PRDA - F:Research Priorities in Preparedness

Research Priorities in Emergency Preparedness and
Response for Public Health Systems: A Letter
Report
Bruce M. Altevogt, Andrew M. Pope, Martha N. Hill, and
Kenneth I. Shine, Editors, Committee on Research
Priorities in Emergency Preparedness and Response for
Public Health Systems
ISBN: 0-309-11650-3, 52 pages, 8 1/2 x 11, (2008)
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Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
http://www.nap.edu/catalog/12136.html

Research Priorities in
Emergency Preparedness
and Response for
Public Health Systems
A Letter Report
Committee on Research Priorities in Emergency
Preparedness and Response for Public Health Systems
Board on Health Sciences Policy
Bruce M. Altevogt, Andrew M. Pope, Martha N. Hill,
and Kenneth I. Shine, Editors

Copyright © National Academy of Sciences. All rights reserved.

Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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regard for appropriate balance.
This study was supported by Contract No. 200-2005-13434, TO #10 between
the National Academy of Sciences and the Centers for Disease Control and
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Suggested citation: Institute of Medicine. 2008. Research priorities in
emergency preparedness and response for public health systems: A letter report.
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Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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COMMITTEE ON RESEARCH PRIORITIES IN
EMERGENCY PREPAREDNESS AND
RESPONSE FOR PUBLIC HEALTH SYSTEMS
KENNETH I. SHINE (Chair), The University of Texas System, Austin
MARTHA HILL (Vice Chair), Johns Hopkins University School of
Nursing, Baltimore, Maryland
DAN BLAZER, Duke University Medical Center, Durham, North
Carolina
THEODORE CHAN, San Diego Metropolitan Medical Strike Team,
and University of California–San Diego School of Medicine
VINCENT T. COVELLO, The Center for Risk Communication, New
York
ED GABRIEL, The Walt Disney Company, Burbank, California
JULIA GUNN, Boston Public Health Commission, Massachusetts
SHARONA HOFFMAN, Case Western Reserve University, Cleveland,
Ohio
PAUL JARRIS, The Association of State and Territorial Health
Officials, Washington, DC
ÂNA-MARIE JONES, CARD: Collaborating Agencies Responding to
Disasters, Oakland, California
RICHARD C. LARSON, Massachusetts Institute of Technology,
Cambridge
JOHN LUMPKIN, The Robert Wood Johnson Foundation, Princeton,
New Jersey
RICARDO MARTINEZ, The Schumacher Group, Kennesaw, Georgia
JOANNE NIGG, University of Delaware, Newark
PATRICIA QUINLISK, Iowa Department of Public Health, Des Moines
DAVID ROSS, Public Health Informatics Institute, Decatur, Georgia
IOM Staff
Bruce Altevogt, Study Director
David Butler, Senior Program Officer
Erin Hammers, Research Associate
Amy Haas, Administrative Assistant
Andrew Pope, Director, Board on Health Sciences Policy
Rose Martinez, Director, Board on Population Health and Public Health
Practice

v

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Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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Copyright © National Academy of Sciences. All rights reserved.

Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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INDEPENDENT REPORT REVIEWERS

This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with
procedures approved by the NRC's Report Review Committee. The
purpose of this independent review is to provide candid and critical
comments that will assist the institution in making its published report as
sound as possible and to ensure that the report meets institutional
standards for objectivity, evidence, and responsiveness to the study
charge. The review comments and draft manuscript remain confidential
to protect the integrity of the deliberative process. We wish to thank the
following individuals for their review of this report:
Edward Baker, University of North Carolina School of Public
Health
Frederick M. Burkle, Jr., Johns Hopkins University Medical
Institutions, and Harvard School of Public Health
Bruce Calonge, Colorado Department of Public Health and
Environment
Linda C. Degutis, Yale Center for Public Health Preparedness and
Yale University Section of Emergency Medicine
Baruch Fischhoff, Carnegie Mellon University
Lynn R. Goldman, Johns Hopkins Bloomberg School of Public
Health
Michelle A. Gourdine, Maryland Department of Health and Mental
Hygiene
Maureen Lichtveld, Tulane University School of Public Health
and Tropical Medicine
Judith Monroe, Indiana State Department of Health
vii

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viii

INDEPENDENT REPORT REVIEWERS

Eric K. Noji, The Pentagon
Peter Sandman, Risk Communication Consultant
Although the reviewers listed above have provided many
constructive comments and suggestions, they were not asked to endorse
the conclusions or recommendations nor did they see the final draft of
the letter report before its release. The review of this letter report was
overseen by Don Detmer, American Medical Informatics Association,
and David R. Challoner, University of Florida. Appointed by the
National Research Council and Institute of Medicine, they were
responsible for making certain that an independent examination of this
letter report was carried out in accordance with institutional procedures
and that all review comments were carefully considered. Responsibility
for the final content of this letter report rests entirely with the authoring
committee and the institution.

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Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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CONTENTS

BACKGROUND
Origin of the CDC-Funded Centers for Public Health
Preparedness

5

METHODS
Definitions

9
9

7

FINDINGS
Guiding Principles for the Organization of Centers
and Evaluation of Proposals

13

RECOMMENDATIONS
Enhancing the Usefulness of Training
Improving Timely Emergency Communications
Creating and Maintaining Sustainable Preparedness
and Response Systems
Generating Effectiveness Criteria and Metrics

16
18
20

CONCLUSIONS

26

15

22
25

APPENDIXES
A References
B Public Meeting and Workshop Agenda

ix

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29
31

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Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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Committee on Research Priorities in Emergency Preparedness
and Response for Public Health Systems

January 22, 2008
Richard Besser, M.D.
Director
Coordinating Office for Terrorism Preparedness
and Emergency Response
Centers for Disease Control and Prevention
1600 Clifton Road, NE
Atlanta, GA 30333
Dear Dr. Besser:
On behalf of the Institute of Medicine (IOM) Committee on Research
Priorities in Emergency Preparedness and Response for Public Health
Systems, we are pleased to report our conclusions and recommendations.
As requested, the report delineates a set of near-term research priorities
for emergency preparedness and response in public health systems that
are relevant to the specific expertise resident at schools of public health
and related fields. We understand that these priorities will be used by the
Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER) to develop research funding opportunity announcements that must be issued and filled, according to congressional mandate,
during the 2008 fiscal year.
As described in the committee’s statement of task, the committee considered areas of interest specifically articulated in the Centers for Disease
Control’s (CDC’s) Advancing the Nation’s Health: A Guide for Public
Health Research Needs, 2006–2015, with special attention given to:
•
•

Protecting vulnerable populations in emergencies (improving the
identification of health vulnerability and evaluating interventions
to lessen the risk of poor health outcomes);
Strengthening response systems (developing and evaluating integrated systems of emergency public health services and incident
management);

1

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2

RESEARCH PRIORITIES

•

•

•

Preparing the public health workforce (developing and evaluating strategies and tools to train and exercise the public health
workforce to meet responsibilities for detection, mitigation, and
recovery in varied settings and populations);
Improving timely emergency communications (evaluating characteristics of effective risk communication in emergency settings
and system enhancements to improve effective information exchange across diverse partners and populations under emergency
conditions); and
Improving information management to increase use (scenario
modeling and forecasting; information and knowledge management tools to improve the availability and usefulness during crisis decision making).

