Making it happen for all Americans

I’d like to refer back to HHS’s stated goal on pandemic preparedness: “to help as many Americans as possible to understand that the threat of a pandemic influenza is real and to actively engage in personal preparedness.”

That’s an appropriate goal and this blog and the summit have been an innovative approach. My sincere thanks to Secretary Leavitt, Admiral Agwunobi and their team at HHS for organizing this effort, and for the many partners who have contributed posts and comments.

We’ve covered a lot of ground. But before this summit concludes, I want to underscore the importance of making sure we include all Americans in our planning and outreach in order to “help as many Americans as possible.”

We may be too quick to dismiss the most vulnerable among us: “They’re unreachable, or they’re too difficult to identify, engage or motivate. They don’t have the resources.”

This sets us up to fail. Vulnerable populations are woven into the fabric of the community, and we can’t expect to fully engage and strengthen a community in pandemic preparedness without reaching across all its threads.

HHS’s “symphony” approach that Stephanie Marshall refers to http://blog.pandemicflu.gov/?p=70 is on target, and among the critical orchestral sections are our nontraditional partners — churches, schools and PTAs, community organizations and soup kitchens — along with health departments. These institutions know the community perhaps best, understand the unique challenges each community faces and already have programs in place working with those who are most vulnerable.

From my own experience working with state and local health departments, these agencies have existing, robust programs in the communities — chronic disease programs, HIV outreach, maternal and child health programs — on which we can piggyback.

Low-income mothers and children coming in for nutrition education through the WIC program can be referred to a preparedness class. Seniors being screened for high blood pressure or prostate or colon cancer can be handed culturally appropriate preparedness brochures. Parents bringing their infants in for newborn immunizations or adults getting their seasonal flu shots can also learn about the importance of preparing for pandemic flu.

There may be jurisdictional hurdles to overcome, but HHS and state http://www.astho.org/ and local http://www.naccho.org/ health officials are well placed to identify solutions. My point is, we already know who these people are and in many instances, we’re already reaching them through existing programs. We can expand our impact in the community by buttressing these existing programs and including pandemic preparedness as a key component. It is doable. Some infrastructure is already in place and, most importantly, there’s already a great deal of interaction and trust.Again, I thank HHS for their leadership and for organizing this summit, and I encourage all of us in our efforts to ensure that all Americans are prepared.

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Getting It Done Will Not Be Easy

Getting the job done, as many posts acknowledge, is easier said than done. We have our work cut out for us. When we talk about preparedness, part of what we’re after is changing people’s behavior. And changing individual behavior can be difficult.

Take seat belt safety, for instance. For more than 30 years, the public health and safety community has been educating the American public about the importance of buckling up as a routine part of their day. Think about it. If you already have a car, fastening a seat belt doesn’t cost any money (unless you have to purchase a child safety seat) and takes most individuals no more than a few seconds to do. And while we’ve made great progress, challenges remain. According to the National Highway Traffic Safety Administration of the 31,910 vehicle occupants killed in crashes in 2001, 60 percent were not wearing a safety belt.

But we’ve learned some lessons. If we educate the public and help make it a routine part of life, then we can see progress.

We face some similar challenges with pandemic flu preparedness albeit on a much grander and complex scale. While many Americans may drive every day, people don’t consider the risks associated with pandemic flu on a daily basis. We need people to understand the importance of preparing and to make it a routine part of their daily lives. We need people to recognize there is a risk and to take steps to mitigate the risk.

As for tools and programs to help communicate the importance of pandemic preparedness, there’s of course PandemicFlu.gov. The American Public Health Association’s Get Ready campaign has fact sheets, resources and a blog at www.getreadyforflu.org, and Trust for
America’s Health has extensive resources at www.pandemicfluandyou.org/.

State and local health departments have produced an array of plans, tips and resources for their residents. For links to state health departments, visit the Association of State and Territorial Health Officials at www.astho.org/index.php?template=regional_links.php

Also, the American Red Cross has a significant program for preparedness geared toward citizens. See www.redcross.org

I would be remiss if I didn’t also mention the need to increase investment in our capacity to respond to a pandemic, which is a key part of preparedness. Earlier this year, APHA released our blueprint for strengthening the nation’s pandemic preparedness (view PDF). We recommended key changes to the nation’s strategy for preparing and responding to a flu pandemic to ensure the health and safety of all individuals.

Among our top concerns was the need for additional resources for an already overburdened public health work force that may lack the resources to fully respond to a flu outbreak. Other needs include clear federal guidance on school closures, quarantine and occupational health in the event of a pandemic.

Our recommendations include:

• Increasing funding for states, localities, hospitals and public health labs to expand their capacity to respond to pandemic flu;
• Increasing investment in the public health work force, so there are enough employees necessary to serve on the frontlines in preparing for and responding to a pandemic and annual seasonal epidemics;
• Creating emergency Medicaid coverage to ensure that uninsured Americans will receive appropriate countermeasures and care in the event of pandemic flu;
• Creating guidelines for the use of non-pharmaceutical interventions, including handwashing, “snow days,” isolation and quarantine;
• Creating new methods to purchase, distribute and track vaccines and antivirals;
• Incorporating occupational and mental health issues, such as potential distress and sick leave from work, in pandemic planning and response efforts; and
• Creating and implementing laws and policies that grant federal, state and local health officers the authority to make decisions about quarantine and isolation orders.

