Leading Through Public Health in 2020 and Beyond: Three Ways for Public Health Leaders to Step to the Fore
Public health emergencies are often delineated by traditional health parameters: an infectious disease outbreak or a toxin in the water supply, for example. However, the consequences of a much broader range of disasters call for the elevation of public health concerns from a secondary to a primary concern. The toxic soup after a flood in a populated area mixes household chemicals, human and animal waste, medications, and other potentially hazardous substances. Massive wildfires dramatically increase the particulate matter in the air, often with traces of those same dangerous materials. The 2019 fire at Notre Dame in Paris, France, was reported to involve 460 tons of lead, some of which was dispersed as dust. Communities are traumatized after shootings, bombings, and other incidents of mass violence.
March, 16 2020 | Eric J. McNulty, Leonard J. Marcus, Joseph M. Henderson & Barry C. Dorn
Each of these has implications for the health of the public. The increased turbulence of our times—whether from terrorism, severe weather, or other causes—creates a “you’re it” moment for public health leaders. There is both a challenge and an opportunity to significantly increase their impact, and that of their organizations, in improving outcomes for affected communities.
In the more than 15 years that we have worked on crisis leadership at the National Preparedness Leadership Initiative (NPLI) at Harvard, we have seen a positive evolution of public health’s participation in preparedness and response activities. Where once public health professionals had to fight for a “seat at the table,” they now have a designated spot in many emergency operations centers. In the United States, we have seen the Centers for Disease Control and Prevention (CDC), the Federal Emergency Management Agency (FEMA), and other agencies at the federal level coordinate and collaborate more effectively with each other as well as with their state and local counterparts. The public, private, and non-profit sectors are working better together as well.
Incorporating public health professionals into the existing preparedness and response infrastructures is a positive step forward. However, it barely scratches the surface of the potential for public health approaches and protocols to stimulate a step change in the thinking and practice of crisis leadership. Below are three concrete opportunities that we see:
- A population-level perspective: “Whole of community” has become a popular approach to disaster preparedness and response in the United States. It is intended to generate cross-sector inclusivity, including working with the general public, so that resources and expertise are linked and leveraged across organizational and jurisdictional boundaries. Whole of community signifies everyone working together toward a mutually beneficial outcome.
In public health, leaders have been taking this broader meta-view for some time. They are trained to look at whole communities for commonalities as well as diversity. They know how to discover and mitigate secondary, tertiary, and even quaternary effects of incidents as well as response and recovery efforts. Such a perspective can be instructional to professionals in agencies more accustomed to viewing events family by family or structure by structure. Public health leaders have much to contribute when included early in overall contingency planning, not simply for those aspects traditionally in their area of functional expertise.
- Social determinants of preparedness, response, and recovery: In public health, it is common to look for the social determinants of health. Through this research, factors such as education and economic stability have been linked to health outcomes. This approach could, and should, be extended to disaster preparedness and response. While some work has been done in this area, we believe that there is the potential for far more extensive investigation into why some communities embrace preparedness, respond cohesively, and recover more rapidly than others.
Public health researchers have the skills and mindset to undertake this important work. In doing so, they can lead other components of the disaster enterprise to more nuanced understandings of the communities they serve, their needs, and the roadblocks to overcoming the challenges they face. This knowledge could be used to help predict where the greatest impact of specific events is likely to be and where to most precisely and productively target efforts at each stage from mitigation through recovery.
- Evidence-based protocols: As a science-based endeavor, public health is deeply rooted in the scientific method and data-driven decision making. That is not as true for public safety, emergency management, and humanitarian organizations. As it becomes possible to collect data across a wide spectrum of events and use sophisticated analytical tools to divine insights from outcomes, public health professionals once again have much to contribute to the larger field of disaster preparedness and response. They can lead their peers toward an understanding of the value of this thinking as well as greater facility with the tools of the trade.
One can imagine great benefit to communities worldwide from the more rapid and systematic sharing of evidence-based outcomes, particularly with regard to novel events and emerging practice methods. For example, Stop the Bleed initiatives to equip bystanders with tourniquets are becoming increasingly common. However, recent research has shown that, while well-meaning, the efficacy of such efforts varies widely based on different training scenarios. The enthusiasm for programs such as Stop the Bleed needs to be matched by data that substantiates outcomes and how to optimize them.
One of the founding precepts of the NPLI was that bad leadership is a public health risk. Missteps by those in charge, no matter how benign or benevolent their intentions, have consequences. That is true more than ever as communities around the world face increased food and water insecurity, severe weather, terrorism, geo-political unrest, rapidly spreading infectious diseases, and other disruptions. Networks across the public, private, and non-profit sectors will be called upon to act surely, swiftly, and in synchrony. Collaboration and innovation will lead to new ways to meet unexpected threats and improve outcomes. Once solid boundaries between disciplines will need to become semi-permeable and continually recalibrated to facilitate knowledge and expertise sharing.
Leaders, formal and informal, will inspire and unify these efforts. Leading will require rallying disparate stakeholders to forego some measure of self-interest in order to accomplish more together than any one of them could achieve alone. With their distinct training and perspective, public health leaders are well positioned to create more value than ever before—if and when they are ready to step up to be “it.”
Eric J. McNulty is Associate Director of Research and for the Program for Health Care Negotiation and Conflict Resolution and Instructor at the Harvard T.H. Chan School of Public Health. He also serves as Program Co-director for the Leading in Health Systems executive education program and holds a similar appointment at the National Preparedness Leadership Initiative, a joint program of the Harvard Chan School and the Harvard Kennedy School of Government. Leonard J. Marcus is founding Director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard T.H. Chan School of Public Health. He is also founding Co-Director of the National Preparedness Leadership Initiative, a collaborative effort of Harvard T.H. Chan School of Public Health and the Kennedy School of Government, developed in collaboration with the Centers for Disease Control and Prevention, the White House, and the Department of Homeland Security, and the Department of Defense. Joseph M. Henderson is Distinguished Senior Fellow and Instructor of Public Health Practice at Harvard T.H. Chan School of Public Health. He is also Director of the Office of Safety, Security and Asset Management at the Centers for Disease Control and Prevention (US health protection agency). Barry C. Dorn is Associate Director of the National Preparedness Leadership Initiative (NPLI), a joint program of Harvard T.H. Chan School of Public Health (HSPH) and the Center for Public Leadership at Harvard’s John F. Kennedy School of Government and Associate Director of the Program for Health Care Negotiation and Conflict Resolution at HSPH. He is also an Instructor in Public Health Practice at HSPH and Clinical Professor of Orthopedic Surgery at the Tufts University School of Medicine.