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Preparedness and response for catastrophic disasters
Based on a popular course for the FEMA Higher Education project, this volume provides important insight into plans to mitigate and respond to the devastation caused by large-scale catastrophic events.
eBook
Lessons of Disaster
Even before the wreckage of a disaster is cleared, one question is foremost in the minds of the public: \"What can be done to prevent this from happening again?\" Today, news media and policymakers often invoke the \"lessons of September 11\" and the \"lessons of Hurricane Katrina.\" Certainly, these unexpected events heightened awareness about problems that might have contributed to or worsened the disasters, particularly about gaps in preparation. Inquiries and investigations are made that claim that \"lessons\" were \"learned\" from a disaster, leading us to assume that we will be more ready the next time a similar threat looms, and that our government will put in place measures to protect us. In Lessons of Disaster, Thomas Birkland takes a critical look at this assumption. We know that disasters play a role in setting policy agendas—in getting policymakers to think about problems—but does our government always take the next step and enact new legislation or regulations? To determine when and how a catastrophic event serves as a catalyst for true policy change, the author examines four categories of disasters: aviation security, homeland security, earthquakes, and hurricanes. He explores lessons learned from each, focusing on three types of policy change: change in the larger social construction of the issues surrounding the disaster; instrumental change, in which laws and regulations are made; and political change, in which alliances are created and shifted. Birkland argues that the type of disaster affects the types of lessons learned from it, and that certain conditions are necessary to translate awareness into new policy, including media attention, salience for a large portion of the public, the existence of advocacy groups for the issue, and the preexistence of policy ideas that can be drawn upon. This timely study concludes with a discussion of the interplay of multiple disasters, focusing on the initial government response to Hurricane Katrina and the negative effect the September 11 catastrophe seems to have had on reaction to that tragedy.
eBook
Disasters and the American State
Disasters and the American State offers a thesis about the trajectory of federal government involvement in preparing for disaster shaped by contingent events. Politicians and bureaucrats claim credit for the government's successes in preparing for and responding to disaster, and they are also blamed for failures outside of government's control. New interventions have created precedents and established organizations and administrative cultures that accumulated over time and produced a general trend in which citizens, politicians and bureaucrats expect the government to provide more security from more kinds of disasters. The trend reached its peak when the Federal Emergency Management Agency adopted the idea of preparing for 'all hazards' as its mantra. Despite the rhetoric, however, the federal government's increasingly bold claims and heightened public expectations are disproportionate to the ability of the federal government to prevent or reduce the damage caused by disaster.
eBook
Universal healthcare as pandemic preparedness
The fragmented and inefficient healthcare system in the United States leads to many preventable deaths and unnecessary costs every year. During a pandemic, the lives saved and economic benefits of a single-payer universal healthcare system relative to the status quo would be even greater. For Americans who are uninsured and underinsured, financial barriers to COVID-19 care delayed diagnosis and exacerbated transmission. Concurrently, deaths beyond COVID-19 accrued from the background rate of uninsurance. Universal healthcare would alleviate the mortality caused by the confluence of these factors. To evaluate the repercussions of incomplete insurance coverage in 2020, we calculated the elevated mortality attributable to the loss of employer-sponsored insurance and to background rates of uninsurance, summing with the increased COVID-19 mortality due to low insurance coverage. Incorporating the demography of the uninsured with age-specific COVID-19 and nonpandemic mortality, we estimated that a single-payer universal healthcare system would have saved about 212,000 lives in 2020 alone. We also calculated that US$105.6 billion of medical expenses associated with COVID-19 hospitalization could have been averted by a single-payer universal healthcare system over the course of the pandemic. These economic benefits are in addition to US$438 billion expected to be saved by single-payer universal healthcare during a nonpandemic year.
Journal Article
United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico
Puerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico’s deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico’s limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico. ( Am J Public Health. 2024;114(S6):S478–S484. https://doi.org/10.2105/AJPH.2024.307585 ) [Formula: see text]
Journal Article
Planning to Reduce the Health Impacts of Extreme Heat: A Content Analysis of Heat Action Plans in Local United States Jurisdictions
Objectives. To examine commonalities and gaps in the content of local US heat action plans (HAPs) designed to decrease the adverse health effects of extreme heat. Methods. We used content analysis to identify common strategies and gaps in extreme heat preparedness among written HAPs in the United States from jurisdictions that serve municipalities with more than 200 000 residents. We reviewed, coded, and analyzed plans to assess the prevalence of key components and strategies. Results. All 21 plans evaluated incorporated data on activation triggers, heat health messaging and risk communication, cooling centers, surveillance activities, and agency coordination, and 95% incorporated information on outreach to at-risk populations. Gaps existed in the specific applications of these broad strategies. Conclusions. Practice-based recommendations as well as future areas of research should focus on increasing targeted strategies for at-risk individuals and expanding the use of surveillance data outside of situational awareness. (Am J Public Health. 2023;113(5):559–567. https://doi.org/10.2105/AJPH.2022.307217 )
Journal Article
Public Health’s Falling Share of US Health Spending
We examined trends in US public health expenditures by analyzing historical and projected National Health Expenditure Accounts data. Per-capita public health spending (inflation-adjusted) rose from$39 in 1960 to $ 281 in 2008, and has fallen by 9.3% since then. Public health’s share of total health expenditures rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014; it is projected to fall to 2.40% in 2023. Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats.
Journal Article
Planning for Postdisaster Resiliency
The focus of this article is planning for resiliency in the aftermath of a catastrophe. First, the authors offer their conception of planning for resiliency as a goal for recovering communities, and the benefits of planning in efforts to create more resilient places. Next, they discuss major issues associated with planning for postdisaster recovery, including barriers posed by federal and state governments to planning for resiliency, the promise and risks of compact urban form models for guiding rebuilding, and the failure to involve citizens in planning for disasters. Finally, they discuss lessons from prior research that address these issues and policy recommendations that foster predisaster recovery planning for resilient communities.
Journal Article
Testing in a Pandemic — Improving Access, Coordination, and Prioritization
The enormous U.S. toll of Covid-19 is attributable in part to the lack of an effective testing regimen. But by building distributed capacity and prioritizing resources appropriately, we can change our trajectory in fighting this pandemic and preempting future ones.
Journal Article