Examining Challenges and Possible Strategies to Strengthen U.S. Health Security Proceedings of a Workshop (2018) / Chapter Skim
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5 Potential Strategies for Strengthening the Nation's Health Security
5 Potential Strategies for Strengthening the Nation's Health Security
Pages 59-72
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From page 59... ...
Similarly, David Blazes, senior program officer, Epidemiology and Surveillance, Vaccine Development, Global Health Program, Bill & Melinda Gates Foundation, suggested focusing on preparedness itself as a significant area, rather than as a precursor to response. Often, Blazes noted, critical gaps 59
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From page 60... ...
Stripling called for national distillation of the mission of health care and public health preparedness, response, and recovery in a way that is specific enough that it can be tied to specific data points and can be measured using an agreed-upon set of metrics in the future. According to Maher, achieving this goal will require establishing a common definition of the problem and the shared dilemma.
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From page 61... ...
Shah suggested leveraging the fact that most Americans support international efforts to improve health in developing countries. Hanfling called for more direct engagement with international partners, by first looking, in particular, at WHO Global Reform and the Global Emergency Workforce, and then promulgating and moving forward a very distinct strategy that brings states, USAID, HHS, and DoD together as domestic partners to work with international partners in clarifying response objectives.
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From page 62... ...
A potential focus area for moving forward, therefore, is facilitating rapid bidirectional communication to ensure there are positive optimal outcomes; to improve preparedness, response, and recovery efficacy and effectiveness; and to make sure decision makers have the right information at the right time. Research should be integrated into ICS if it can be done on a quickenough feedback loop that it will actually improve the response, according to Stripling.
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From page 63... ...
Phillips noted a lack of time spent evaluating progress in the field over the previous 15 years and suggested putting in place an evaluation process to strategically assess what works and what does not across broader and more expansive activities, new responsibilities, new organizational structures, and grant programs that have expanded or collapsed. Goodman suggested promoting the concept of disaster science, which involves both the inter-emergency science agenda and the during-emergency science agenda (e.g., how to collect data during the event to enable a more effective response)
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From page 64... ...
Leesa Lin, Harvard University, suggested developing a "rapid science response," a meaningful, rapid assessment that allows evidence to be used quickly to inform response and decision making. Blazes proposed applying the concept of "precision public health" and promoting open, transparent access to data, because "the best public health decisions will require the best data and in many ways, that equates to the most precise data." He suggested that data precision is an equity issue (e.g., precision of determining the risk of transmission of Zika virus in neighborhoods)
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From page 65... ...
Marinissen offered several suggestions for how the United States could integrate with international preparedness and response efforts, including participating in the worldwide implementation of IHR to establish a better understanding of the world's global capacity to respond to emergencies. She pointed to the WHO Health Emergencies Programme as a clear global lead to coordinate emergency response and called for finding ways for the U.S.
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From page 66... ...
Stevens suggested that a key strategy moving forward will be finding ways to ensure the interoperability of electronic health data working across disparate systems across the country. The target outcome is a learning health system enabled by nationwide interoperability that supports all stakeholders, especially individuals and providers (see Figure 5-1)
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From page 67... ...
The Office of the National Coordinator for Health Information Technology and ASPR were given $50,000 by the HHS IDEA Lab, $40,000 of which funded a local contractor to build a technical architecture to make it possible to request patient information across all 43 HIE organizations in the state.a The target population was displaced victims of disasters and all victims experiencing a medical or trauma emergency served by EMS.b In PULSE, Stevens explained, requested patient query demographics in clude first and last name, gender, and fields for date of birth and Social Security number. The system is activated inside each EHR (using existing log-on creden tials)
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From page 68... ...
during disasters and public health emergencies. Margolis specified that comprehensive situational awareness requires integrating many different data sources, including EHRs, but also other sources of data such as operational data, administrative data, scheduling data, workforce data, inventory management data, and social media information.
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From page 69... ...
For example, he noted that although CDC is one of the gold standards for public trust about health messages, a local health provider or local fire chief is even more effective at the community level. Dodgen suggested designing messages for people who need to be persuaded to garner funding, attention, and diligence to preparedness: "We tend to design messages for people who are already persuaded." Hick suggested framing messages in ways that can be digested and appreciated in
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From page 70... ...
Wolf suggested using risk assessment tools and enterprise risk management to make the case for investment. Lin emphasized that evaluation and cost-effectiveness analysis are needed to demonstrate ROI, which will be required to move the public emergency preparedness agenda toward improvements.
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From page 71... ...
He additionally suggested producing a financial base plan for diversifying preparedness funding that does not diminish the federal need for grant funding. Barone drew attention to the overreliance on federal funding and the resulting complacency, arguing that disasters are local, so investment should be local: "Convince local leaders to start investing in local preparedness, or the infrastructure will fail." He noted that federal programs will inevitably change, but reliance on those programs has created local-level expectations that they will continue to receive federal funds in perpetuity.
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From page 72... ...
that it can be difficult for local communities, coalitions, and health care partnerships to find local businesses willing to contribute, cautioning that there are often a host of assumptions made about how foundations and private-sector businesses are willing to invest. She suggested that communities approach such conversations in more organized ways by helping to define the business case and frame the message to justify and garner investment at the local level and giving it a frame of context so as to justify and present the advantages of investment.
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