File Name: emergency public health preparedness and response .zip
In recent decades, a wide range of abrupt and unpredictable events—including bioterrorism, natural disasters, industrial disasters, and infectious disease outbreaks—have endangered population health and challenged even the most advanced public health and health care systems. Affected populations may face imminent risk to life or health; scarce medical resources; lack of food, water, and shelter; electrical power outages; and interrupted communication.
- September 2017
- An Overview of Public Health Ethics in Emergency Preparedness and Response
- Conceptualizing and Defining Public Health Emergency Preparedness
- Emergency Preparedness and Response Resources: Public Health
In recent decades, a wide range of abrupt and unpredictable events—including bioterrorism, natural disasters, industrial disasters, and infectious disease outbreaks—have endangered population health and challenged even the most advanced public health and health care systems. Affected populations may face imminent risk to life or health; scarce medical resources; lack of food, water, and shelter; electrical power outages; and interrupted communication. The urgent need to mitigate harms to population health may necessitate rapid decision-making, with incomplete or imperfect information, against a backdrop of political, economic, and social instability.
These defining characteristics of public health emergencies are morally significant, not only because they present normatively complex questions about what constitutes an ethical emergency response, but also because they highlight the vital importance of incorporating ethics into public health emergency preparedness. Keywords: public health ethics , public health emergency , emergency preparedness , emergency response , bioterrorism , natural disasters , industrial disasters , infectious disease outbreaks.
Since the beginning of the twenty-first century, a growing number of large-scale events have endangered population health and challenged even the most advanced public health and health care systems. These events—whether classified as bioterrorism, such as the anthrax attacks; natural disasters, such as the Indian Ocean tsunami; industrial disasters, such as the BP Deepwater Horizon oil spill; or infectious disease outbreaks, such as Zika virus—collectively highlight human vulnerability to abrupt, unpredictable, and often uncontrollable threats.
Affected populations may face imminent risk to life or health; scarce medical resources; lack of food, water, and shelter; electrical power outages; and interrupted communication networks. These defining characteristics of public health emergencies are morally significant, not only because they reinforce the vital importance of emergency preparedness and response, but also because they present normatively complex questions about what constitutes an ethical public health emergency response Viens and Selgelid, Governments, institutions, and communities have prepared for and responded to public health emergencies for hundreds of years Clements and Casani, The field of public health emergency preparedness and response, however, is relatively young Rose et al.
Nevertheless, there is broad consensus about what public health emergency preparedness and response entails, and growing attention to the tragic choices that communities, health care providers, emergency managers, and others must confront in the emergency context.
As its definition suggests, preparedness and response is a multisector, multistep endeavor. It requires the participation, cooperation, and coordination not only of public health and health care systems, but also of other sectors, including national security agencies, humanitarian aid organizations, industries, economists, engineers, and members of the community.
Each group brings important knowledge to the process, as well as particular priorities, interests, and values. Instead of engaging in specific planning for each type of emergency, an all-hazards approach assumes that certain core functions and capacities will be required in any emergency.
The process of emergency preparedness and response unfolds in four phases: mitigation, preparedness, response, and recovery. Mitigation takes place before an emergency event and involves assessing potential threats and present vulnerabilities in an effort to prevent either the occurrence or the impact of a large-scale public health emergency. An example of mitigation is enacting and enforcing building codes to limit structural damage during natural disasters.
Preparedness attempts to improve the capacity of governments, institutions, and communities to respond to public health emergencies once they are underway.
Establishing a strategic national stockpile of essential medicines is a form of preparedness. Response describes the actions taken during an emergency event to protect people, property, infrastructure, and the environment. The decision to quarantine individuals to limit the spread of an infectious disease is one type of response. Recovery , the final phase, describes actions that aim to return populations to normalcy as soon as possible.
Reopening hospitals, restoring electricity and potable water, and offering mental health services are examples of recovery activities. Mitigation strategies may raise questions, for example, about the use of societal resources. How much of its budget should a city allocate to strengthening its infrastructure e.
Recognizing that emergencies often exacerbate existing patterns of social injustice, should the city focus its initial efforts on improving infrastructure in poor communities? What if better-off communities have larger populations in equal need of those improvements? Ethics does not offer quick or discrete answers to morally challenging questions that arise in the context of emergency preparedness and response.