The committee conducted a public meeting and workshop (December
18–20, 2007), with invited experts giving their views on research priorities in emergency preparedness and response for public health systems.
Based on the committee’s expert judgment, as well as information exchanged in the public meeting and workshop, we identified four toppriority research areas.
The committee recommends that COTPER give priority to the following
four areas of research in its upcoming funding solicitation for Centers for
Public Health Preparedness (CPHPs):
Recommendation 1: Enhance the Usefulness of
Training
CPHPs should conduct research that will create best
practices for the design and implementation of training
(e.g. simulations, drills, and exercises) and facilitate the
translation of their results into improvements in public
health preparedness.
Recommendation 2: Improve Communications in
Preparedness and Response
CPHPs should conduct research that will identify and
develop communications in relation to preparedness and
response that effectively exchange vital and accurate information in a timely manner with diverse audiences.

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LETTER REPORT

3

Recommendation 3: Create and Maintain Sustainable Preparedness and Response Systems
CPHPs should conduct research that will identify the
factors that affect a community’s ability to successfully
respond to a crisis with public health consequences, and
the systems and infrastructure needed to foster constructive responses in a sustainable manner.
Recommendation 4: Generate Criteria and Metrics
to Measure Effectiveness and Efficiency
CPHPs should conduct research that will generate criteria for evaluating public health emergency preparedness,
response, and recovery and metrics for measuring their
efficiency and effectiveness.
The committee acknowledges that—and indeed intends for—these areas
to generate overlapping research initiatives. All research projects conducted under this initiative should address or be aware of issues regarding vulnerable populations, workforce, behavioral health, and the use and
integration of new technologies as appropriate to the proposed area of
study. In addition, research that is conducted in all of these areas needs to
be translational—designed to result in practical, applicable, and sustainable outcomes that produce a more robust public health system for preparedness. Finally, research must be both multidisciplinary and
crossdisciplinary. Centers should be strongly encouraged to seek collaboration and integration with expertise that may be outside the traditional
arena of schools of public health. For example, disciplines may include
social and behavioral sciences, engineering, economics, ethics, business,
and law, for example.
The committee also acknowledges that the priority area on creating criteria and metrics to measure effectiveness and efficiency is a particularly
challenging one and overlaps with the other three research needs. It is
included as a separate research priority because of its central importance
to the production of sound evidence regarding the state of public health
preparedness. The committee discussed the importance of creating criteria for public health preparedness that would resemble the approach
taken to describe the health-care delivery system in the 2001 IOM report
Crossing the Quality Chasm report (IOM, 2001). Decisions about workforce needs, technology, and other resources depend critically on the re-

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4

RESEARCH PRIORITIES

liable and valid evaluation of public health preparedness systems. Thus
there is a need for specific endeavors that focus on research and development of well-defined measures for use in the assessment of public
health preparedness systems.
The committee wishes to thank you for the opportunity to be of assistance to the Centers for Disease Control and Prevention and its Coordinating Office for Terrorism Emergency Preparedness and Response as
they work to protect the nation’s health.
Kenneth I. Shine, M.D., Chair
Martha N. Hill, Ph.D., R.N., Vice Chair
Committee on Research Priorities in Emergency Preparedness
and Response for Public Health Systems

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LETTER REPORT

5

BACKGROUND
In response to the Pandemic and All Hazards Preparedness Act
(PAHPA) (Public Law 109–417, 2006, § 101 et seq.) there is an immediate and critical need to define research priorities for the Centers for Public Health Preparedness (CPHP) at schools of public health. The
Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER) of the Centers for Disease Control and Prevention
(CDC) charged the Institute of Medicine (IOM) committee responsible
for this study with the task of delineating a set of near-term research priorities for emergency preparedness and response in public health systems
relevant to the expertise resident at schools of public health and related
fields (Box 1). These priorities will be used by COTPER to help develop
a research agenda that will be used to inform research funding opportunity announcements for an enhanced CPHP program. This letter report is
not intended to obviate or substitute the need for a broader research
agenda, but is focused on articulating near-term research priorities for
public health systems research.
In accord with PAHPA, the research agenda, funding opportunity
announcements, and initial funding must be completed by the end of fiscal year 2008. As a framework for their deliberations, the committee’s
statement of task required that they consider the areas of interest articulated in the CDC’s Advancing the Nation’s Health: A Guide for Public
Health Research Needs, 2006–2015 (CDC, 2006), with special attention
given to
•
•
•
•
•

protecting vulnerable populations in emergencies;
strengthening response systems;
preparing the public health workforce;
improving timely emergency communications; and
improving information management to increase use.

COTPER requested that the identified research priorities focus on an
all-hazards approach and not agent-specific activities. Furthermore, it
asked that the committee consider other federal preparedness frameworks—such as applicable Homeland Security Presidential Directives;
the President’s National Science and Technology Council, Subcommittee
on Disaster Reduction; Department of Health and Human Services
(DHHS) guidelines and policies; the CDC’s Advancing the Nation’s

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6

RESEARCH PRIORITIES

BOX 1
Statement of Task
In response to a request from the Centers for Disease Control and Prevention’s (CDC’s) Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER), the Institute of Medicine will convene an ad hoc
committee to conduct a fast-track study and issue a letter report to the director of COTPER. The report will delineate a set of near-term research priorities for emergency preparedness and response in public health systems that
are relevant to the specific expertise resident at schools of public health.
These priorities will be used by COTPER to develop research funding announcements and requests for applications that must be issued and filled,
according to congressional mandate, during the 2008 fiscal year. The committee will be responsible for identifying appropriate research opportunities
and a list of three to five top-priority research areas, each of which may also
include related short-term research opportunities-all with measurable outcomes and impact over the next 3 to 5 years. As a framework for deliberations, the committee will consider areas of interest specifically articulated in
the CDC’s Advancing the Nation’s Health: A Guide for Public Health Research Needs, 2006-2015, with special attention given to
• protecting vulnerable populations in emergencies (improving the identification of health vulnerability and evaluating interventions to lessen the
risk of poor health outcomes);
• strengthening response systems (developing and evaluating strategies
and tools to train and exercise the public health workforce to meet responsibilities for detection, mitigation, and recovery in varied settings
and populations);
• preparing the public health workforce (developing and evaluating strategies and tools to train and exercise the public health workforce to meet
responsibilities for detection, mitigation, and recovery in varied settings
and populations);
• improving timely emergency communications (evaluating characteristics
of effective risk communication in emergency settings and system enhancements to improve effective information exchange across diverse
partners and populations under emergency conditions); and
• improving information management to increase use (scenario modeling
and forecasting; information and knowledge management tools to improve the availability and usefulness during crisis decision making).
The identified research priorities for public health systems should not focus
on agent-specific research questions such as development of highthroughput diagnostic tests or medical countermeasures.

