Healthy, Resilient, and Sustainable Communities After Disasters Strategies, Opportunities, and Planning for Recovery (2015) / Chapter Skim
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3 A Framework for Integrating Health into Recovery Planning
3 A Framework for Integrating Health into Recovery Planning
Pages 73-116
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From page 73... ...
It should be emphasized that the intent here is not to provide a comprehensive description of the recovery planning process; such a description is beyond the scope of this study and has been provided elsewhere.1 THE STRATEGIC PLANNING PROCESS AS A FRAMEWORK In strategic planning, quantifiable data and a process of systematic analysis are used to develop goals, identify alternatives, and establish criteria for decision making. Although there are slight variations and differences in terminology, the general structure of such planning processes (whether developing a comprehensive plan, health improvement plan, or disaster recovery plan)
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From page 74... ...
Thus, obtaining buy-in from leadership is an essential step in ensuring that the plan is acted upon. In the context of integrating health into the disaster recovery planning process, each of the steps in the strategic planning cycle presents opportunities.
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From page 75... ...
The Current State of Integration of Planning Processes Unfortunately, the committee found that the predominant model at present is one in which community comprehensive planning, health improvement planning, resiliency and sustainability planning, and disaster recovery planning occur largely in isolation. Barriers to integration noted by both public health and planning professionals include a lack of resources, tools, and guidelines, as well as an absence of qualified personnel able to bridge the two fields (APA, 2006a)
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From page 76... ...
a Although the committee strongly encourages communities to undertake these activities in the pre-disaster period to maximize opportunities for leveraging the post-event recovery process to create healthier and more resilient and sustainable communities, there is still benefit to incorporating them into post-disaster recovery planning if they have not been undertaken beforehand.
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From page 77... ...
. To better understand the degree to which community health improvement goals have been incorporated into pre-disaster recovery planning, the committee reviewed available pre-disaster recovery plans and sought testimony from public health, emergency management, and city management representatives.
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From page 78... ...
; • inadequate integration of health improvement planning and the community comprehensive (strategic) planning process used to set priorities and allocate funds; • lack of integration of health improvement planning and disaster recovery planning; • insufficient awareness across all sectors of the health-related threats and opportunities posed by disasters and of the benefits to be gained from integrating community health improvement objectives and priorities into comprehensive and disaster recovery plans to achieve shared goals.
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From page 79... ...
are integrated Lead(s) Public health, Public health, health Public health Emergency emergency care management management, urban and regional planning Partners All sectors, all Social services, All sectors All sectors stakeholders, behavioral health community members Whenb w w w u Task Conduct community Assess vulnerability of Develop comprehensive Adopt regulations, visioning process critical infrastructure plan, ensuring incentives, programs, inclusion of all budgets, and relevant plans (e.g., community outreach hazard mitigation, to achieve community health improvement, vision and goals economic, redevelopment)
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From page 80... ...
Urban and regional Social services Public health Designated recovery planning, public manager health, emergency management Partners All sectors, plus Public health, All sectors All sectors management, finance, behavioral health, budget offices emergency management Whenb u w w w Task Monitor economic Conduct post- Develop post-disaster Carry out recovery development disaster assessment recovery plan projects and and community of disaster impact on programs; arrange development initiatives infrastructure and project and program that may strengthen systems management the community, add resilience, create sustainability
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From page 81... ...
b 1 = pre-disaster; 2 = response and short-term recovery; 3 = long-term post-disaster recovery. Coloring of the symbols indicates urgency: red = priority; black = possibility. A HEALTHY, RESILIENT, SUSTAINABLE COMMUNITY VISION FOR DISASTER RECOVERY Disasters, although devastating, create an opportunity through the recovery process to advance a shared vision of a healthier and more resilient and sustainable community.
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From page 82... ...
. Communities undertake a number of planning processes that yield a shared vision for the future that could be incorporated into pre- and post-disaster recovery planning efforts.
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From page 83... ...
. Creating a Shared Vision as a First Step in Engaging the Public in Disaster Recovery The involvement of informed and empowered individuals and communities through an authentic community engagement process is nearly universally recognized as a factor in the success of any community planning endeavor, including healthy community planning and disaster recovery (FEMA, 2011c; Love and Vallance, 2014)
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From page 84... ...
Three common assessments of relevance to disaster recovery planning are community health assessments, threat and hazard identification and risk assessments, and disaster impact assessments (see also the discussion of health impact assessments later in this chapter)
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From page 85... ...
. Consequently, a community health assessment may inform the Threat and Hazard Identification and Risk Assessment process, particularly with regard to social vulnerability (discussed in Chapter 2)
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From page 86... ...
