disaster and public health management essay

30,000+ students realised their study abroad dream with us. Take the first step today

Here’s your new year gift, one app for all your, study abroad needs, start your journey, track your progress, grow with the community and so much more.

Verification Code

An OTP has been sent to your registered mobile no. Please verify

Thanks for your comment !

Our team will review it before it's shown to our readers.

Essay on Disaster Management

• Updated on  
• May 10, 2023

Disaster Management has been essentially included in the study curriculums of secondary education. Whether it is natural or man-made, disasters can wreak havoc on our surroundings and cost human lives as well. To familiarise students with efficiently preventing and ensuring the safety of living beings and our environment from unprecedented events, the study of Disaster Management has been included as an important part of the Geography class 10 syllabus. This blog aims to focus on imparting how you can draft a well-written essay on Disaster Management.

This Blog Includes:

What is disaster management, essay on disaster management: tips & tricks, sample format for essay on disaster management in 150 words, sample essay of disaster management (150 words), sample essay on disaster management (300 words) , sample essay on disaster management (500 words), essay on disaster management for class 9 onwards, essay on disaster management in india.

To begin with your essay on Disaster Management, the most important thing is to comprehend this concept as well as what it aims to facilitate. In simple terms, Disaster Management is termed as the management and utilisation of resources as well as responsibilities to tackle different emergencies, be it man-made disasters or natural ones. It concentrates on preparing human beings for a varied range of calamities and helping them respond in a better way as well as ensure recovery thus lessening their overall impact. 

Preparing for the Writing Section for Your English Exam? Then Check Out Message Writing and Letter Writing !

Before drafting your essay on Disaster Management, another thing you need to ensure is familiarising yourself with the structure of essay writing. To help you understand the do’s and don’ts, we have listed down some of the major things you need to keep in mind.

• Research thoroughly about your topic. For example, while writing an essay on Disaster Management, explore the recent happenings and mention them to provide the reader with a view into your understanding of this concept.
• Create important pointers while researching that you can further incorporate into your essay.
• Don’t mug up the definitions but comprehend them through examples.
• Use transitions between paragraphs to keep a coherent flow for the reader as a long paragraph might seem too lengthy and segregating your introduction and conclusion can provide a better structure.
• Quote important examples not only in your introduction but also in the following paragraphs where you detail the given topic.
• Revise and add finishing touches once you have completed the essay to locate any grammatical errors as well as other mistakes.

Now that you are aware of the key elements of writing an essay on Disaster Management, take a look at the format of essay writing first:

Introduction (30-40 words)

Begin with defining your topic explained in simple terms. For Disaster Management, You can make it more interesting by adding a question or a recent instance. The introduction should be understandable aiming to become more specific in the subsequent paragraphs.

Related Article: Geography for UPSC Preparation

Body of Content (80 words)

Also termed as the thesis statement , the content after the introduction should explain your given topic in detail. It should contain the maximum content out of the whole format because it needs to be detailed. For Disaster Management, you can delve deeper into its process, how it is carried out for different situations as well as prevention and protection.

Conclusion (30-40 words)

This section should mainly wrap up what you have described in the above paragraphs. For an essay on Disaster Management, you can focus on summing it up by writing its aim, types and purposes briefly.

Disaster can be simply termed as a sudden incident or happening which can be either natural or man-made and can potentially cause damage to the surroundings or loss of human life. To facilitate preparedness and better responsiveness to unforeseen events which can harm human beings and the environment, Disaster Management came into the picture.

Disaster Management aims to lessen the impact of natural and man-made calamities by designing and planning efficient ways to tackle them. It centrally comprises ensuring better control of the situation, its immediate evaluation, calling up required medical aids and transports, supplying drinking and food sources, among others and during this whole process, protecting the surroundings from more harm and keeping the lawfulness. The importance of Disaster Management has further increased in the contemporary scenario with the prevalent climate change and some of its latest examples include the unprecedented Australian wildfires.

Thus, the planet is getting bogged down by infinite technological devices, and their possible effects on the climate and the environment are inescapable. This has led to Disaster Management becoming the need of the hour as every country is aiming to become efficient and prepared to face both natural and man-made calamities.

Since the dawn of time, disasters, whether natural or man-made, have been a part of man’s evolution. Tsunamis, cyclones, earthquakes, floods, accidents, plane crashes, forest fires, chemical disasters, and other natural disasters frequently strike without notice, leading to massive loss of life and property. Disaster management refers to the strategies and actions put in place to lessen and prevent the effects of a disaster.

The word “disaster management” refers to all aspects of catastrophe mitigation, including preventive and protective measures, preparedness, and relief activities. The disaster management process can be separated into two phases: pre-disaster planning and post-disaster recovery. This encompasses measures such as prevention, mitigation, and preparedness aimed at minimising human and property losses as a result of a possible danger.

The second category is activity post-disaster recovery in which response, rehabilitation, and reconstruction are all included. Search and rescue evacuation, meeting the victims’ basic needs, and rapid medical support from regional, national, and international authorities were all part of the response phase. The immediate purpose of the recovery phase is to restore some degree of normalcy to the afflicted areas. In resource-scarce countries, ex-ante risk mitigation investment in development planning is critical for decreasing disaster damage. It would be prudent to go from a risk-blind to a risk-informed investment decision.

We cannot prevent disasters, but we can reduce their severity and arm ourselves with knowledge so that too many lives are spared.

Introduction: 

The globe is plagued with disasters, some of which are terrible and others that are controllable. Natural calamities, for example, are sudden occurrences that wreak significant devastation to lives and property. Disasters can occur either naturally or are man-made. To repair the damage caused by these disasters, emergency management is required. Through a disaster management procedure, the damage is contained and the hazards of the event are controlled. The procedure is aimed at averting disasters and reducing the effects of those that are unavoidable. Floods, droughts, landslides, and earthquakes are all threats to India. The Indian government’s disaster management measures have vastly improved over time.

The Process of Disaster Management: 

The disaster management process is split into four stages. The first phase is mitigation, which involves reducing the likelihood of a disaster or its negative consequences. Public education on the nature of the calamity and how people may prepare to protect themselves, as well as structural construction projects, are among the actions. These projects are intended at reducing the number of people killed and property destroyed in the event of a disaster.

Preparedness is the second phase of disaster management, and it aims to improve government-led preparedness to deal with emergencies. The majority of the preparations are aimed toward life-saving activities. Plan writing, communication system development, public education, and drills are all part of the preparation process. The disaster management team implements measures to keep people alive and limit the number of people affected in the third phase, reaction. Transport, shelter, and food are provided to the afflicted population as part of the response. Repairs are being made, and temporary solutions, such as temporary housing for the impacted population, are being sought.

Recovery is the ultimate stage of disaster management. This normally happens after the tragedy has subsided and the harm has been done. During the recovery process, the team works to restore people’s livelihoods and infrastructure. Short-term or long-term recovery is possible. The goal is to return the affected population to a normal or better way of life. During public education, the importance of health safety is highlighted. The recovery phase allows catastrophe management to move forward with long-term solutions.

Disaster Management Challenges:

The management of disasters is a difficult task, and there are certain flaws to be found. Since the individual dangers and disasters in some countries are not well understood, the government is unable to deploy disaster management in the event of an unforeseen disaster. There’s also the issue of a country’s technical and framework capabilities being insufficient. Government support is required for disaster management frameworks. Due to the generally large population, the disaster management approach includes public education, but there is no psychological counselling for individuals. People are more likely to develop post-traumatic stress disorder and psychiatric illnesses.

Conclusion:

Disaster management is a very important activity that countries should embrace to prevent disasters and lessen the negative consequences of disasters. However, disaster management has limitations that restrict the techniques’ ability to be implemented successfully.

Disasters can cause chaos, mass death of humans and animals, and a rise in crime rates. Disasters are unfavourable events that cause widespread anxiety and terror. They also make it difficult for society to respond to its causes.

Natural or man-made disasters can emerge. In both circumstances, they have the potential to cause significant loss of life and property. A combination of man-made and natural disasters can occur in severe circumstances. For example, violent conflicts and food scarcity. As a result, disaster management is required to limit or prevent massive loss and damage.

Disaster management includes disaster avoidance, disaster awareness, and disaster planning. These ideas will be discussed further down.

Prevention of Disaster: 

Countries all across the world have taken precautions to prevent diseases or viruses from spreading. These initiatives include the funding of research into natural disaster aversion. Other sources of revenue include food distribution, healthcare services, and so on. In Africa and the Middle East, the latter is commonly used in economically challenged areas.

Improved scientific research has also made it feasible to predict potential natural disasters. For example, equipment to detect earthquakes and tsunamis has been developed. As a result, more people are concerned about the environment. In this sense, consciousness translates to a reduction in all forms of pollution in the environment.

Disaster Awareness :

Another strategy to minimise the excesses of widespread epidemics is to raise disaster awareness. Members of the public must be made aware of the importance of maintaining peace, de-escalating dangerous circumstances, and prioritising safety in the face of any possible tragedy.

The goal of disaster management is to reduce human death and suffering. The impact of disasters can be reduced if all of these factors are successfully managed. As a result, the necessity of disaster management cannot be emphasised.

The National Disaster Management Authority (NDMA) is the main agency charged with establishing rules and guidelines for disaster management in order to ensure prompt and effective disaster response. There is also a separate fund for mitigation called the “national disaster management fund” (NDMF). Functions performed by this agency are:

• Administration
• Formation of policies for disaster management
• Approval of the strategies made up for disaster mitigation
• Formation of revenue or funds for disaster mitigation
• Managing multiple programmes and disseminating instructions.

The disaster has had both direct and indirect repercussions on human life, both of which have been deadly devastating and detrimental. There have been fatalities as well as stock losses. Natural disasters are unavoidable; even if we have mechanisms in place to predict or forecast them, we cannot prevent them from occurring. While preparing plans for our disaster management, the best that can be done is to prevent behaviours that are detrimental to the environment and lead to environmental deterioration. When a disaster strikes, it causes widespread devastation and loss of life. In the event of a disaster such as earthquakes, floods, or other natural disasters, a large number of people are displaced, and a large number of people die as a result of the disaster. This is when the true emergency begins by providing first aid to the injured, as well as rescue and relief efforts for the victims. To limit the risk of human life, everyone must participate actively in disaster management. When a crisis happens, the appropriate disaster management team can seize over as soon as possible.

Also Read: Career in Ecology and Environment

The 4 phases of disaster management are Mitigation, Preparedness, Response, and Recovery. 

The 3 types of disasters are natural, man-made, and hybrid disasters.

On 23 December 2005, the Government of India enacted the Disaster Management Act

Hence, we hope that this blog has helped you understand the key steps to writing a scoring essay on Disaster Management. If you are at the conclusion of the 10th grade and confused about which stream to take in the next standard, reach out to our Leverage Edu expert and we’ll guide you in choosing the right stream of study as well as gain clarity about your interests and aspirations so that you take an informed step towards a rewarding career.

Sonal is a creative, enthusiastic writer and editor who has worked extensively for the Study Abroad domain. She splits her time between shooting fun insta reels and learning new tools for content marketing. If she is missing from her desk, you can find her with a group of people cracking silly jokes or petting neighbourhood dogs.

Leave a Reply Cancel reply

Save my name, email, and website in this browser for the next time I comment.

Contact no. *

Leaving already?

8 Universities with higher ROI than IITs and IIMs

Grab this one-time opportunity to download this ebook

Connect With Us

30,000+ students realised their study abroad dream with us. take the first step today..

Resend OTP in

Need help with?

Study abroad.

UK, Canada, US & More

IELTS, GRE, GMAT & More

Scholarship, Loans & Forex

Country Preference

New Zealand

Which English test are you planning to take?

Which academic test are you planning to take.

Not Sure yet

When are you planning to take the exam?

Already booked my exam slot

Within 2 Months

Want to learn about the test

Which Degree do you wish to pursue?

When do you want to start studying abroad.

September 2024

January 2025

What is your budget to study abroad?

How would you describe this article ?

Please rate this article

We would like to hear more.

• Research article
• Open access
• Published: 05 December 2018

Public health emergency preparedness: a framework to promote resilience

• Yasmin Khan   ORCID: orcid.org/0000-0001-5870-5546 1 , 2 , 3 ,
• Tracey O’Sullivan 4 ,
• Adalsteinn Brown 5 ,
• Shannon Tracey 1 ,
• Jennifer Gibson 5 , 6 ,
• Mélissa Généreux 7 , 8 ,
• Bonnie Henry 9 &
• Brian Schwartz 1 , 5  

BMC Public Health volume  18 , Article number:  1344 ( 2018 ) Cite this article

71k Accesses

120 Citations

23 Altmetric

Metrics details

Emergencies and disasters impact population health. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared. There is a knowledge gap in that existing frameworks lack consideration for complexity relevant to health systems and the emergency context. The objective of this study is to describe the essential elements of a resilient public health system and how the elements interact as a complex adaptive system.

This study used a qualitative design employing the Structured Interview Matrix facilitation technique in six focus groups across Canada. Focus group participants were practitioners from public health and related sectors. Data collection generated qualitative data on the essential elements, and interactions between elements, for a resilient public health system. Data analysis employed qualitative content analysis and the lens of complexity theory to account for the complex nature of public health emergency preparedness (PHEP). The unit of study was the local/regional public health agency. Ethics and values were considered in the development of the framework.

A total of 130 participants attended the six focus groups. Urban, urban-rural and rural regions from across Canada participated and focus group size ranged from 15 to 33 across the six sites. Eleven elements emerged from the data; these included one cross-cutting element (Governance and leadership) and 10 distinct but interlinked elements. The essential elements define a conceptual framework for PHEP. The framework was refined to ensure practice and policy relevance for local/regional public health agencies; the framework has ethics and values at its core.

Conclusions

This framework describes the complexity of the system yet moves beyond description to use tenets of complexity to support building resilience. This applied public health framework for local/regional public health agencies is empirically-derived and theoretically-informed and represents a complex adaptive systems approach to upstream readiness for PHEP.

Peer Review reports

Emergencies and disasters impact population health, as we face diverse hazards influenced by complexities in our environment, demographics and social constructs. Novel and re-emerging infectious diseases continue to cause morbidity and mortality and can rapidly spread beyond borders. In Canada, wildfires have resulted in large population evacuations, air pollution and deaths [ 1 , 2 , 3 ]; floods are an annual risk causing displacement of Indigenous communities, urban infrastructure damage and adverse health impacts [ 4 , 5 , 6 ]. The 2013 Lac-Mégantic train derailment and explosion resulted in 47 deaths, environmental contamination, and adverse mental health impacts [ 7 , 8 ]. Reducing risks and the short and long-term impacts of all-hazards emergencies on population health is a key responsibility for the public health sector [ 9 , 10 ]. Public health plays a critical role in working with health and non-health sectors responsible for preparing for and responding to emergencies, yet have limited resources and competing priorities in delivering community health protection and promotion programs. While emergencies tend to raise awareness about the significance of being prepared, public health agency readiness activities operate largely in the background until an event occurs. Despite the importance of upstream readiness, a persistent challenge for public health practitioners is defining what it means to be prepared [ 11 , 12 , 13 , 14 ].