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LETTER REPORT

7

Health guide for research, preparedness goals and objectives, and relevant Department of Homeland Security programs—to focus on research
and development that advances capabilities of the CDC/DHHS mission
in public health preparedness systems.
Origin of the CDC-Funded
Centers for Public Health Preparedness
The CPHPs originated in 1999, when former CDC Director Dr.
Jeffrey Koplan instructed the then-Public Health Practice Program Office
to develop an agency-wide plan to address the CDC’s training and continuing education needs.1 The plan was to establish a cohesive, integrated
approach to training that focused on the domestic public health workforce, a group that was found to have little formal training in public
health, particularly in bioterrorism. This led to the establishment of
CPHPs, whose purpose was to leverage existing expertise and educational materials developed by academic public health institutions and
create linkages to public health practice (Council on Linkages between
Academia and Public Health Practice, 2000).
In December 2007, 27 CPHPs were located within accredited
schools of public health (CDC, 2007). A June 2004 Cooperative Agreement announcement, which was used as a funding mechanism for the
Centers, listed three major goals for them:
1. Strengthen public health workforce readiness through implementation of programs for life-long learning.
2. Strengthen capacity at state and local levels for terrorism preparedness and emergency public health response.
3. Develop a network of academic-based programs that contribute
to national terrorism preparedness and emergency response capacity by sharing expertise and resources across state and local
jurisdictions (69 C.F.R. 30927, et seq.).
However, in response to the PAHPA legislation, the CPHP program
is undergoing a change in emphasis. The legislation requires that accred-

1

Personal communication, L. Biesiadecki, Association of Schools of Public Health,
December 17, 2007.

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8

RESEARCH PRIORITIES

ited schools of public health that wish to receive funding to establish a
center must perform work in one of three areas:2
1. Development, implementation, and dissemination of competency-based programs to train public health practitioners, integrating and emphasizing “essential public health security
capabilities”
2. Evaluation of the public health preparedness and response needs
of the school’s community and development (if necessary) and
dissemination of relevant education materials as well as evaluation of the effectiveness of new training and materials
3. Public health systems research that is consistent with an agenda
to be developed by the Secretary of DHHS (Public Law 109–
417; 120 STAT. 2861)
The first two areas of work are consonant with Centers’ duties prescribed in the earlier Cooperative Agreements. However, the third—the
public health systems research requirement—is new. Legislators realized
that the Act “reflected new priorities in public health preparedness” (U.S.
Senate, 2006, p. 5) and inserted this narrative into the report accompanying it:
The committee finds that public health systems research
is a priority because there has been tremendous financial
investment made to date for public health preparedness
with no evidence-based measures for evaluating progress
or preparedness. Over time, this research will contribute
sufficiently to the knowledge base to further develop
benchmarks and standards (pp. 16–17).
The reference to this new area of focus, public health systems for
preparedness, provides the impetus for the subsequent findings and
recommendations.

2

The committee was informed by COTPER that the CDC has interpreted the congressional intent in this manner; that is, to have separate centers focusing on research on public health systems or the other two areas. However, in testimony received by the
committee, it was stated that some individuals outside COTPER and the CDC believe the
intent of Congress was to expand the mission of the CPHPs to include a focus on all three
areas, not just one.

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LETTER REPORT

9

METHODS
To conduct this expert assessment and identify a set of research priorities, the committee met from December 18 through 21, 2007. This
meeting was held in conjunction with a day-and-a-half long public meeting and workshop (see Appendix B). (Note: Some workshop speakers
used slides in their presentations. Slides are available at http://www.iom.
edu/PHSRpriorities.) The purpose of the workshop was to hear from experts about the importance, feasibility, and “ripeness” of areas of interest,
focusing on broad, integrative research needs that would be helpful in
creating successful systems for preparedness and response and then
evaluating them. In addition, the committee also heard from relevant
stakeholder organizations, including federal agencies and representatives
from the key components of the public health system, to inform the
committee about relevant ongoing and planned initiatives. This letter
report is based on the committee’s expert judgment and assessment of
research priorities in emergency preparedness and response for public
health systems.
Definitions
Public Health Emergency Preparedness
Before identifying research priorities in emergency preparedness and
response for public health systems, the committee believed that it was
necessary to establish a definition of “public health emergency preparedness.” It chose to adopt the definition proposed by Nelson and colleagues
in a 2007 editorial in the American Journal of Public Health:
Public health emergency preparedness (PHEP) is the capability of the public health and health-care systems,
communities, and individuals to prevent, protect against,
quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities.
Preparedness involves a coordinated and continuous
process of planning and implementation that relies on
measuring performance and taking corrective action
(Nelson et al., 2007, p. S9).

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RESEARCH PRIORITIES

The committee recognizes that public health emergency preparedness, response, and recovery takes place in the context of scalable local,
state, tribal, and federal response systems composed of traditional emergency response agencies, public safety agencies, and other governmental
and nongovernmental organizations. Moreover, it recognizes that effective response requires that particular attention be paid to interfaces
among these many interconnected response systems. The committee also
referred to the key elements of preparedness described in Nelson et al.
(2007) (see Box 2). Thus, for the purposes of this report, the committee
uses the term “preparedness” to include the full breadth of preparednessrelated activities, that is, the activities that range from prevention to recovery that are performed by all relevant organizations, including the
many levels of governmental and community organizations.
Public Health and Public Health System
Considering preparedness in the context of the entirety of the public
health system (as is required by the committee’s charge to identify research priorities for preparedness and response in public health systems)
also requires the definitions of “public health” and a “public health system.” To that end, the committee adopted the definition of public health
from the landmark 1988 IOM report The Future of Public Health, which
defined public health as “what we, as a society, do collectively to assure
the conditions in which people can be healthy” (IOM, 1988, p. 1). The
2002 IOM report The Future of the Public’s Health in the 21st Century
describes the concept of a “public health system” as “a complex network
of individuals and organizations that have the potential to play critical
roles in creating the conditions for health” (IOM, 2002, p. 28). It also
lists various factors in a public health system, and explains that they can
both act individually and together to affect health. Figure 1 illustrates
these factors, which include communities, health-care delivery systems,
employers and business, the media, homeland security and public safety,
academia, and the governmental public health infrastructure. As highlighted in the 2002 IOM report, there are other less obvious actors that
can play a significant role “by influencing and even generating the multiple determinants of health” (IOM, 2002). Included in this perspective
are not only the individual and organizational participants, but also the
relevant critical infrastructures that are associated with each. Although

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LETTER REPORT

11

BOX 2
Key Elements of Preparedness, as Defined by Nelson et al. (2007)
A prepared community is one that develops, maintains, and uses a realistic
preparedness plan that is integrated with routine practices and has the
following components:
Preplanned and coordinated rapid-response capability
1. Health risk assessment. Identify the hazards and vulnerabilities (e.g.,
community health assessment, populations at risk, high-hazard industries,
physical structures of importance) that will form the basis of planning.
2. Legal climate. Identify and address issues concerning legal authority and
liability barriers to effectively monitor, prevent, or respond to a public
health emergency.
3. Roles and responsibilities. Clearly define, assign, and test responsibilities
in all sectors, at all levels of government, and with all individuals, and
ensure each group’s integration.
4. Incident Command System (ICS). Develop, test, and improve decision
making and response capability using an integrated ICS at all response
levels.
5. Public engagement. Educate, engage, and mobilize the public to be full
and active participants in public health emergency preparedness.
6. Epidemiology functions. Maintain and improve the systems to monitor,
detect, and investigate potential hazards, particularly those that are
environmental, radiological, toxic, or infectious.
7. Laboratory functions. Maintain and improve the systems to test for
potential hazards, particularly those that are environmental, radiological,
toxic, or infectious.
8. Countermeasures and mitigation strategies. Develop, test, and improve
community mitigation strategies (e.g., isolation and quarantine, social
distancing) and countermeasure distribution strategies when appropriate.
9. Mass health-care. Develop, test, and improve the capability to provide
mass health-care services.
10. Public information and communication. Develop, practice, and improve the
capability to rapidly provide accurate and credible information to the public
in culturally appropriate ways.
11. Robust supply chain. Identify critical resources for public health
emergency response and practice and improve the ability to deliver these
resources throughout the supply chain.
Expert and fully staffed workforce
1. Operations-ready workers and volunteers. Develop and maintain a public
health and health-care workforce that has the skills and capabilities to
perform optimally in a public health emergency.
2. Leadership. Train, recruit, and develop public health leaders (e.g., to
mobilize resources, engage the community, develop interagency
relationships, and communicate with the public).

