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Title: PUBLIC HEALTH ... The Public Health System Process ..


1
State Role in Public Health Emergencies
Division of Communicable Disease Control
  • Jessica M. Núñez de Ybarra, MD, MPH
  • Public Health Medical Officer III
  • CA Department of Public Health (CDPH)
  • Division of Communicable Disease Control (DCDC)
  • Office of Workforce Development
  • All Hazards Workshop San Joaquin County
  • August 2008

2
Purpose
  • Provide a basic understanding of the State
    communicable disease control role as part of the
    overall State Public Health Emergency
    Preparedness and Response system in California.

3
PUBLIC HEALTH
  • While health care is vital to each of us some of
    the time, public health is vital to all of us all
    the time.
  • C. Everett Koop, M.D., former U.S. Surgeon
    General
  • Mission The fulfillment of societys interest
    in assuring conditions in which people can be
    healthy. Institute of Medicine.
  • Functions Assessment, Policy development
    Assurance.

4
The Public Health System Process
  • a continuous cycle of gathering information,
    deciding, acting, evaluating
  • Public health is always evaluating the health of
    the community

5
System
  • More than just the public health agency
  • Public health system
  • All public, private, and voluntary entities that
    contribute to public health in a given area.
  • A network of entities with differing roles,
    relationships, and interactions.
  • All entities contribute to the health and
    well-being of the community.

6
The Public Health System
7
Public Health in America
  • Prevent epidemics and spread of disease
  • Protect against environmental hazards
  • Prevent injuries
  • Promote and encourage health behaviors
  • Assure the quality and accessibility of health
    services
  • Respond to disasters and assist communities in
    recovery

8
Public Health Preparedness Threats and
Emergencies7 Core Capacities
  • Workforce
  • Information Systems
  • Communication
  • Epidemiology/surveillance
  • Laboratory
  • Policy and Evaluation
  • Preparedness and Response

9
California
10
(No Transcript)
11
Definitions

12
Workforce
  • The public health system maintains a public
    health workforce capable of delivering the
    Essential Public Health Services during routine
    and emergency operations

13
The Essential Public Health Services (1994)
  • Monitor health status
  • Diagnose and investigate health problems
  • Inform and educate
  • Mobilize communities to address health problems
  • Develop policies and plans
  • Enforce laws and regulations
  • Link people to needed health services
  • Assure a competent health services workforce
  • Evaluate health services
  • Conduct research for new innovations

14
Information Systems
  • Public Health Systems establish and maintain
    secure accessible information systems for rapid
    communication, analysis and interpretation of
    health data, and public access to health
    information.

15
Communication
  • Public Health systems maintain communication
    mechanisms to
  • Routinely translate scientific and health
    information for communities and policy makers
  • Provide timely, accurate public information and
    advice to policy makers during emergency events
  • Coordinate logistical communication within the
    response community.

16
Epidemiology/Surveillance
  • Public health systems monitor health events to
    identify changes or patterns and to investigate
    underlying causes and factors.

17
Laboratory
  • Public health systems maintain the ability to
    produce timely and accurate laboratory results
    for diagnostic and investigative public health
    coverage.

18
Policy and Evaluation
  • Public health systems use community assessment
    findings to establish priorities and improve the
    effectiveness of programs and policy decisions.

19
Preparedness and Response
  • Public health systems maintain the ability to
    effectively detect and respond to public health
    threats and emergencies.

20
Communication with Your Family
  • Your family may be concerned, involved and/or
    have their routines changed.
  • Do you have a
  • Family Disaster Plan?
  • Personal Emergency Plan?

21
Family Disaster Plan Materials

Source FEMA www.fema.gov
22
Example Personal Emergency Plans
During Working Hours
After Working Hours
NYC-DOH School Health Program Draft, August
2001
23
Remember
  • Make provisions for
  • Child(ren)
  • Spouse/Partner
  • Parents
  • Pets
  • Others

24
COMPETENCY
  • A complex combination of knowledge, skills and
    abilities demonstrated by organization members
    that are critical to the effective and efficient
    function of the organization
  • (Center for Public Health Practice, Emory
    University)

25
Core Public Health Worker Competencies for
Emergency Preparedness and Response
Effective public health emergency preparedness
and response depends upon the coordinated efforts
of multiple people from many different agencies,
working in concert. Mastery of the Core
Public Health Worker Emergency Preparedness and
Response Competencies is the first step for the
public health team.
26
In order to respond to any emergency/disaster,
ALL public health workers should be able to
  • IDENTIFY LOCATE the emergency plan
  • DESCRIBE the role of Public Health
  • DESCRIBE the Chain of Command
  • DESCRIBE DEMONSTRATE ones functional role
  • RECOGNIZE deviations from the norm
  • IDENTIFY limits to own authority
  • DESCRIBE communication roles
  • DEMONSTRATE use of communication equipment
  • APPLY creative problem solving skills

27
Role of the State Public Health Agency in
Emergency Response
  • Collaborate with other agencies in policy
    decisions and actions (e.g., request to Feds for
    Strategic National Stockpile)
  • Surveillance
  • Investigation
  • Public information

28
Role of the State Public Health Agency in
Emergency Response (contd)
  • Medical provider information
  • Reference laboratory support
  • Public health interventions (e.g. mass
    vaccinations)

29
Role of the State or Local Office of Emergency
Services (OES)
  • Plans, monitors and coordinates all
    inter-agency activities for potential or actual
    emergency situations.