Defining preparedness using an evidence-informed approach is challenging, due to the general lack of evidence to inform disaster risk reduction (DRR) for public health [ 15 ]. To our knowledge, there are few published frameworks for public health emergency preparedness (PHEP) or DRR which used empirical methods in derivation [ 11 , 16 , 17 , 18 , 19 , 20 ]. Some frameworks reflect authors’ opinion [ 11 ], others describe some form of stakeholder consultation process; however, the methodology used to achieve consensus lacks detail [ 17 , 21 ] and there is no widely accepted framework that can be used to guide and compare efforts.

In reviewing the extant literature, we note most country-specific PHEP frameworks were developed in the United States (US) and have unclear relevance to other settings with substantially different health systems and governance structures [ 16 , 22 , 23 ]. Outside the US, the European Centres for Disease Control has adapted a US model [ 19 , 24 ] in considering core competencies for cross-border threats across the European Union [ 20 , 25 ]. Globally, there are a number of frameworks and initiatives that have relevance to PHEP and DRR [ 26 , 27 , 28 ]. The World Health Organization (WHO) framework to inform emergency preparedness is based on consultation with global stakeholders and lessons learned [ 28 ]. The framework is designed to be relevant to health systems globally and emphasizes national, subnational and local connections. The United Nations Sendai Framework for DRR has four key priorities and takes a whole-of-society approach [ 27 ]. It expands on its predecessor, the Hyogo Framework, with specific reference to the health impacts of disasters and reducing risks. These frameworks highlight the importance of national action and global collaboration to improve health system preparedness and reduce disaster risks; however, empirically-derived and contextually-relevant evidence to inform public health actions for local/regional public health agencies remains a knowledge gap.

In the aftermath of the 2014–16 West Africa Ebola Virus Disease outbreak, the WHO called on all countries “to create resilient integrated systems that can be responsive and proactive to any future threat” [ 29 , 30 ]. Resilient systems have been defined as: “those that rapidly acquire information about their environments, quickly adapt their behaviors and structures to changing circumstances, communicate easily and thoroughly with others, and broadly mobilize networks of expertise and material support” [ 31 ]. A challenge with existing PHEP frameworks is an inconsistency of elements or components, and lack of consideration for PHEP as part of a system [ 22 , 24 ]. For example, social capital was missed in one framework, when disaster resilience research has noted the importance of both hard, or physical, infrastructure and soft, or social, infrastructure [ 32 , 33 ]. Further, none of the identified frameworks articulate a consideration for the role and contribution of values in PHEP, yet Canadian experiences have underscored the importance of ethics and values. Questions such as “Who will get the limited supply of antivirals and vaccines?” cannot be informed solely by science, and failure to acknowledge underlying value judgments can result in a loss of public trust and low health worker morale, impacting community recovery after an event [ 34 , 35 , 36 , 37 ]. Incorporating ethics and values explicitly could add to the legitimacy and usefulness of a PHEP framework.

The knowledge gap that exists with PHEP frameworks thus extends to their comprehensiveness to reflect the dynamic and social context of public health emergencies and the complex public health system. Resilience-oriented interventions for community disaster preparedness have been proposed by accounting for the complexity of the emergency context and we argue that complexity is the backdrop that must guide strategy in re-framing PHEP [ 32 ]. Complexity as a theoretical approach is described as a set of concepts and analytic tools that can be applied to understand various properties of systems and is potentially useful in developing management or intervention strategies [ 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. This theoretical foundation is necessary in developing a PHEP framework to provide the depth required to account for the emergency context, a complex adaptive system like the public health system, and building resilience.

In this paper we present an empirically-derived and theoretically-informed framework for emergency preparedness to inform local/regional public health agency practice. Our objective is to describe the essential elements of a resilient public health system and how the elements interact as a complex adaptive system.

This study is part of a two-phase project that aims to advance performance measurement for public health emergency preparedness (Additional file 1 ) [ 45 ]. The overall project approach is an exploratory, sequential, mixed methods model to inform the development of indicators for PHEP (Additional file 2 ). The two-phase project is based in Canada and this paper reports findings from phase 1, corresponding with the first objective stated above. Several papers are planned from the overarching project.

For phase 1 we used a qualitative design employing the Structured Interview Matrix (SIM) facilitation technique in six focus groups across Canada [ 46 , 47 ]. As an applied public health project, the study was structured to include Integrated Knowledge Translation (iKT) and knowledge users who are defined as individuals likely to use research results to make informed decisions about health policies, programs and/or practices [ 48 ]. A steering committee of knowledge users provided input on study milestones to ensure that the research was relevant and useful to the field [ 48 ]. Detailed reporting for this qualitative study is found in the Consolidated Criteria for Reporting Qualitative Research checklist (Additional file 3 ).

In planning the SIM focus group sites, we included anglophone and francophone communities and focused on representation of Canadian regions with diverse experiences with public health emergencies. Recent emergencies and disasters include emerging infectious disease outbreaks, industrial disasters, wildfires, extreme weather and planned mass gatherings. The six sites spanned four provinces in Canada, representing Atlantic, Central, and Western regions. The focus groups were held in two urban centres, three urban-rural communities, and one rural location [ 49 , 50 , 51 ]. Ethics approval was obtained from the Public Health Ontario and University of Ottawa Ethics Review Boards.

We used purposive and snowball sampling to ensure diversity of expertise and involvement of people in senior decision-making roles [ 52 , 53 ]. Between eight and 40 participants can participate in one SIM session [ 46 ]. Optimal rich data generation balanced with feasibility of recruitment and flow of the session is observed with 16–24 participants, thus informing our target SIM size. Participants represented the public health system at multiple levels (local/regional, provincial, federal), with an emphasis on local/regional public health as the unit of public health delivery in Canada. Participants from other sectors involved in aspects of PHEP were recruited to reflect the complex adaptive system. Public health participants consisted of decision-makers or experts at multiple levels. Participants from health care and the health system consisted of senior decision-makers or professionals with expert knowledge of emergency preparedness for the health care sector (e.g., primary care, acute care) and linkages with public health. Government and policy-maker participants included decision-makers from health ministries or emergency management agencies of government, with expert knowledge of emergency preparedness. Community, social service or private industry participants included senior decision-makers or professionals in community organizations with expert knowledge of and roles in emergency preparedness and service provision for high-risk populations.

For recruitment, the research team and knowledge users generated a list of potential participants and organizations. Invitations were distributed by email. Informed consent was obtained from each research participant prior to participation in the study. Data generation occurred over a three month period from April to June 2016. Focus groups were held in a professional meeting space during working hours separate from participants’ workplaces and were 2.5 h in duration.

The three-part SIM facilitation technique consists of one-on-one interviews, small group and plenary discussions (Additional file 4 ) [ 46 ]. Data collection for the SIMs was anchored around four questions developed by the research team, refined with knowledge user input, and piloted. Equity and ethical considerations related to emergencies informed the data collection approach. The final four questions are found in Table  1 . The English focus groups were facilitated by a study co-investigator (TO) who is a doctoral-trained qualitative researcher with extensive experience in implementing SIM focus groups. The French focus group was facilitated by an experienced bilingual facilitator who was involved in developing the SIM technique for application in research settings. Focus group resources were translated to French by a professional translator. Both facilitators have experience collaborating on SIM implementation for research and use a consistent approach. Facilitators’ credentials and experience in the field of emergency/disaster research were shared with participants.

Each focus group was attended by the facilitator, the Principal Investigator and two research team members in addition to research participants. The facilitators interacted directly with participants for data collection. For the majority of sites, participants had no knowledge of any research team members prior to the SIMs. Exceptions to this were knowledge users from the steering committee who participated in SIMs in their region. A small group of participants at one focus group were familiar with the facilitator (TO) from prior research initiatives.

The data generated during the SIM sessions included field notes, audio-recordings of small and large group discussions, and observations from the research team [ 46 ]. Participant checking occurs in the third part of the SIM focus group, as participants confirm the data during the plenary discussion. Audio-recordings were transcribed verbatim at the Resilience and High Risk Populations Research Lab at the University of Ottawa. Transcriptions were performed by students supervised by a graduate trainee in qualitative methods and were all familiar with the SIM method and process. Each transcript was checked for quality and accuracy. The data from the French focus group were translated to English for analysis after transcription.

Qualitative content analysis was conducted in several steps (Additional file 4 ) [ 46 , 54 ]. Interview field notes were used to develop the coding grid by four team members. The final coding grid is provided in Additional file 5 . Transcripts from small and large group deliberations were coded by two research team members iteratively until agreement was reached on application of the grid to the data. Subsequently, one team member coded the remaining transcripts. NVivo™ 10 software was used for qualitative data management. The coding reports were analyzed inductively to identify emergent themes, which were revised until consensus was reached.

The themes represent collective responses at the system level for all the questions pertaining to the essential elements of PHEP, resilience in the public health system, and the consideration of ethics in PHEP. The research team involved in analysis included both insider and outsider perspectives in terms of positionality in relation to the PHEP field. Expertise of the team included public health, health emergency management, disaster risk reduction, ethics, and health systems and services. The themes were developed iteratively and went through several revisions incorporating input from the knowledge user steering committee.

Complexity theory was applied as a lens to the themes by two authors (TO and YK) to explain how different elements of the framework account for tenets of complexity. Theory on complex adaptive systems, health systems and emergency management were used to inform our complexity approach [ 40 , 42 ]. The seven tenets applied in analysis relate to characteristics of complex systems (dynamic context; interconnectivity; feedback loops; emergence) and change (adaptability; self-organization; non-linearity) [ 40 ]. Each thematic description below finishes with an explanation of its complexity as an element of PHEP. A more detailed description of the methods and results from the complexity analysis will be presented in a separate paper.

A total of 262 individuals were approached to participate in a SIM at a fixed date, time and place in their region. We over-sampled given travel required away from participants’ workplaces and the substantial time commitment during working hours. The number of participants across Canada who accepted the invitation was 146. In some instances interest exceeded the capacity of the focus groups. In deciding allocation for participation, priority was given to ensure a diverse participant mix based on the sampling strategy. Of the 146, 19 individuals across the six sites were unable to attend the focus groups. Reasons cited included professional conflicts and illness. Three individuals who did not attend sent a delegate.

The final sample represents a total of 130 participants who attended the six focus groups. Participation in the focus groups ranged from 15 to 33 across the six sites. The smaller sizes for focus groups corresponded with smaller sized communities. Focus group size for each site in relation to geographic regions in Canada is displayed in Table  2 . Focus group sites are denoted by an anonymized letter. Diversity in the sample was achieved with representation across the complex adaptive system of PHEP is also displayed as Table 2 .

The results of data analysis are presented in two sections. The first presents the emergent themes resulting from qualitative data analysis. The themes represent the essential elements of PHEP. For the remainder of this paper the themes will be discussed and referred to as elements. Eleven elements emerged from the data; these included one cross-cutting element ( governance and leadership ) and 10 distinct but linked elements. The second section presents the developed framework and depicts the relationships of each element to the role of public health in the complex system of emergency management.

Governance and leadership: Integrated structures, partnerships and accountabilities with clear leadership to support a coordinated, interoperable system

Leadership as a concept is related to, but separate from governance. Both are foundational, cross-cutting elements for PHEP and form the basis for the PHEP system. The integration of public health with health and non-health sectors was identified as essential. Leadership is a mechanism for articulating the role of public health agencies in responding to emergencies from different types of hazards, and ensuring alignment between governance and agency plans.

“…before the plan can be developed you need to create a mandate. First clearly define the role of public health, then develop a plan to support that role…we know what our role is – other people may not understand.” (Site F)

Coordination was highlighted as an important output of an integrated system of emergency management, and a lack of integration was described as a precursor for inconsistency and uncoordinated emergency actions. Finding the right balance of separation and connectedness in governance is paramount; where organizations are specialized yet still coordinated within an integrated system. Views on whether there is a need to bridge or to dismantle silos in public health varied across the sites, as evidenced in the following quotations:

“You don’t want to pull down your silos, because those are your pillars of excellence, you need to build proper bridges in between those silos.” (Site A)

“It’s breaking those silos down. But I think we need to do it long before an incident occurs. So I think preparedness is the perfect time to begin building those relationships. And looking for those champions in each area… finding your experts, finding your resources.” (Site B)

When we applied complexity theory to governance and leadership , the tenet of interconnectivity stood out as an important consideration when examining the role and influence of silos, and adaptively bridging or dismantling as required. Pre, during or post-disaster different sectors, organizations, and jurisdictions must collaborate to adapt to changing situational awareness. Governance structures which are sensitive to interconnectivity will support innovation when flexibility is required.

Clarity – in relation to authority, roles and responsibilities – was emphasized across all sites. The importance of identifying a lead agency and authority was underscored in relation to governance and leadership . Understanding where public health fits in the governance structure is important, as well as the governance and management models agencies use to organize their internal structure and its interface with the system. Incident Management or Command Systems were discussed in relation to the characteristics they enabled, such as adaptability. System flexibility is essential in a disaster, particularly in terms of interoperability. As a disaster unfolds, the context influences the way an emergency plan can be implemented, within and across organizations.

“For infectious disease it’s fairly clear who has that lead … public health is the lead in that. But when it comes to other kinds of disasters it’s not as clear where does public health actually fit within all of that structure. So, we need to establish that leadership and whoever is going to take that leadership needs to know where does everybody fit.” (Site F)

The role of public health as a collaborator was emphasized in discussions on leadership. In addition, roles related to prioritizing preparedness for emergencies, and leadership influencing a culture of preparedness within public health agencies. Leadership is dynamic and can emerge as organizations connect and understand the different and common constraints they face. Leaders with skills to bring different people and organizations to the planning table emerge as the planning and/or response evolves. The need for innovative or improved governance structures may also emerge as leaders assume new roles in planning and preparedness and the different factors influencing collaborative action are discussed.

Planning process: Develop a plan through a dynamic, collaborative planning process

This theme underscores the value of the process of planning in public health preparedness. Planning is important for clarifying roles and responsibilities, and understanding organizational structures and functions. Equally important is the development of relationships, which contributes to efficiency in preparedness and response. As evidenced in the following quotation, participants de-emphasized the static nature of the plan as a “book” or document, and discussed the planning process as the anchor for ensuring system adaptability and responsiveness.

“We call it planning, but it is more developing a process. … in the sense of the [health system structure] where it’s scalable and it encompasses all portions of it, not just public health. So don’t think of it just as a plan like a book sitting on a table, it’s more the whole aspect of everything that encompasses the response process.” (Site B)

The planning process links with other elements of PHEP, as described by this participant and developed further in this section.