Ethical awareness and analysis can, however, illuminate the values at stake in those decisions and provide the moral language to describe and resolve situations in which values conflict. Events like Hurricane Katrina and the West African Ebola epidemic have graphically demonstrated that during public health emergencies, it is just as important to have policies and practices on ethics e. Determining how to allocate scarce, life-saving resources is one of the most difficult and ethically fraught aspects of emergency preparedness and response.
Regardless of whether the limited resources are medical e. In confronting issues of distributive justice, decision-makers should strive for policies that are fair, steward scarce resources, and address the needs of special and at-risk populations.
Allocation schemes that treat groups differently based on morally irrelevant factors like gender or religion are, therefore, presumptively unethical. Decision-makers should also ensure that allocation policies manage limited resources prudently. Lastly, every allocation policy should account for the needs of populations, which, because of p. Because groups that are disadvantaged or marginalized before a public health emergency are more likely to suffer poor outcomes during an emergency, planning for their needs is critical.
Several allocation schemes, each reflecting particular values, have been proposed to address the emergency distribution of scarce health care resources. One frequently articulated strategy, grounded in utilitarianism, aims to maximize net benefits, which are specified, for example, as the number of people who survive to hospital discharge Powell, Christ, and Birkhead, or the number of adjusted life years saved White et al.
Because choosing an allocation scheme involves value-based determinations that people may disagree about, it is important that the decision-making process is itself ethical. In an emergency, resource allocation is more likely to be effective and perceived as legitimate when the planning process is transparent, inclusive, and involves open public engagement Jennings and Arras, ; Daniels and Sabin, The second ethical challenge that emergency planners should prepare for involves the tensions that can arise between protecting population health and individual liberty.
Massachusetts , U. In the context of an infectious disease outbreak, for example, public health interventions such as social distancing, travel restrictions, contact tracing, isolation, and quarantine, may stem the tide of new infections, but at the cost of infringing on individual liberty.
Targeted individuals may also face additional burdens, including loss of privacy, stigmatization, discrimination, lost wages, and psychological stress Wynia, a. For these reasons, and because liberty-restricting interventions have historically targeted marginalized groups e.
Whenever possible, such measures should be voluntary, but in all cases they should be implemented with due process protections, such as reasonable notice and the right to appeal.
As the SARS and Ebola outbreaks demonstrated, health care workers exposed to infectious diseases may acquire the infection, cross-contaminate their families, and even become victims of the outbreak themselves. At the same time, planners should consider what society owes providers who assume personal risks to advance population health. Policies such as preferential access to countermeasures, immunity from liability under certain circumstances, and hazard pay demonstrate that emergency response is a collective undertaking.
The chapters in the Emergency Preparedness and Response section of The Oxford Handbook of Public Health Ethics introduce and consider the ethical challenges associated with planning for and responding to three types of public health emergencies: biosecurity threats, natural and industrial disasters, and pandemic disease.
As a primer to biosecurity, the authors explore the moral distinction between deliberate biological attacks, which are the primary focus of the chapter, and other biological threats, such as pandemics. Because biological attacks have implications for public health and national security, ethical norms from both fields are critical in assessing government actions aimed at preventing and responding to such attacks.
To account for the range of values at stake, Evans and Inglesby propose a pluralistic framework that emphasizes utility, fairness, and liberty, as well as the security of those fundamental values. They then illustrate the various ways in which those values are challenged at three critical times: before a crisis, during a crisis, and after a crisis.
In the process, the authors consider circumstances, such as the allocation of scarce resources, in which two or more values are in conflict, and they suggest avenues for addressing such situations.
While everyone is vulnerable to disaster events, certain subpopulations are disproportionately at risk of adverse outcomes, such as people with cognitive and physical disabilities who depend on others. Focusing on natural disasters e. The authors contend that those involved in emergency preparedness and response have an ethical obligation—grounded not only in the principles of social justice, equity, and reciprocity, but also as a matter of civic practice—to include all vulnerable populations in the planning process, ensure their safety during a response, and establish sufficient public health capacity to reduce systematic health disparities over the long term.
