Healthy, Resilient, and Sustainable
Strategies, Opportunities, and
Planning for Recovery
Committee on Post-Disaster Recovery of a Community’s Public Health, Medical, and Social Services
Board on Health Sciences Policy
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by contracts between the National Academy of Sciences and the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response (Contract No. HHSO100201200037A and Contract No. 1 HITEP130013-01-00); the U.S. Department of Housing and Urban Development (Contract No. 1 HITEP130013-01-00); and the Robert Wood Johnson Foundation (Contract No. 71003 and Contract No. 72398). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
Library of Congress Cataloging-in-Publication Data
Institute of Medicine (U.S.). Committee on Post-Disaster Recovery of a Community’s Public Health, Medical, and Social Services, author.
Healthy, resilient, and sustainable communities after disasters : strategies, opportunities, and planning for recovery / Committee on Post-Disaster Recovery of a Community’s Public Health, Medical, and Social Services, Board on Health Sciences Policy, Institute of Medicine of the National Academies.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-309-31619-4 (pbk.) — ISBN 978-0-309-31620-0 (pdf) I. Title.
[DNLM: 1. Community Health Services—organization & administration—United States. 2. Disaster Planning—organization & administration—United States. 3. Health Policy—United States. 4. Public Health Administration—methods—United States. 5. Relief Work--organization & administration—United States. 6. Survivors—United States. WA 546 AA1]
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Suggested citation: IOM (Institute of Medicine). 2015. Healthy, resilient, and sustainable communities after disasters: Strategies, opportunities, and planning for recovery. Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.
COMMITTEE ON POST-DISASTER RECOVERY OF A COMMUNITY’S
PUBLIC HEALTH, MEDICAL, AND SOCIAL SERVICES
REED V. TUCKSON (Chair), Managing Director, Tuckson Health Connections, LLC, Sandy Springs, Georgia
DANIEL P. ALDRICH, Associate Professor of Political Science, Purdue University, West Lafayette, Indiana
STEVEN BLESSING, Chief, Emergency Medical Services and Preparedness Section, Delaware Division of Public Health, Smyrna, Delaware
LYNN BRITTON, President and Chief Executive Officer, Mercy Health, Chesterfield, Missouri
HARRY L. BROWN, Senior Vice President of Community Planning and Initiatives, United Way of Central Alabama, South Birmingham, Alabama
TERRY L. CLINE, Commissioner of Health, Oklahoma State Department of Health, Oklahoma City, Oklahoma
LAWRENCE DEYTON, Clinical Professor of Medicine, School of Medicine and Health Sciences and Professor of Health Policy, School of Public Health, The George Washington University, Washington, DC
ALISA DIGGS, Clinical Advisor, Office of Preparedness and Response, Maricopa County Department of Public Health, Phoenix, Arizona
DENNIS DURA, Emergency Management Consultant, Trenton, New Jersey
J. BARRY HOKANSON, Principal, PLN Associates, Grayslake, Illinois
DAVID E. JACOBS, Director of Research, National Center for Healthy Housing, Chicago, Illinois
AGNES LESHNER, Former Director of Child Welfare Services, Montgomery County Department of Health and Human Services, Potomac, Maryland
ROBERT S. OGILVIE, Director, SPUR Oakland, Oakland, California
RICHARD REED, Senior Vice President, Disaster Cycle Services, American Red Cross, Washington, DC
RICHARD SERINO, Distinguished Visiting Fellow, National Preparedness Leadership Initiative, Harvard School of Public Health; Deputy Administrator Federal Emergency Management Agency (retired), Abington, Massachusetts
CIRO UGARTE, Director, Department of Emergency Preparedness and Disaster Relief, Pan American Health Organization/World Health Organization, Washington, DC
LINDA USDIN, President, swamplily, llc, New Orleans, Louisiana
AUTUMN S. DOWNEY, Study Director
LAUREN SHERN, Associate Program Officer (August 2013 to May 2014)
RACHEL KIRKLAND, Associate Program Officer (April 2014 to September 2014)
MEGAN REEVE, Associate Program Officer (from November 2014)
ELIZABETH CORNETT, Research Assistant (from October 2014)
Y. CRYSTI PARK, Senior Program Assistant
JACK HERRMANN, Senior Program Officer (from November 2014)
BRUCE ALTEVOGT, Senior Program Officer
ANDREW M. POPE, Director, Board on Health Sciences Policy
STEVEN BINGLER, President, Concordia
RONA BRIERE, Senior Editor