“And in the process of developing the plan, collaborating or communicating with others in the development of that plan. So, making sure that we are engaging each other, and stakeholder communities, in that plan so that we can develop role clarity as part of that process and get to know each other. Identifying the tools and resources that we would need to respond would be part of planning, and then investing in the training and, exercising that plan.” (Site A)

PHEP planning is a complex process, given the multiple influences and interdependencies in public health emergencies. Planning must consider changing population demographics, political and environmental factors. It must take into account not only local and regional contexts, but also global influences. When changes occur within a complex adaptive system, interdependencies create a ripple effect and impact other parts of the system. This creates the opportunity for a feedback loop, which provides information that can be used to adapt. Readiness for emergencies depends on the ability of a system to adapt to changing circumstances, thus planning must be updated on an ongoing basis.

Collaborative networks: Develop relationships, partnerships and strong networks

Linked with planning process , collaboration emerged as a strong concept in participant discussions on resilience, particularly with respect to efficiency in response activities and organizational learning. Collaborative networks can support readiness, response and recovery across multiple levels of the system, and include stakeholders outside the public health system, whether in clinical care, emergency management, government or the private sector.

“Stakeholder engagement, so again the importance of this connectivity across the system and with others outside of the health system.” (Site D)

“Well, how do you make a public health system resilient is collaboration and that’s straightforward. Many groups working together, being able to understand what each other’s roles are and what their strengths and weaknesses they bring; it’s that collaborative framework that’s going to make your public health system resilient.” (Site E)

Collaborative networks are essential for accessing needed expertise, which in turn contributes to awareness and adaptive management as new knowledge is created and context changes. Sharing of expertise can be formal or informal, but is the cornerstone of strategic renewal in organizational learning. The concept of the networked system bringing together skillsets and resources contributes to emergence in the system. System behaviour can be unpredictable related to interactions between its components, and emergence pertains to how system behaviour emerges and the whole being more than the sum of its parts [ 40 ]. Further, networks are often the source of non-linearity, which may be positive or negative in nature. Non-linearity depends on feedback where cause and effect are not proportional [ 40 ]. Both positive and negative feedback contribute to change in the system as actors and parts interact over time.

“Sharing resources and skillsets, because we all bring to the table different skillsets.” (Site C)

“It’s important to have those trusted, open relationships to develop our individual skillsets, but also our collective ones.” (Site C) .

Trust develops through collaboration which can strengthen the connectedness and resilience of the networked system. In relation to complexity, the interconnectivity tenet is integral to the idea of partnerships and strong networks. PHEP is highly dependent on actors and the relationships between actors leading to adaptive response. Networks are inherently dynamic; people or actors within networks change, their relationships and personal networks are dynamic, and their experience / expertise also change. This ever-changing profile contributes to the dynamic nature of the entire system.

Community engagement: Understand and engage with the community

Collaboration with the community intersects with planning, in that it enables the consideration of community risks, cultural considerations and experiences. Planning that takes an inclusive approach and engages the public promotes common understanding of risks, assets and values, and can facilitate transparency between public health agencies and the community. Participants noted the link between resiliency among the public and the resilience of the public health system.

“Why Public Health is resilient is because the people are engaged…because of that, the mobilization of the vital elements is easy, and their engagement is built up through past experiences.” (Site C)

The ability for community engagement to build trust between public health agencies/leaders and the public was recognized as crucial to public health protection for emergencies, and important in building long-term community support for emergency preparedness, response and recovery. Transparent and responsive engagement and communication with the public promotes credibility and trust for urgent population health messages such as boil water advisories or evacuation.

“It’s the public trusting us as agencies… or the agencies being trustworthy enough that when the time comes the public goes ‘I feel like I can rely on this as good pertinent information’.” (Site D)

Community engagement is a mechanism to assist with difficult decision-making; specifically involving community groups in planning decisions that may impact them. Engagement with communities can promote the consideration of assets within particular groups, rather than focusing solely on deficits or vulnerabilities. Connection between public health agencies and the population whose health it aims to protect was described as essential to resilience in the public health system.

“There was no engagement with the communities that the plans were most meant to affect. So back to your equity question, there was a lot of concern in pandemic preparedness for vulnerable populations. So we brought vulnerable groups together who were identified in the plans and they told us ‘why are you calling us vulnerable? Your plan is actually what makes us vulnerable in the first place’...” (Site F)

Communities are part of the complex system and interconnectivity is inherent. When considering community engagement , it is important to understand where the influential connections are in the community and how this can support or create challenges for response plans. Connections are important assets for public health activities across all phases of a disaster. They represent specific knowledge and communication channels that can support resilience.

It is important to recognize that community engagement is dynamic at different times and places, different phases of a disaster, and over time as community members change. Community engagement will emerge as the context changes and as opportunities are presented to contribute. Inclusive opportunities for engagement provide feedback loops to develop and contribute to innovation, situational awareness, and mobilization of resources.

Risk analysis: Robust understanding of community hazards and risks

Understanding risk is essential to inform planning; risk analysis is a critical contribution of public health agencies during an adverse event. While assessment of risk is a crucial first step in proactively understanding the dynamic and interconnected context of each community, it is important to follow it up with analysis and strategies to build capacity for resilience.

“… analytical capacity as a prerequisite to resilience. If the situation isn’t analyzed correctly, you’re going to have responses that are not appropriate. ... Analytical capacity, even being proactive, even before, in the area’s risk profiles, that can make all the difference [for] resilience.” (Site C)

Pre-existing disparities in the social determinants of health were emphasized as important pieces of the picture in understanding risk across a community and within specific populations. This underscores the link between risk analysis and community engagement as essential elements of PHEP, and the importance of inclusivity as a principle in planning.

“Social risk factors… poverty, disability, versus clinical, physical… pre-disaster someone may be a person with a disability or may not be a person with a disability, but when a disaster happens they may become higher-risk. Like, someone with mental illness for example likes routine all set, but when an emergency happens they’ve got to leave their home, they then become a person at risk.” (Site E)

Conducting a thorough risk analysis implies strong partnerships and information-sharing capabilities in accessing information from other sectors. Risk analysis is an ongoing process for complex adaptive systems. Context is constantly changing. Situational awareness must be continually updated and shared – to understand the risk profile at any given time. The nature of risk within a complex adaptive system creates a situation where it may be challenging to anticipate consequences. Complex interdependencies can quickly cascade into serious operational issues when risk is realized in one highly interconnected part of the system. Risk analysis provides a means to understand environmental and contextual influences, and make contingency plans to account for interdependencies.

Surveillance and monitoring: Timely information to provide situational awareness and guide action

The essential element of surveillance and monitoring incorporates early detection and warning; situational awareness; and formal surveillance systems. Surveillance and monitoring includes routine public health surveillance such as formal lab-based and emergency department surveillance, some of which are legislatively mandated. Other information sources such as global situational awareness facilitate “early warning” that enable initial alerts of emerging risks to public health authorities and the broader system.

“We need to have intelligence to be able to know when to react… Because in case of emergency, you want to actually ensure that if something does happen, then you want to ensure that the right people are told in a timely fashion.” (Site B)

The essential nature of surveillance and monitoring as an element was clear; however, there were apparent discrepancies in how well-functioning and resourced surveillance systems are across Canada, to support management of emergencies and disasters.

“For monitoring/surveillance, well, the importance of epidemiological monitoring, of what’s happening elsewhere in the world to be able to increase our own vigilance, then adapt the network’s capacities in greater detail based on that.” (Site C)

“A big one, particularly around monitoring, gathering, and real-time information that comes back and feeds back to the people that need to know about it.” (Site F)

Surveillance and situational awareness connect different parts of a complex system, and relate to collaborative networks , risk analysis and communication . For accurate surveillance and monitoring , it is important that interconnectivity be considered, to ensure actions taken in one part of the system are assessed in terms of how they may affect another part of the system. When one part of the system becomes aware of information that can impact another part of the system, it is important to share that information; these are essentially feedback loops which update situational awareness and inform decision makers if different actions must be taken.

Practice and experience: Invest in testing and practicing plans and processes

Whether practice occurs through simulations, exercises or experience in actual events, it was deemed essential for building capacity for response. Practice is a mechanism by which plans can be tested, gaps identified and processes tweaked. Two dimensions of experience emerged: 1) knowledge , skills and training of the workforce; and 2) application of the skills or training. The latter emphasizes practicing/testing plans and developing experiential learning for staff. Experience enables teams to revise protocols and provide feedback on parts of the plan that are no longer relevant or effective.

“… training, simulation. That really came up a lot. But not just training on the contents of toxicological evidence and all that, but also training on how to work in emergency mode, with whom, and then everyone’s roles and responsibilities.” (Site C)

Practice and experience enables and reinforces other elements of PHEP. Roles can be clarified, relationships developed and planning processes refined. Practice and experience can therefore function as a strategy to build resilience in the system.

“… roles, and responsibilities, and relationships are really clear and have been developed in advance. Those might be developed in advance through a variety of ways including through the planning process, through training, through exercises and also just through experience, so we get involved through responses together…” (Site D)

Evaluation of practice and experience enables a jurisdiction to understand if it is ready and potentially resilient to a threat. Practice and experience thus links with learning and evaluation (described below) and it is important that measures are collected consistently and completely. If practice is not possible through experience, it is closely linked with resources. Challenges arise if funding for relevant practice or simulations is lacking.

“We don’t have any funding for drills or exercises to ensure that we are being resilient, because we have not had these kind of events we really do not really know what the level of our resilience is, it’s theoretical.” (Site D)

Through a complexity lens, practice and experience support resilience through feedback and co-evolution of the actors within the public health system and the entire system as an entity. Actors within the system must have the confidence and skills to adapt their activities and decisions as situational awareness changes. As teams or actors adapt, they co-evolve over time so that both actors and the system evolve together, based on practical experience.

Resources: Ensure dedicated resource capacity and mobilization capacity

Discussion around resources focused on two large aspects which are represented as distinct elements: first, physical, structural, and financial resources; and second, human and workforce assets. Human resources and workforce assets are discussed as a separate theme below. Structural/physical resources were described in terms of the capacity for systems and infrastructure to support elements of PHEP, such as adequate systems for risk analysis. Resources underpins multiple elements that require sufficient infrastructure and investment to function effectively.

“Resources is another thing, you just, you can’t do this on the cheap. If you’re going to do it, you’ve got to pay for it… Resources to invest in the actual structures and then the resources that are available to sustain function…as separate from people…” (Site D)

Participants highlighted intangible assets, such as time and organizational support so people actually have time to do emergency preparedness. Creating space in peoples’ workloads for preparedness activities requires not only a cultural shift, but financial investment to show organizational commitment to ensuring resources are there for PHEP.

Difficult decisions surround allocation of limited resources . It was identified that there is a need for proactive decision-making around resource allocation as part of planning. This includes development of processes to assist with challenging resource decisions that emerge and are time-sensitive during the response phase. Transparency and consideration of diverse values and priorities in the community are also important for building trust.

With respect to the complexity of resource allocation for emergency response, the need for adaptability is paramount. At any time of year and during any phase of an emergency, the asset-profile of a community is dynamic. Feedback loops provide information about available resources that can be mobilized or gaps where resources need to be secured to enhance preparedness. When resources are limited, not available or hard to mobilize, self-organization will occur naturally as people and organizations work innovatively with what they have.

Workforce capacity: Develop and support knowledgeable, skilled and resilient staff

People and social infrastructure emerged as essential in PHEP. Knowledgeable people developed through training, experience, and possessing specialized expertise, are crucial assets to support resilience. Training was described in terms of content expertise, but also as relevant skills important for emergency management, such as communication and collaboration. Having sufficient human resources within the system provides redundancy (for back up) and supports interoperability.

“I think what we’ve heard is that people— it’s about proper training and redundancy. And so, you have people that are well trained and there is enough of them. And this is all around being in the public health system being resilient, right? Staff resilience coming from being adequately funded, trained.” (Site D)

Adaptability across different workforces involved in public health emergency response is a necessary ingredient for resiliency; and is part of the complexity. When unexpected events appear – or the context changes within a current event – the workforce must be prepared and skilled at adapting its response strategies. Supporting staff to deal with challenges during an event is an important organizational role and demonstrates reciprocity [ 55 ]. Staff may be directly impacted by an emergency as individuals in the community, or experience distress through their experience as responders. Public health agencies are critically dependent on the resilience of staff; therefore, having some redundancy in the system builds adaptive capacity to support resilience.

Communication: A strategy to deliver clear, consistent messaging across networks and the public

Communication involves multiple audiences and purposes, such as delivering information to promote public action/behaviour change, providing guidance for health care professionals, or sharing information internally with staff. Strategy is an essential part of communications planning and includes determination of the amount of information, the audience, messaging methods and content. Communication was described largely as communication out from public health agencies; however, mechanisms for gathering information and feedback also emerged.

“Communications, knowing who to call… targeting the risk communications, keeping the simple messaging that people can understand, actions they need to take. And it goes both ways. I think there’s the public communications but there’s also the internal for the practitioners” (Site D)

Communication supports adaptability in PHEP; as situational awareness changes, decisions must be made about how to share information with different stakeholders. Communication links with the other themes in this framework, as participants clustered it with resources and infrastructure as critical to support response capacity.

In participant discussions related to resilience of the public health system, communication became subsumed under discussions on collaboration. Discussion around communication as it relates to a resilient health system was described in terms of public engagement, and how an engaged and informed public can be more resilient. Trust built through community engagement promotes effective communication and public action.

“Internal and external communications, so communications within your organisation making sure people understand…and then that external communications out with the public.” (Site E)

“If we can educate … if we can have a good public communication system so we can get the public to participate in generating resilience. And we’re going to see that it’s often there that being more resilient starts.” (Site C)

Communication as a specific activity represents an essential element of PHEP; however, the networks, relationships, feedback and collaborative processes that enable effective communication are part of the inherent complexity in public health, and are prominent in building resilience. Adaptability and feedback are central to communication . Feedback loops provide information about how messages are being received within and outside the system. If communication is not available or accurate, people will explore different channels to obtain information they need to perform their roles or reduce uncertainty. Informal networks provide innovative channels for communication, particularly when channels are down or ineffective.

Learning and evaluation: Evaluation as a strategy to build resilience

Learning was described by participants as adaptability during emergency response, and in preparing for future events. Learning links with other essential elements for PHEP, such as surveillance and monitoring , with a forward thinking lens.

“I think we learn from our mistakes. And I think the back-end of any good plan is to make sure that when there is an incident that there’s a debrief, robust after-action or post-incident review of what was done correctly, what was done incorrectly, where could we improve and what did we learn from this... Now that helps to inform how we respond going forward.” (Site F)

Developing a learning and evaluation strategy proactively, to facilitate feedback is key. Learning and evaluation enables understanding of what has worked and not worked in the past for public health emergency management; this in turn enables improved planning, recovery and response for the future. Learning longitudinally gives perspective on the system over time, rather than for just one incident.

“I think we have to look back not just on the last emergency and how well we managed that. What’s our track-record in the last five years and the last ten years? And is there a kind of systemic failure, a weak point in the system still?” (Site F)

Linkages for evaluation across the PHEP framework are important. Information systems are needed to support data collection; measures to evaluate practice and experience ; and processes and resources are needed to support real-time “course correction” to promote adaptability and flexibility of PHEP systems.

