Q&A with author and preparedness expert Linda Landesman

Linda Landesman, DrPH, MSW, assistant vice president for the New York City Health and Hospitals Corporation, is author of the recently updated APHA book “Public Health Management of Disasters: The Practice Guide,” which is now in its third edition. She is a pioneer in the field due to her work in preparedness, leading an initiative to place public health preparedness on the APHA agenda. She has been an active member of APHA since 1990.

Q: What is the origin of the idea for the book “Public Health Management of Disasters: The Practice Guide?”
My interest in emergency preparedness began in the early 1980s when I lived in Southern California where everyone was concerned with earthquake preparedness. Back then, public health issues were rarely considered part of emergency preparedness. My involvement with the efforts in Orange County helped me understand that the resources needed for effective readiness and response are broad and include the technical knowledge of many disciplines. I originally developed this book to provide both a basic understanding of the public health role in preparedness and response, and to bring together the many diverse and widespread tools needed for public health practitioners to carry out their responsibilities.

The first edition was the culmination of more than 10 years of working and thinking. As a doctoral student, I came to APHA’s Program Development Board (now the Science Board) to suggest that the Association increase its activities regarding emergency preparedness. The next few years, I worked in the Health Administration Section to organize solicited sessions for the Annual Meeting on topics related to emergency preparedness. Needing material for one of those papers, I learned that few courses about emergency preparedness topics were available through a review of the course catalogues from schools of public health. After the tremendous impact of Hurricane Andrew in 1992, the results of my survey became the basis for a letter to the American Journal of Public Health calling for formalized public health training in disaster preparedness and response. That call to action led to three years of conference support through the Association of Schools of Public Health cooperative agreement with the Centers for Disease Control and Prevention. Working with colleagues who attended those conferences, I developed the first public health curriculum on emergency preparedness. With permission, I used the content of this curriculum as the foundation for writing the first edition of “Public Health Management of Disasters: The Practice Guide.”

Q: Why is there a third edition, and what is new in this edition from the previous editions?

The three editions track progress in the field of public health preparedness. The first book, at the printer on Sept. 11, 2001, established foundational principles. The second edition incorporated the many improvements that were made after the Sept. 11 terrorist attacks. The numerous difficulties following Hurricane Katrina in 2005 highlighted the need for a reorganization of response and the provision of services to vulnerable populations. The third edition includes all of the advancements made following 2005, including updated information on roles and responsibilities, the organization of the federal response, working with emergency management, surveillance and information systems, emergency communications and more. In addition, sections and chapters have been added on current legislation, ethics, functional needs and chronic disease, resilience, response systems and capabilities, social media and whole community preparedness.

Now, as in any established field, there is a large body of specialized technical information critical to the public health function. When I wrote the first edition of the book, a key goal was to consolidate important information about a range of public health problems into one source. The third edition continues to bring together that essential knowledge for the preparedness practitioner.

Q: How did this spring’s disaster in Japan — one marked by not one, but three emergencies — affect the way you think about disaster preparedness and response?

There is much to learn from the Japanese experience, as similar hazards exist in the United States and worldwide. To apply the lessons, we first have to believe that catastrophic events can happen to us. Thinking that catastrophes are rare prevents us from taking the kinds of measures needed to be better prepared.

Many think that catastrophic events only happen with a rare combination of conditions and to someone else. As an example, New York City developed a catastrophic hurricane plan in 2006, yet many who live in the metropolitan region think that hurricanes hit Florida or the Gulf, not us. Living in New York as Hurricane Irene approached in August 2011, I listened to officials publicly plead for people to evacuate from high-risk areas. While Irene may be the costliest disaster in U.S. history, we were spared the loss of many lives because so many evacuated from the areas of highest risk. Unfortunately, deaths occurred that could have been prevented because not everyone took appropriate precautions.

Q: As we near the 10th anniversary of the Sept. 11 terrorist attacks, what does that milestone mean for the field of public health preparedness? You must have a personal recollection of that day as a New York resident.

The Sept. 11 attacks were a watershed for the field of public health preparedness. The breadth of issues requiring public health expertise demonstrated how crucial our profession is to the nation’s emergency preparedness and disaster response. With full recognition of our important role occurring after Hurricane Katrina, designated responsibilities are now defined and specific capabilities are expected of public health professionals. It is so different from the early 1980s when I was asked by emergency management officials, “What does mental health have to do with disasters?”

When the terrorists struck New York City on Sept. 11, I was in Los Angeles on a college tour with my son. We were scheduled to fly home that day when my husband woke us and informed us about the attacks. We were unable to fly home, and for over a week we watched the people around us happily moving on with their lives – it was a bit surreal. Since I worked in Lower Manhattan, I watched the television coverage of unfolding events with a personal intensity. The workday for city employees was not normal for a long time. We had to cover our faces when outside due to the offensive odor in the air. We sought comfort from each other, especially my staff who witnessed one of the planes hitting the towers. There was a collective disbelief confronted with the reality on a daily basis.

Q: What is valuable about being a long-time member of APHA?

I came to APHA as a student because I was interested in finding out what the Association was doing about a public health problem that I was interested in. What I found was an organization that brought practitioners and academics together to collaborate on protecting and advancing the health of communities. In addition to expanding my understanding of public health’s role in a healthy society, APHA provided opportunities to serve the organization and develop leadership skills that had direct application as my career evolved. 

APHA is a wonderful organization where members from all parts of the country and around the world can discuss both their unique concerns and different approaches to shared problems. The diversity of experience and the sharing of common values create richer conversations between our members.

More important, my involvement during the year and my active participation at the Annual Meeting has facilitated wonderful friendships from many places. Through APHA, this global network of like-minded colleagues works to advance and advocate for policies and values that I believe in.

Q: In your opinion, is it the responsibility of every public health professional to be a public health advocate?It is absolutely critical that every public health professional advocate for the people that we help and the work that we do. Unlike banking, engineering or manufacturing, where the services are concrete and the societal contribution universally understood, it is difficult to demonstrate the value of prevention. If we don’t speak out, essential public health services provided by government will be targeted for reduction or elimination. Through public health advocacy, we can educate our neighbors, policy-makers and community leaders so that the impacts governmental decisions have on health are considered. We need everyone who works in public health to join together so that our voice is strong and heard across our country.  The future of our profession and our children depends on it.

To learn more or purchase a copy of “Public Health Management of Disasters: The Practice Guide,” newly released from APHA Press, visit the APHA Bookstore.