30
Example of a Common Multi-level Scheme for
Disaster Communication and Coordination
PRESIDENT
DHS FEMA
HHS CDC
GOVERNORS OFFICE
STATE OES
STATE DOH
Office of Local Elected Official
LOCAL OES
LOCAL DOH
Police
Fire
Other
31
Federal, State and Local Coordination in
California DISASTERS for Public Health
DHS/FEMA
PRESIDENT
HHS/CDC/VA etc.
Governors OFFICE OF EMERGENCY SERVICES
(OES) SOC
GOVERNORS OFFICE
CDPH/EMSA JEOC
RDMHC
OES/REOC Admin Mutual Aid Regions
Local Officials OFFICE
MHOAC LHJ
OPERATIONAL Area EOCs Cities, Counties, Special
Districts
Incident Command
Voluntary Health Sector
Police
FIRE-EMS
Media
Voluntary Agencies (ARC, etc.)
32
EMERGENCY PREPAREDNESS COMPETENCY
  • IDENTIFY limits to own knowledge/skills/authority
    and..
  • IDENTIFY key system resources for referring
    matters that exceed these limits

33
Role of Local Health Officershttp//www.cdph.ca.g
ov/programs/dcdc/Pages/default.aspxHealth
Officer Practice Guide for Communicable Disease
Control in California
34
Examples
  • LIMITS TO OWN SKILLS OR AUTHORITY
  • Communication with media
  • Legal authority
  • Supervision of others
  • Allocation of resources
  • Clinical skills or decision making
  • Policy decision
  • KEY SYSTEM RESOURCES
  • Agency chain of command
  • Web resources
  • Logistics Officer
  • Policy and procedure manual
  • Disaster plan / protocols

35
ExamplesPublic Health Nurse in the Shelter
Setting
  • Limits
  • Treatment of the seriously ill
  • Providing information to the media
  • Re-assigning roles of other shelter staff
  • Resources
  • Local Emergency Room
  • DOH Public Relations (or Public Affairs Dept.)
  • Shelter manager

36
Cultural and Linguistic COMPETENCE
  • A set of congruent behaviors, attitudes and
    policies that come together in a system, agency
    or among professionals that enables effective
    work in cross-cultural situations.
  • Terri Cross, 1989
  • From March 2005 Presentation by Dr. Melanie
    Tervalon, MD, MPH, Education Director, COE
    Nutritional Genomics

37
Rationale for Cultural Competence
  • Responding to demographic changes
  • Eliminating disparities in the health status of
    people of diverse, ethnic cultural backgrounds
  • Improving quality of services and outcomes
  • Cohen E, Goode T. Policy Brief 1Rationale for
    cultural competence in primary health care.
    Georgetown University Child Development Ctr,
    National Center for Cultural Competence.
    Washington DC, 1999. From March 2005
    Presentation by Dr. Tervalon

38
Rationale for Cultural Competence (cont.)
  • Meeting legislative, regulatory, and
    accreditation mandates
  • Gaining a competitive edge in the marketplace
  • Decreasing the likelihood of liability/malpractice
    claims
  • Cohen E, Goode T. Policy Brief 1Rationale for
    cultural competence in primary health care.
    Georgetown University Child Development Ctr,
    National Center for Cultural Competence.
    Washington DC, 1999.

39
Cultural Humility
  • Self-reflection and life long learner
  • Patient-focused interviewing and care
  • Community-based care and advocacy
  • Institutional consistency
  • From March 2005 Presentation by Dr. Tervalon

40
Public Health for Emergency Preparedness and
Response
Effective public health emergency preparedness
and response depends upon the coordinated efforts
of multiple people from many different agencies,
working in concert.
41
State of California Executive Branch
Voters
GOVERNORS OFFICE
Health and Human Services
Depts.
CDPH
42
California Dept. of Public Health www.cdph.ca.gov
43
CDPH
  • VISION Healthy individuals and families in
    healthful communities
  • MISSION Dedicated to optimizing the health and
    well-being of the people in California.

44
CDPH
Directors Office
  • OWH
  • OMH
  • OBBH
  • EPO
  • CCLHO
  • Advisory Cmte

Center for Chronic Disease
Center for Environmental Health
Center for Infectious Disease
Center for Family Health
Center for Healthcare Quality
  • Chronic Disease
  • Injury Control
  • Environmental
  • Occupational
  • Disease Control
  • Food, Drug
  • Radiation Safety
  • Drinking Water
  • Environmental
  • Mgmt.
  • Communicable
  • Disease Control
  • Office of AIDS
  • Licensing
  • Certification
  • Laboratory Field
  • Services
  • WIC
  • Maternal, Child
  • Adolescent
  • Health
  • Genetic Disease

45
  • CDPH through DCDC is responsible for
    investigating and controlling all communicable
    disease and conditions in the State of California.