“And what I find really interesting is that, I think there’s more and more recognition around how important that phase is, and yet even though, in my perspective, we’ve moved into doing something like debriefing and even doing it together in partnership, it still isn’t necessarily translating itself into the next iteration of the planning. We don’t actually necessarily change or act on those things that we see repeatedly.” (Site A)

Despite participants’ awareness of the importance of learning and evaluation , they discussed gaps in how well this element is implemented in practice. The themes of learning and evaluation and practice and experience are linked. Learning opens opportunities for positive emergence or innovation, and evaluation can enable documenting of innovations implemented during a response to inform system preparedness and revise practice. Strategies to solicit feedback or share lessons learned are important for evaluation of an event or a training exercise. Evaluation serves to document and can assist in understanding the unpredictable or disproportionate impacts or behaviours from an event that relate to non-linearity of the system, and contribute to learning for better preparedness for the next event. Sharing knowledge across systems and across jurisdictions can promote change in a broader context.

A high-level synthesis and description of the essential elements is provided in Table  3 .

Ethics and values: Core principles guiding PHEP policy and practice

The described 11 themes represent an integration of the essential elements of PHEP with relevant ethical values and processes discussed by participants. This integration of ethics with the elements was validated through knowledge user input and ethics and values were confirmed as informing the core principles at the heart of a PHEP framework.

To summarize ethical considerations which emerged as part of the elements, the following values and processes are seen as integrated within. Values discussed important to PHEP included: equity, trust, public protection, reciprocity, duty to care, stewardship and solidarity. In addition to the values which emerged, approaches to ethical decision-making and actions for PHEP included processes such as: inclusiveness, accountability, transparency, responsiveness and reasonableness. Further details on our analysis around ethics and values will be presented in a separate paper.

In this study, we developed an empirically-derived and theoretically-informed framework for PHEP. The framework identifies 11 essential elements of a resilient public health system and how the elements interact as a complex adaptive system. With an upstream orientation, the framework pertains to all aspects of emergency management - encompassing readiness, response and recovery - and promotion of adaptive capacity to support resilience among local/regional public health agencies. This framework addresses an important gap by contributing to the evidence base for PHEP. While overlap exists between the essential elements identified and some existing US frameworks for PHEP and emergency management [ 24 , 56 ], our rigorous approach empirically defines a framework for a non-US context, supporting US approaches and expanding a conceptualization of PHEP with relevance to other countries with similar health systems to Canada.

In developing a visual concept to represent the framework, the essential elements for PHEP found in this study, and the complexity surrounding them, were used as a starting point. Application with practice and policy relevance was an important objective; therefore, we ensured the framework resonated with knowledge users as we proceeded through different stages of the development. Figure 1 was developed iteratively and collaboratively with the research team and knowledge users through our iKT process.

Resilience Framework for Public Health Emergency Preparedness

Figure 1 : Resilience framework for public health emergency preparedness

Moving away from technocratic visuals, the figure is influenced by an organic image, aligning with social resilience concepts [ 32 ]. The figure reflects the interconnectedness of the elements, overlapping at the centre as a symbolic connection in the core of the framework. The elements are depicted as part of the whole, while emphasizing the cross-cutting element of governance and leadership encircling the stand-alone elements. The representation of governance and leadership surrounding the tenets of complexity theory and the 10 other elements highlights the crucial importance of governance and leadership as a means to facilitate and manage the dynamic, complex adaptive system of PHEP.

This framework for local/regional public health agencies addresses a knowledge gap in frameworks for this level, and also aligns with global guidelines for emergency preparedness and disaster risk reduction. The Sendai Framework for DRR (2015–2030) aims to reduce disaster risk and losses in lives, livelihoods and health [ 27 ]. Health protection and reduction of morbidity and mortality from disasters are situated within the inter-sectoral approach of Sendai [ 57 ]. Our framework supports all priorities, in particular Priority 4: Enhancing disaster preparedness for effective response and to “Build Back Better” in recovery, rehabilitation and reconstruction . Preparedness is described as enabling effective response and recovery; building back better is the result of resilience in the system. By using this framework to enhance preparedness, local/public health agencies can contribute to advancing progress toward the Sendai targets and the global imperative to reduce disaster risk and impact. Specific to public health, the WHO defines emergency preparedness as: “…the knowledge and capacities and organizational systems developed by governments, response and recovery organizations, communities and individuals to effectively anticipate, respond to, and recover from the impacts of likely, imminent, emerging, or current emergencies” [ 28 ]. Our resilience framework for PHEP aligns with this inclusive definition of preparedness and conceptualizes an actionable definition of preparedness that is dynamic rather than static, consistent with complexity theory.

The principles of ethics and values are conceptualized as the core of the framework, underpinning all elements and the complexity. This placement reflects the central importance of ethical principles in public health practice. A scoping review conducted by members of this team identified that ethical considerations in PHEP is a knowledge gap [ 15 ]. In emergency planning, operational frameworks have traditionally been separate from ethical frameworks [ 28 , 58 , 59 ]. This represents a challenge when urgent operational activities and decisions in stressful situations do not implicitly take ethics into account. The values and processes found in this study resonate with other published work on public health ethics [ 34 , 59 ]; however, the integration of ethics as part of this framework and recognizing ethical values and processes at its core is a novel contribution. One salient example of how ethics and values are integrated with PHEP relates to workforce capacity. The capacity of a workforce is about having knowledgeable and skilled staff as a starting point, but there is much more to capacity building. ‘Duty to care’ and the need for organizational reciprocity and transparency in supporting staff are essential for workforce capacity and represent important aspects of ethical practice [ 55 ]. Through this element and others we identify that the human and social aspects of the framework elements enhance resilience in the system. Resilience of staff, collaboration, community engagement, leadership and the ability to learn are social dimensions that are essential for PHEP practice and this framework incorporates yet moves beyond technical competencies and physical infrastructure to emphasize how attention to social infrastructure can promote resilience in the system.

This study has limitations which are important to consider. While this framework has an upstream orientation aimed at readiness for public health agencies throughout all phases of an emergency, it is important to acknowledge that longer term impacts of disasters may not have been fully captured [ 8 ]. Linkages of public health agency practice as it overlaps with mental health care and post-disaster community recovery can be explored to consider how the elements relate to long-term population health impacts of disasters. Related to study design and to the resource-intensive nature of qualitative data collection in the field and feasibility implications, we conducted six focus groups in four provinces, rather than holding focus groups in all 10 provinces and three territories in Canada. While limited in representation, the transferability of the findings to other settings is enhanced by our purposive selection of sites across diverse geographic areas of Canada and their experience with emergency events. Further, our choice of method resulted in other advantages important for iKT and building resilience. The SIM facilitates collaboration and networking [ 46 ]; it served to bring an opportunity for each site to build its PHEP capacity through developing relationships and common ground [ 60 ].

We recognize a limitation which acknowledges Canada’s context related to its history of colonization of Indigenous peoples, their culture and lands. While representatives from First Nations health organizations were included through purposive sampling, we did not host focus groups in Indigenous communities. The research team acknowledges the disproportionate impact that emergencies may have on Indigenous communities due to different risk profiles. We recognize that future collaboration with Indigenous communities and health organizations is needed to ensure Indigenous voices are included in public health emergency planning. Given the complex governance implications of Indigenous health and emergency services, future work is needed to validate the developed framework in other settings and communities.

Any exploration of PHEP needs to consider complexity and look at various elements and interactions within a system. Complexity is inherent in health systems and is a useful lens for preparedness. The essential elements for PHEP for local/regional public health agencies are integrated within the system and the networked, interconnected and dynamic nature is reflected in the element descriptions. These descriptions inform health system activities, change and potentially support improvement by identifying actionable concepts for the field. This work thus integrates the current state of science in incorporating relevant theory to inform framework development. The framework identifies essential and potentially actionable elements relevant to change at the local/regional public health agency level.

A challenge emerges in moving from a definition for upstream activities to support resilience to measurement of a state of preparedness. Measurement and reporting of preparedness should provide support for ensuring preparedness but the typical ‘new public management’ use of measurement in health policy with a focus on benchmarking, accountabilities, and other aspects of performance management may present challenges to the use of the framework itself [ 61 ]. The framework stresses the interconnectedness of measures, an aspect of measurement and reporting that can be difficult to capture in tools like scorecards and report cards. Likewise, the use of this framework for evaluating preparedness and response to emergencies and disasters may be challenging as it does not support typical approaches to public health intervention evaluation and may require new approaches that stress concept mapping and a more sophisticated articulation of interconnectedness [ 44 ].

However, the pressure for translation of this framework or similar frameworks into measurement frameworks will likely increase. Emergencies are increasing in frequency, although may still be rare for a given jurisdiction and the culture of preparedness discussed as part of governance and leadership may vary in terms of establishment across public health agencies. Emergencies create public concern and often become political. Public attention on risks and impacts of emergencies can lead to significant investment in emergency management, as was seen in the last few decades in North America. In the absence of an emergency to generate political and public attention, challenges remain in organizational accountability to politicians, decision-makers and the public on the state of an agency’s preparedness, and to justify investment in preparedness. Although this study addresses a definition of readiness relevant to local/regional public health agencies in Canada and for other relevant health systems, careful consideration of how it can link to different approaches to measurement and management of the concepts represented by the framework elements may be useful to enhance practice, guide improvement and support accountability. Our future work will address these challenges.

In summary, we present a conceptual framework of the essential elements for a resilient PHEP system, aimed at identifying upstream actions to promote readiness for disasters and emergencies. Our analysis describes the complexity of the system yet moves beyond description to using tenets of complexity to define a framework focused on resilience, for practice and policy action. This applied public health framework for local/regional public health agencies forms an evidentiary basis for PHEP and DRR which will be further augmented by developing key indicators.

Abbreviations

• Disaster risk reduction

Public health emergency preparedness

United States

World Health Organization

Government of Alberta. Update 6: Wood Buffalo wildfire recovery (July 27 at 11 am). https://www.alberta.ca/release.cfm?xID=4292755C48F66-F699-FE35-6208390C990D8594 (2017) Accessed 11 July 2018.

KPMG LLP. 2016 Wood Buffalo Wildfire, Post-Incident Assessment Report. Final Report; 2017. https://www.alberta.ca/assets/documents/Wildfire-KPMG-Report.pdf . Accessed 11 July 2018.

Population, public and Aboriginal health strategic clinical network, Alberta Health Services. Overview of the strategic clinical network for population health and Aboriginal health. Alberta Health Services ; 2016. https://www.albertahealthservices.ca/scns/Page13061.aspx . Accessed 11 July 2018.

MNP LLP. Review and analysis of the government of Alberta's response to and recovery from 2013 floods. Government of Alberta; 2016. http://www.aema.alberta.ca/documents/2013-flood-response-report.pdf . Accessed 11 July 2018.

Google Scholar  

Moghal Z, Peddle S. At the front lines of flood: How prepared are Ontario communities. Waterloo, ON: Partners for Action; 2016. https://uwaterloo.ca/partners-for-action/sites/ca.partners-for-action/files/uploads/files/p4a_front_lines_of_the_flood_04jul16.pdf . Accessed 11 July 2018.

Abbott G, Chapman M. Addressing the new normal: 21st century disaster management in British Columbia. A report and findings of the BC flood and wildfire review: an independent review examining the 2017 flood and wildfire seasons; 2013. https://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/emergency-preparedness-response-recovery/embc/bc-flood-and-wildfire-review-addressing-the-new-normal-21st-century-disaster-management-in-bc-web.pdf . Accessed 11 July 2018.

Généreux M, Petit G, Maltais D, Roy M, Simard R, Boivin S, et al. The public health response during and after the Lac-Mégantic train derailment tragedy: a case study. Disaster Health. 2014;2(3–4):113–20.

Article   Google Scholar  

Généreux M, Petit G, Roy M, Maltais D, O’Sullivan T. The “Lac-Mégantic tragedy” seen through the lens of the EnRiCH community resilience framework for high-risk populations. Can J Public Health. 2018;109(2):261–67.

Costich JF, Scutchfield FD. Public health preparedness and response capacity inventory validity study. J Public Health Manag Pract. 2004;10(3):225–33.

British Columbia Ministry of Health. Promote, protect, prevent: our health begins here: BC's guiding framework for public health. 2013. ISBN 978–0–7726-6689-5. https://www.health.gov.bc.ca/library/publications/year/2013/BC-guiding-framework-for-public-health.pdf . Accessed 11 July 2018.

McCabe OL, Barnett DJ, Taylor HG, Links JM. Ready, willing, and able: a framework for improving the public health emergency preparedness system. Disaster med public health prep. 2010;4(2):161–8.

Nelson C, Lurie N, Wasserman J, Zakowski S. Conceptualizing and defining public health emergency preparedness. Am J Public Health. 2007;97(S1):S9–S11.

Nelson C, Lurie N, Wasserman J. Assessing public health emergency preparedness: concepts, tools, and challenges. Annu Rev Public Health. 2007;28:1–18.

Smith K, Jarris P, Inglesby T, Hatchett R, Kellermann A. Public health preparedness research. J Public Health Manag Pract. 2013;19(2):S6–8.

Khan Y, Fazli G, Henry B, de Villa E, Tsamis C, Grant M, et al. The evidence base of primary research in public health emergency preparedness: a scoping review and stakeholder consultation. BMC Public Health. 2015;15(1):1.

Centers for Disease Control and Prevention. Public health preparedness capabilities: National standards for state and local planning. Centers for Disease Control and Prevention. 2011. https://www.cdc.gov/phpr/readiness/capabilities.htm . Accessed 11 July 2018.

Gibson PJ, Theadore F, Jellison JB. The common ground preparedness framework: a comprehensive description of public health emergency preparedness. Am J Public Health. 2012;102(4):633–42.

National Health Security Preparedness Index. Strengthening national health security and preparedness helps build a culture of health. National Health Security Preparedness Index. 2018. https://nhspi.org/ (2018). Accessed 27 Jun 2018.

Stoto M. Measuring and assessing public health emergency preparedness. J Public Health Manag Pract. 2013;19(Suppl 5):S16–21.

Stoto MA, Nelson C, Savoia E, Ljungqvist I, Ciotti M. A public health preparedness logic model: assessing preparedness for cross-border threats in the European region. Health Secur. 2017;15(5):473–82.

National Health Security Preparedness Index. Methodology for the 2018 Release. National Health Security Preparedness Index. 2018. https://nhspi.org/wp-content/uploads/2018/04/Index_Methodology_2018.pdf . Accessed 27 Jun 2018.

Potter M, Houck O, Miner K, Shoaf K. National Health Security Preparedness Index: opportunity and challenges. White paper. Association of the Schools of Public Health; 2012.

Public Health Agency of Canada (PHAC). About the agency: Who we are and what we do. http://www.phac-aspc.gc.ca/about_apropos/index-eng.php (2015). Accessed 20 Feb 2015.