MELISSA BRYMER, Director, Terrorism and Disaster Programs, National Center for Child Traumatic Stress, University of California, Los Angeles
MIRIAM DAVIS, Independent Medical Writer
ERIN HAMMERS FORSTAG, Independent Medical Writer
GAVIN SMITH, Executive Director, Department of Homeland Security Coastal Hazards Center of Excellence, Associate Professor, Department of City and Regional Planning, University of North Carolina at Chapel Hill
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 National Research Council’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:
John Agwunobi, Former President Walmart Health and Wellness
Allison Blake, New Jersey Department of Children and Families
Frederick M. Burkle, Jr., Harvard School of Public Health
Anita Chandra, RAND Corporation
C. Robert Cloninger, Washington University School of Medicine
James Craig, Mississippi State Department of Health
Brian W. Flynn, Uniformed Services University of the Health Sciences
Jeffery Hebert, New Orleans Redevelopment Authority
Anthony B. Iton, The California Endowment
Vivian E. Loftness, Carnegie Mellon University
Kevin Massey, Advocate Lutheran General Hospital
Scott M. Needle, Healthcare Network of Southwest Florida
Jan Opper, Opper Strategies & Solutions, LLC
Samantha Phillips, City of Philadelphia
Mary Pittman, Public Health Institute
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft
of the report before its release. The review of this report was overseen by Bobbie Berkowitz, Columbia University, and Joan B. Rose, Michigan State University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Healthy, Resilient, and Sustainable Communities After Disasters is intended as both a call to action and an action guide for maximally leveraging the resources associated with disaster planning and recovery toward realizing healthier communities. The report is premised in the study committee’s appreciation of the importance of engaging all community stakeholders and available resources thoughtfully, creatively, and appropriately in working synergistically to address the unacceptable reality that the nation’s communities, and its people, are less healthy than they can and should be. The report is intended to focus the attention of those individuals and organizations involved in planning for and carrying out disaster recovery activities and those involved in planning for and building healthy communities on leveraging the millions and sometimes billions of dollars associated with disaster events more effectively toward maximizing healthiness. It would seem intuitive that a community confronted by the tragic necessity of rebuilding roads, houses, health care institutions, parks, and other critical elements of its infrastructure would intentionally seek to optimize health status as one of its major priorities. Unfortunately, as documented in this report, creating healthy communities usually is not high on the list of disaster planning or recovery efforts, and too often a significant gulf exists between the nation’s dedicated disaster officials and their equally praiseworthy health leader counterparts. In this context, this report is intended to highlight the key opportunities that disaster recovery offers to advance the social goal of maximizing the health of communities, and to provide practical recommendations for how diverse stakeholders can work more collaboratively to realize this goal in the normal course of addressing their specific accountabilities. It is the committee’s hope that the disaster professional community and the health professional community both will see this report as relevant to their work and, in the process, be drawn more closely together.
In this report, the committee endorses a comprehensive definition of a healthy community proposed by the National Network of Public Health Institutes:
A healthy community is one in which a diverse group of stakeholders collaborate to use their expertise and local knowledge to create a community that is socially and physically conducive to health. Community members are empowered and civically engaged, assuring that all local policies consider health. The community has the capacity to identify, address, and evaluate their own health concerns on an ongoing basis, using data to guide and benchmark efforts. As a result, a healthy community is safe, economically secure, and environmentally sound, as all residents have equal access to high quality educational and employment
opportunities, transportation and housing options, prevention and healthcare services, and healthy food and physical activity opportunities.
