diseases and conditions such as cancer, autism and heart disease, states are hampered by a lack of personnel, resources and proper communication between agencies.
Based on an inventory of state public health agency Web sites and a Web-based survey of state health agency personnel, researchers found that although non-communicable diseases are considered a key concern in communities across the country, states vary in their response to tracking and addressing the concern. Of the Web sites, 26 listed a non-communicable diseases contact and 12 mentioned a response team. Of the 37 states that completed the study’s Web-based survey, all addressed cancer and 30 also responded to clusters of other non-communicable diseases such as multiple sclerosis and autism.
Yet training and expertise among professionals responsible for responding to non-communicable disease clusters varied widely, not all professionals who address non-communicable diseases work in traditional public health agencies and even the federal agency role in non-communicable disease investigation “was not well defined and was inconsistent across states,” according to the study’s authors. States also lack systematic records keeping and established protocols for responding to possible non-communicable disease clusters. The study gives recommendations on how states can strengthen their ability to track and respond to non-communicable disease investigations.
[From: “Adequacy of State Capacity to Address Noncommunicable Disease Clusters in the Era of Environmental Public Health Tracking” Contact: Nadia Shalauta Juzych, MS, ScD, Michigan Public Health Institute, Bloomfield Hills, email@example.com.]