Stoto M, Nelson C, and the LAMPS investigators. Measuring and assessing public health emergency preparedness: a methodological primer. 2012. https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1609/2015/04/MeasurementWhitePaper.pdf . Accessed 27 Jun 2018.

European Centre for Disease Prevention and Control. Public health emergency preparedness - core competencies for EU member states. Stockholm: ECDC; 2017. https://ecdc.europa.eu/sites/portal/files/documents/public-health-emergency-preparedness-core-competencies-eu-member-states.pdf . Accessed 16 Oct 2018

Global Health Observatory (GHO) Data. Geneva: World Health Organization; 2016. http://www.who.int/gho/publications/world_health_statistics/2016/en/ . Accessed 11 July 2018.

United Nations Office for Disaster Risk Reduction (UNISDR). Sendai framework for disaster risk reduction 2015–2030. 2015. http://www.unisdr.org/files/43291_sendaiframeworkfordrren.pdf . Accessed 11 July 2018.

World Health Organization. A strategic framework for emergency preparedness. Geneva: World Health Organization; 2016. Licence: CC BY-NC-SA 3.0 IGO. http://www.who.int/ihr/publications/9789241511827/en/ . Accessed 11 July 2018

Kieny MP. World Health Organization media centre commentary: Ebola and health systems: now is the time for change. 2014. http://www.who.int/mediacentre/commentaries/health-systems-ebola/en/ . Accessed 11 July 2018.

Centers for Disease Control and Prevention. 2014–2016 Ebola outbreak distribution in West Africa. (2017). https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/distribution-map.html Accessed 11 July 2018.

La Porte T. Organizational strategies for complex system esilience, reliability, and adaptation. In: Auerswald P, Branscomb L, La Porte T, Michel-Kerjan E, editors. Seeds of disaster, roots of response: how private action can reduce public vulnerability. First ed. Cambridge: Cambridge University Press; 2006. p. 135–53.

O'Sullivan TL, Kuziemsky CE, Toal-Sullivan D, Corneil W. Unraveling the complexities of disaster management: a framework for critical social infrastructure to promote population health and resilience. Soc Sci Med. 2013;93:238–46.

Abramson DM, Grattan LM, Mayer B, Colten CE, Arosemena FA, Bedimo-Rung A, et al. The resilience activation framework: a conceptual model of how access to social resources promotes adaptation and rapid recovery in post-disaster settings. J Behav Health Serv Res. 2015;42(1):42–57.

Singer P, Benatar S, Bernstein M, Daar A, Dickens B, MacRae S, et al. Ethics and SARS: lessons from Toronto. BMJ. 2003;327:1342–4.

Berstein M, Hawryluck L. Challenging beliefs and ethical concepts: the collateral damage of SARS. Crit Care. 2003;7:269–71.

Upshur REG, VanDenKerkhof EG, Goel V. Meaning and measurement: an inclusive model of evidence in health care. J Eval Clin Pract. 2001;7(2):91.

Article   CAS   Google Scholar  

Gershon RR, Magda LA, Qureshi KA, Riley HE, Scanlon E, Carney MT, et al. Factors associated with the ability and willingness of essential workers to report to duty during a pandemic. J Occup Environ Med. 2010;52(10):995–1003.

Litaker D, Tomolo A, Liberatore V, Stange K, Aron D. Using complexity theory to build interventions that improve health care delivery in primary care. J Gen Intern Med. 2006;21:S30–4.

Manson S. Simplifying complexity: a review of complexity theory. Geoforum. 2001;32:405–14.

Etkin D. Disaster theory: an interdisciplinary approach to concepts and causes. Oxford: Butterworth-Heinemann; 2015.

Cilliers P. Complexity and postmodernism: understanding complex systems. 1st ed. New York, NY: Routledge; 1998.

Cilliers P. Preiser R editors. Complexity, difference and identity: an ethical perspective. London: Springer; 2010.

Book   Google Scholar  

Greenhalgh T, Papoutsi C. Studying complexity in health services research: desperately seeking an overdue paradigm shift. BMC Medicine. 2018;16:95.

Rutter H, Savona N, Glonti K, Bibby J, Cummins S, Finegood DT, et al. The need for a complex systems model of evidence for public health. Lancet. 2017;390(10112):2602–4.

Canadian Institutes of Health Research. Funding decisions database. Project title: advancing performance measurement for public health emergency preparedness in Canada. (2015). http://webapps.cihr-irsc.gc.ca/decisions/p/project_details.html?applId=321634&lang=en . Accessed 11 July 2018.

O’Sullivan T, Corneil W, Kuziemsky C, Toal-Sullivan D. Use of the structured interview matrix to enhance community resilience through collaboration and inclusive engagement. Syst Res Behav Sci. 2014;32(6):616–28.

O'Sullivan TL, Corneil W. SIM: Structured interview matrix (video). (2013). http://www.enrichproject.ca/publications-and-resources.html Accessed 11 July 2018.

Canadian Institutes of Health Research. Guide to knowledge translation planning at CIHR: integrated and end-of-grant approaches. 2012. http://www.cihr-irsc.gc.ca/e/documents/kt_lm_ktplan-en.pdf . Accessed 11 July 2018.

Statistics Canada. Standard Geographical Classification (SGC). Statistics Canada. 2012. http://www12.statcan.gc.ca/census-recensement/2011/ref/dict/geo044-eng.cfm . Accessed 11 July 2018.

Statistics Canada. Data and definitions. Statistics Canada. 2013. http://www.statcan.gc.ca/pub/21-006-x/2008008/section/s2-eng.htm . Accessed 11 July 2018.

Statistics Canada. Health regions and peer groups. Statistics Canada. 2015. https://www150.statcan.gc.ca/n1/pub/82-402-x/2015002/hrpg-rsgh-eng.htm . Accessed 11 July 2018.

Morgan DL. Snowball Sampling. In: Gibbons LM, editor. The Sage encyclopedia of qualitative research methods thousand oaks. CA: Sage Publications; 2008.

Quinn PM. Qualitative research and evaluation methods. Fourth ed. Thousand Oaks, CA: SAGE Publications; 2015.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

Upshur REG, Faith K, Gibson JL, Thompson AK, Tracy CS, Wilson K, et al. Stand on guard for thee: ethical considerations in preparedness planning for pandemic influenza. A report of the University of Toronto Joint Centre for bioethics, pandemic influenza working Group; 2005. http://www.jcb.utoronto.ca/people/documents/upshur_stand_guard.pdf . Accessed 11 July 2018.

The Department of Homeland Security Federal Emergency Management Agency. National response framework. 2016;Third edition https://www.fema.gov/media-library-data/1466014682982-9bcf8245ba4c60c120aa915abe74e15d/National_Response_Framework3rd.pdf . Accessed 19 Oct 2018.

Maini R, Clarke L, Blanchard K, Murray V. The Sendai framework for disaster risk reduction and its indicators—where does health fit in? Int J Disaster Risk Sci. 2017;8(2):150–5.

Emergency Management Policy Directorate. An Emergency Management Framework for Canada Second Edition. 2018. https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/mrgnc-mngmnt-frmwrk/mrgnc-mngmnt-frmwrk-eng.pdf. Accessed 11 July 2018.

Thompson AK, Faith K, Gibson JL, Upshur REG. Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics. 2006;7(12):1–11.

Kuziemsky CE, O'Sullivan TL. A model for common ground development to support collaborative health communities. Soc Sci Med. 2015;128:231–8.

Brignall S, Modell S. An institutional perspective on performance measurement and management in the ‘new public sector’. Manag Account Res. 2000;11(3):281–306.

Download references

Acknowledgements

The authors would like to acknowledge the following individuals for their support of study implementation and data management: Prof. Alison Thompson, Sarah Nayani, Wayne Corneil, Emily Guy, Vanessa Bournival, Lyric Oblin-Moses, Camille Mageau, and Claude Martel. We would like to acknowledge Sara Lacarte for her contributions to manuscript preparation.

We would also like to acknowledge our knowledge user team for their contributions to study implementation and their support of the research: Dr. Frank Atherton, Jill Courtemanche, Dr. Eileen de Villa; Jean-Francois Duperré; Dr. Victoria Lee; Dr. Mark Lysyshyn; Dr. Sue Pollock; Clint Shingler; Russell Stuart; Dr. Theresa Tam and Dr. David Williams. We also wish to thank our international collaborators for their support of the research: Drs. Daniel Barnett, Jamil Bayram, Kirsty Challen, David Etkin, Daniel Kollek, Laurie Mazurik, Andrew Lee and Brenda Phillips.

This work was supported by the Canadian Institutes of Health Research [funding reference number 142292].

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available due to containing information that could compromise research participant privacy/consent. Limited de-identified data may be available from the corresponding author [YK] upon reasonable request and with permission of Public Health Ontario.

Author information

Authors and affiliations.

Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada

Yasmin Khan, Shannon Tracey & Brian Schwartz

Department of Medicine, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

Yasmin Khan

University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada

University of Ottawa, 25 University Pvt, Ottawa, ON, K1N 6N5, Canada

Tracey O’Sullivan

Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, 6th Floor, Toronto, ON, M5T 3M7, Canada

Adalsteinn Brown, Jennifer Gibson & Brian Schwartz

Joint Centre for Bioethics, University of Toronto, 155 College Street, Suite 754, Toronto, ON, M5T 1P8, Canada

Jennifer Gibson

Université de Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5N4, Canada

Mélissa Généreux

Centre intégré universitaire de santé et de services sociaux de l’Estrie -Centre hospitalier universitaire de Sherbrooke, 300, rue King Est, Sherbrooke, QC, J1G 1B1, Canada

Office of the Provincial Health Officer, Ministry of Health, PO Box 9648, Victoria, BC, V8W 9P4, Canada

Bonnie Henry

You can also search for this author in PubMed   Google Scholar

Contributions

YK was the Nominated Principal Investigator for the study and led study design, implementation, data collection and analysis. TO was the methodological lead for the study and played a key role in study design, implementation, data collection and analysis. BS was the co-principal investigator and contributed to study design and data analysis. ST contributed to implementation, data collection, analysis and development of the framework visual. AB, JG, MG, BH contributed to study design and data analysis. YK and TO drafted the manuscript. All authors contributed to manuscript revisions. All authors approved the final manuscript.

Corresponding author

Correspondence to Yasmin Khan .

Ethics declarations

Ethics approval and consent to participate.

Research ethics approval was obtained from the Ethics Review Board at Public Health Ontario (project ID: 2015.080) and the Research Ethics Board and the University of Ottawa (REB #H02–16-16). A signed declaration of consent to participate was obtained from all research participants prior to data collection.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests with respect to this research.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Additional files

Additional file 1:.

Current study in relation to overarching aim to advance performance measurement for public health emergency preparedness. (DOCX 27 kb)

Additional file 2:

Methodology and links across phases 1 and 2 for the study Advancing performance measurement for public health emergency preparedness in Canada. (DOCX 71 kb)

Additional file 3:

Consolidated criteria for reporting qualitative research (COREQ). (PDF 436 kb)

Additional file 4:

Flowchart of focus groups implemented using Structured Interview Matrix (SIM) technique. (DOCX 45 kb)

Additional file 5:

Coding grid applied for content analysis. (DOCX 41 kb)

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Khan, Y., O’Sullivan, T., Brown, A. et al. Public health emergency preparedness: a framework to promote resilience. BMC Public Health 18 , 1344 (2018). https://doi.org/10.1186/s12889-018-6250-7

Download citation

Received : 17 July 2018

Accepted : 22 November 2018

Published : 05 December 2018

DOI : https://doi.org/10.1186/s12889-018-6250-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Public health
• Emergency preparedness
• Emergency management
• Qualitative research
• Complexity theory

BMC Public Health

ISSN: 1471-2458

• Submission enquiries: [email protected]
• General enquiries: [email protected]

Public Health and Disasters

Health Emergency and Disaster Risk Management in Asia

• © 2020
• Emily Ying Yang Chan 0 ,
• Rajib Shaw   ORCID: https://orcid.org/0000-0003-3153-1800 1

JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China

You can also search for this editor in PubMed   Google Scholar

Graduate School of Media and Governance, Keio University, Shonan Fujisawa Campus, Fujisawa, Japan

• Comprises a seminal work chartering the contours of the emerging field of health emergency and disaster risk management (H-EDRM)
• Includes cutting-edge information in H-EDRM contributed by scholars and practitioners with specific expertise in their own subfields
• Provides an interdisciplinary framework and insights into the field of H-EDRM from multidisciplinary scholars
• Presents illustrative examples from the most disaster-prone continent – Asia

Part of the book series: Disaster Risk Reduction (DRR)

15k Accesses

49 Citations

16 Altmetric

This is a preview of subscription content, log in via an institution to check access.

Access this book

• Available as EPUB and PDF
• Read on any device
• Instant download
• Own it forever
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Other ways to access

Licence this eBook for your library

Institutional subscriptions

About this book

Similar content being viewed by others.

Health Emergency and Disaster Risk Management: Five Years into Implementation of the Sendai Framework

Integrated Disaster Risk Management (IDRM): Elements to Advance Its Study and Assessment

The sendai framework for disaster risk reduction: renewing the global commitment to people’s resilience, health, and well-being.

• Health emergency and disaster risk management (H-EDRM)
• Emergency and disaster medicine
• Humanitarian response
• Community health resilience
• Health system resilience
• H-EDRM in Asia
• Sendai Framework for Disaster Risk Reduction 2015–2030
• 2030 Sustainable Development Goals (SDGs)
• Paris climate agreement
• New Urban Agenda (Habitat III)
• Health issues in DRR

Table of contents (23 chapters)

Front matter, overview of health-edrm and health issues in drr: practices and challenges.

