The Robert Wood Johnson Foundation released results of the 2016 National Health Security Preparedness Index last week. This annual assessment showed the nation is relatively well-prepared for managing an emergency, although there is room for improvement.

In this guest post, Paul Kuehnert, DNP, RN, assistant vice president for programs at the foundation and member of APHA, discusses the invaluable role public health plays in convening diverse stakeholders to meet challenges and argues that the public health community must take the lead in preparing our communities for emergencies.


Paul Kuehnert

Paul Kuehnert, DNP, RN, assistant vice president for programs at the Robert Wood Johnson Foundation. Photo courtesy RWJF

The American public health system has a well-earned reputation for pushing past immediate events and conventional wisdom to better understand the larger pattern of a root problem. We need to call upon that strength again today, in order to meet the challenges of tomorrow.

In the 1960s, public health experts began recognizing traffic deaths and injuries as something more than random accidents. Bit by bit, they deconstructed them to find patterns. They convened stakeholders from government, business and the community to identify needed changes. Despite exponential growth in vehicle traffic, the mortality rate declined from 18 per 100 million vehicle miles traveled in 1925 to 1.08 in 2014 — a 94 percent decrease. Over time, seatbelts (and eventually their use) became mandatory, roads improved and drunken driving was banned. Efforts of the public health community saved millions of lives.

Times are more complicated than the 1960s. There are more of us, and the country is more interconnected to the rest of the world. The range of threats to our health and well-being are greater and emerge more quickly, while others, like natural disasters, inflict damage on a greater scale. As the preparedness challenge has ramped up, so too has the necessity to meet it. There’s no doubt that this issue is bigger than public health alone, but I think that our public health system can take a leading role in a collaborative, multi-sectoral effort to enhance our national health security preparedness. In order to create the strong and resilient communities that can meet and overcome threats to our health security, we need to collaborate across the disparate aspects of our health security infrastructure and coordinate with each level of government nearly every single day. It’s no simple task, but one that public health can lead.

Recognizing the dizzying array of overlapping responsibilities and capacity challenges, the Centers for Disease Control and Prevention led the effort to establish the National Health Security Preparedness Index as a streamlined tool to better understand the nation’s capabilities. The Index annually reports an overall national aggregate preparedness score from 0 to 10, and provides state scores to be used as a benchmark and tool for collaboration. This work, continued by the Robert Wood Johnson Foundation in partnership with the University of Kentucky, has functioned as a clearinghouse across six areas for assessing the nation’s health security and preparedness — from surveillance and community planning, to incident management, care delivery, environmental health and countermeasure management.

It’s no simple task, but one that public health can lead. — Paul Kuehnert

Whether health threats emerge from natural disasters like Hurricane Sandy or communicable diseases like Zika, we need to understand and constantly improve the nation’s ability to respond quickly and effectively. This year, the United States earned an overall score of 6.7 out of 10 for emergency preparedness — an improvement of 3.6 percent since the Index was launched. Overall, the Index observed particularly strong preparation in incident command and control, but data indicated a real need to improve in environmental and occupational health. National preparedness has improved most in community planning and engagement, rising 8.4 percent in three years. These improvements are real and significant, but incomplete. We must do more, and the Index can serve as a valuable tool to assess progress, and help us recognize that no single sector, agency, organization or programs can be held accountable for all of the measures tracked within the Index. Achieving preparedness is a shared responsibility.

In its first three years, the Index focused primarily on measures of public health and health care preparedness and observed important capabilities that can be universally achieved and institutionalized across the nation. Those achievements must be sustained, but they must be built upon as we move forward. In that vein, as the Index evolves it will incorporate additional sectors to better identify gaps and inform planning as well as draw in stakeholders from the private sector, academia and community organizations. These changes will take into account the contextual factors that shape community risk, vulnerability and resilience, which vary from state to state and change over time. Recognizing their impact will empower authorities to make better decisions about how to protect their citizens, make their community a healthier place, and help improve our nation’s national health security preparedness.

Like it was in the 1960s, and so many other times, America’s public health system should be at the effort’s forefront.