, and it presents a rationale for the relevance of this approach to the recovery context. Operationalizing Health in All Policies in the disaster recovery context entails (1)
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From page 87... ...
The resulting delays in individual and community recovery impact all facets of community life, including the health of the population, social cohesion, and economic viability. The committee concludes that disaster recovery and ultimately the health of the community would be improved by the development of organizational structures that support • integrating horizontally across sectors and agencies; • integrating vertically from the federal to the local level; • integrating across phases of the disaster continuum, from pre-event planning to long-term recovery; and • integrating health considerations into recovery planning and practices.
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From page 88... ...
defined by the National Response Framework,10 the NDRF defines six Recovery Support Functions (RSFs) : Community Planning and Capacity Building; Economic; Health and Social Services; Housing; Infrastructure Systems; and Natural and Cultural Resources (described in more detail in Box 3-3)
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From page 89... ...
For the health sector, the Health and Social Services RSF should include representatives working on an everyday basis to create healthier communities through community health improvement and social services activities. It is important to have clear plans in place for this transition and mechanisms for bringing in those trained in long-term community planning.
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From page 90... ...
Through its information gathering process, however, the committee noted several issues that will ultimately influence the effectiveness of the NDRF as a mechanism for integrating health into the recovery process and thus warrant discussion here. First, although the NDRF promotes pre-event planning in principle, the framework is not accompanied by any funding to support such planning or capacity building for recovery.
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From page 91... ...
SOURCE: FEMA, 2011d. pre-disaster recovery planning is critical to seizing opportunities for health improvement during recovery.
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From page 92... ...
• FEMA • HHS • SBA • DOJ • DOJ (as indicated in the • DOE • EPA • Treasury • DOL • USDA NDRF) • DOT • USDA • Ed • EPA • VA • Planning, • Community Development • Housing • Planning • Economic • Department of Finance • Community Development Environmental • Planning Agency • Department of Development • Social Welfare, Protection Possible Aligned • Community • Planning, Environmental • Economic Child, and Family • Health Department Entities at the State Development • Community Protection Development Services • Natural Level • Economic Development • Department of • Housing • Health Resources, Development • Economic Transportation Finance Department Fish/Wildlife, and Development Agency • State mental Parks health authority • Education Department • MPOs • RPCs • RTPOs Possible Aligned • RPCs • RPCs • COGs • RPCs • MPOs • RPCs Entities at the • COGs • COGs • EDDs • COGs • COGs • COGs Regional Level • RTPOs • RTPOs • Health care • EDDs • RPCs • EDDs • EDDs coalitions • Health Department (Public Health, • Planning, Channels Through Which Federal Agencies Assist in Recovery Plan Development Environmental • Community • Planning, Health, Mental • Housing • Transportation Development, • Community Health Authority)
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From page 93... ...
Department of Health and Human Services; HUD = U.S. Department of Housing and Urban Development; MPO = metropolitan planning organization; NDRF = National Disaster Recovery Framework; NPPD = National Protection and Programs Directorate; RPC = regional planning commission; RTPO = regional transportation planning organization; SBA = U.S.
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From page 94... ...
Moreover, after a disaster HUD can have a significant influence on recovery planning at the state and local levels as a funding agency if Congress passes a supplemental appropriation through the HUD Community Development Block Grant for Disaster Recovery (CDBG-DR) vehicle (described in more detail in Chapter 4)
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From page 95... ...
Making HHS a supporting organization for the Natural and Cultural Resources RSF as well might better enable HHS and its component agencies to infuse health across the full spectrum of RSFs and promote a broader vision for the role of health in recovery. Although the Office of the Assistant Secretary for Preparedness and Response provides the coordinating function for the Health and Social Services RSF on behalf of the HHS Secretary, greater involvement of other HHS agencies and most notably the CDC, which is a major funder of both community health improvement and community resilience building efforts, might facilitate a healthy community approach to recovery.
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From page 96... ...
. Leveraging local community development institutions during disaster recovery will have the effect of improving health outcomes.
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From page 97... ...
Community leaders will want to be mindful of the possibility of a region-wide disaster as they develop their vision for improving health outcomes in a post-disaster environment, assess the comprehensiveness of their social networks, and conduct disaster recovery planning. The National Disaster Recovery Frame work and its Recovery Support Functions (RSFs)
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From page 98... ...
To better support a whole-community approach to recovery, the committee has attempted to provide a cogent, high-level description of the processes and resources pertinent to disaster recovery (see Chapter
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From page 99... ...
, • Robert T Stafford Disaster Relief and Emergency Assistance Act,16 • Post-Katrina Emergency Reform Act of 2006,17 • Sandy Recovery Improvement Act of 2013,18 and • Pandemic and All-Hazards Preparedness Act.19 In the face of such complexity, communities often need to hire outside professional consultants to navigate the disaster recovery process.