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RESEARCH PRIORITIES

Accountability and quality improvement
1. Testing operational capabilities. Practice, review, report on, and improve
public health emergency preparedness by regularly using real public
health events, supplemented with drills and exercises when appropriate.
2. Performance management. Implement a performance management and
accountability system.
3. Financial tracking. Develop, test, and improve charge capture,a
accounting, and other financial systems to track resources and ensure
adequate and timely reimbursement.
a
Charge capture systems collect and analyze charges for medical care.
SOURCE: Reprinted with permission from Nelson et al., 2007, p. S10.

Homeland
Security
and Public
Safety

Health Care
Delivery
System

Employers
and
Business

Governmental
Public Health
Infrastructure

Communities

Academia

The Media

FIGURE 1 Public health emergency preparedness system.
SOURCE: Modified from the Future of Public Health in the 21st Century, the
shaded ovals represent the key actors who can work individually or together as
part of a public health system to create the conditions necessary for public health
emergency preparedness, response, and recovery. While each of these actors is a
separate entity, a robust public health system for preparedness requires that each
work together when appropriate. The unshaded ovals represent the necessary
overlap between the key actors as well as the many less obvious actors that play
a significant role in integrating the public health preparedness system (adapted
from IOM, 2002b, Figure 1-2, p. 30).

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these factors have independent functions, their integration, coordination,
and partnerships result in a public health system that can prevent, protect
against, quickly respond to, and recover from public health emergencies.3
In addition, although all parties share responsibility for the integration
and coordination of community resources, the final accountable entity for
resource integration is the local, state, tribal, and federal governmental
public health infrastructure.
Together, these definitions, concepts, and elements provide the
framework that the committee used in its deliberations to identify research priorities for emergency preparedness and response in public
health systems.
FINDINGS
The organization and operations of effective systems of public health
preparedness need to be constituted to cope with a wide range of
threats—the all-hazards approach—including catastrophic health events.
As discussed earlier these systems need to include state, local, tribal, and
federal public health agencies; practitioners from emergency response
and health-care systems; communities, homeland security and public
safety, health-care delivery systems, employers and business, the media,
academia, and individual citizens. Effective response requires that particular attention be paid to interfaces between these many interconnected
systems. Broad integrated systems are needed to prevent, protect against,
quickly respond to, and recover from public health emergencies. Public
health emergencies will vary in scale, timing, predictability, and the potential to overwhelm routine capabilities and to disrupt the provision of
daily life and health-care services.
Research on such systems will require the participation of experts
traditionally represented in schools of public health as well as many
other relevant disciplines, such as social and behavioral sciences, engineering, law, business, economics, communications and the media, ethics, and health professional expertise. The public health preparedness
system requires a sufficiently large infrastructure to support a multi3
“Public health emergencies” have been defined by Burkle (2007) as those “that adversely impact the public health system and/or its protective infrastructure (i.e., water,
sanitation, shelter, food, and health), resulting in both direct and indirect consequences to
the health of a population, and occur when this protective threshold is absent, destroyed,
overwhelmed, not recovered or maintained, or denied to populations.”

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agency, multi-professional, coordinated, and continuous process of planning, drilling and exercising against indicators and metrics, and implementing and testing improvements. Therefore, although PAHPA requires
that CPHPs be established within accredited schools of public health, in
delineating its recommendations, the committee recognizes the need to
integrate additional areas of expertise from the public health system as
well as other relevant areas of expertise that may not traditionally be represented in accredited schools of public health.
The CDC research agenda for CPHPs needs to support studies of
public health systems that address questions whose answers directly impact “on the ground” efforts to protect, improve, and sustain health outcomes and generate results that are generalizable. The design and
conduct of research programs needs to include input from communities
and public health system service providers, particularly those in government. While the charge to this committee focuses upon research that will
produce results in the near-term, over a 3- to 5-year period, it is understood that some important research questions can be answered only by
longer and larger studies of broader scope than those contemplated by
the funding available for the current programs.
After considering the information presented during the public meeting and workshop and based on its expert judgment, the committee identified four priority areas for research that represent specific important
aspects of systems of public health preparedness. The four areas are
•
•
•
•

enhancing the usefulness of training;
improving timely emergency communications;
creating and maintaining sustainable response systems; and
generating effectiveness criteria and metrics.

This fourth research priority area, generating effectiveness criteria and
metrics, does not preclude such criteria and metrics from being developed as part of the research in the other three priority areas. Instead, this
priority emphasizes the central importance that the committee places on
the generation of sound evidence regarding the effectiveness and efficiency of public health preparedness and the need for well-defined criteria and metrics for the overall assessment of the systems.
Research that is conducted in all of these areas needs to be
translational—designed to result in practical, applicable, and sustainable
outcomes that produce a more robust public health system for preparedness. It also needs to address relevant workforce needs, public involve-

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ment in the enterprise, and especially, the effective participation of vulnerable populations. The vulnerabilities of population subgroups vary as
a function of many environmental, sociodemographic, medical/health
status, and other situational factors. Often misunderstood, vulnerability is
not synonymous with ethnicity or race, but rather it varies as a function
of attributes such as age (young and old), literacy, language, functional
health/disability status, isolation, culture, and social networks. The committee also believes that the behavioral and social health of individuals
and community resilience after an episode should be explicitly addressed
in research in all priority areas.
Guiding Principles for the Organization of Centers
and Evaluation of Proposals
The committee assumes that the currently contemplated CDC funding will support administrative functions and a limited number of program grants that could grow into broader support for the network of
research centers. To maximize the research yield the committee offers
the following guiding principles.
Given the limited resources currently allotted to the CDC’s CPHP
program, the committee advises the CDC to fund centers that focus on
research depth, rather than breadth, by focusing primarily only on one of
the committee’s recommended areas, rather than several. To optimize the
research opportunities across CPHPs, centers should also have the capacity to work in partnership with other schools of public health and relevant
academic centers that have complementary research expertise. Further,
the committee also advises the CDC to fund centers that agree to work
together and collaborate, in a network, with other funded centers, and
thereby leverage scarce resources. Through meetings held at least annually, the network of centers would have an opportunity to maximize
analysis of projects, research opportunities, and funding strategies. Meetings of the network of centers might regularly include members of the
practice community.
Each center should assemble investigators from the appropriate
backgrounds and disciplines to allow them to bring their specific competency to their research. This would ensure that the network of centers
would have the full range of competencies needed to answer questions of
public health preparedness (e.g., at least one center would include experts in operations research or in decision analysis). The committee further suggests that each center include additional relevant competency

