Prevention and Public Health Policy Archives - Page 12 of 19

Prevention and Public Health Policy

Health and well-being involve more than treating illness. Fostering optimal health means understanding the factors that lead to both illness and health. A modern public health system serves as a community’s chief health strategist. Such a system uses the best available evidence to inform strategies, policies and programs to improve and protect the health and well-being of the communities it serves.

TFAH’s mission is to report on and help amplify evidence-based programs and policies that promote healthy behaviors and support conditions in communities, schools and workplaces that foster health and well-being. Our work is designed to advance a national public health system that supports optimal health for every person and community, resolves health disparities and is centered on prevention.

Pain in the Nation Update: Deaths from Alcohol, Drugs and Suicide Reach the Highest Level Ever Recorded

Building a Community Roadmap to Health and Equity in Jackson, Mississippi

By Beneta D. Burt, Executive Director, Mississippi Roadmap to Health Equity

The Mississippi Roadmap to Health Equity, a community-run organization that seeks to generate and mobilize resources, utilizes our expertise to improve how community institutions operate and, at the same time, protect and promote the health of community members.

By working with everyday institutions that touch everyone’s life, we can advocate for changes that are good for the bottom line and promote better health equity in Jackson. By building important relationships, we can ensure community institutions support the community’s efforts to be healthy—and are true partners in making the healthy choice the easy choice.

How we started

With primary support from the W.K. Kellogg Foundation, Mississippi Roadmap’s work began in 2003 with a series of sessions aimed at addressing why African-Americans are sicker and die sooner than their peers.

Through concept mapping, we identified the many factors that contribute to poor health. And, just one year later, nearly 200 community residents, members of the Mississippi Roadmap Community Steering Committee (CSC) and National Advisory Board members created ideas to improve community health outcomes. Participants laid out a “roadmap” for a healthy present and an even healthier future, especially for the economically-disadvantaged citizens of Jackson. While the state of affairs regarding the health of African-Americans was central to the purpose of the conference, the overall goal was to develop a community-driven health movement that fostered equity, justice and respect for all people.

Initially we set out to improve access to fresh and affordable produce and safe and affordable places for people to exercise – there were simply no grocery stores or farmers’ markets in the area and no price-conscious fitness centers.

To solve these problems, we re-purposed a shuttered grocery store to include:

A state-of-the-art adult fitness center;
An indoor farmers’ market;
A children’ fitness area that accommodates pre-school through teens;
Space for healthy cooking classes, in partnership with dietitians from The University of Mississippi Medical Center;
A venue for senior citizens to congregate;
An affordable rental facility for community events and a venue to convene community conversations; and
A Technology Learning Lab that serves 4^th and 5^th grade students who participate in our afterschool program.

Additionally—in an effort to promote healthy eating habits, to demonstrate to city kids where good food comes from, and to encourage them to eat more fruits and vegetables—we developed 15 garden-based projects in elementary/middle schools in the Mississippi Delta, in Jackson, and on the Gulf Coast.

How we do it

A Community Steering Committee guides our work. An executive director, together with a staff of six, provides day-to-day management. CSC members each have their own “community constituents” who they work with and/or advocate for. These community constituents range from neighborhood associations to church groups to social justice and advocacy organizations—they run the full gamut of the community.

The diversity of ages, backgrounds, interests, professions, and community connections of the CSC members provide access to the pulse of each segment of Jackson and provides a voice for their issues, ideas, needs and concerns.

Going Forward

We are scaling up our work to focus even more on promoting the health and well-being of children by creating job training programs targeted to non-college bound high school graduates and other out of- school youth.

To do so, we began the process of becoming an affiliate of the National Urban League—this vital partnership, which was fully formed in February 2018, will promote employment equity.

Unemployment among teenagers and young adults are major issues in Jackson, especially during the summer, while unemployment among out-of-school youth is equally concerning. In 2016, approximately 600 Jackson high school graduates did not attend college and most had no plans or employment prospects.

In an effort to close this gap, Roadmap entered into a Memorandum of Understanding (MOU) with the City of Jackson in to acquire a city-owned, soon-to-be-shuttered golf course and club house that we will now use to develop a job training program in golf course management designed to develop landscaping-related employment opportunities.

