Bioterrorism PreparednessLessons for Research

Carmen Rita Nevarez, MD, MPHVice President for External Relationsand Medical Director

Definition

Definition of public health systems research

“…a field of inquiry examining the organization, financing, and delivery of public health services and the impact of these activities on population health.”

Mays GP, Halverson PK, and Scutchfield DF. Behind the curve? What we know and need to learn from public health systems research. Journal of Public Health Management and Practice 2003; 9(3):179-

182.

Organization

Preparedness Models = 62 in California

– 61 Local Health Departments– 3 City Health Jurisdictions– 1 State of California

Organization Cont.

Overlapping jurisdictional authority (extent of police powers of health officer/jurisdiction: – resolution of jurisdictional authorities between

health/police/fire (FBI, Office of Homeland Security, other national governments)

As a result of 9-1-1 CDC uses Unified Incident Command System – evidence

Organization cont

Evidence for effectiveness of “regionalization” as an organizational model

“Best” parameters used to determine boundariesCommunication systems

Natural boundaries (geographic & transportation)Social organization boundaries/unifiersLanguage, culture, social status???Population density

Organization cont

How often should plans be revised Impact of immigratiuon Globalization Economy Growth parameters (housing starts,

redevelopment.. Plans coordinated with other planning entities

(housing & redevelopmnent, city planning (jurisdictions are mostly county jurisdictions, only 3 city LHDs

Financing

Impact of population based funding distribution formulas on integrity of LHD

Do PBF formulas further fragment functioning of small population counties

How does jurisdiction hire .25FTE epidemiologist?

Financing

Measures of improvement over time

How does the roll-out of federal funding to state to LHJ

Delivery

Key players-RELATIONSHIPS Government institutional Health Depts, other “police power/public safety”

depts.- law enforcement, fire, toxics, emergency operations

Delivery

Key players-RELATIONSHIPS Non-government institutions

Voluntaries

Traditional – Red Cross

Non traditional – Food programs serving homeless, church,

HIV/AIDS

Impact on Population Health

Vulnerable populations Language, age, geography, transportation,

proximity distance, weather systems, corridors, social corridors, homeless, disabled

Disenfranchised- knowing and unknowing vectors of communicable disease

Impact on Population Health

What is the impact of improved response systems on chronic disease– Positives

New methods of bilateral communication, improved social marketing tehcnologies

- Negatives