This vision was important to the committee’s work in large measure because of its emphasis on holistic engagement and community-specific strategies. Testimony before the committee consistently emphasized that no “one-size-fits-all” strategy or menu of recommendations will work everywhere or fit every scenario. A consistent lesson learned, however, was the importance of pre-disaster planning that proactively links disaster and health leadership at the community level and that benefits from the accumulated wisdom gleaned from other experiences.
The committee appreciates the thoughtful vision of the study sponsors: the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services (HHS); the Office of Lead Hazard Control and Healthy Homes at the U.S. Department of Housing and Urban Development (HUD); the Veterans Health Administration at the U.S. Department of Veterans Affairs (VA); and the Robert Wood Johnson Foundation. They all recognized the need for recommendations and guidance that would be useful to local and national leaders who were sensitized to the need to mitigate disaster-related health impacts and optimize the use of rebuilding resources to pursue the goal of creating communities that are healthier and more resilient in a more proactive, deliberate, and thoughtful manner. The committee’s work benefited greatly from the exceptional Institute of Medicine staff team, led by study director Autumn Downey and including Bruce Altevogt, Elizabeth Cornett, Jack Herrmann, Rachel Kirkland, Crysti Park, Megan Reeve, and Lauren Shern. We are also indebted to the consultants who contributed substantially to this project. Steven Bingler, Melissa Brymer, and Gavin Smith lent the committee their invaluable expertise, and the report could not have been produced without the technical writing and editing contributions of Rona Briere, Miriam Davis, and Erin Hammers Forstag. Finally, I wish to offer thanks and acknowledgment to my fellow committee members, all of whom gave generously of their time in the undertaking of this important and challenging task.
After 18 months of careful examination of testimony from a wide array of officials and experts, case studies, and the available literature, three compelling impressions remain with the committee members. First are the heartbreaking stories of misery and suffering experienced by so many people who live with or die prematurely from preventable illnesses and the many others who become sickened or injured as a result of experiencing a disaster event. We want better for them. Second is the gratitude that cannot be expressed often enough to the nation’s disaster planning and response officials, workers, and volunteers, most of whom labor in anonymity and often are taken for granted. The nation needs more of them, and they deserve more from all Americans. Third, because no community is immune to a devastating event and because no community is maximally healthy, every reader of this report is urged to use this opportunity to contribute immediately to a process of collaborative planning that brings all stakeholders and community residents together to envision a healthy community, assess and prioritize key deficiencies, and then engage the resources and expertise of the disaster community as a key component of the collective effort to achieve an environment in which all people have the opportunity to live maximally healthy lives. It is the committee’s hope that the observations and recommendations offered in this report will serve as a call to action and a useful guide for transformative action.
Reed V. Tuckson, M.D., Chair
Committee on Post-Disaster Recovery of a Community’s
Public Health, Medical, and Social Services
Boxes, Figures, and Tables
Acronyms and Abbreviations
|ACA||Patient Protection and Affordable Care Act|
|ACF||Administration for Children and Families|
|ACL||Administration for Community Living|
|AHRQ||Agency for Healthcare Research and Quality|
|ASLA||American Society of Landscape Architects|
|ASPR||Assistant Secretary for Preparedness and Response|
|ASTHO||Association of State and Territorial Health Officials|
|CAN||Coordinated Assistance Network|
|CART||Citizens Advisory Recovery Team|
|CBITS||Cognitive-Behavioral Intervention for Trauma in Schools|
|CCDF||Child Care and Development Fund|
|CCP||Crisis Counseling Assistance and Training Program|
|CDBG||Community Development Block Grant|