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that they can bring to the research questions, which they might identify.
As in any field of research, the objectives should include clear and welldefined questions and/or hypotheses about methodologies that will improve the preparedness, response, and recovery of systems of public
health and outcomes for the public.
The evaluation of research proposals should consider the extent to
which multidisciplinary, interdisciplinary, and/or crossdisciplinary
knowledge, expertise and collaboration are employed to maximize effective and efficient response. Evaluation of proposals should also consider
clear efforts to define criteria and metrics for effective programs that include vulnerable populations, an appropriately prepared workforce,
the potential for appropriate and timely change, and the capacity for
continuous quality improvement. Additionally, evaluation of issues
related to communication among public health systems, the health-care
system, political jurisdictions, the private sector, the media, the public,
and particularly, vulnerable populations should be conducted. Ethical and
legal issues also are pervasive concerns in a system of emergency
preparedness and should be included in all research projects. Finally,
each center should have strong connections with the public health practice community.
New technologies have important roles to play in systems of public
health preparedness. These include communications technologies; computer technologies, such as grid computing or virtual reality simulations;
and a host of engineering, biochemical, and medical strategies. Although
these technologies should play a role in center proposals, they must be
assessed in relation to the mission and goals of public health preparedness systems and should be evaluated by metrics that are created to indicate the extent to which they improve system outcomes.
RECOMMENDATIONS
The committee recommends that COTPER give priority to four areas
of research in its upcoming funding solicitation for Centers for Public
Health Preparedness:
Recommendation 1: Enhance the Usefulness of
Training
CPHPs should conduct research that will create best
practices for the design and implementation of training
(e.g., simulations, drills, and exercises) and facilitate the

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translation of their results into improvements in public
health preparedness.
Recommendation 2: Improve Communications in
Preparedness and Response
CPHPs should conduct research that will identify and
develop communications in relation to preparedness and
response that effectively exchange vital and accurate information in a timely manner with diverse audiences.
Recommendation 3: Create and Maintain Sustainable Preparedness and Response Systems
CPHPs should conduct research that will identify the
factors that affect a community’s ability to successfully
respond to a crisis with public health consequences, and
the systems and infrastructure needed to foster constructive responses in a sustainable manner.
Recommendation 4: Generate Criteria and Metrics
to Measure Effectiveness and Efficiency
CPHPs should conduct research that will generate criteria for evaluating public health emergency preparedness,
response, and recovery and metrics for measuring their
efficiency and effectiveness.
The committee acknowledges that—and indeed intends for—these
areas to generate overlapping research initiatives. All research projects
conducted under this initiative should address or be aware of issues regarding vulnerable populations, workforce, behavioral health, and the
use and integration of new technologies.
In relation to each priority area, the thinking that underlies each recommendation and a number of specific potential research questions are
elucidated below. These questions are not meant to be all inclusive, but
rather to provide further clarification of the overall direction the committee suggests for each priority area. However, these suggestions do indicate some of the more pressing issues, which the committee identified for
consideration by the CDC and the research community.

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RESEARCH PRIORITIES

Enhancing the Usefulness of Training
Recommendation 1: Enhance the Usefulness of
Training
CPHPs should conduct research that will create best
practices for the design and implementation of training
(e.g., simulations, drills, and exercises) and facilitate the
translation of their results into improvements in public
health preparedness.
Public health preparedness systems should have the goal of creating
a sustained, replicable capability through formal education, experiential
learning, practice, and experience to plan for, detect, respond to and recover from all hazards. However, the current state of such systems often
falls short of this goal. Training—which includes exercises, drills, the
use of simulation methods, after action analysis of real-life events—does
not readily translate into day-to-day public health practice. There are no
agreed-upon competencies, standards, or performance measures for public health emergency preparedness; however, many groups have begun to
work in this area and these efforts need to be validated and expanded.
The role of public health in the all-hazards continuum is not well described, making it difficult to design training that is relevant and applicable to practice. At times heavily resource-dependent training and drills
are conducted with little or no grounding in conceptual models to guide
development and implementation, and with little or no evaluation of their
cost-effectiveness. To address these deficiencies, the committee believes
that it is necessary to
•
•

•
•

better define the public health emergency response system and
its performance outcomes;
clarify the roles and responsibilities of public health emergency
preparedness and response systems within and across local, state,
tribal, and federal public health systems and the larger emergency response system;
create measurable, meaningful input, process, and outcome performance measures; and
evaluate how training, as defined above, improves the proficiency and performance of public health response systems.

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Among the specific research questions that have merit are
•
•
•
•
•

•
•

•
•
•

What training modalities build lasting capacity and improved
performance?
о Why are these modalities successful?
What education and training promote administrative and operational collaboration and cooperation between public health and
the health-care system?
What are the characteristics of training simulations that produce
the capabilities needed to enhance system performance in a costeffective manner?
What are the advantages and disadvantages of computer simulations compared to other training in enhancing system and specific personnel performance?
What is the evidence that persons involved in different training
modalities perform at a higher level, and for how long is this
higher level of performance sustained? What is the frequency of
training necessary to maintain desired skills?
Which subsets of the public health workforce can best benefit
from various training modalities and why?
Which, and how valid are, training modalities that address the
needs of special populations, including children and vulnerable
populations, and that account for the effect of public health crises and disasters on behavioral health?
Which, and how valid are, training modalities that prepare the
workforce and the public to better respond to emergencies and to
limit the effect of the additional stressors they engender?
Which, and how valid are, training modalities that improve information management and visualization4 to improve decision
analysis and outcomes?
How valid are case studies and standardized assessment tools for
after-action reporting when applied retrospectively to actual public health emergency events?

To address such questions, the committee recommends that tools and
measures be developed that will allow process and performance meas4
Visualization refers to techniques that allow data to be understood by seeing patterns
that are detected by statistical methods, such as pattern recognition methods, and/or simply understood by seeing how geospatial relationships look on a map.

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RESEARCH PRIORITIES

ures of training modalities for evaluation, analysis and comparison of
types of training and experience models. Cost-effective simulation techniques should be given priority, based upon their ability to improve system performance, enhance personnel proficiency, and provide
sustainability.
Improving Timely Emergency Communications
Recommendation 2: Improve Communications in
Preparedness and Response
CPHPs should conduct research that will identify and
develop communications in relation to preparedness and
response that effectively exchange vital and accurate information in a timely manner with diverse audiences.
This recommendation considers all aspects of effective communication, including the importance of content, channels, mechanisms, target
audiences, and other relevant components. Successful emergency communications is a crucial element in effective emergency management and
should assume a central role from the start. It establishes public confidence in the ability of an organization or government to address an
emergency, and to achieve a satisfactory outcome. Effective emergency
communication is also integral to the larger process of information exchange aimed at eliciting trust and promoting understanding of the relevant issues or actions. However, while emergency communication is an
integral component, pre-emergency preparedness communication, including risk communication, also plays a significant role in the development of resilient communities and sustainable response systems.
Effective preparedness and emergency communication aids emergency
management by building, maintaining or restoring trust; improving
knowledge and understanding; guiding and encouraging appropriate attitudes, decisions, actions and behaviors; and encouraging collaboration
and cooperation.
The committee believes that research in this area should concentrate
on two topics: (1) evaluating the characteristics of effective risk communication in pre-emergency and emergency settings, and (2) developing
system enhancements to improve effective information exchange across
diverse populations and entities in pre-emergency and emergency
situations.

