Alonzo L. Plough

Building Community Disaster Resilience: Perspectives From a Large Urban County Department of Public Health

An emerging approach to public health emergency preparedness and response, community resilience encompasses individual preparedness as well as establishing a supportive social context in communities to withstand and recover from disasters. We examine why building community resilience has become a key component of national policy across multiple federal agencies and discuss the core principles embodied in community resilience theory-specifically, the focus on incorporating equity and social justice considerations in preparedness planning and response. We also examine the challenges of integrating community resilience with traditional public health practices and the importance of developing metrics for evaluation and strategic planning purposes. Using the example of the Los Angeles County Community Disaster Resilience Project, we discuss our experience and perspective from a large urban county to better understand how to implement a community resilience framework in public health practice.

Getting Actionable About Community Resilience: The Los Angeles County Community Disaster Resilience Project

Community resilience (CR)--ability to withstand and recover from a disaster--is a national policy expectation that challenges health departments to merge disaster preparedness and community health promotion and to build stronger partnerships with organizations outside government, yet guidance is limited. A baseline survey documented community resilience-building barriers and facilitators for health department and community-based organization (CBO) staff. Questions focused on CBO engagement, government-CBO partnerships, and community education. Most health department staff and CBO members devoted minimal time to community disaster preparedness though many serve populations that would benefit. Respondents observed limited CR activities to activate in a disaster. The findings highlighted opportunities for engaging communities in disaster preparedness and informed the development of a community action plan and toolkit.

Applying Community Engagement to Disaster Planning: Developing the Vision and Design for the Los Angeles County Community Disaster Resilience Initiative

Community resilience (CR) is a priority for preparedness, but few models exist. A steering council used community-partnered participatory research to support workgroups in developing CR action plans and hosted forums for input to design a pilot demonstration of implementing CR versus enhanced individual preparedness toolkits. Qualitative data describe how stakeholders viewed CR, how toolkits were developed, and demonstration design evolution. Stakeholders viewed community engagement as facilitating partnerships to implement CR programs when appropriately supported by policy and CR resources. Community engagement exercises clarified motivations and informed action plans (e.g., including vulnerable populations). Community input identified barriers (e.g., trust in government) and CR-building strategies. A CR toolkit and demonstration comparing its implementation with individual preparedness were codeveloped. Community-partnered participatory research was a useful framework to plan a CR initiative through knowledge exchange.

The ABCDs of Treating the Most Prevalent Childhood Disease

Dental caries is a potentially preventable infectious disease that, untreated, can cause significant morbidity requiring costly treatment. The Access to Baby and Child Dentistry (ABCD) program increases access to prevention and early treatment for Medicaid-eligible children aged younger than 6 years in Washington State. The program is a partnership of Washington Dental Service Foundation, the University of Washington School of Pediatric Dentistry, the state Medical Assistance Administration, and local stakeholders. Through training in pediatric dental techniques and enhanced reimbursement, ABCD equips and encourages dentists to serve young Medicaid patients. Family counseling increases oral care compliance and reduces no-show rates. Program evaluation demonstrates changing attitudes and behavior among participating families and dentists, with more young, low-income Washington children receiving oral health care.

Building a Culture of Health: A Critical Role for Public Health Services and Systems Research

The authors reflect on the development of a culture of health in the United States and on the role that public health services and systems research can play in it. They suggest that health and health care have reached a pivotal point in the United States and that new skills and perspectives will be needed to inform public health systems and services research. They argue that a culture of health must be established and that it will require changes in education and health services administration.

Building a culture of health: challenges for the public health workforce.

Health and health care have reached a pivotal point in the U.S. For generations, Americans’ health has been unequally influenced by income, education, ethnicity, and where people live. Healthcare systems have operated largely apart from each other and from community life. The definition of health has been “not needing to seek health care,” rather than the broader public health view that all aspects of our lives—in our work, families, and communities—should support active and healthy living. Today, however, the world is changing and the education, training, and practice strategies of the public health workforce must adapt to these changes. This requires new skills and perspectives, some of which are presented in papers in this special issue. A growing number of communities, regions, and states are working to redefine what it means to get and stay healthy by addressing social and physical spaces and conditions in which people live, learn, work, and play—the social, environmental, and economic determinants of health. Demographics are shifting, especially in terms of the U.S. population’s age, ethnic diversity, and education levels. Workforce constraints and financial pressures, along with the requirements of federal healthcare reform, are changing who has access to care, how care is paid for and delivered, and how patients and providers interact. Coordinated efforts to promote wellness and prevent disease are proliferating among a diverse set of stakeholders, including organizations that are traditionally “non-health” focused. Providers of personal health services are connecting with their public health colleagues and multiple levels, and “big data”—large, varied data sets that are available in real or almost-real time—make it possible to analyze health patterns in unprecedented ways to gain a clearer picture of the actionable determinants, trends, and outcomes of societal health and well-being. These developments in health and society present a window of opportunity for real societal transformation and an imperative for public health professionals to