Out-of-school youth will be recruited during the course of the year and enrolled in a GED program provided by Hinds Community College prior to enrolling in the job training program. We will incentivize participant training to encourage consistent attendance and attainment of GEDs prior to transitioning to the program. Additionally, a job developer will work with non-college bound high school seniors in March of each year to prepare them for entering the training program.

Upon completion of classroom and on-the-job training activities, and with Roadmap’s oversight, some participants will bid on landscaping management contracts with local public school districts. Successful bids will result in permanent, unsubsidized employment for participants.

To leverage these relationships and also improve physical fitness, golf pros will develop a program for integration into the curriculum of the local elementary school, which is located next to the golf course. And, a concurrent physical fitness program will be incorporated into the program. Eventually, we hope these plans and resources can benefit the health of the entire community.

Partnerships are Vital

Any measure of success that we have achieved can be attributed to the long-term support from the W. K. Kellogg Foundation, and to the large group of public and private sector members whose actions demonstrate that community partnerships play an integral part in achieving improved health outcomes. We have the good fortune to have local chefs, hospitals and health professionals, church ministries, and community-academic partners involved.

Just one partnership example: we are the grant recipient in partnership with the Mississippi State Department of Health and the University of Mississippi Medical Center (UMMC). For this grant, the Department of Health provides staff resources and UMMC provides the required match for the project, which allows us to create a culture of breastfeeding among young women in Jackson.

Leading Public Health Groups: Using the Prevention Fund to help fund CHIP: A Serious Mistake

Statement from Trust for America’s Health, American Public Health Association, National Association of County and City Health Officials, Prevention Institute, and Public Health Institute

December 22, 2017

Washington, D.C., December 22, 2017 –It is a serious mistake to cut $750 million from the Prevention and Public Health Fund to provide very short-term funding for the Children’s Health Insurance Program (CHIP) and community health centers. The below is a statement from the American Public Health Association, National Association of County and City Health Officials, Prevention Institute, Public Health Institute, and Trust for America’s Health:

“The Prevention Fund supports critical public health activities—including lead poisoning surveillance, vaccination initiatives and other programs—in every state and community across the country. Cutting this significant funding source would leave communities without the vital resources needed to keep children and families happy, healthy and safe.

It is even more alarming and contradictory that this cut will be used to provide very short-term funding for CHIP and community health centers. Our organizations are united in support of CHIP and community health centers, which are vital to improving children’s health. But losing the Prevention Fund would just create another hole in the public health support children need.

The Prevention Fund is supported strongly by national, state and local groups alike—indeed to-date 1,142 have joined the Prevention Fund supporter’s list. They know the value of the $630 million annually that goes directly to states and communities to prevent illness and disease.

A strong public health system makes the difference between health and illness, safety and injury, life and death.

We urge Congress to oppose any and all future cuts to the Prevention Fund and to begin the long-overdue process of increasing support to CHIP, community health centers, CDC and other public health agencies so today’s children can be our healthiest and happiest generation.”

John Auerbach, President & CEO, Trust for America’s Health

Georges C. Benjamin, MD, Executive Director, American Public Health Association

Larry Cohen, Executive Director, Prevention Institute

Laura Hanen, MPP, Interim Executive Director and Chief of Government Affairs, National Association of County and City Health Officials

Mary A. Pittman, President & CEO, Public Health Institute

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority. www.healthyamericans.org

The American Public Health Association champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that combines a 145-year perspective, a broad-based member community and the ability to influence federal policy to improve the public’s health. Visit us at www.apha.org.

The National Association of County and City Health Officials (NACCHO) represents the nation’s nearly 3,000 local governmental health departments. These city, county, metropolitan, district, and tribal departments work every day to protect and promote health and well-being for all people in their communities. For more information about NACCHO, please visit www.naccho.org.

The Public Health Institute, an independent nonprofit organization, is dedicated to promoting health, well-being and quality of life for people throughout California, across the nation and around the world.

Prevention Institute is an Oakland, California-based nonprofit research, policy, and action center that works nationally to promote prevention, health, and equity by fostering community and policy change so that all people live in healthy, safe environments.