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Among the research questions that would generate practical, applicable, and sustainable results on the first topic—the evaluation of effective
risk communication in pre-emergency and emergency settings—are
•

•
•

•

•

•

•

What are the criteria and metrics for effective risk communication in emergency situations with (1) the public health workforce, (2) emergency response partners, (3) the media, (4)
the public, and (5) vulnerable populations? (See also research
opportunities associated with Recommendation 4: Criteria and
Metrics.)
Which risk communication messages motivate people, especially
vulnerable populations, to take protective action and engage in
appropriate behaviors related to emergencies at different scales?
To what extent can market research techniques be used to test
the effectiveness and cultural competence of risk communication
messages developed for the emergency scenarios identified in
the Department of Homeland Security’s National Response Plan
(DHS, 2007) and other relevant preparedness frameworks?
To what extent can research techniques be used to improve the
cultural competence of frontline responders and others involved
disaster policy and decision-makers to improve the success and
outcome of the community response in emergencies?
How can new technologies (e.g., Internet and web-based technologies, and cellular/text messaging) be better used to fill risk
communication gaps in emergency settings, including those experience by vulnerable populations?
How does one optimize and leverage the use of existing channels
of risk communication in emergency settings to reach diverse
audiences, including nonprofit organizations, faith-based organizations, schools, business community, and relevant professional
associations? What are the existing risk communication capacities of these community partners in pre-emergency and emergency settings?
What are the barriers preventing effective translation of preemergency and emergency communication strategies to practitioners?
о What organizational changes are required to implement effective communication strategies?

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RESEARCH PRIORITIES

Research questions relevant to the second topic—system enhancements to improve effective information exchange across diverse populations in pre-emergency and emergency settings—include
•

•

•
•
•

What are the criteria and metrics for system enhancements to
improve effective information exchange within and across diverse partners and populations under pre-emergency and emergency conditions? (See also research opportunities associated
with Recommendation 4: Criteria and Metrics.)
How can information technology innovations (e.g., wireless
technologies, electronic health records, systems integration,
emergency medical response) strengthen emergency response
systems by improving situational awareness, data sharing, and
decision support for the public health workforce?
How can challenges to information technology adoption (e.g.,
robustness, reliability, bandwidth limitations) be overcome for
routine as well as emergency response use?
How do we measure the value of “relationships” or “connectivity” of public health with traditional and nontraditional partners in information exchange in emergency settings?
What are effective mechanisms for enhancing systems of information exchange to reach into vulnerable and special needs
communities in pre-emergency and emergency settings?

Creating and Maintaining Sustainable Preparedness
and Response Systems
Recommendation 3: Create and Maintain Sustainable Preparedness and Response Systems
CPHPs should conduct research that will identify the
factors that affect a community’s ability to successfully
respond to a crisis having public health consequences,
and the systems and infrastructure needed to foster constructive responses.
Systems of public health preparedness, response, and recovery
should be organized to cope with a wide range of threats, including
catastrophic health events and use the all-hazards approach. These systems should be accountable for achieving performance expectations. To

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prevent, protect against, quickly respond to, and recover from health
emergencies, they should include local, state, tribal, and federal public
health agencies; practitioners from emergency response and health-care
systems; communities (e.g., private-sector and civic entities, for example); and individuals. Although crises and disasters having public health
consequences may vary in their scale, timing, and predictability, they all
have the potential to overwhelm routine response capabilities and disrupt
the provision of daily life and health-care services. While some research
has been performed to examine how the different components of the system should interact and be organized, much more research is required to
identify and develop the optimal components, arrangement, and interfaces of the public health system.
Preparedness systems also require infrastructure to support a multiagency, multiprofessional, inclusive, coordinated and continuous process
of planning, testing/exercising, and implementing that relies on measuring performance and taking corrective action. Effective response systems
must have a complex matrix that includes broad use of social, behavioral,
engineering, legal, business, economic, ethical, and media expertise,
among other disciplines. Thus, to be useful, research requires multidisciplinary, interdisciplinary and/or cross-disciplinary expertise that
reaches beyond the traditional boundaries of schools of public health.
However, such public health preparedness systems are not systematically
in place, and therefore the research is required to identify how this matrix
should be developed so that the public health preparedness system as
effective and efficient as possible.
History is full of with examples of communities responding to disasters and catastrophic events, with the quality of response ranging from
exemplary to dysfunctional. These examples can inform more productive
responses in the future. However, lessons can also be learned from other
fields not traditionally a part of the public health system, including operations research, systems engineering, and the business sector.
The major issue to be addressed is what are the preparatory activities
that public health officials can take—working with communities, agencies, and organizations—to maximize effective outcomes of the emergency response system that will have both planned and emergent selforganizing components? Research is needed to identify those factors that
impact the community's ability to respond in a manner that allows for the
best outcome. Among the research questions that would generate practical, applicable, and sustainable results are

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RESEARCH PRIORITIES

•
•

•
•

•

•

•
•
•

What are the critical elements of a public health system that
make it scalable and thereby capable of responding to different
levels of emergency?
What are the lessons to be learned from other academic, professional, and international fields of research and practice (e.g., operations research, systems engineering, and the business sector)
that can and should be integrated into the public health system?
What strategies, if any, should be established improved
coordination of the public health system with other critical
infrastructures?
To what extent does training (e.g., simulations, drills, and exercises) demonstrate the efficacy and capabilities of communities
to become integrated into the response system? (See also research opportunities associated with Recommendation 1: Enhance the Usefulness of Training.)
Can historical accounts, after-action reports, lessons learned, and
similar data from real life events increase the understanding
of how communities best respond, and if so how can this knowledge be better integrated into the public health preparedness
system?
To what extent do coordinated pre-event preparedness activities
impact the efficacy and capability of the public health system to
integrate into the broader response system, including public,
community, and private sectors?
о How can these findings be better integrated into the public
health preparedness system?
How can research results and findings be best applied to ensure a
more effective and rapid response across all scales of emergencies, from small community to national events?
Are there ways to collect and maintain data during events for
later analysis that are not time or resource intensive and do not
disrupt response?
How can the “tipping points” that require abrupt changes to alternative response systems be identified, and how are these alternative systems sustained?

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Generating Effectiveness Criteria and Metrics
Recommendation 4: Generate Criteria and Metrics
to Measure Effectiveness and Efficiency
CPHPs should conduct research that will generate criteria for evaluating public health emergency preparedness,
response and recovery, and metrics for measuring their
efficiency and effectiveness.
The nation has invested large amounts of financial and human capital
in enhancing the public health system’s ability to prepare for, respond to,
and recover from emergency events. However, it is difficult to measure
objectively the progress that has been made and the preparedness gaps. A
critical need exists for validated criteria and metrics that enable public
health systems to achieve continuous improvement and to demonstrate
the value of society’s investment. The committee believes that work in
this area should concentrate on the following issues:
1. What are the appropriate criteria for evaluating public health
emergency preparedness, response, and recovery?
Priority areas include (1) the public health workforce; (2) information management; (3) emergency communications; (4) vulnerable populations; and (5) response systems. The criteria
should include components of planning, structure, process, and
continuous improvement. The legal and ethical implications of
recommended criteria should be analyzed. Likewise, recommendations should address how each criterion is applicable at the local, tribal, state, and federal levels.
2. What are the appropriate metrics to quantify achievement with
respect to these criteria, and how can they be validated?
Metrics should be practical, clear, and accessible to practitioners
and the public. They should be designed to drive and reward
continuous quality improvement, measuring both efficiency and
effectiveness.
Among the research questions that would generate practical, applicable, and sustainable results in the development of criteria and metrics are
•

What are appropriate criteria for decision-making processes in
planning, response, and recovery? These include criteria for im-

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RESEARCH PRIORITIES

•
•

•
•
•

plementation, testing, and improvement of the decision-making
process. The criteria should take into account existing practice,
experience, and theory.
What are appropriate criteria for the application of continuous
quality improvement of the structure and process of planning, response, and recovery?
What are appropriate criteria for planning and implementation of
clear and accessible communication with the public, recognizing
the specific needs of vulnerable populations? (See also Recommendation 2: Communications.)
What are appropriate criteria to quantify the effectiveness with
which the public health system addresses the social and behavioral impacts of events in planning, response, and recovery?
What are appropriate criteria to measure the public’s expectations, experience and satisfaction with respect to public health
emergency planning response and recovery efforts?
To what extent, if any, will accreditation standards for state and
local health departments contribute to an agency’s preparedness
as it relates to capacity and performance?

