1. Bioterrorism Preparedness Lessons for Research Carmen Rita Nevarez, MD, MPH Vice President for External Relations and Medical Director

2. 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.

3. Organization Preparedness Models = 62 in California – 61 Local Health Departments – 3 City Health Jurisdictions – 1 State of California

4. 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

5. Organization cont Evidence for effectiveness of regionalization as an organizational model Best parameters used to determine boundaries Communication systems Natural boundaries (geographic & transportation) Social organization boundaries/unifiers Language, culture, social status??? Population density

6. 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

7. 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?

8. Financing Measures of improvement over time How does the roll-out of federal funding to state to LHJ

9. Delivery Key players-RELATIONSHIPS Government institutional Health Depts, other police power/public safety depts.- law enforcement, fire, toxics, emergency operations

10. Delivery Key players-RELATIONSHIPS Non-government institutions Voluntaries Traditional – Red Cross Non traditional – Food programs serving homeless, church, HIV/AIDS

11. 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

12. 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