Los Angeles County has one of the largest and most diverse populations in the country, with more than 11 million people living in 88 cities, speaking multiple languages with various education levels and economic statuses.
Such diversity makes preparing for a large-scale public health disaster extra challenging since it’s nearly impossible for county officials to reach all residents.
The Los Angeles County Department of Public Health (LACDPH) and Emergency Network Los Angeles, a voluntary agency, are experimenting with the idea that engaging nongovernmental community organizations already involved in disaster and pandemic preparedness is the key to communicating with the county’s diverse populations and building resilience.
Working with the RAND Corp., a nonprofit that focuses on improving policy, the three groups are in the second year of a five-year project called Los Angeles County Community Disaster Resilience. Funded by the Centers for Disease Control and Prevention, National Institute of Mental Health and Robert Wood Johnson Foundation, the initiative seeks to educate and engage community leaders to promote resiliency in Los Angeles County.
The project revolves around developing an active network of community agencies that will work consistently with the LACDPH and Emergency Network Los Angeles. “One of the missing pieces in preparedness and response is understanding better community response and resilience, and understanding it in the context of a large metropolitan area,” said Alonzo Plough, director of emergency preparedness and response for the LACDPH.
In L.A. County, with 4,000 square miles and threats from wildfires to earthquakes to three or four suspicious calls a week, Plough said it’s necessary to use every resource possible to help reach the most diverse areas that may not be as knowledgeable about the importance of emergency preparedness. Plough and his team are working on making their whole community concept completely operational.
Based on a report about the response to the 2009 H1N1 pandemic, vaccination rates varied greatly throughout L.A. County with racial and ethnic disparities, according to an article in the Journal of Public Health Management and Practice.
From the report, Plough realized, “one of the things we could improve on was pre-event connection with a variety of community-based organizations, faith-based organizations — all kinds of coalitions concerned with community well-being,” he said.
This approach of engaging the entire community from child-care organizations to churches is part of the whole community concept that FEMA Administrator Craig Fugate has publicized. The idea is that government alone cannot adequately prepare for, respond to or recover from disaster; it takes the whole community to create resiliency.
Faith-based and community organizations alone have the resources to shelter and feed hundreds, sometimes thousands, of people and offer other services at a time when government and traditional emergency recovery groups have limited funds and resources.
RAND kicked off the project by sending various surveys to both LACDPH and community-based organization staff with the hopes of discovering preparedness engagement and education levels, along with any potential barriers to building resilience.
Results showed that “the concept of being socially and physically resilient to disasters is fairly new,” said Malcolm Williams, RAND policy researcher. Traditionally the focus has been on individual preparedness.
A first step was creating a standard definition and process that each person involved could use as a reference. Williams and his team developed a set of eight categories for communities to use as objectives for building resiliency: wellness, access, education, engagement, self-sufficiency, partnership, quality and efficiency.
For example, engagement and self-sufficiency are needed to build social connectedness, and the partnership category helps ensure that governmental and nongovernmental organizations are integrated and involved in resilience-building and disaster planning activities.
Sixteen diverse communities were chosen to participate in the pilot. Eight communities are acting as the control group, working with traditional materials that LACDPH has previously used.
The other eight communities received a resilience toolkit with helpful resources like lessons learned from other U.S. communities that have attempted to join government and community organizations, guided activities to encourage community engagement and the Community Resilience Mapping Tool.
The mapping tool, developed by the nonprofit Sahana Software Foundation, helps communities collect data on vulnerability, hazards and resources within their own territories. Using that data, communities can think more concretely about populations that could be most affected by a disaster, like those with limited English proficiency or low trust in public health, and what resources are available.
For example, in one community, many residents have bars on their windows, which would leave them at greater risk during a fire. The community is discussing ways to map the locations of those houses and contact the landlords to come up with a solution to make those houses safer, said Williams.
“We’re right on the cusp of seeing some real results in these communities,” he said.
Each community’s leaders have the responsibility of figuring out what works best for its residents. To help, an LACDPH nurse was assigned to each community to facilitate meetings, encourage activity planning and provide support.
“Overall it’s been well received,” said Cullen Armet, program coordinator for the Emergency Network Los Angeles. “There’s a lot of excitement around it, a lot of positive energy.”
In the two years since the project’s inception, communities are already making progress.
In the Watts area, known for its violent gang activity, the coalition leaders worked with public nurses and the L.A. Fire Department to develop a teen Community Emergency Response Team program for kids living in the most distressed housing projects. This year, the program had a graduating class of about 40 teenagers, who were involved in flu outreach.
“These kids now see possible careers in public health,” Plough said.
The Compton group has been using local cable television to produce a program about community response and preparedness. And other communities have used social media to reach residents.
As the project progresses, LACDPH is constantly sharing information with other large urban cities like New York City, Chicago and Washington, D.C., which have begun to model L.A.’s project, Plough said. “We’ve learned that you don’t have to invent new coalitions to do community preparedness.”
Plenty of organizations concerned with these issues already exist — it’s a matter of engaging them by understanding the issues that are important to each group, according to Plough, and being open to acknowledging the varying degrees of what each person considers a disaster. “You have to do a lot of engagement with communities prior to an event to have a response.”
The L.A. city police chief also embraced the county’s notion of building resilience, Plough said, because the county’s approach is complementary to the neighborhood-level work the city is doing.
One of the next steps is putting together a tabletop exercise for communities to practice how they would react in a disaster, Williams said.
RAND is also beginning to evaluate different components in each community to see how well they would respond or hold up during an emergency situation.
“There’s still a lot of work to do,” Williams said.
But for now, the project’s leaders are happy with the overall acceptance of the whole community concept and the ideas the communities are bringing to the table.
“It’s a new concept,” Plough said. “We’re at the forefront of trying to make this operational.”