Finally, the committee discussed the importance of creating criteria
for public health preparedness that would resemble the approach taken to
describe the health-care delivery system in the 2001 IOM report Crossing the Quality Chasm (IOM, 2001).
CONCLUSIONS
Although the overall success of this research initiative will necessitate substantially more resources than those currently available, the
committee believes the thrust of this activity is extremely important and
potentially powerful for the field of public health preparedness. The proposed research projects seek to provide evidence on which important
decisions about the nature and distribution of public health preparedness
resources can be based. By insisting on well-described metrics, the research offers the chance for more rational decisions about these resource
requirements as well as the opportunity to undertake continuous quality
improvement in the preparedness field.
This initiative needs to bring research rigor to the analysis of existing
data about previous events and test hypotheses that can further advance

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the field. It will stimulate important new collaborations between two
groups: (1) traditional public health researchers and practitioners, and (2)
collaborators from a variety of other disciplines not previously engaged
in public health systems of research.
Through the engagement of those who provide public health preparedness services in the community, this initiative offers the opportunity
for research that is practical, applicable, and sustainable. In so doing, it
will strengthen the growing relationships between academic public health
and public health practitioners, in addition to the broader public and
other emergency preparedness practitioners. The committee is convinced
that the creative energies of those in academia and in the public health
community can provide a body of well-researched evidence that will
contribute to the best possible system for maintaining the health and welfare of the American people.

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A
References

Burkle, F. M., Jr. 2007. Public health emergencies, cancer, and the legacy of
Katrina. Prehosp Disaster Med 22(4):291–292.
CDC (Centers for Disease Control and Prevention). 2006. Advancing the nation’s health: A guide to public health research needs, 2006–2015. Washington, DC: CDC, http://www.cdc.gov/od/science/PHResearch/cdcra/AdvancingTheNationsHealth.pdf (accessed December 4, 2007).
CDC. 2007. Centers for Public Health Preparedness (CPHP) program. The
centers, http://www.bt.cdc.gov/training/cphp/centers.asp (accessed December 12, 2007).
Council on Linkages Between Academia and Public Health Practice. 2000.
Meeting minutes. Wednesday, October 5, 2000, http://www.phf.org/Link/
min102500.pdf (accessed December 23, 2007).
DHS (Department of Homeland Security). 2007. DHS National Response Plan,
http://www.dhs.gov/xprepresp/committees/editorial_0566.shtm.
IOM (Institute of Medicine). 1998. The future of public health. Washington,
DC: National Academy Press.
IOM. 2001. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
IOM. 2002. The future of the public’s health in the 21st century. Washington,
DC: The National Academies Press.
Nelson, C., N. Lurie, J. Wasserman, and S. Zakowski. 2007. Conceptualizing
and defining public health emergency preparedness. Am J Public Health
97(Suppl 1):S9–S11.
U.S. Senate. 2006 (August 3). Pandemic and All-Hazards Preparedness Act.
Report [to accompany S. 3678]. Report 109–319, http://frwebgate.access.
gpo.gov/cgi-bin/getdoc.cgi?dbname=109_cong_reports&docid=f:sr319.109.
pdf. (accessed December 23, 2007).

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B
Public Meeting and Workshop Agenda

Research Priorities in Emergency Preparedness and Response
for Public Health Systems
Board on Health Sciences Policy
Public Meeting
Tuesday, December 18, 2007
National Academy of Sciences Keck Building
Room 100
500 Fifth St., NW
Washington, DC 20001
BACKGROUND AND OVERVIEW
Session Objective: To obtain a better understanding of the background to the
study and the charge to the committee. To have a discussion with the key
stakeholders and others about existing frameworks and viewpoints on the critical
research gaps and challenges for public health preparedness systems.
3:00 p.m.

Welcome and Introductions
KENNETH SHINE
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System
MARTHA HILL
Committee Vice Chair
Dean
The Johns Hopkins University School of Nursing
31

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32
3:15

RESEARCH PRIORTIES

Background and Charge to the Committee
RICHARD BESSER
Director
Coordinating Office for Terrorism Preparedness and
Emergency Response
Centers for Disease Control and Prevention

3:45

Panel Discussion: Stakeholder Perspectives
Each panelist will be asked to limit remarks to 15 minutes;
committee discussion will follow all panelist presentations.
Related Activities Underway by the DHHS Office of the
Assistant Secretary for Preparedness and Response
WILLIAM RAUB
Science Advisor to the Secretary
Department of Health and Human Services
Related Activities Underway by the Department of Homeland
Security
JEFF RUNGE
Chief Medical Officer
Department of Homeland Security
Related Activities Underway at the State Level
JUDITH MONROE
President-Elect
Association of State and Territorial Health Officials
What Should the PHEP Evidence Base Look Like?
CHRISTOPHER NELSON
Senior Political Scientist
Thomas Lord Distinguished Scholar
RAND Corporation
Science Functions in Public Health Emergency Response and
Key Support Systems
EDDY BRESNITZ
President
Council of State and Territorial Epidemiologists
Deputy Commissioner/State Epidemiologist
NJ Department of Health and Senior Services

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33

APPENDIX B

Perspectives from the American Public Health Association
LINDA DEGUTIS
President
American Public Health Association
5:00

Committee Discussion
KENNETH SHINE
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System

6:00

Adjourn

Research Priorities in Emergency Preparedness and Response
for Public Health Systems
Board on Health Sciences Policy
Public Workshop
Wednesday, December 19, 2007
National Academy of Sciences Keck Building
Room 100
500 Fifth St., NW
Washington, DC 20001
Workshop Goals
• Identify the most promising near-term (3- to 5-year) opportunities to
improve the public health systems responsible for emergency
preparedness and response for catastrophic events.
о Each speaker has been asked to specifically identify 1–2 areas
where there are gaps in knowledge in public health systems and
a set of short-term research priorities to help address them.
• Identify research opportunities for emergency preparedness and response
in public health systems that are relevant to the specific expertise resident
at schools of public health.
о Each priority should have measurable outcomes that will likely
result in near-term improvements to public health systems for
preparedness over the next 3 to 5 years.

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Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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34
8:00 a.m.