46
DCDC
  • DCDC, through its Branches, works in partnership
    with local, national and international health
    officials, health care providers, and the public
    to
  • monitor health,
  • identify and investigate existing and potential
    health problems,
  • develop and implement prevention strategies,
  • conduct research,
  • provide education and training,
  • and formulate and advise on public health policy

47
DCDC Branches
  • Infant Botulism Treatment and Prevention Program
  • Infectious Diseases Branch
  • Immunization Branch
  • Sexually Transmitted Disease Control Branch
  • Tuberculosis Control Branch
  • Microbial Diseases Laboratory Branch
  • Viral Rickettsial Disease Laboratory Branch

48
Epidemiology/SurveillanceRoles and
Responsibilities in Emergency Response
  • Provide background info on emergency surveillance
    data
  • Conduct field epidemiological investigations
    (prn)
  • Monitor existing surveillance systems
  • Establish new surveillance system
  • - Assemble field teams - Establish
    databases
  • - Develop questionnaires/forms - Enter data
  • - Liaison with hospital/field personnel -
    Analyze data
  • - Collect data
  • - Develop recommendations for policy

49
LaboratoriesRoles and Responsibilities in
Emergency Response
  • Provide recommendations for specimen types and
    handling
  • Accept specimens for testing
  • Ensure rapid transports to reference labs
  • Perform testing
  • Coordinate with epi/surveillance re data entry
  • Liaison with Laboratory Response Network (LRN)
    i.e., outside labs re testing and data reporting

50
OperationsRoles and Responsibilities in
Emergency Response
  • Provide resources to facilitate others activities
  • Transportation
  • Communication
  • Facilities
  • Security
  • Personnel
  • Printing
  • Coordinate hotlines for public
  • providers

51
EnvironmentalRoles and Responsibilities in
Emergency Response
  • Research specific topic
  • Provide background information
  • Prepare recommendations re
  • -Public health threat
  • -Sample collection
  • -Evacuation/reoccupation
  • Collect samples
  • Collaboration w/ Hazmat

52
Medical Information Systems (MIS)Roles and
Responsibilities in Emergency Response
  • Facilitate computing issues during emergencies
  • -Field to Headquarters data transmission
  • -Database management
  • -Mapping/GIS

53
Local Medical/ClinicalRoles and Responsibilities
in Emergency Response
  • Prepare recommendations on clinical aspects of
    emergency
  • -Public safety issues
    -Training of community MDs
  • -Occupational safety issues
    -Disinfection/decon issues
  • -Develop prevention treatment message
  • Establish and staff prophylaxis/treatment
    distribution centers
  • Staff DOH clinics involved in emergency
  • Liaison with Coroner regarding mortuary issues
  • Supplement clinical backup to school health
    program sheltering activities

54
EMERGENCY PREPAREDNESS COMPETENCY
APPLY creative problem solving and flexible
thinking to unusual challenges within functional
roles and responsibilities and EVALUATE the
effectiveness of all actions taken.
55
CREATIVE PROBLEM SOLVING
  • What situations requiring creative problem
    solving and flexible thinking can you imagine
    occurring?
  • Telephone system fails?
  • Expected supplies are not delivered?
  • Agency facility is inaccessible?
  • Other types of problems???

56
CREATIVE PROBLEM SOLVING
What situations requiring creative problem
solving and flexible thinking can you imagine
occurring?
57
Evaluation
  • How would you evaluate the effectiveness of all
    actions you took?
  • Were the issues you referred to others acted
    upon?
  • Was the issue that you addressed resolved?
  • After the situation, evaluate the effectiveness
    of the plan.

58
QUESTIONS?
59
Acknowledgement
  • Special thanks to the Columbia University Center
    for Public Health Preparedness upon whose Public
    Health Emergency Preparedness and Training
    Program this Presentation has been based.
  • Website http//cpmcnet.columbia.edu/dept/sph/CPHP
    /index.html

60
Resources
  • American Public Health Association www.apha.org
  • Association of State and Territorial Health
    Officials www.astho.org
  • Centers for Disease Control and Prevention
  • http//www.cdc.gov/

61
Resources
  • National Association of County and City Health
    Officials www.naccho.org
  • National Association of Local Boards of Health
    www.nalboh.org
  • National Network of Public Health Institutes
    www.nnphi.org
  • Public Health Foundation www.phf.org

62
Contact Information
  • Jessica M. Núñez de Ybarra, MD, MPH
  • jnunez2_at_cdph.ca.gov
  • Phone 916 650-6875
  • Fax 916 552-8973
  • California Department of Public Health
  • Division of Communicable Disease Control
  • 1616 Capitol Avenue, MS 7300
  • PO Box 997377
  • Sacramento, CA 95899-7377

63
Thank You
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