Mental Health is Vital to Preparedness and Response

By Dr. Octavio N. Martinez, Jr., MD, MPH, MBA, FAPA, Executive Director, the Hogg Foundation for Mental Health at The University of Texas at Austin

This story was published in Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism.

The health effects from a public health emergency go way beyond the physical, taking an enormous mental toll in the immediate aftermath and the years following—and often can harm our children the most.

We must do more to know how to ensure mental health and physical health go hand-in-hand in response planning and efforts. We must also do a far better job of increasing our mental health workforce and ensuring and increasing access to mental health services both during and after an emergency.

Using Data to Plan for Maintaining Access to Mental Health Services

To prepare for any type of emergency, communities must be aware of vulnerable populations—typically children, the elderly and those who have an underlying medical condition or are mentally ill. We have gotten better at identifying where groups of these populations live.

And, we should also be able to access databases to predict what portion of a certain population might have substance use disorders, for example—and then understand what kind of continued treatment and medication are needed and where they might best be distributed.

Paired with this, we should be able to identify geographically which communities will have the hardest time bouncing back from an emergency and will need more resources.

While some neighborhoods might have good infrastructure and better access to transportation and physical and mental health services, others will struggle. The neighborhoods that will struggle should be identified in advance and plans created to help them. And, we can create plans based on any number of scenarios: fires, floods, wind damage, loss of power, etc. If you combine all the knowledge and data together, you can then coordinate resources and everyone has a chance to be healthy.

Long-term Strategies to Improve Responses to Emergencies

We also must acknowledge that human connections are incredibly important. In-between disasters, preparedness work should focus on strengthening families and communities so they are resilient enough to weather an emergency.

For example, after Hurricane Katrina, New Orleans developed community leaders specifically focused on mental wellness, resilience and recovery. The gains in improved access to care and lessened stigma were noticeable—and these should help ensure responders and communities can work together to forge a better response during the next emergency.

While this is by no means a quick fix, taking a long-term approach to emergency preparedness and community health will pay dividends in improved health of the entire population. We should bring this research to other cities and communities that will likely face similar events.

Additionally, psychological effects can take years to manifest and get under control—especially if there isn’t access to mental health services. We learned from Hurricanes Katrina and Sandy that PTSD and suicidal ideation increased dramatically after these events. However, if we were able to step in earlier and connect individuals with mental health professionals, it’s likely these issues and potentially other health issues (substance use disorders, increased anxiety, depression, etc.) could have been prevented or lessened.

Further, while we are getting better at recognizing that mental health is a key component to physical health, the workforce in this area is inadequate—and we’ve known this for a while, especially as the opioid epidemic has continued. By increasing our workforce and ensure they have the right skill sets; we could help tackle the opioid epidemic and better prepare our communities to bounce back from a disaster.

Additional Research is Needed

The devil is often in the details and coordination among the various federal, state and local agencies, organizations and others must be improved. To do so, the nation has to prioritize funding into research and assessments post emergencies—so we can truly understand how these events affect the mental health and stability of a community at a population level.

While the National Institutes of Health has a Disaster Research Response Project, it needs to better include measures on mental health and substance use disorders. We must take each disaster as a learning opportunity that can prepare us for the next one and enable us to save more lives. Increasing research would also help build a network of behavioral health disaster experts.

First Responders

Our first responders and volunteers must be trained to identify and assist people who exhibit psychiatric symptoms, i.e., in “psychological first aid.” And, going beyond this training, we know that mental health must be better integrated with the traditional health services.

Responders and volunteers must also be cared for—they are at risk for suffering secondary psychiatric distress themselves. We need better ways to monitor them during but also after the crisis to ensure they are receiving the appropriate interventions and care.

Part of the solution is increased mental health providers, which would serve many roles: keeping our first responders in good shape, filling gaps in mental health services and, by increasing access to care, hopefully preventing someone from developing a serious and chronic mental health illness.

Quite simply, if we intentionally make mental health part of our preparedness and response systems it will have untold benefits for communities before, during and after an emergency—we will build resiliency and improve well-being.

Local Public Health Preparedness and Response to Hurricanes and Other Emergencies: High Tech and High Touch

By Umair Shah, MD, MPH, Executive Director and Local Health Authority for Harris County Public Health

This story was published in Ready or Not? 2017.