• Emily Ying Yang Chan, Rajib Shaw

Public Health Prevention Hierarchy in Disaster Context

• Emily Ying Yang Chan, Chi Shing Wong

Key Public Health Challenges for Health-EDRM in the Twenty-First Century: Demographic and Epidemiological Transitions

• Emily Ying Yang Chan, Heidi Hung

Evidence Gaps in Community Resilience Building of Health-EDRM in Asia

• Emily Ying Yang Chan, Gloria Kwong Wai Chan

Health-EDRM in International Policy Agenda I: Sendai Framework for Disaster Risk Reduction 2015–2030

• Emily Ying Yang Chan, Heidi Hung, Virginia Murray, Rajib Shaw

Health-EDRM in International Policy Agenda II: Paris Climate Agreement

• Emily Ying Yang Chan, Heidi Hung, Rajib Shaw

Health-EDRM in International Policy Agenda III: 2030 Sustainable Development Goals and New Urban Agenda (Habitat III)

• Emily Ying Yang Chan, Janice Y. Ho, Chi Shing Wong, Rajib Shaw

Bangladesh Public Health Issues and Implications to Flood Risk Reduction

• Akiko Matsuyama, Fahmida Afroz Khan, Md. Khalequzzaman

Smart Water Solutions to Address Salinity, Drinking Water and Health Issues in Coastal Bangladesh

• Md. Anwarul Abedin, Bhaswati Ray, Mohammad Golam Kibria, Rajib Shaw

Health Issues and Disaster Risk Reduction Perspectives in China

• Emily Ying Yang Chan, Sida Liu

Health and Disaster Risk Management in India

• Supriya Krishnan, Ila Patnaik

Safe Drinking Water Solutions in Parts of West Bengal, India: Combating Health Issues Through Participatory Water Management

• Bhaswati Ray, Md. Anwarul Abedin, Rajib Shaw

External Support and Community Cooperation During Long-Term Sheltering—From the Case of the Great East Japan Earthquake

• Shoko Miyagawa, Miho Satoh, Satoshi Furuya, Yoko Yamada, Rajib Shaw

Health Issues in the Aftermath of Nuclear Power Plant Accident in Fukushima

• Takeshi Komino

EpiNurse, Health Monitoring by Local Nurses on Nepal Earth Quake 2015

• Sakiko Kanbara, Apsara Pandey, Maria Regina E. Estuar, Hyeon Ju Lee, Hiroyuki Miyazaki

An Assessment of Primary Health Care Facilities and Their Preparedness Level in Khyber Pakhtunkhwa Province of Pakistan: Strengths, Weaknesses, Opportunities, and Threats (SWOT)

• Ashfaq Ahmad Shah, Muhammad Abid, Jingzhong Ye

Public Health and Disaster Risk Reduction: Experiences from Vietnam

• Tran Nu Quy Linh, Tran Thi Tuyet Hanh

Health Emergency and Public Involvement in the Philippines: Syndromic Surveillance Efforts and System Integration

• Maria Regina Justina E. Estuar, Kennedy E. Espina, Christian E. Pulmano, Charles Ventura, Roy Miguel G. Romarate

Breakthrough on Health Data Collection in Disasters—Knowledge Arises in Asia Spread to the World

• Tatsuhiko Kubo, Flavio Salio, Yuichi Koido

Editors and Affiliations

Emily Ying Yang Chan

About the editors

Professor Emily Ying Yang Chan is a Professor, Assistant Dean of the Faculty of Medicine, and Associate Director, of the JC School of Public Health and Primary Care, The Chinese University of Hong Kong (CUHK); Director of the Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Centre for Global Health (CGH) and Centre of Excellence (ICoE-CCOUC), Integrated Research on Disaster Risk (IRDR); Co-chair of the WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Group; and a member of the Asia Science Technology and Academia Advisory Group (ASTAAG). She is also a visiting professor at the University of Oxford Nuffield Department of Medicine; senior fellow, Harvard Humanitarian Initiative, and visiting scholar, FXB Center, Harvard University. Her research interests include disaster and humanitarian medicine, climate change and health, global and planetary health, human health security and health emergency and disaster risk management (H-EDRM), remote rural health, implementation and translational science, ethnic minority health, injury and violence epidemiology, and primary care. Awarded the American Public Health Association’s 2007 Nobuo Maeda International Research Award, Professor Chan has published more than 200 international peer-reviewed academic, technical, and conference articles and eight academic books. She also has extensive experience as an international frontline emergency relief practitioner in the mid-1990s.

Rajib Shaw is a Professor at the Graduate School of Media and Governance at Keio University’s Shonan Fujisawa Campus (SFC). Before that, he was the Executive Director of the Integrated Research on Disaster Risk (IRDR), a decade-long research program co-sponsored by the International Council for Science (ICSU), the International Social Science Council (ISSC), and the United Nations International Strategy for Disaster Reduction (UNISDR). He is also a senior fellow of the Institute of Global Environmental Strategies (IGES) Japan, and the chair of SEEDS Asia, CWS Japan, two Japanese NGOs. He was  a Professor at Kyoto University’s Graduate School of Global Environmental Studies. His expertise includes community-based disaster risk management, climate change adaptation, urban risk management, and disaster and environmental education. He is the Chair of the United Nations Global Science Technology Advisory Group (STAG); and is the co-chair of the Asia Science Technology Academic Advisory Group (ASTAAG). He serves as the Coordinating Lead Author (CLA) of Asia chapter of IPCC 6th Assessment Report on Climate change impact, adaptation and vulnerability. He is the editor of a book series on disaster risk reduction, published by Springer. Prof. Shaw has published more than 45 books and over 300 academic papers and book chapters.

Bibliographic Information

Book Title : Public Health and Disasters

Book Subtitle : Health Emergency and Disaster Risk Management in Asia

Editors : Emily Ying Yang Chan, Rajib Shaw

Series Title : Disaster Risk Reduction

DOI : https://doi.org/10.1007/978-981-15-0924-7

Publisher : Springer Singapore

eBook Packages : Earth and Environmental Science , Earth and Environmental Science (R0)

Copyright Information : Springer Nature Singapore Pte Ltd. 2020

Hardcover ISBN : 978-981-15-0923-0 Published: 25 February 2020

Softcover ISBN : 978-981-15-0926-1 Published: 25 February 2021

eBook ISBN : 978-981-15-0924-7 Published: 24 February 2020

Series ISSN : 2196-4106

Series E-ISSN : 2196-4114

Edition Number : 1

Number of Pages : XVI, 343

Number of Illustrations : 14 b/w illustrations, 35 illustrations in colour

Topics : Natural Hazards , Public Health , Sustainable Development

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Disaster Planning for Public Health Essay

The nursing response, community preparedness.

My community is the city of Portsmouth in Virginia, and a potential natural disaster likely to affect the area is flooding. Information from the Portsmouth Virginia Department of Emergency Management (2021) shows that hurricane season starts in June and ends in November. Still, the peak point for this calamity is between August and October (Council et al., 2018). Coastal communities such as Portsmouth face the risk of powerful storms that cause an abnormal rise in water levels in the oceans. When hurricanes make landfall, they create a significant water push onto the shore. Elevation and proximity of beaches enable storms to travel far inland in the Portsmouth community, creating massive destruction. Nearly every year, when it rains or during hurricanes, floodwaters are a threat. Portsmouth community faces immediate health impacts from flooding, including injuries, hypothermia, animal bites, drowning, and waterborne illnesses (Council et al., 2018). Other associated risks include loss of health workers, destruction of health infrastructure such as drug supplies, and patient evacuation. Council et al. (2018) inform that, commonly, floods increase the likelihood of waterborne disease transmissions such as typhoid fever, hepatitis A or E, and cholera. Some vector-borne diseases such as malaria, West Nile fever, and dengue can affect community members.

The risk of waterborne disease infections is high, and they can be acquired through direct contact with contaminated waters. Although some illnesses such as throat infection, dermatitis, and wound infections are not a threat, they pose significant harm to people along with other severe risk factors. Flooding is associated with contamination of drinking water, which leads to serious diseases like typhoid. Prone infections are directly transmissible by bacteria when skin gets in contact with contaminated water. During the disaster, the Portsmouth community needs to watch poor hygiene as it is a major cause of disease outbreaks.

The first action of a response plan is to initiate warnings for potential flood events to the community. The Environmental Agency (EA) is responsible for managing and warning of possible flooding from severe weather while providing daily guidance statements. Daily updates or guidance on floods are issued by the Flood Forecasting Center (FFC) (Portsmouth Virginia Department of Emergency Management, 2021). Warning services are issued by the EA, which split floodplain in Portsmouth into warning areas with respect to risk or level of defense. The EA department uses key flood codes to notify the level of risk.

Most flood events take place on a small scale and can be dealt with by local authorities, emergency service centers, and other agencies within the response plan. When the actual impact of flooding is severe, emergency services must contact support from various response teams. An example of external assistance contacted includes diversions, evacuation measures, and road closure. Public warning and alert messages are issued to community members upon identification of the threat. The level of disaster response requires coordinated efforts using Portsmouth multi-agency flood plan.

Preventive actions are necessary to avoid the occurrence or escalation of risks during the flooding event. In Portsmouth’s community response plan, prevention measures include floodgate operations, closing shoreline roads, distributing sandbags as stand-by, informing the public, and protecting critical infrastructures such as electricity and communication lines. During actual flooding, actions taken are gulley pumping, road closures, establishing emergency helpline services, opening flood response rooms or centers, evacuating, and implementing business continuity plans. The key priority for action is paid to people, houses, roads, commercial property, and infrastructures.

Based on local website evaluation, the level of intervention on flooding in the city of Portsmouth is maintained through a proper reporting system (Portsmouth Virginia Department of Emergency Management, 2021). During flood response practices, the emergency department in the community structure procedures for use by the city council and establish twenty-four hours call out details. Communication flow is maintained to alert various response teams and residents of warnings (Portsmouth Virginia Department of Emergency Management, 2021). Nurses play a crucial role during a natural disaster such as flooding, as they help victims prevent and manage illnesses resulting from the incidents. The professional do this by educating the community about waterborne diseases and how to reach care upon symptoms onset. Also, the fundamental attribute of nurses is to give care to the injured, help individuals and their families to manage physical or emotional issues.

Evidence-based practice guidelines pinpoint key issues concerning sustainable prevention, protection, and mitigation of flooding from literature work (Behr et al., 2016). Specific guidelines include identifying the nature of the risk, building a community response team, making vital information accessible to people, updating and alerting on procedures. Natural events continue to exist, and human interference must be prevented. Assessment of community needs must incorporate existing knowledge about floods or community members and should be flexible. From a nursing perspective, community needs are essential to give an overview of how to better respond in a disaster outbreak. While much attention is paid to most likely diseases that are waterborne related during floods, studies point that mental health consequences are an area worth considering. For example, post-traumatic stress disorder can affect community members, and these health issues should be incorporated into the recovery plan. The risks of suicides after natural disasters like flooding is high due to depression from loss experienced.

Portsmouth has experienced storms and flooding, and instead of focusing on how to respond to the events, the community should focus on improving drainage systems. Hurricanes are recurrent natural events: hence, there is a need to ensure sufficient equipment types to lessen impacts. Also, it can be concluded that the community’s preparedness for flood calamity is not enough because health issues are not well addressed. Disease surveillance is essential and must be included in the plan to detect changing patterns of common illnesses or other outbreaks. The probability of epidemics when a population is displaced is high aid interruption to healthcare systems. Long-term health impacts such as mental illnesses should be considered in the plan as victims suffer a severe loss that might induce stress, panic, or anxiety. Disaster occurrence impact challenges, some of which are predictable, while others can be difficult to perceive. As such, the Portsmouth community preparedness plan requires regular updates.

Behr, J. G., Diaz, R., & Mitchell, M. (2016). Building resiliency in response to sea-level rise and recurrent flooding: Comprehensive planning in Hampton roads. The Virginia News Letter , 92 (1), 1-7. Web.

Council, D., Covi, M., Yusuf, W., Behr, J., Brown, M., & Grant, V. S. (2018). The ‘new normal’ of flooding in Portsmouth, Virginia: Perspectives, experiences, and adaptive Responses of Residents and Business Owners in Low to Moderate-Income Communities [PDF document ], 1-26. Web.

Portsmouth Virginia Department of Emergency Management (2021). Flood Emergency preparedness. The City of Portsmouthva.gov. Web.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2022, May 24). Disaster Planning for Public Health. https://ivypanda.com/essays/disaster-planning-for-public-health/

"Disaster Planning for Public Health." IvyPanda , 24 May 2022, ivypanda.com/essays/disaster-planning-for-public-health/.

IvyPanda . (2022) 'Disaster Planning for Public Health'. 24 May.

IvyPanda . 2022. "Disaster Planning for Public Health." May 24, 2022. https://ivypanda.com/essays/disaster-planning-for-public-health/.

1. IvyPanda . "Disaster Planning for Public Health." May 24, 2022. https://ivypanda.com/essays/disaster-planning-for-public-health/.

Bibliography

IvyPanda . "Disaster Planning for Public Health." May 24, 2022. https://ivypanda.com/essays/disaster-planning-for-public-health/.

• First Home Care: Internship Clinical Practice
• Water Quality Issues in Developing Countries
• Hurricanes and Tropical Storms
• Discrimination Against People of Color and Queer Community
• Body-Mass Index and Waist Circumference in Children
• Bioterrorism Preparedness and Public Health Response
• Culturally Competent Care in Indian Health Service
• The John Muir Health Facility's Addiction Medicine Recovery Services

• Search Menu
• Advance articles
• Editor's Choice
• Supplements
• Author Guidelines
• Submission Site
• Open Access
• About Journal of Public Health
• About the Faculty of Public Health of the Royal Colleges of Physicians of the United Kingdom
• Editorial Board
• Self-Archiving Policy
• Dispatch Dates
• Advertising and Corporate Services
• Journals Career Network
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Natural disasters as a public health issue.

• Article contents
• Figures & tables
• Supplementary Data

Christopher Ryan Maboloc, Natural disasters as a public health issue, Journal of Public Health , 2024;, fdae039, https://doi.org/10.1093/pubmed/fdae039

• Permissions Icon Permissions

This paper explains why natural disasters are a public health issue. A case in point is the Masara landslide in Maco Town, the Philippines. Public health concerns are not just the physical but also the ‘total well-being of persons’. Classifying natural calamities as a concern related to public health will give a sense of urgency on the matter and thereby encourage governments to act on the negative effects of climate change, especially in developing countries.

Email alerts

Citing articles via.

• Recommend to your Library

Affiliations

• Online ISSN 1741-3850
• Print ISSN 1741-3842
• Copyright © 2024 Faculty of Public Health
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Advertising
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

Disaster Management and Public Health

Disaster types include the following:

• Earthquakes
• Pandemics/Epidemics
• Volcanic eruptions
• Mass shootings
• Nuclear explosions
• Chemical emergencies

Specifically, disaster management is about planning and directing resources to manage a disaster and synchronizing the roles and duties of responders, private sector organizations, public sector agencies, nonprofit and faith-based organizations, volunteers, donations, etc. The ultimate goal of the disaster-management authority is to reduce the disaster’s effect, which involves preparedness, mitigation, response, and recovery.