While I wish preparing for pandemic flu was as easy as buckling up your seat belt, it is not. It will take time, focus and resources. I believe we can do it and the benefits are worth it.

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Building Community Resiliency: A Key Step in Preparedness

To identify one of our greatest challenges in pandemic preparedness, we don’t have to delve deeply into history. Let’s go back two years to Hurricane Katrina.

As the storm approached the Gulf Coast, millions of people prepared as well as they could or knew how. Many evacuated. Some hunkered down to shelter in place. Others did little to prepare and hoped to ride it out. But as we learned, those most greatly affected by this catastrophe were the ones least able to sustain it — those who were low-income, young, elderly and chronically ill among others.

This very recent tragedy laid bare one of our greatest challenges in preparing for the next health emergency, whether it’s a hurricane or flu pandemic. How do we — health, business, faith and community leaders — best help the most vulnerable and those living in underserved communities prepare? We work to build resilient communities.

In a disaster, a resilient community should be able to mitigate the risks to individuals, families and the community as a whole from preventable, serious health threats. Its goal should be to go from chaos to controlled disorder and then to recovery. But how do we start to build resilient communities?

1. We first begin with planning. We must engage the entire community in local emergency and pandemic planning, including food banks and soup kitchens and the clients they serve, religious congregations and schools. The goal should be to identify and proactively reach out to all community stakeholders. Some activities include developing individual and family plans, business continuity plans and school emergency plans and assessing the surge capacity of the health system.
2. We need to educate the community and build awareness within the community of the need and steps to prepare. We should build awareness of the plan, engage the community in drills and reach out to the local media. These activities may require developing materials in multiple languages and establishing culturally appropriate mechanisms for distribution.
3. We need to work to empower the individual or family to prepare. This may include helping individuals develop a family plan or learn first aid. Many living in underserved communities don’t have health insurance, don’t have a medical “home” or primary care physician and don’t have health records or a personal health history. Immunizations are often not up-to-date. Many are not health literate. We need to help them resolve these problems.
4. We need to strengthen the community’s capacity to respond by strengthening first responders such as
   EMS and police and fire departments, and the capacity of the public health system to provide disease identification and tracking services and to deliver potable water, food and basic sanitation among other services.
5. We also need to support communities’ capacity to recover. This may require addressing housing needs, conducting environmental assessments and mitigation, rebuilding the health infrastructure and ensuring the delivery of mental health services.

While catastrophic, Hurricane Katrina was a relatively localized event. A flu pandemic will likely be far more widespread and pose greater challenges to vulnerable populations and to the government’s response. By building resilient communities as a part of our preparedness approach, we can better minimize the impact pandemic flu will have on all of us.

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Americans Should Get Ready For Flu

Experts agree that we are long overdue for the next flu pandemic, and concerns persist. A 5-year-old girl died in Indonesia last week from avian flu, raising the country’s H5N1 death toll to 77. Vietnam this week confirmed its first case of human bird flu - a 30-year-old man from the northern Vinh Phuc province - since 2005. And the World Health Organization, recently adopted a resolution to help countries better prepare for a flu pandemic.

Many of us have mobilized to help educate Americans about the importance of preparing. But too few have heeded our call. The American Public Health Association (APHA) released a poll in April, that found that almost 90 percent of the general public say they have not taken enough steps to prepare for a public health crisis and know they could do more. The lack of preparations is particularly high among vulnerable communities such as mothers of young children, people with health conditions such as diabetes and high blood pressure and hourly wage workers who live from paycheck to paycheck. For example:

· 58 percent of mothers of children age five and younger do not have a three-day supply of water on hand for their family;· Only 61 percent of chronically ill people have at least a two-week supply of medications; and
· Only 18 percent of employers say they could continue to pay all their employees if there were an interruption in operations, and just 15 percent of hourly workers have saved enough money to provide for their families in such an event.

These stats are sobering. To help address some of these challenges, APHA, launched the Get Ready campaign, to provide information, resources and tools for individuals, families and communities to prepare for a potential flu pandemic and other health emergencies.

One feature of this campaign is the “Get Ready For Flu” blog. The blog is a discussion forum on pandemic flu that provides advice for the public on how to prepare for flu. Recent entries have covered egg and chicken safety, pets and avian flu and the development of flu vaccines.

Helping individuals, families and communities prepare for pandemic flu also provides protection in the event of other health emergencies such as blizzards, tornadoes, hurricanes and acts of terrorism. It’s an “all-hazards preparedness” approach that gives our preparedness dollars more bang for their buck and protects families and communities from a broad range of health threats.

When it comes to preparing for pandemic flu, the question is not whether we should be ready, but how can we afford not to be prepared?

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