Harris County, Texas, is a large and rapidly growing community. We are the third largest county in the United States with 4.5 million residents spread over 1,700 square miles.

We are diverse in every sense of the word, making it vital to communicate in culturally competent ways. Additionally, since we are growing and people come from all over, they might not have experience with mosquito or hurricane seasons. We cannot assume our constituents, year after year, are the same. So we must continue to reach out to our community and educate.

That means we need adequate capacity within the department and a diverse team with a broad array of skills and experiences who continual drill and train.

To ensure we reach all our constituents, we are mobile—we take public health to the public. We’ve built health villages with large RV units—that focus on all aspects of health from mosquito abatement to dental services to immunizations.

We didn’t stop there – we knew to be a trusted source during an emergency we must foster a real intimate sense of community.

I mention this because, day-to-day, we rely both on high tech and high touch. We must remember the importance of both. As much as we talk about technology, social media and sophisticated surveillance systems, we cannot lose the high touch of knocking on a door or stopping to share a story, laugh or cry. At the end of the day, the high tech gets the visibility, but it’s the high touch that allows the high tech to succeed.

This is the backdrop that all our preparedness activities take.

Being Prepared

Even preceding Hurricane Katrina, we made sure that every single Harris County Public Health employee had up-to-date Incident Command Systems (ICS) training—and new staffers get this training as part of initiation.

And, every year, we practice—drills, exercises, call down lists, etc.—making sure we can perform all the tasks we’ll need to do during a response.

So, in reality, our response to Hurricane Harvey started more than a decade before the hurricane ever made landfall.

Hurricane Harvey

Before Harvey even hit, our preparedness director alerted staff and the executive team that a major response would be necessary. With this advanced warning, we put all assets in place before landfall.

We set up communications pathways and communicated to all staff, ensuring they were aware of what was coming and their roles and responsibilities.

Once we were in place, we turned to the community. Our communications team sent out messages before the storm about how to be prepared: get your kits ready; what will you do without power; what if you’re displaced; how will you care for the elderly, children and pets; and many more.

Aside from those messages, we needed to make sure people avoided flood water—there could be any number of dangers from power lines to insects to animals to sewage to toxins.

I highlight talking to the public because we’re all in this together. We can respond great from a systems perspective, but if, for instance, people lose access to medications or begin to eat unsafe foods, we could see infectious disease outbreaks or worsened chronic conditions.

In addition to communicating, building and leveraging partnerships is key to a good response.

For example, we worked with state public health and federal partners (the U.S. Air Force) to continue ground and aerial spraying for mosquitos to ensure there wouldn’t be increased levels of Zika or dengue or chikungunya. All levels of government coordinated to ensure we maintained adequate control over mosquitos and other infectious diseases.

Harris County also sheltered a number of people. Our epidemiologists relied on outside experts and volunteers to help them go cot-to-cot to make sure there wasn’t an infectious disease outbreak and that people maintained access to medicines—a high touch strategy.

This is just a small sample of all the activities we did to keep people safe. At the end of the day, a good response involves working across systems to ensure strong partnerships are in place.

Going Forward

I’m always struck by the fact that everyone talks about the importance of health during an emergency, but, when the emergency goes away, we often forget that we need to adequately resource public health agencies so they have the tools and resources to take on the next emergency.

It’s about capacity.

I worry, one day, there will be an emergency that we haven’t trained for enough and don’t have adequate resources in place. Public health can’t all of a sudden be ready to respond to a major emergency – we need to drill and train and have access to infrastructure and technology.

To better prepare for and respond to emergencies, we also must improve technology solutions, electronic surveillance activities, and infrastructure support. We need more epidemiologists and environmental toxicology experts. And, we need more social workers and community health workers to fan into the community and link folks with vital social services.

The best response features a combination of high tech and high touch. This is where our department shines day in and day out. We’ve never let one overtake the other.

Nationally, though, we can’t rest on our laurels—the next storm could be different and we need to be ready and prepared.

The Private Sector’s Role in Preparing for and Responding to Public Health Emergencies

By Nicolette A. Louissaint, Ph.D., Executive Director, Healthcare Ready

This story was published in Ready or Not? 2017.