RESEARCH PRIORTIES

Welcome and Introductions
KENNETH SHINE
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System

8:15

Background and Charge to the Committee
RICHARD BESSER
Director
Coordinating Office for Terrorism Preparedness and
Emergency Response
Centers for Disease Control and Prevention

8:30

Public Health System Research: Survey of the Field, Gaps and
Near-Term Needs
DAVID ABRAMSON
Director of Research
National Center for Disaster Preparedness
Mailman School of Public Health
Columbia University

8:45

Perspectives from Schools of Public Health
HARRISON SPENCER
President and CEO
Association of Schools of Public Health
SESSION I: PANEL DISCUSSION:
PREPARING THE PUBLIC HEALTH WORKFORCE

Session Objective: To identify research opportunities that may be used to
develop and evaluate strategies and tools that can be used to train and exercise
the public health workforce to meet responsibilities for detection, mitigation,
and recovery in varied settings and populations.
KENNETH SHINE, Session Chair
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System

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35

APPENDIX B

9:00

Panel Discussion: Preparing the Public Health Workforce
Each panelist will be asked to speak for 10 minutes to give his
or her perspective on research gaps and priorities.
ED BAKER
Director
North Carolina Institute for Public Health
University of North Carolina School of Public Health
DEBRA OLSON
Associate Dean of Public Health Practice
University of Minnesota School of Public Health
BRIAN FLYNN
Associate Director of the Center for the Study of
Traumatic Stress
Adjunct Professor of Psychiatry
Department of Psychiatry
Uniformed Services University of Health Sciences
SALLY PHILLIPS
Director
Public Health Emergency Preparedness
Agency for Healthcare Research and Quality
REBECCA HEAD
Health Officer
Monroe County Public Health Department
National Association of County and City Health Officials

10:00

Discussion with Committee
KENNETH SHINE, Session Chair
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System

10:40

Break

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36

RESEARCH PRIORTIES

SESSION II: PANEL DISCUSSION:
IMPROVING INFORMATION MANAGEMENT
Session Objective: To identify research opportunities that would allow for
improved availability and usefulness of scenario modeling and forecasting and
knowledge management tools during crisis decision making.
MARTHA HILL, Session Chair
Committee Vice Chair
Dean
The Johns Hopkins University School of Nursing
10:55

Panel Discussion: Improving Information Management
Each panelist will be asked to speak for 10 minutes to give his
or her perspective on research gaps and priorities.
STEVEN PHILLIPS
Associate Director for Specialized Information Services
National Library of Medicine
JOHN HARRALD
Director
Institute for Crisis, Disaster, and Risk Management
George Washington University
STEVEN H. HINRICHS
University of Nebraska
Stokes-Shackleford Professor of Pathology
Department of Pathology/Microbiology
Director, Center for Biosecurity
Director, Nebraska Public Health Laboratory
GUS BIRKHEAD
Deputy Commissioner, Office of Public Health
New York State Department of Health

11:40

Discussion with Committee
MARTHA HILL, Session Chair
Committee Vice Chair
Dean
The Johns Hopkins University School of Nursing

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37

APPENDIX B

SESSION III: PANEL DISCUSSION:
IMPROVING TIMELY EMERGENCY COMMUNICATIONS
Session Objective: To identify research opportunities and evaluate
characteristics of effective risk communication in emergency settings and
system enhancements to improve effective information exchange across diverse
partners and populations under emergency conditions.
KENNETH SHINE, Session Chair
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System
1:00 p.m.

Panel Discussion: Improving Timely Emergency
Communications
Each panelist will be asked to speak for 10 minutes to give his
or her perspective on research gaps and priorities.
NANCY MCKELVEY
Chief Nurse
American Red Cross
DAVID ROPEIK
Risk Communication Consultant
BARBARA COCHRAN
President
Radio-Television News Directors Association
JAYNE LUX
Director
Global Health Benefits Institute
National Business Group on Health

1:45

Discussion with Committee
KENNETH SHINE, Session Chair
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System

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38

RESEARCH PRIORTIES

SESSION IV: PANEL DISCUSSION:
PROTECTING VULNERABLE POPULATIONS IN EMERGENCIES
Session Objective: To identify research opportunities that will result in
improved identification of health vulnerabilities and evaluation of interventions
designed to lessen the risk of poor health outcomes.
MARTHA HILL, Session Chair
Committee Vice Chair
Dean
The Johns Hopkins University School of Nursing
2:45

Panel Discussion: Protecting Vulnerable Populations in
Emergencies
Each panelist will be asked to speak for 10 minutes to give his
or her perspective on research gaps and priorities.
GEORGE FOLTIN
Director
Center for Pediatric Emergency Medicine
NYU Medical Center
ERIC BAUMGARTNER
Director
Office of Policy and Program Development
Louisiana Public Health Institute
MAUREEN LICHTVELD
Chair
Department of Environmental Health Science
Tulane University School of Public Health and Tropical
Medicine
MICHELLE GOURDINE
Deputy Secretary of Public Health Services
Maryland Department of Health and Mental Hygiene
MONICA SCHOCH-SPANA
Senior Fellow
Center for BioSecurity
University of Pittsburgh Medical Center

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Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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39

APPENDIX B

3:40

Discussion with Committee
MARTHA HILL, Session Chair
Committee Vice Chair
Dean
The Johns Hopkins University School of Nursing
GENERAL DISCUSSION WITH ATTENDEES

4:25

Discussion with Meeting Participants and Audience
KENNETH SHINE
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System
MARTHA HILL
Committee Vice Chair
Dean
The Johns Hopkins University School of Nursing

5:00

Workshop Adjourns for the Day
Thursday, December 20, 2007

10:00 a.m.

Welcome and Introductions
KENNETH SHINE
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System
SESSION V: PANEL DISCUSSION:
STRENGTHENING RESPONSE SYSTEMS

Session Objective: To identify research opportunities that will assist in the
development and evaluation of integrated systems of emergency public health
services and incident management, including performance measurement and
evaluation.
KENNETH SHINE, Session Chair
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System

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40
10:10

RESEARCH PRIORTIES

Panel Discussion: Strengthening Response Systems
Each panelist will be asked to speak for 10 minutes to give his
or her perspective on research gaps and priorities.
DREW DAWSON
Director
Office of Emergency Medical Services
National Highway Traffic Safety Administration
LESLEE STEIN-SPENCER
Program Advisor
National Association of State EMS Officials
LEONARD MARCUS
Co-Director
National Preparedness Leadership Initiative: A joint
program of the Harvard School of Public Health and the
Kennedy School of Government Director Program for
Health Care Negotiation and Conflict Resolution
Harvard School of Public Health
JOSEPH BARBERA
Co-Director
Institute for Crisis, Disaster, and Risk Management
The George Washington University

10:55

Discussion with Committee
KENNETH SHINE, Session Chair
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System
SUMMARY AND GENERAL DISCUSSION

11:30

Panel Discussion: Summary of Major Issues and Potential
Research Priorities
LYNN GOLDMAN
Chair
Interdepartmental Program in Applied Public Health
Johns Hopkins Bloomberg School of Public Health

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Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
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41

APPENDIX B

JOHN HARRALD
Director
Institute for Crisis, Disaster, and Risk Management
The George Washington University
JUDITH MONROE
President-Elect
Association of State and Territorial Health Officials
12:00 p.m.

General Discussion with Committee and Attendees
KENNETH SHINE
Committee Chair
Executive Vice Chancellor for Health Affairs
The University of Texas System
MARTHA HILL
Committee Vice Chair
Dean
The Johns Hopkins University School of Nursing

1:00

Adjourn Workshop

Copyright © National Academy of Sciences. All rights reserved.

Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report
http://www.nap.edu/catalog/12136.html

Copyright © National Academy of Sciences. All rights reserved.