Components of Disaster Management Cycle:

When properly executed, the disaster-management cycle can reduce the impact of a catastrophic incident. It can also integrate the policies and emergency responses needed for a full, advanced recovery. The cycle includes the following five stages:

• Prevention: The best way to address a disaster is by being vigilant. This means finding potential hazards and developing safeguards to alleviate their impact. Although prevention involves putting long-lasting measures into place that can help curtail disaster risk, it’s important to concede that disasters can’t always be prevented. Prevention includes scenarios like:
• Executing an evacuation plan in a school, for example, demonstrating to teachers how to herd students to shelter in the event of a tornado or fire
• Planning and designing a city in a way that lessens the risk of flooding, for example, with the use of locks, dams or channels to divert water away from populous areas
• Mitigation: Mitigation intends to minimize the loss to human life that would be caused due to a disaster. Both structural and nonstructural efforts can be made:
• A structural measure means altering the physical characteristics of a building or an environment to control the effects of a disaster. For example, clearing trees away from a house can ensure that dangerous storms don’t knock down the trees and send them crashing into homes and public buildings.
• Nonstructural measures involve embracing or improving building codes to elevate safety for all future building construction.
• Preparedness: Preparedness is an ongoing process in which individuals, communities, businesses and organizations can plan and exercise for what they’ll do in the occurrence of a disaster. Preparedness is defined by ongoing drills, evaluating and corrective action, confirming the highest level of readiness. Fire drills, active-shooter drills and evacuation trials are all good instances of the preparedness stage.
• Response: Response is what happens after the disaster befalls. It implicates both short- and long-term reactions. Ideally, the disaster-management team will manage the use of resources (including workforce, provisions and equipment) to help reestablish personal and environmental safety, as well as to reduce the threat of any extra property damage. During the response stage, any ongoing hazards are removed from the area; for example, in the aftermath of a wildfire, any remaining fires will be put out, and areas that pose a high flammability hazard will be controlled.
• Recovery: The last stage is recovery. This can take a long period of time, sometimes years or even decades. It comprises steadying the area and reinstating all critical community functions. Recovery necessitates prioritization: first, essential services like food, clean water, utilities, transportation and healthcare will be reestablished, with less-essential services being arranged later. Eventually, this stage is about assisting individuals, populations, businesses and establishments return to usual or a new system dependent on the effect of the disaster.

One of the most vitals lessons of the COVID-19 pandemic is that disasters can come to pass any community, at any point of time. While infectious disease characterizes one type of disaster, it could just as possibly be a cyclone, flood or chemical spill. There have been many instances around the world to call upon public health disaster preparedness and response and to face the moral predicaments that come with it—such as the difficult lessons learned in the calamitous earthquake in Haiti in 2010, the flooding and destruction to Fukushima Daiichi nuclear reactor in Japan in 2011 that resulted in extreme radiation, Hurricane Sandy in the New York city urban area in 2013, and the grave Ebola 2014 outbreak in West Africa in 2014.

Disasters can happen anytime. Dealing with them and recuperating and rebuilding subsequently are nothing new. Methodical, evidence-based advance planning and preparedness are more innovative, however, and seeing disasters as essential matters of public health, in addition to matters of public well-being, is a modern improvement with significant ethical implications and consequences.

Further public health challenges emerge on the horizon, counting new strains of pandemic infections and other communicable diseases and the prospect of long-term climate modification with its numerous dangers to public health and well-being—comprising lethal heat waves; increasing violent storms and flooding, sea level upsurge and the corruption of fresh water supplies, drought, malnutrition, the spread of zoonotic disease, worsening of chronic conditions such as allergies and pulmonary disease, and significant human migration with associated sanitation and epidemic consequences.

A public health emergency occurs when the ordinary health service abilities of a community are stunned by a dangerous situation or incident. Emergency preparedness is that facet of public health intended to guarantee constant public health and medical vigilance in the episode of an emergency, minimalize the impact of emergencies on affected populations, and nurture safe and healthy environments before, during, and after an emergency.

Emergency preparedness incorporates more than sufficient equipment, organization of health professionals, training, and provisions. It also comprises community involvement and contribution from the beginning of the pre-emergency planning procedure. Emergency plans drawn up behind closed doors are not enough. A much more intricate and continuing process of community asset and wants assessment, stakeholder involvement, and public consciousness and commitment is vital. Public confidence and assurance are indispensable in emergency preparedness, and public health decision-making will be most advantageous generally when it is easily figured out and has direct associations to the people it serves.

About the author

Recent Posts

• Economic Impact of – Breast Feeding, Alcohol Abuse, Smoking, Disease Prevention, HIV, Malaria, Cancer
• By 2030, the demand for Indian healthcare professionals is expected to surge, doubling both within the country and worldwide.
• Top Hospital Administration Jobs in India
• Requirement for Health Education Specialist Jobs in India
• Digital Health Analyst Jobs in India
• February 2024
• January 2024
• December 2023
• November 2023
• October 2023
• September 2023
• August 2023
• January 2023
• December 2022
• November 2022
• October 2022
• September 2022
• January 2022
• November 2021
• October 2021
• September 2021
• August 2021
• February 2021
• January 2021
• December 2020
• November 2020
• October 2020
• September 2020
• August 2020
• February 2020
• February 2019
• Masters in Public Health
• Masters In Hospital Administration
• Bachelors In Hospital Administration
• Testimonials

Copyright AIHMS Blog . All rights reserved. | Designed by Crafthemes

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Am J Public Health
• v.109(3); Mar 2019

From Disaster Response to Community Recovery: Nongovernmental Entities, Government, and Public Health

The authors contributed equally to this article.

In this article, we examine the role of nongovernmental entities (NGEs; nonprofits, religious groups, and businesses) in disaster response and recovery. Although media reports and the existing scholarly literature focus heavily on the role of governments, NGEs provide critical services related to public safety and public health after disasters. NGEs are crucial because of their ability to quickly provide services, their flexibility, and their unique capacity to reach marginalized populations.

To examine the role of NGEs, we surveyed 115 NGEs engaged in disaster response. We also conducted extensive field work, completing 44 hours of semistructured interviews with staff from NGEs and government agencies in postdisaster areas in Texas, Florida, Puerto Rico, Northern California, and Southern California. Finally, we compiled quantitative data on the distribution of nonprofit organizations.

We found that, in addition to high levels of variation in NGE resources across counties, NGEs face serious coordination and service delivery problems. Federal funding for expanding the capacity of local Voluntary Organizations Active in Disaster groups, we suggest, would help NGEs and government to coordinate response efforts and ensure that recoveries better address underlying social and economic vulnerabilities.

Disasters have significant implications for public health. 1,2 Creating immediate risks to health and safety, events such as hurricanes, tornadoes, floods, earthquakes, and wildfires may also damage electrical grids, communications networks, and transportation infrastructure ( Figures 1a and 1b ). This leads to serious disruptions in patient care and in access to medical facilities and technology. In Puerto Rico following Hurricane Maria, the result was a large-scale public health crisis and thousands of deaths. 3,4 Over the long run, disasters may reshape local economies as well as neighborhoods and physical environments, with harmful consequences for those living on the social and economic margins. 5–8

Aftermath of (a) Hurricane Irma, Southwest Florida (October 2017), and (b) Thomas Fire, Southern California (March 2018)

Source . Photos by Daniel Sledge. Printed with permission.

Media discussions and the existing scholarly literature on disaster response and recovery focus heavily on the successes and failures of government. In this article, however, we examine the role of nongovernmental entities (NGEs) such as nonprofits, religious groups, and private businesses. 9–14 Our analysis is grounded in research on the aftermath of Hurricane Harvey, Hurricane Irma, and Hurricane Maria (each of which made landfall during 2017), as well as the massive 2017 wildfires in Northern and Southern California. We selected these cases because of their geographic variation, differing political and governmental contexts, and temporal proximity. 15 We employed a mixed-methods research approach. First, we fielded surveys of NGEs engaged in disaster response. Second, we engaged in extensive field work, completing semistructured interviews with staff from NGEs and government agencies in postdisaster areas in Texas, Florida, Puerto Rico, Northern California, and Southern California. Finally, we compiled quantitative data from the Internal Revenue Service (IRS) and Census Bureau on the extent and distribution of nonprofit organizations.

We find that NGEs critically shape the path of disaster response and recovery. Formally included in the nation’s disaster response framework, NGEs are crucial because of their ability to quickly provide services that may not be provided by government, their flexibility, and their unique capacity to reach marginalized populations. Nonetheless, the prominence of NGEs in disaster response creates issues to which policymakers must be attuned.

Our analysis of IRS and Census data shows that NGE capacity varies significantly across communities. Whereas some communities possess robust nonprofit assets, others lack locally embedded capacity to provide postdisaster resources. Our surveys and in-depth interviews demonstrate that NGEs also face serious information constraints, limiting their ability to coordinate among each other and with government. 16 This may lead to haphazard targeting of services and duplication of effort. Finally, our interviews suggest that NGEs are motivated by a variety of missions and strategies. Whereas some are formally committed to serving entire communities, others are focused on specific groups or categories of people. 17

RESPONDING TO DISASTERS

Disasters require swift attention to public safety and health. Access to water, food, and shelter are pressing issues, as are mental health and emotional well-being. 18,19 Disasters may also cause significant disruptions to health care systems, exacerbated by electricity outages, fuel shortages, and damage to transportation and communication infrastructure. For patients with chronic diseases, access to prescriptions, medical technology, and existing plans of treatment may be interrupted. Those with functional needs, residents of nursing homes, and dialysis patients also face high levels of risk. 20–22

In the United States, disaster response is undertaken by local, state, and federal authorities, in conjunction with nonprofits, faith-based groups, and private businesses. 12 Under the 1988 Stafford Act, presidential emergency and major disaster declarations may be made following the request of a governor, who must certify that local government is incapable of responding to a disaster on its own. Presidential declarations allow federal support to flow to US states, commonwealths, federally recognized Indian tribes, and territories. 23,24

The Federal Emergency Management Agency’s (FEMA’s) National Response Framework (NRF) lays out expectations about the role of different levels of government and of NGEs after a disaster. 25 Under the NRF, local governments retain primary responsibility for preparing for and responding to disasters, with local first responders assisted by state and federal authorities. Along with FEMA, entities such as the National Guard, Army Corps of Engineers, and Environmental Protection Agency may take part in response efforts. Depending on the nature of the disaster, a presidential declaration may allow for the implementation of FEMA disaster programs, such as Individual Assistance, Public Assistance, and Hazard Mitigation Assistance. These programs cover an array of activities, including Disaster Supplemental Nutrition Assistance, case management, and support for debris removal and infrastructure projects. FEMA assistance may be augmented by loans to individuals and businesses from the US Small Business Administration.

The box on page 439 outlines the roles the NRF assigns to government and NGEs. The NRF anticipates that nonprofits, religious groups, and businesses will provide key functions after a disaster. For nonprofits and religious groups, these include feeding, sheltering, case management, provision of health resources, management and coordination of volunteers and donations, and search and rescue support. For businesses, they include protecting privately owned critical infrastructure, commodity provision, and logistical support.

BOX 1—

Roles of governmental and nongovernmental entities under national response framework.

Source. Adapted by the authors from US Department of National Security 25 and US Government Accountability Office. 26

RANGE OF NONGOVERNMENTAL ENTITIES

Under FEMA’s National Response Framework and in practice, NGEs provide crucial postdisaster services. These NGEs range from nonprofits and businesses with highly institutionalized response capabilities to groups with no previous experience. Larger organizations with extensive response and relief history, such as the Red Cross and the Salvation Army, often have seats in emergency operations centers during a disaster event. Local-level voluntary, civic, and religious groups are also prominent in activities such as distributing food and water and gutting water-damaged homes. Although these groups may face acute difficulties in assessing need and coordinating with each other and government, they may often be well-equipped to provide services to marginalized populations. Locally embedded groups, meanwhile, may be particularly responsive and accountable to community needs and concerns. 17

The logistical capabilities of large businesses can facilitate deployment of needed goods. Wal-Mart, notably, maintains an emergency operations center with nationwide reach. 27 Following Hurricane Harvey, supermarket chain HEB delivered water to the city of Beaumont, Texas, where the municipal water system was nonfunctional. 28 For businesses, postdisaster work fulfills goals of community engagement and corporate responsibility along with restoring functionality to retail, office, or storage spaces. These efforts may also foster a positive public image. A 2018 Super Bowl ad, for instance, touted Budweiser’s delivery of water to disaster-impacted areas in Texas, Florida, Puerto Rico, and California. 29

EXAMINING NONGOVERNMENTAL ENTITY ROLES

To examine the role of NGEs in disasters, we engaged in a mixed-method approach, combining fieldwork and surveys with secondary data analysis. First, following disasters in Texas, Florida, Puerto Rico, and Northern and Southern California, we conducted surveys of NGEs active in each area (n = 115). We identified NGEs through media reports, governmental and nonprofit assistance Web sites, and lists of community foundation grant recipients. Surveyed groups included nonprofit, civic, and charitable or philanthropic organizations (74.8% of respondents); faith-based groups (13.9%); and businesses (4.3%). Response rates ranged from 39.5% to 23.6% across the 5 disaster areas, with recruitment occurring in up to 3 waves of e-mails and supplemental telephone calls.

Second, we conducted in-person and telephone interviews with 57 respondents from government agencies and NGEs selected from survey lists or arranged through in-person contacts. We engaged in 2 waves of postdisaster fieldwork in Texas, Florida, Puerto Rico, and 1 wave in both Northern and Southern California. Our fieldwork yielded 44 hours of in-depth, semistructured interviews, conducted in English and Spanish.

Finally, we compiled data on nonprofit resources from the IRS’s cumulative exempt business master files as well as county and Puerto Rican municipality-level population data from the US Census Bureau.

Our survey results emphasize the array of services that NGEs provide under normal conditions, as well as the shifts in their actions after disaster. As Figure 2 illustrates, the NGEs we surveyed often redirected their activities after disaster, moving toward housing-related services such as shelter, clean-up, and construction, as well as food assistance and emergency financial assistance. Following disaster, NGEs supplemented the capabilities of government by providing critical services.

Services Provided by Nongovernmental Entities, Typically vs During Disaster Response: Texas, Florida, Puerto Rico, Northern and Southern California, November—April 2018

Note . Mgmt = management. Data collected by author survey of 115 nongovernmental entities active in postdisaster areas. Housing includes shelter, clean-up, and construction; spiritual includes emotional, religious, and spiritual care.

These findings were reinforced by our postdisaster interviews, which highlighted the potential swiftness and flexibility of NGEs as well as NGE ability to engage with marginalized communities. A representative of a faith-based group active following Hurricane Harvey asserted that NGEs were critical because “government, in general, is very bad at moving quickly and immediately on a ground level.” In Puerto Rico, meanwhile, a representative from a major disease-related organization detailed her group’s shift toward providing basic necessities. Rather than focusing on facilitating treatment, as it would have before Hurricane Maria, the group recognized that its clients needed “water . . . food, gasoline for their generators—so we changed our program of work and started paying for those kind of things . . . that’s what people really needed at that time.” Adapting to developing circumstances, this organization relied on its existing client network to provide new services.

Discussing the role of government after Hurricane Irma, a member of a civic group in Southwest Florida emphasized her group’s sense of urgency: “[W]e can get the response out faster than the government can, and we’re not going to sit around and wait for somebody to do it. We need to help these people now.” This urgency was complemented by the recognition that the population her group sought to help included a number of undocumented immigrants who “might be afraid to get help from certain organizations” or “from the government.” As another member of the same group explained, “We actually made a conscious effort not to wear lanyards with name tags or anything like that—we didn’t want to look ‘official’ . . . . We didn’t want people seeing us and going into hiding. We’re there to help.” Other interview respondents routinely made similar statements about their ability, relative to that of government, to engage with marginalized communities.