The private sector can often respond to rapidly changing circumstances nimbly and usually knows the communities they serve incredibly well. As such, amidst an emergency, there is opportunity for private organizations to step in and fill any response gaps.

The public sector takes on an enormous burden and works tirelessly to respond to emergencies, and the private sector sees its role, especially when it operates in affected regions, to surge alongside the public sector, pivot nimbly and augment public efforts—thereby enhancing the public system’s response efforts.

Often to take advantage of public and private sector expertise, there just needs to be a connection between the two.

For example, during the Hepatitis A outbreak in San Diego, public officials reached out to the private sector for help locating a significant amount of vaccines—since one of the solutions was to do a mass vaccination campaign.

Instead of suggesting they import or special order something (possibly at an extremely high cost), Healthcare Ready (HcR), my organization, checked the levels of vaccines in pharmacies in the area. We found the private sector had enough in stock to supply what was needed. Sometimes you just need to know how and who to ask.

As evidenced by this example, one important aspect of coordinating emergency response is sharing critical information. HcR is designated by the Department of Homeland Security as an information sharing and analysis center (ISAC). So, the private sector knows they can trust us with their proprietary information—and we won’t share with any outside parties inappropriately.

This designation also gives us a fuller view of the resources in a community during an emergency. For example, during a flood, we can know where emerging challenges in the medical pipeline might be because roads are not accessible. We can inform the public sector and work on a solution to ensure vital supplies make it to the public workers who are saving lives.

The public sector knows we can provide them with accurate status of response supplies and what is or isn’t happening along the supply chain. It’s absolutely vital for the public sector to know what kind of relief they’ll be getting and when and what might be missing so they can adjust on the fly.

What we’ve learned from 2017’s Hurricanes

After this hurricane season, we realized that the private sector can do a lot fast and rapidly fill gaps to supplement public sector efforts by getting around bureaucracy.

When faced with an emergency response, we initially focus on resuming supply chain operation and work to support any patients who might be falling through the gaps that naturally occur. The public sector can rely on us to gain insight into what the private sector sees—with us being a central hub coordinating private sector information.

One recent example: There was a small group of patients on St. Thomas who needed a specific drug that could only be prescribed every 30 days. The public sector folks asked us to look for ways to get the drug from Puerto Rico and onto a plane that was making routine trips between the islands after the hurricane.

As we looked into that, we also were able to reach out to the pharmacies on St. Thomas that we knew had re-opened. And we asked them to speak with their distributors who supply them with medicine. We actually found that one pharmacy had the necessary medicine and it was already on the island. We just had to connect the dots.

While this sounds easy written down, there are many competing priorities and everything is in flux during an emergency response. With the public sector relying on the private sector for these kinds of responsibilities it can free them up to handle other vital activities.

How we can better use the private sector?

While there many examples of public and private sectors working well together, too often the private sector is only looked at a supplier, notably of money and medicine, which is frustrating because clearly the private sector wants to and can help in other ways.

This might seem like a minor problem—but if the public sector is only engaging with the private sector amidst a crisis or when money is needed, the relationships aren’t developed that are necessary to work alongside one another during an emergency. A lot of emergency preparedness and response is about knowing the right organization or person to contact to obtain the life saving measure/supply you need.

Currently, in most places, states have just one Emergency Management Coordinator for the entire private sector—encompassing industries like transportation, healthcare, agriculture, food, etc. It really isn’t feasible for the level of coordination that needs to happen to go through a single node.

As such, there should be a coordinator for each industry, setup in advance with regular meetings to fold private sector emergency capabilities into the public sector’s response plans—so when a hurricane makes landfall we all know what to do.

Hurricane Katrina: What we learned, Then and Now

By Karen DeSalvo, Former Acting Assistant Secretary for Health, U.S. Department of Health and Human Services

This story was published in Ready or Not? 2017.

There are a significant amount of vital lessons that need to and have been learned from the preparation for, response to, and recovery from Hurricane Katrina. One long-term lesson that I think is worth highlighting and has shown its importance during recent weather-related emergencies is the need for public health to take a significant leadership and coordinator role before, during and after an emergency.

In the immediate aftermath of Hurricane Katrina, it was evident that connections were missing—whether it be local public health to state officials, public health to first responders, or public health to the community.