Smith and Upshur examine the ethical issues that arise in each of these contexts, and consider prominent ethical frameworks developed to address these issues. Drawing on recent pandemic responses, however, they observe that the global health community remains ill-prepared for future pandemics.
People living in countries with inadequate public health and health care infrastructure, for example, are especially vulnerable to pandemics. Smith and Upshur therefore urge global actors to not only strengthen outbreak capacity, but also to invest in health care systems in the worst-off countries. Together, these chapters suggest that, in the context of public health emergencies, ethical preparedness is as important as scientific or technical preparedness.
Capron, A. Find this resource:. Clements, B. Disasters and Public Health: Planning and Response. Oxford: Elsevier. Daniels, N. Oxford: Oxford University Press. Jennings, J.
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An Overview of Public Health Ethics in Emergency Preparedness and Response
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Yet despite anecdotal reports suggesting that progress has been made, it is unclear whether these investments have left the nation better prepared to respond to a bioterrorist attack, pandemic influenza, or any other large-scale public health emergency. This situation is not because of a shortage of measures of preparedness. Over the past 5 years, federal agencies, state health departments, and various nongovernmental organizations have proposed and implemented myriad measures of public health emergency preparedness. What our nation needs in order to bring coherence to the debate is a clear definition of public health emergency preparedness and an articulation of the key elements that characterize a well-prepared community. In this editorial, we propose a candidate definition of public health emergency preparedness and describe its key elements. Both the definition and the elements were developed by a diverse panel of experts convened by RAND in February
public health preparedness and response, –, and is tailored to the needs of the and effectively to public health risks and public health emergencies of pdf?ua=1), presents the vision for partnerships for health in the WHO.
Conceptualizing and Defining Public Health Emergency Preparedness
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Emergency Preparedness and Response Resources: Public Health
Emergency Preparedness and Response. This material provides information on how to prepare for an emergency using a neighborhood plan. This material provides pet owners with information on how to prepare for an emergency with their pets. This material provides pet owners with detailed information on how to prepare for an emergency with their pets. The information and tools in this kit are meant to provide child care providers in child care centers and family child care homes with guidance on how to prepare, respond, and recover from an emergency. English PDF. Font Size A A A.
Metrics details. Emergencies and disasters impact population health. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared. There is a knowledge gap in that existing frameworks lack consideration for complexity relevant to health systems and the emergency context.
Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. All partners who can contribute to action as a public health system should be encouraged to assess their roles and responsibilities, consider changes, and devise ways to better collaborate with other partners.
Reducing mortality, morbidity, and societal disruption resulting from emergencies and disasters through the detection, management and mitigation of high-threat pathogens, and all-hazards risk reduction, preparedness, response and early recovery activities that build resilience and use a multi-sectoral approach to contribute to health security. The PHE Department focuses on strengthening the health sector's capacities in prevention, risk reduction, preparedness, surveillance, response, and early recovery for emergencies and disasters related to any hazard natural, man-made, biological, chemical, radiological and others and, when national capacities are overwhelmed, to lead and coordinate the international health response to contain disasters, including outbreaks, and to provide effective relief and recovery to affected populations. Work in PHE Department aims to define the Organization's overall strategy to prevent mitigate, respond, and recover from emergencies and disasters in the health sector; build the capacities of Member States to face emergencies and disasters, including capacities required under the International Health Regulations to manage risks to health from all hazards; detect acute threats to heath and undertake timely risk assessments in response to such events; provide technical leadership and develop networks to address risks related to high-threat pathogens; manage PAHO's response to acute and protracted emergencies and disasters; strengthen partnerships to promote collective action; develop and promote technical standards and guidance; provide credible technical advice to stakeholders in response to acute events and emergencies; and ensure risk and performance monitoring.
Public health protects and improves the health of individuals, families, communities, and populations, locally and globally. We support education in public health by providing a variety of comprehensive classroom and curriculum resources. ASPPH developed workforce-level competencies that demonstrate the abilities that not only a public health professional involved in preparedness work must display, but which are recommended for all members of the public health workforce to enhance their readiness to response to public health disasters and emergencies. Find an Academic Program Discover Discover Overview Public health protects and improves the health of individuals, families, communities, and populations, locally and globally. Connect Overview Keep up with members and their contributions to advancing the field.