Public Health Preparedness: Going Global

This guest post to the Bifurcated Needle was written by Malaya Fletcher, MPH. Ms. Fletcher is a Public Health Preparedness Planner at the Philadelphia Department of Health, and a 2015 Fellow in the Emerging Leaders in Biosecurity Initiative.

This year’s Public Health Preparedness Summit focused on Global Health Security: Preparing a Nation for Emerging Threats, and opened with a talk by Mike Walker, senior consultant with the Center for Homeland Defense and Security. Walker reviewed a large number of high-consequence, emerging threats, such as drought, asteroids, terrorist groups like the Islamic State of Iraq and the Levant, supply chain network vulnerability, and the vulnerability of our power grid. These myriad threats can be overwhelming. How DO you plan for large-scale disasters, especially when critical infrastructure may not exist post-event?  Discussions of nuclear winter, for example, conjure up images of broken governmental structures and a return to communal living à la Alas, Babylon (Pat Frank’s novel of the post-nuclear age). In addition, most agencies are dealing with insufficient staff capacity, incident-specific grant restrictions, knowledge management issues, and too many competing priorities. In a resource-scarce and inherently reactionary system, maintaining a long-term view while playing perpetual catch-up can feel like a Sisyphean task.

With our ever-evolving and interconnected world, we must be cognizant of the broader context of our work. This has been illustrated with the current Ebola outbreak, and the disease surfacing in Texas and New York after healthcare workers returned from affected West African countries. ISIL may seem far away, but the potential for a domestic terrorist event, and the corresponding mental health impact on our nation’s psyche, are real. Following the Oklahoma City bombing, a study by North et al. found that 34% of survivors developed PTSD.1 During the Summit, I went to a number of sessions that covered water emergencies, where health departments had to bring water in when their systems became contaminated. This makes me think of the situation in Vanuatu, where more than 100,000 people still have no clean drinking water a month after a cyclone struck.2 Hurricane Katrina resulted in the displacement of large numbers to various cities throughout the nation. Climate change and the resultant loss of land mass are a major threat to low-lying areas and many island nations, such as those in the Pacific. Population displacement will continue to be something for which we need to plan. Maintaining a global perspective allows us to be aware of future threats and take inspiration from others who have faced similar challenges.

The sessions I found most useful addressed cross-cutting topics (e.g., decision-making and ethics) and skills building (i.e., new methods for data capture and evaluation). I noted the incorporation of mixed methods approaches, such as root cause analysis and CASPER. One session of particular interest was by New York City Department of Health and Mental Hygiene  and discussed how to develop an after action report/improvement plan database. The insights provided by other people’s struggles, triumphs, and lessons learned are invaluable.

Yet, it is the informal information exchange that I most enjoyed. Late-night conversations are a great way to crowd source my daily challenges to thousands of peers and learn about the innovation occurring outside of my own backyard. The practices I learned about cut through the decision fatigue and information overload and turn preparing for the unthinkable into strategic, pragmatic steps. As one panelist said, we can no longer use the past to predict the future; we can just build resilience. The new frontier is daunting, but the Summit shed light on what we can do to better prepare ourselves for that future.


1. North, CS, et al. Personality and posttraumatic stress disorder among directly exposed survivors of the Oklahoma City bombing. Comprehensive Psychiatry 53 (2012) 1-8.

2. Mis, M. Almost half Vanuatu people lack clean water, month after cyclone. Thomas Reuters Foundation. 22 April 2015.