Public health leaders simply weren’t the chief health strategists for their communities. The field was focused on an important set of discrete responsibilities or program but not on the need to build connections with community leaders, first responders and other critical infrastructure that could ensure people had safe places to go and access to medications and other critical supports.

With this realization, it was apparent public health had to connect more with the full gamut of organizations and people involved with an emergency response. And, since then, we have done so not only in New Orleans, but in communities across the country.

For example, during subsequent hurricanes in New Orleans, public health was able to work directly and quickly with hospitals and other care facilities to know if power was on and what beds and medications were available.

And, if you look at the response in Houston, you’ll note that public health was everywhere. They were in communities meeting people and alerting them to potential dangers and infectious diseases, what food and water was safe, etc. And, they were all over social media in a culturally competent way, reaching more and more people.

If you compare the Houston Harvey response to Katrina, it should be apparent that one of the benefits in Houston was the high level of connectedness between public health and the community they serve.

How we can better Prepare for the Next Emergency

In addition to public health continuing to be the coordinator for health for our communities in disaster and every day, to better respond to the next public health emergency, the nation needs to:

Expand funding;
Improve the foundational capabilities of public health;
Better leverage technology;
Increase training; and
Focus on the underlying health and resiliency of our communities—particularly those who are most vulnerable.

We need more funding for public health—we need public health departments at the local and state levels to have the foundational capabilities required to respond to public health emergencies but also to help build resilience between events. These funds can’t be categorical, they have to provide core funding that can be nimble for a community to address their biggest health needs. For instance, parts of California might be more prone to wildfires while the Gulf Coast needs to focus on hurricanes. If we don’t have these capabilities in place, we’re forcing our public health workers to just react, rather than prepare to respond.

We also need more funding to go directly to local health departments. States have a huge responsibility during an emergency and often can’t funnel as many resources as you’d think to the local level. During Katrina, we saw this front and center.

While more funding is important, it must be paired with concrete expectations and accountability. Every single health department in the country should be accredited which will help ensure that they can stand up emergency operations when necessary.

When Katrina hit, we were using flip phones, Blackberries and an early version of Google maps. We’ve come a long way with technology in little over a decade, but our preparedness hasn’t quite kept up. We must do better with technology.

We have a great start with this by better leveraging the Department of Health and Human Services’ emPOWER, an online tool that houses and provides Medicare claims data to hospitals, first responders, and health officials to help map the electricity needs during an emergency. emPOWER enables responders to prioritize evacuations and can identify vulnerable populations who will need follow-up services. But it’s limited to the Medicare population. This type of tool must be expanded to or created for Medicaid and, where appropriate, private payers. First responders and public health must have real-time population level data.

An additional reason more resources are needed is to increase drills and training that specifically focuses on local leadership and the U.S. Public Health Service Commissioned Corps. Annually, public health workers should drill in a vulnerable area alongside the Commissioned Corps—an invaluable resource. Currently, when the Commissioned Corps deploys to an emergency the connections with local responders aren’t there and often the Commissioned Corps can be underutilized.

Lastly, we simply must do more to improve the resiliency of our communities. The healthier a group of people are, the better they respond to an emergency.

In-between emergencies, public health must use data and find opportunities to engage more with vulnerable populations. For example, this could include creating pilot programs with Medicare providers, home health organizations and others involved with the care of older adults. We must improve the health of our older population and, at the same time, have the processes in place that can maintain their connection to care during an emergency that might result in evacuations and/or loss of power.

The nation’s preparedness has improved immensely since Hurricane Katrina—we must keep improving.

Q/A with Celeste Philip, MD, MPH Surgeon General and Secretary of the Florida Department of Health

This was published in Ready or Not? 2017.

TFAH: What are state public health responsibilities before a storm?

Dr. Philip: The Florida Department of Health (DOH) is designated as the lead agency for State Emergency Support Function 8 (EFS8), health and medical services. DOH coordinates the availability and staffing of special needs shelters; supports patient evacuation; ensures the safety of food and drugs; provide critical incident stress debriefing; and provides surveillance and control of radiological, chemical, biological and other environmental hazards.

