Session 7, Section 2 Public Health Rick Bissell, PhD Tom Kirsch, MD, MPH

Role of Public Health Public health is crucial to helping catastrophe victims survive the impact of the event and in helping the public regain sufficient personal physical energy and stability that they can recover from their losses and actively participate in the community recovery and rehabilitation processes. In some cases, e.g. pandemics, the catastrophe may be primarily a public health event.

Basic Vocabulary Public health: The scientific and service discipline that deals with the health of populations, including, among other things, investigating the causes of good and poor health, applying scientifically validated interventions to protect or improve health, and educating the public regarding good personal health practices.

Basic Vocabulary - 2 Epidemiology: The discipline within public health that investigates the causes and pathways of diseases and injuries, as well as their distribution within a population. Surveillance: The monitoring of behavior. It can be the behavior of an infectious disease, a population (e.g. birth control or sanitation practices), or other health conditions (e.g. diabetes, arthritis, hunger).

Key Points Health of the population, not an individual patient. Uses scientific methods (epidemiology and surveillance) to identify and intervene in health problems (e.g. epidemics).

Discussion Point There are many more rescuers (EMTs, firefighters, SAR personnel, etc.) than emergency managers. There are many more physicians and nurses practicing medicine than there are personnel practicing public health. How might the roles of emergency managers be similar to those of public health professionals?

Infectious Disease Vocabulary Etiology: The causes and pathway of a disease. –e.g. the bacteria or virus and its behavior Infectious disease control: The use of epidemiologic, public health, and medical tools to limit or control the spread of infectious diseases. –e.g. quarantine infected persons

Infectious Disease Vocabulary - 2 Endemic: A disease or health condition that has a long-term presence in a population at a relatively stable level. –e.g. the common cold Epidemic: A disease or health condition that rises above expected levels. –e.g. the annual Influenza outbreak Pandemic: An epidemic that affects the entire world, or substantial portions of it. –e.g. the 1918 Influenza pandemic

Infectious Disease Vocabulary - 3 Ways to Prevent Disease Spread –Immunity: The ability of an individual’s immune system to fight off an invading microbe and avoid infection. This can be natural or with the use of vaccines

Infectious Disease Vocabulary - 4 –Herd immunity: When there are enough immune individuals in a population (usually >80%) then that specific infection cannot easily spread and cause an outbreak. –Herd immunity can be from having a prior infection in a population, or by mass vaccinations.

Infectious Disease Vocabulary - 5 –Social distancing: The strategy of limiting disease spread by limiting public gatherings. e.g. Closing schools and churches, or staying at least 3 feet from other people. –Quarantine: The strategy of limiting disease spread by holding ill or exposed individuals out of contact with the public.

Infectious Disease Vocabulary - 6 –Isolation: The strategy of limiting disease spread by holding an ill individual in a controlled-access room. e.g. Isolation rooms in hospitals use special air filtration systems and protective clothing.

Disease Control Mechanisms How diseases spread: –Waterborne droplet (e.g. respiratory diseases) –Fecal-oral or hand-to-mouth (e.g. diarrheal diseases) –Water- and Foodborne –Sexual contact (e.g. STDs and HIV) –Fomites (microbes on inanimate surfaces) –Blood exposures (e.g. HIV, hepatitis C) –Vectors (insects, rats, airplanes, etc) –Ignorance and bad choices!

Disease Control Mechanisms -2 Disease control: –Epidemiologic investigation to determine causes, mechanisms of spread, extent of spread. –Vaccination, use of medication to induce herd immunity, treat ill individuals. –Social distancing, quarantine, isolation, reduce vectors. –Treatment of individuals to reduce their infectivity (ability to spread the infection).

Review Public Health and epidemiology are scientific methods to prevent or reduce the spread of illness in a population. Endemic and epidemic infectious diseases are the leading cause of death worldwide. There are specific tools used to reduce the spread of infections. For example:

WASH YOUR HANDS! COVER YOUR COUGH!

Discussion Question 2 In an epidemic scenario, why is it not sufficient to just treat everybody who comes down with the disease?

Catastrophes & Public Health The catastrophe can be caused by a health emergency. e.g. pandemics. Catastrophes with a non-health etiology can strongly affect population health status. Examples: hurricanes, earthquakes, tsunamis, drought, sea level rise/flooding, etc.

Catastrophes & Public Health - 2 Sample primary health impacts: –Hurricanes: injuries from falling and flying debris; drowning –Earthquakes: injuries from collapsing structures and landslides –Tsunamis: drowning, traumatic injury –Droughts: starvation, thirst

Catastrophes & Public Health - 3 There are many secondary health effects, depending on circumstances and human responses: –Crowding in shelters enhances disease transmission. –Water contamination transmits microbes. –Injuries from debris clearing. –Mass relocation can lead to violence, starvation, disease transmission.

Catastrophes & Public Health - 4 Health effects are accentuated by: –Loss of housing and sanitation –Loss of food & potable water –Loss of health care facilities and personnel –Loss of employment –Loss of organized government support services.

Catastrophes & Public Health - 5 Some determinants of health outcome: –Magnitude and extent of the event –Pre-event health status: Nutritional status Immunological experience/vaccines –Educational level –Preparedness and training of the public and health care workers (Bissell et al, 2004)

Public Health Priorities Clean water and sanitation Safe and adequate food Shelter Epidemiologic surveillance/info Access to labs Access to pharmaceuticals Clinical personnel and facilities

Infrastructure and Support Needed for Public Health Water supply engineers and technicians. Clean bulk food, means of transporting it, personnel and equipment to prepare and distribute it. Adequate temporary shelter (not over-crowded or dirty) and shelter management personnel, as well as building supplies for people to repair their own shelters. Broad variety of temporary and permanent sanitation strategies, equipment and personnel. May need heavy equipment to create sewage systems.

Infrastructure and Support Needed for Public Health - 2 Trained epidemiologic field personnel with assistants, computers, means of communication, transportation, mobile lab equipment, shelter. Means of conveying specimen samples to a qualified reference lab for diagnosis. Pharmaceutical supply and distribution network. Temporary or permanent hospitals, clinics, diagnostic and treatment equipment, all with power, water, sanitation and food. Clinicians of all levels, particularly those with primary care skills, and ancillary support staff.

Role of Surge Capacity Planning in Catastrophes Given the overwhelming character of catastrophes, local surge capacity planning may be of little value. For catastrophes, the sense of “surge capacity” has to take on a national meaning, with the surge being taken up in clinical care facilities that may be geographically quite far away from the primary sites of the event.

EM-Public Health Collaboration in Catastrophes Public health has scientific capability and, in some places, statutory responsibility, but virtually no logistics, transport, communications or law enforcement resources with which to conduct its work. Public health authorities have good experience coordinating within the health sector, but not with outside agencies.

EM-Public Health Collaboration in Catastrophes - 2 EM can conduct damage and needs assessments, except in the area of health, where EM will need the expertise and methods of public health. Public health workers and methods are needed to protect the health and productivity of EM personnel and responders.

Public Health Section Exercise Group discussion: Assume a major earthquake along the New Madrid Seismic Zone (NMSZ). There are >100,000 injured. Hospitals and clinics are down, water and sewer systems are severed, road and bridge failures block food and medicine deliveries. What health concerns emerge from this scenario and how must EM and public health collaborate?