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From page 100... ...
After Hurricane Sandy struck New York City, for example, many BOX 3-5 Leveraging Social Networks After Disasters Encouraging or even requiring the solicitation of input from neighborhood-level organizations (e.g., homeowners associations) in a community requiring significant redevelopment after a disaster can help ensure that the people most affected by recovery plans are included in their development.
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From page 101... ...
The effectiveness of an integrated planning and recovery approach is greatly enhanced by shared information. One of the greatest challenges associated with disaster recovery is that decision makers often must take action before the information needed to support those decisions can arrive (Olshansky, 2014)
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From page 102... ...
However, additional guidance on using HIA in the disaster recovery context is needed. Although HIA has gained traction only recently as an important decision-making tool, a model for this kind of impact assessment has been in place in communities for decades.
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From page 103... ...
Additionally, although there is some emphasis on utilizing recovery actions to mitigate damage from future events, completely absent from current guidance is any messaging regarding the opportunities to use recovery as a vehicle for creating healthier communities or the need to create a healthy community vision to guide long-term recovery efforts -- both of which need to be key messages of RSF-specific as well as PHEP/HPP guidance.
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From page 104... ...
As discussed earlier in this chapter, a healthy community approach to disaster recovery requires that public health professionals with an understanding of the key principles behind healthy communities be engaged in the recovery planning process. Although the public health sector increasingly is being engaged across the full continuum of the emergency management cycle, its representatives generally are those working in the field of public health emergency preparedness.
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From page 105... ...
This MOA serves as a model and a point of departure for a broader interagency effort to better coordinate federal assistance to local communities and help them use the post-disaster recovery process as an opportunity to rebuild healthier and more resilient and sustainable communities (DHS and EPA, 2010)
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From page 106... ...
Communities are complex adaptive systems, and an adaptive management approach to disaster recovery is therefore warranted. Adaptive management is an approach that allows community leaders and members to explore alternative ways of achieving disaster recovery objectives, identify potential outcomes, implement one or more methods, and monitor their impacts on the recovery process so that course corrections can be made in the process of iterative decision making.
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From page 107... ...
RESEARCH NEEDS The committee identified four key areas in which additional research could significantly improve the integration of health considerations into recovery planning processes: • How does integration of health improvement plans with comprehensive plans and pre-disaster recovery plans prior to a disaster support a healthy community approach to disaster recovery? • What are the optimal organizational arrangements at the state and local levels under the structure of the NDRF that facilitate coordination across sectors, including the often separate health and social services domains?
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From page 108... ...
Specifically, federal agencies should take the following actions: • HHS, HUD, DOT, EPA, and other federal agencies should use aligned grant guidance and technical assistance for existing and future grant programs to incentivize preparedness, community health, and community development grantees to collaborate on the integration of local health improvement goals into comprehensive plans and disaster recovery plans. • The CDC and the Office of the Assistant Secretary for Preparedness and Response should revise preparedness grant guidance related to the recovery capability to include greater focus on long term recovery and opportunities for using recovery to advance healthier and more resilient and sustainable communities.
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From page 109... ...
The committee recommends that the Federal Emergency Management Agency (FEMA) and the five other federal agencies that represent coordinating agencies for the Recovery Support Functions take steps to further develop and promote the National Disaster Recovery Framework (NDRF)
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From page 110... ...
When appropriate, existing federal and professional disaster preparedness training programs, such as those for public health emergency preparedness coordinators and the FEMA Emergency Management Institute's classroom and independent study courses for emergency managers (including those for federal disaster recovery coordinators) , should be leveraged.
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From page 111... ...
Strategies for enhancing and preserving social networks should be specifi cally included in community health improvement and disaster recovery plans. Before and after a disaster, existing social networks, such as neighborhood associations, should be leveraged to enhance mechanisms for integrating the community into recovery planning.
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From page 112... ...
2014. Considerations for community health in disaster recovery.
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From page 113... ...
Paper presented at IOM Committee on Post-Disaster Recovery of a Community's Public Health, Medical, and Social Services: Meeting One, November 25, Washington, DC.
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From page 114... ...
Paper presented at IOM Committee on Post-Disaster Recovery of a Community's Public Health, Medical, and Social Services: Meeting Three, April 28-29, Washington, DC.
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From page 115... ...
Paper presented at IOM Committee on Post-Disaster Recovery of a Community's Public Health, Medical, and Social Services: Meeting Four, June 13, Washington, DC. Norris, T., and M
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From page 116... ...
Paper presented at IOM Committee on Post-Disaster Recovery of a Community's Public Health, Medical, and Social Services: Meeting Two, February 3, Washington, DC.
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