DOH administers two statewide preparedness grants to build local capacity within the public health and health care community. The federal Public Health Emergency Preparedness (PHEP) grant supports all 67 county health departments (CHD) and public health laboratories in developing community preparedness, epidemiological surveillance and investigation, and medical countermeasure delivery. The Hospital Preparedness Program (HPP) funds 10 health care coalitions to build capabilities for medical surge, continuity of health care delivery, and preparedness partnerships among local health care partners.

TFAH: What are state public health responsibilities after a storm?

Dr. Philip: ESF8 assesses and stabilizes the public health and medical system; supports the ongoing sheltering of persons with special medical needs; coordinates patient movement and evacuations of health care facilities; conducts public health messaging; monitors, investigates and controls any threats to human health; and coordinates disaster behavioral health services with a sister agency.

During Hurricane Irma, ESF8 assisted with 76 patient movement missions that supported the transport of hospital, skilled nursing facility and assisted living facility clients. We conducted more than 1,000 post-impact facility inspections and more than 2,600 tests of public and private water systems and operated 113 special needs shelters.

TFAH: How do state health departments coordinate the public health response to a major storm?

Dr. Philip: Preparedness and response are driven by local leadership, personnel and assets. In Florida, each CHD coordinates and works directly with their local Emergency Management to meet the preparedness and response needs of their community. If the county Emergency Operations Center (EOC) cannot meet the local need, they request assistance through the state EOC via a web-based system that allows us to track and ensure completion of mission requests.

Based on these mission requests, the state ESF8 assesses regional and state assets. If the requested resources are not available in-state, ESF8 next looks to resources available from other states through the Emergency Management Assistance Compact (EMAC), or, in the case of a declared state of emergency, potential federal assets such as Disaster Medical Assistant Teams.

TFAH: Why are federal investments in public health critical on an ongoing basis?

Dr. Philip: During a major event, we are often shoulder-to-shoulder with our federal partners in the state EOC. This includes representatives from HHS, ASPR, and also FEMA who help to coordinate any requests we make for federal assistance.

Federal investment is critical for building a public health infrastructure that has the capacity to prepare for and recover from weather and other hazardous situations. If states are better prepared to respond, requests for federal assistance may be lessened. With the close succession of Hurricanes Harvey, Irma, and Maria, and wildfires in California, federal response agencies had to sustain their efforts across time and location which may not be feasible in the future.

TFAH: What federal programs and supports are critical for preparedness and response?

Dr. Philip: Both the PHEP and HPP statewide preparedness grants are important for public health preparedness and response. Preparedness programs in various HHS agencies hold meetings that provide training and networking opportunities for states.

TFAH: What is needed from the federal government to improve preparedness and response?

Dr. Philip: Knowing and having a relationship with our federal counterparts that will be deployed to the state EOC improves communication and manages expectations more effectively. A federal system that allows for tracking of deployed assets would improve situational awareness and real-time decision-making.

Better coordination of credentialing health care professionals between states would be helpful for patients who evacuate with their provider and for providers coming into disaster areas.

Streamlined and flexible funding to allow for nimble response as needed would greatly enhance public health’s ability to be effective.

TFAH: What lessons did you learn from the most recent storm? Was there anything different or new that happened?

Dr. Philip: Hurricane Irma posed a unique challenge because the track was very unpredictable, meaning that more hospitals decided to evacuate and more residents decided to shelter. This storm at some points was 500 miles wide – which exceeded the width of our state. And, personnel could not be moved around in advance of the storm as the track changed to support other counties in the new path. EMAC, federal and contracted assets were mobilized to support sheltering operations but some counties had to wait until the storm passed to receive additional staffing.

Because of the surge in last minute registrations to special need shelters, comprehensive planning and placement for each registrant could not be conducted resulting in the shelter having to accept clients with medical needs that exceeded the shelters’ level of care capacity.

Moving forward, we recognize a need to anticipate future storms that may impact much, or all of the state, a scenario not contemplated prior to Hurricane Irma. For DOH, statewide emergency response efforts could be bolstered by improving planning for our special needs residents, including better training and increased collaboration with other state agencies and the private sector to support Floridians with special needs.