To illuminate how NGEs perceived their roles relative to that of government, we asked survey respondents who would have provided the disaster-related services they rendered had they not been active. Fully 76.2% of surveyed NGEs reported that, had they not been active, their services may not have been provided (n = 101). Of these organizations, 40.3% believed that, if someone else did provide these services, it would have been another NGE that did so. Highlighting their perception of the unique nature of the services that they provided, only 16.9% of these NGEs believed government might have stepped in and provided their services had they not been active, and 13.0% believed that private contractors might have replaced NGE-provided services.

VARIATION IN NONGOVERNMENTAL ENTITY CAPACITY

Although NGEs play a critical role in the nation’s disaster response framework, substantial variation exists across communities in terms of NGE ability to deliver needed services. 30,31 To measure and conceptualize NGE capacity, we compiled data on nonprofit assets in counties (in Puerto Rico, municipalities) in Texas, Florida, Puerto Rico, and California impacted by Hurricanes Harvey, Irma, and Maria and by the 2017 California wildfires. Figure 3 plots nonprofit assets in disaster-declared counties in millions of US dollars, weighted per 10 000 population. Weighted assets, we observed, demonstrated high levels of dispersion. Some counties are home to robust nonprofit sectors, while others are characterized by comparatively low funding. Alachua County, Florida, for example, had the highest weighted nonprofit assets among disaster-impacted counties, at $246.3 million per 10 000 population. In Alachua County, 5414 people registered for FEMA’s Individuals and Households Program, which seeks to meet basic needs for disaster survivors. 32 Four other Florida counties with comparable Individuals and Households Program registrations (ranging from 4672 to 5509) varied notably in the extent of their nonprofit assets. Our data show that Volusia County had $32.5 million in weighted assets, Orange County had $35.0 million, Lake County had $24.3 million, and Charlotte County had $6.5 million.

Variation in Aggregated Nonprofit Assets Across Disaster-Declared Counties or Municipalities in Texas, Florida, Puerto Rico, and California

Note . Data are nonprofit assets in millions of US dollars as reported to the Internal Revenue Service by organizations when revenues exceed $25 000 between June 2015 and June 2016 (Form 990), per 10 000 individuals residing in each county or municipality. Included counties or municipalities are those presidentially declared disaster areas receiving Federal Emergency Management Agency Individual Assistance following Hurricanes Harvey, Irma, and Maria, and Northern and Southern California wildfires in 2017.

The variation in capacity identified by our analysis of IRS data emphasizes the importance of location. Whereas some communities possess significant locally embedded resources, others are relatively ill-equipped. In Puerto Rico, failures in the aftermath of Hurricane Maria stemmed in part from federal and commonwealth-level decisions and actions. 33 They were also, however, the result of a national response framework that relies on NGEs, which were themselves overwhelmed by Maria or, in many areas, were not present or adequately funded. Given the assumptions of the National Response Framework, areas with large portions of the population living on the economic and social margins and relatively low nonprofit resources will face serious challenges in responding to and recovering from disasters.

COORDINATION

The NGEs that we surveyed following Hurricanes Harvey, Irma, and Maria and the 2017 Northern and Southern California wildfires consistently highlighted information and coordination issues as postdisaster obstacles. Asked to rate their coordination on a 100-point scale ranging from “not effective” to “very effective,” the NGEs we surveyed reported highly varying experiences. Coordination was rated best among NGEs themselves, with a median of 79.4 (SD = 21.8). The mean response for coordination with local government was above “moderately effective,” at 61.0 (SD = 29.7). For state or commonwealth governments and the federal government, it fell just below “moderately effective,” to 49.0 (SD = 31.6) and 47.9 (SD = 29.8), respectively.

One means through which NGEs may coordinate is through an umbrella Voluntary Organizations Active in Disaster (VOAD) group. The National VOAD organization provides a broad framework through which organizations may seek to coordinate their actions, share information, and more effectively target their efforts. Local chapters of state VOADs are sometimes known as Community Organizations Active in Disaster. The VOADs bring together NGEs active during disaster and representatives from government agencies, providing a platform for coordination. In some cases, local VOADs have seats in emergency operations centers. On Texas’s Gulf Coast, one VOAD representative who was in an emergency operations center during Hurricane Harvey described his role as “gathering information” and “distributing that out to everybody else,” so that VOAD-affiliated groups “had a situational awareness.” A representative from an international nonprofit that provided medical care following Hurricane Irma, meanwhile, noted that the “government typically relies on national and regional/local VOADs to facilitate coordination between voluntary organizations.”

The postdisaster interviews that we conducted highlighted the importance of VOADs in facilitating postdisaster coordination. In California’s wine country, a representative from the local branch of a major nonprofit described the difficulties that NGEs faced in Sonoma County, which did not have a county-level VOAD group. Community groups, he reported, had difficulty coordinating with the Red Cross, many of whose local volunteers were deployed to Texas and Florida as a result of Hurricanes Harvey and Irma. Although local groups began creating a VOAD after wildfires ravaged the area, “it wasn’t active prior to this, so from a volunteer perspective, people didn’t know where to donate items,” and there was no centralized information source. In neighboring Napa County, a Community Organizations Active in Disaster group (funded by a donation the local vintners’ trade association made after a 2014 earthquake) launched just before the wildfires. There, NGEs reported coordinating well with each other and with local government. As an important player in a Napa County nonprofit explained, the damage in Sonoma County differed in significant ways from that in Napa, “but the key difference here is that we had that [Community Organizations Active in Disaster] in place and they didn’t.”

For outside organizations, our postdisaster interviews made clear that coordination issues may prove acute during disaster response. From the perspective of local government officials, the influx of well-intentioned volunteers and groups may prove problematic. As an emergency management official in Southwest Florida described his experiences following Hurricane Irma, there is “never a commitment for routine communications.” Following disasters, groups may begin showing up on the scene within days, when “we’re so crazy busy, still responding, still putting out fires, still responding to 911 calls.” While groups may make contact with local officials, government is often stretched thin during the response period, and local authorities may not yet have completed situational assessments. In many cases, the official explained, groups “do their own situations assessment, and then I find out 24 hours later that they’re in the gymnasium at some church and that’s all I know.” In the official’s experience, the result was often that assistance from NGEs was not targeted at communities with the highest need. With a variety of NGEs seeking to become involved and with haphazard information sharing, disaster response may entail “enormous duplication of effort,” meaning that “a lot of money and a lot of resources” may be wasted.

SERVICE DELIVERY

The postdisaster interviews that we conducted highlighted the extent to which NGEs are motivated by differing missions and the variety of methods they employ to identify to whom they will provide services. Larger and more professionalized NGEs tend to have broad eligibility criteria and employ sophisticated demographic and mapping data. Other groups may rely on door-to-door canvassing, opportunity-based placement of service delivery, and media-driven targeting of response and relief efforts. Community embeddedness also played an important role in service delivery. As one individual involved in the response to Hurricane Irma explained, her group’s religious nature made it a beacon for the residents of an inland Florida town with a large immigrant farmworker population: “[B]ecause of our location on the church grounds . . . people in the community trust that this is a safe place for them to come. We didn’t need to advertise that we were a disaster site. People know and they show up.”

Groups with an existing client base often reported expanding from their targeted population to broader parts of the community. During a postdisaster interview in Puerto Rico, a staff member with a nonprofit that provided services for the homeless, including those with drug use disorders or HIV, described how Hurricane Maria impacted his organization’s mission. Following the hurricane, the organization sought to identify members of the homeless community with unmet needs but quickly decided that they would have to expand their reach. Though “our mission is for the homeless,” the representative explained, “we could not be blind toward the needs in the community, so we began to cook, not only for the homeless, but also for those persons in the communities.” Over the months that followed, the group pursued new funding to serve the broader community.

FROM RESPONSE TO RECOVERY

Government and NGEs play key roles in disaster response and recovery. Working together, they might pursue policies and efforts aimed at improving coordination and addressing social vulnerability to disasters. 34,35 As a first step, the coordination issues that were routinely described during our postdisaster interviews might be addressed through a significant and ongoing federal commitment to helping fund state, regional, and county VOADs. This commitment should be pursued regardless of location or proximity to recent disasters. A vigorous locally embedded VOAD structure might also engage in outreach to organizations only intermittently involved in disaster response. Expanded resources for VOADs might prove particularly useful in areas where local NGE resources are comparatively limited, helping groups target their resources and providing a locally embedded structure for outside organizations to coordinate with during disaster response.

As scholars of social vulnerability have shown, susceptibility to disasters is shaped by underlying social structures, economic resources, and political relationships. 5–7 Although disasters have an impact on individuals across social and economic categories, the poor, racial and ethnic minorities, and other marginalized groups are particularly susceptible to the adverse short- and long-run effects of disasters. 6,36,37 Housing quality, location, and affordability, which are deeply interconnected with socioeconomic status, are key drivers of these outcomes. 6

Interview respondents regularly highlighted the secondary economic impacts of disaster and government failures to address them. These impacts include displacement, unemployment, reduced wages because of decreased economic activity, and rising rental prices. Interview respondents drew attention to the long-term strain that disasters place on marginalized communities, along with a sense that these communities would likely receive little aid from government. Lack of access to safe and affordable housing was a consistent concern. They also noted that FEMA programs often appear to work most effectively for financially stable homeowners. In Puerto Rico, respondents explained that it was often difficult for homeowners to prove to FEMA that they owned their homes, given local building and land tenure practices. In one inland mountainous municipality, for instance, a government official reported (translated from Spanish) that the area’s primary long-run challenge was the “issue of home titles, which limits both federal and state help,” as residents were unable “to show that those are indeed their homes.”

While disasters often draw attention to the social and economic conditions that fuel community susceptibility, current federal policy is largely targeted toward a return to normalcy that may do little to address underlying issues of vulnerability within a community. A representative for a prominent antihomelessness nonprofit in the Houston, Texas, area was typical in expressing concern with FEMA’s underlying mission. “FEMA’s charge,” she pointed out, “is to return people to the state they were in prior to the storm.” As a result, “if you were living under a bridge prior to the storm, as long as you are living under the bridge after they leave, then they’ve done their job.”

Depending on the nature of a disaster and federal government decisions, recovery funds may be available from sources such as FEMA and the Small Business Administration. Disaster-specific federal Community Development Block Grants may also be available, although they are contingent on supplemental congressional appropriations. 38 Following Hurricane Katrina, however, empirical evidence demonstrates that federal funding for permanent housing, including funding from FEMA and from Community Development Block Grants, was heavily slanted over the long run toward owner-occupied homes over rental units. 39 Meanwhile, FEMA’s 2011 National Disaster Recovery Framework, which pays attention to health, housing, infrastructure, and sustainability, has only partially been implemented. State and local governments have expressed confusion about its relation to their efforts and those of federal agencies. 40 Although federal money may be available for disaster unemployment insurance, this is a short-term program with strict eligibility requirements. There is no recourse for undocumented workers, though their American-born children may be eligible for some programs.

The cascading economic and social effects of disasters require recovery efforts that are flexible and attuned to local conditions. Expanded resources for locally embedded VOADs might provide a pathway toward addressing the needs of the poor, minorities, and other marginalized groups throughout the recovery process. During the period between initial disaster response and the release of federal recovery funding, NGEs are critical in responding to unmet needs related to housing, construction, clean-up, and financial strain. Effective VOADs facilitate the formation of Long-Term Recovery Groups, which bring together NGE resources to help families recover. High-quality Long-Term Recovery Groups may provide an effective means of helping government officials and NGEs to pursue recovery efforts that address underlying community vulnerabilities and rebuild in a manner that fosters resilience.

CONCLUSIONS

Relying on survey data, field research, and analysis of IRS data on nonprofits, we examined the role of NGEs during disaster response and in disaster recovery. Under FEMA’s National Response Framework and in practice, NGEs address issues of public safety, health, housing, and economic strain. Our surveys and field research show that NGEs are capable of adapting swiftly and providing services to populations that might be overlooked or wary of interacting with government. As a result, they are well-equipped to address gaps in government ability to address the needs of the marginalized populations that are particularly vulnerable to disasters.

Our analysis of IRS data, however, demonstrated high levels of variation in locally embedded nonprofit resources across counties. While some communities are well-positioned to respond to disasters and to engage in long-term recovery, others are not. In addition, our surveys and interviews highlighted the challenges that NGEs face in coordinating with each other and with government. Our research also draws attention to the differing strategies that NGEs use to identify to whom they will provide services.

As a means of better coordinating response efforts and ensuring that recoveries address underlying social and economic vulnerabilities within a community, the federal government should make an ongoing commitment to funding locally embedded VOADs, regardless of an area’s proximity to recent disasters. Expanded resources for VOADs would improve information sharing and coordination capabilities, helping NGEs to better target their actions and increasing NGE impact in areas with comparatively limited nonprofit resources. Effective VOADs, meanwhile, will facilitate the creation of long-term recovery groups that address underlying community vulnerabilities, helping to reduce local susceptibility to future disasters.

ACKNOWLEDGMENTS

This material is based upon work supported by the National Science Foundation under grant 1800302.

We thank Josué Rosales Rodriguez and Nikita Webb for their invaluable research assistance. We are also thankful to Derek Epp, Zac Greene, George Sledge, Heather Hughes, and Herschel Nachlis for their feedback on this project at various stages. We thank Maranda Spencer, Courtney Pool, and Julian Rangel for providing additional research assistance. We deeply appreciate the feedback and comments we received from anonymous reviewers and from the journal editor. This project was facilitated by the efforts of Ami Keller, Kim Bell, and Rebecca Deen. The University of Texas, Arlington, provided additional research support. We also acknowledge Andrew Caird for providing data visualization code.

Note. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

HUMAN PARTICIPANT PROTECTION

The institutional review board at the University of Texas, Arlington, concluded that our study did not meet the criteria for human participant research given our focus on organizational behavior. We collected written or audio informed consent for all interviewees.

A .gov website belongs to an official government organization in the United States.

A lock ( ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

• Hurricanes or Other Tropical Storms
• Preparedness and Safety Messaging for Hurricanes, Flooding, and Similar Disasters (Second Edition | 2022)
• Natural Disasters and Severe Weather

About Hurricanes and Other Tropical Storms

• Hurricane season starts on May 15 in the north Pacific and June 1 in the Atlantic and the Caribbean. It ends on November 30.
• Know what to do to keep yourself and your loved ones safe before, during, and after the storm.

Be prepared for hurricanes

Hurricane season starts on May 15 in the north Pacific and June 1 in the Atlantic and the Caribbean. It ends on November 30. Before hurricane season each year, make sure you and your family are prepared by planning ahead.

Learn more:

• Preparing for Hurricanes or Other Tropical Storms

Stay safe after the storm

The storm might be over, but that doesn't mean the danger is. Keep yourself and your loved ones safe after the storm by following our safety tips.

• Safety Guidelines: After a Hurricane or Other Tropical Storm
• Floods and Your Safety
• Hurricanes | Ready.gov
• Hurricane Preparedness | Red Cross
• National Hurricane Center (noaa.gov)

Know what to do to keep yourself and your loved ones safe before, during, and after a hurricane or other tropical storm.

For Everyone

Public health.