In talking to ASPR Acting Director of the Division of Policy and Strategic Planning Jonathan Ban, the hope for the NHSS is to better bridge the worlds of health-care planning and emergency management to support seamless response and recovery efforts. The NHSS is centered on five strategic objectives: build and sustain healthy, resilient communities; enhance the national capability to produce and effectively use both medical countermeasures and non-pharmaceutical interventions; ensure comprehensive health situational awareness to support decision-making before incidents and during response and recovery operations; enhance the integration and effectiveness of the public health, health-care and emergency management systems; and strengthen global health security.
The first thing that struck me about the NHSS implementation plan was the alignment (finally!) of the NHSS, FEMA’s Whole Community Approach and the National Disaster Recovery Framework. In my years in health-care emergency management, I’ve seen an alphabet soup of federal agencies that issue conflicting and uncoordinated guidance that impact the same health-care settings (CMS, CDC, OSHA, HRSA, FDA, SAMHSA, etc.). It makes it challenging to comply with these uncoordinated government requirements from the many agencies that touch health care and serve our patients to the best of our ability.
NHSS Figure 2: An Inclusive, Proactive Approach to Partnerships and Collaboration Within and Among Communities to Enhance National Health Security
With the first NHSS Strategic Objective, both the NHSS and Whole Community Approach put community resilience front and center to recognize the importance of coordinated cross-sector preparedness, response and recovery. Community health resilience is defined in the NHSS as the “ability of a community to use its assets to strengthen public health and health-care systems and improve the community’s physical, behavioral and social health to withstand and recover from adversity.” Many think that health-care response and recovery is all about triage, body bags and surge tents, but the NHSS’ emphasis on behavioral health — usually the last to the local health-care coalition planning table — means that the mental health of communities affected are valued. The more severe the disaster, the more difficult the mental health recovery impact is for community members recovering from an event.
Comprehensive health situational awareness is a great strategic objective because it allows emergency managers to make better real-time response and recovery decisions in disaster-ravaged communities. Operationalizing health situational awareness and information sharing is much easier said than done. It takes time, a commitment to open source sharing of information for all levels of public and private sector, and some political will to fund a better information sharing platform.
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This graphic provides examples of how to gain health situational awareness.
One of the Preparedness Summit sessions highlighted a promising situational awareness platform called Operation Dragon Fire, which serves as a clearinghouse or data marketplace to provide a means to identify, aggregate, validate and analyze data from multiple sources, and access to applicable information via multiple channels. Let’s cross our fingers on this one!
Public health and medical planning is not just about preventing the next disease outbreak and bandages, but there are physical, mental and social health impacts to every disaster. The NHSS Strategic Objective 4, integrated emergency management with public health and health care, underscores the need for coordination across sectors to support effective community response and recovery. In light of fickle federal funding streams and in the spirit of doing more with less, public health, health-care system and emergency management agencies need to plan, train and exercise with each other so they are well acquainted well before disaster strikes. I’ve never been a fan of what I call “just-in-time” relationships (i.e., exchanging business cards in the EOC).
Lastly, we turn to the issue of NHSS Strategic Objective 5: strengthening global health security. With the massive magnitude 7.8 earthquake in Nepal, the emergency requires an immediate, short-term and long-term response and recovery that takes into account the initial health needs as well as the secondary health threats such as disease outbreaks related to poor living conditions and improper sanitation. For example, Haiti had to deal with a nasty cholera outbreak after the 2010 earthquake.
I’m hoping the NHSS and its ambitious implementation plan get the backing they need from all sectors to make the security strategy work. We emergency managers are always preparing for the worst but planning for the best. What do you think? Do we have your buy-in to improve our global health and protect our communities?