Kentucky Injury Prevention and Research Center’s Work to Prevent Substance Misuse

In 2005, the Kentucky Injury Prevention and Research Center (KIPRC) began focusing on transportation-related injuries under the state’s Fatality Assessment Control and Evaluation Program. KIPRC travels to sites of worker fatalities, investigates the causes, and ultimately makes behavioral, administrative and engineering control recommendations that would prevent future occupational deaths.

The first investigation was of a truck driver who was only 23 miles from his start point when he went through a busy intersection then up an embankment before crashing. The toxicology report found that he had methamphetamines and benzodiazepines in his system.

The next month, they had another case that was related to drugs. KIPRC quickly made the recommendation to build a statewide drug database focused on identifying truck drivers who tested positive for drugs and ensuring that job applications to other trucking companies would be aware of their previous substance use history.

From that point, analyses of multiple data sets became an integral part of Kentucky’s efforts to fight what became the opioid epidemic.

Comprehensive Data Sources

After they identified the drug-related pattern in transportation-related truck driver deaths, they examined all their data sources—spanning emergency department, trauma, crash, inpatient hospital, mortality, and workers’ compensation data, etc.—and produced comprehensive reports on drug overdoses.

The information KIPRC provided resonated with what the State Department for Public Health was finding—as they had begun to see spikes in drug overdoses in the data they monitor and manage.

KIPRC collaborated with the state’s prescription drug monitoring program called KASPER, which produces reports showing all Schedule II through V prescriptions dispensed for a person over a specified time period.

To further enhance the PDMP reports, the Bureau of Justice Assistance funded KIPRC and the PDMP to develop and implement an algorithm that calculates milligram morphine equivalents and make them available to physicians in PDMP patient reports to inform appropriate opioid prescribing. This also included a separate algorithm to calculate overlapping opioid and benzodiazepine prescriptions.

Additionally, the PDMP added a flag to the electronic reports that identifies elevated MME situations where it might be appropriate for the physician to also co-prescribe naloxone, mostly when the physician is prescribing opioid medications. To further the use of naloxone, KIPRC worked with the Kentucky Department of Criminal Justice Training to train more than 900 law enforcement officers on the proper use and administration.

In 2016, KIPRC helped create training for advanced practitioner registered nurses on the epidemic. During the training, nurses were educated on querying the PDMP, possible alternative opioid prescribing strategies, Kentucky’s opioid prescribing regulations, and care of patients with pain in both acute and primary care settings. Later that year, the program was extended to physicians. And, to date, more than 1,500 controlled substance prescribers have received training.

KIPRC additionally performs ad hoc data requests, allowing counties and state agencies to ask for a certain slice of data that is specific to their communities and populations. It can also be broken down by age, substance, and whether there are overlapping diagnoses for illnesses like HIV, Hepatitis C and endocarditis.

Going forward, a KIPRC epidemiologist is overlaying public health and public safety data that looks at heroin and methamphetamine trafficking arrests, possession arrests and related emergency department visits, hospitalizations, and overdose deaths to find hot and cold spots. Future analyses will include fentanyl and other drugs as well as comprehensive drug seizure data.KIPRC also manages the Drug Overdose Fatality Surveillance system, which draws on multiple data systems (autopsy reports, death certificates, coroner investigation, the state PDMP, etc.).

The results are used to inform legislative policymaking and provide info to stakeholders to advocate. For example, data pulled from the 2013-2015 reports found that in one-third of overdoses, gabapentin was involved. With this knowledge, the state made gabapentin a Schedule V substance and fully integrated it into the PDMP in July 2017.

Kentucky is the only state in nation that requires—when no specific cause of death is determined—decedent testing for controlled substances. Previously, 70 percent of drug overdose death certificates listed the specific drug(s) involved in drug overdose deaths. Now, 81 percent of drug overdose death certificates list the specific drug(s) involved in the fatal overdose.

Going Beyond Data

A KIPRC community coalition specialist goes into counties with the highest overdose death rates to provide technical assistance and strategic planning to establish or improve drug overdose prevention programs and initiatives.

KIPRC is also establishing a website with a substance use disorder treatment availability locator – so people can get help. They are working with every single treatment provider in the state to update their treatment slot availability on a nightly basis. The website will become live in January 2018 and will include available level of care, treatment type and payment type accepted.