The Los Angeles County Community Disaster Resilience Project — A Community-Level, Public Health Initiative to Build Community Disaster Resilience

Public health officials need evidence-based methods for improving community disaster resilience and strategies for measuring results. This methods paper describes how one public health department is addressing this problem. This paper provides a detailed description of the theoretical rationale, intervention design and novel evaluation of the Los Angeles County Community Disaster Resilience Project (LACCDR), a public health program for increasing community disaster resilience. The LACCDR Project utilizes a pretest–posttest method with control group design. Sixteen communities in Los Angeles County were selected and randomly assigned to the experimental community resilience group or the comparison group. Community coalitions in the experimental group receive training from a public health nurse trained in community resilience in a toolkit developed for the project. The toolkit is grounded in theory and uses multiple components to address education, community engagement, community and individual self-sufficiency, and partnerships among community organizations and governmental agencies. The comparison communities receive training in traditional disaster preparedness topics of disaster supplies and emergency communication plans. Outcome indicators include longitudinal changes in inter-organizational linkages among community organizations, community member responses in table-top exercises, and changes in household level community resilience behaviors and attitudes. The LACCDR Project is a significant opportunity and effort to operationalize and meaningfully measure factors and strategies to increase community resilience. This paper is intended to provide public health and academic researchers with new tools to conduct their community resilience programs and evaluation research. Results are not yet available and will be presented in future reports.

Understanding the financing and functions of metropolitan health departments: a key to improved public health response.

Addressing the financing challenges of the governmental public health system requires a more detailed understanding of the specific role and functions of local health departments, particularly for metropolitan health departments. Many current studies and reports mistakenly aggregate all 3,000 local health departments as a single unit of analysis and, as a result, fail to highlight the increasingly important role of metropolitan health departments. These large departments represent less than 10% of local health departments, but at the same time, serve more than 60% of the US population. The largest 25 metropolitan health departments serve jurisdictions averaging 2 million persons; a larger population than 14 of the states. This article presents a description of the capacity and organizational characteristics of metropolitan health departments, the essential role these agencies play in the preparedness and health disparities areas, and the very different public health financing issues that are raised when the policy focus is on the form of local public health practice serving most of the population.

The Public Health Disaster Trust Scale: Validation of a Brief Measure

CONTEXT Trust contributes to community resilience by the critical influence it has on the communitys responses to public health recommendations before, during, and after disasters. However, trust in public health is a multifactorial concept that has rarely been defined and measured empirically in public health jurisdictional risk assessment surveys. Measuring trust helps public health departments identify and ameliorate a threat to effective risk communications and increase resilience. Such a measure should be brief to be incorporated into assessments conducted by public health departments. OBJECTIVE We report on a brief scale of public health disaster-related trust, its psychometric properties, and its validity. DESIGN On the basis of a literature review, our conceptual model of public health disaster-related trust and previously conducted focus groups, we postulated that public health disaster-related trust includes 4 major domains: competency, honesty, fairness, and confidentiality. SETTING A random-digit-dialed telephone survey of the Los Angeles county population, conducted in 2004-2005 in 6 languages. PARTICIPANTS Two thousand five hundred eighty-eight adults aged 18 years and older including oversamples of African Americans and Asian Americans. MAIN OUTCOME MEASURES Trust was measured by 4 items scored on a 4-point Likert scale. A summary score from 4 to 16 was constructed. RESULTS Scores ranged from 4 to 16 and were normally distributed with a mean of 8.5 (SD 2.7). Cronbach α = 0.79. As hypothesized, scores were lower among racial/ethnic minority populations than whites. Also, trust was associated with lower likelihood of following public health recommendations in a hypothetical disaster and lower likelihood of household disaster preparedness. CONCLUSIONS The Public Health Disaster Trust scale may facilitate identifying communities where trust is low and prioritizing them for inclusion in community partnership building efforts under Function 2 of the Centers for Disease Control and Preventions Public Health Preparedness Capability 1. The scale is brief, reliable, and validated in multiple ethnic populations and languages.

Community engagement in disaster preparedness and recovery: A tale of two cities - Los Angeles and New Orleans

Awareness of the impact of disasters globally on mental health is increasing. Known difficulties in preparing communities for disasters and a lack of focus on relationship building and organizational capacity in preparedness and response have led to a greater policy focus on community resiliency as a key public health approach to disaster response. In this article, the authors describe how an approach to community engagement for improving mental health services, disaster recovery, and preparedness from a community resiliency perspective emerged from their work in applying a partnered, participatory research framework, iteratively, in Los Angeles County and the City of New Orleans.