|CDBG-DR||Community Development Block Grant for Disaster Recovery|
|CDC||Centers for Disease Control and Prevention|
|CDFI||Community Development Financial Institution|
|CEHD||Center to Eliminate Health Disparities|
|CERA||Canterbury Earthquake Recovery Authority|
|CHNA||community health needs assessment|
|CHW||community health worker|
|CMS||Centers for Medicare & Medicaid Services|
|COAD||Community Organizations Active in Disaster|
|CONOPS||Concept of Operations|
|COOP||continuity of operations|
|CPCB||Community Planning and Capacity Building|
|DCMP||Disaster Case Management Program|
|DHS||U.S. Department of Homeland Security|
|DMAT||disaster medical assistance team|
|DMORT||disaster mortuary operational response team|
|DOT||U.S. Department of Transportation|
|D-SNAP||Disaster-Supplemental Nutrition Assistance Program|
|EDA||Economic Development Administration|
|EMAC||Emergency Management Assistance Compact|
|EMPG||Emergency Management Performance Grant|
|EMTALA||Emergency Medical Treatment and Active Labor Act|
|EPA||U.S. Environmental Protection Agency|
|ESAR-VHP||Emergency System for Advance Registration of Volunteer Health Professionals|
|ESF||Emergency Support Function|
|FEMA||Federal Emergency Management Agency|
|FHA||Federal Housing Administration|
|FHWA||Federal Highway Administration|
|FQHC||federally qualified health center|
|FTA||Federal Transit Administration|
|GAO||U.S. Government Accountability Office|
|GIS||geographic information systems|
|HAvBED||Hospital Available Beds for Emergencies and Disasters|
|HDMT||Healthy Development Measurement Tool|
|HFA||Hyogo Framework for Action|
|HHS||U.S. Department of Health and Human Services|
|HIA||health impact assessment|
|HiAP||Health in All Policies|
|HIPAA||Health Insurance Portability and Accountability Act|
|HMGP||Hazard Mitigation Grant Program|
|HPP||Hospital Preparedness Program|
|HSGP||Homeland Security Grant Program|
|HUD||U.S. Department of Housing and Urban Development|
|HVA||hazard vulnerability assessment|
|IOM||Institute of Medicine|
|IRS||Internal Revenue Service|
|LACCDR||Los Angeles County Community Disaster Resilience|
|LEED||Leadership in Energy & Environmental Design|
|LEED-ND||Leadership in Energy & Environmental Design for Neighborhood Development|
|LTRC||long-term recovery committee|
|MAPP||Mobilizing for Action through Planning and Partnerships|
|MARC||multi-agency resource/relief center|
|MOA||memorandum of agreement|
|MPO||metropolitan planning organization|
|MRC||Medical Reserve Corps|
|NACCHO||National Association of County and City Health Officials|
|NDRF||National Disaster Recovery Framework|
|NEN||Neighborhood Empowerment Network|
|NEPA||National Environmental Policy Act|
|NHSS||National Health Security Strategy|
|NHTSA||National Highway Traffic Safety Administration|
|NIH||National Institutes of Health|
|NRF||National Response Framework|
|PAHPA||Pandemic and All-Hazards Preparedness Act|
|PCCI||Parkland Center for Clinical Innovation|
|PCMH||patient-centered medical home|
|PDRP||post-disaster redevelopment plan|
|PFA||psychological first aid|
|PHEP||Public Health Emergency Preparedness|
|PTSD||posttraumatic stress disorder|
|RSF||Recovery Support Function|
|SAMHSA||Substance Abuse and Mental Health Services Administration|
|SBA||Small Business Administration|
|SCI||Sustainable Communities Index|
|SERG||SAMHSA’s Emergency Response Grant|
|SFRA||San Francisco Redevelopment Agency|
|SNAP||Supplemental Nutrition Assistance Program|
|SPR||skills for psychological recovery|
|SSBG||Social Services Block Grant|
|SSBG-DR||Social Services Block Grant for Disaster Recovery|
|TAC||Technical Advisory Committee|
|TF-CBT||trauma-focused cognitive-behavioral therapy|
|THIRA||threat and hazard identification and risk assessment|
|TIF||tax increment financing|
|TIGER||Transportation Investment Generating Economic Recovery|
|UNISDR||United Nations International Strategy for Disaster Reduction|
|USDA||U.S. Department of Agriculture|
|VA||U.S. Department of Veterans Affairs|
|VOAD||Voluntary Organizations Active in Disaster|
|WHO||World Health Organization|
|WIC||Special Supplemental Nutrition Program for Women, Infants, and Children|
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|Community health assessment1||A systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. The ultimate goal of a community health assessment is to develop strategies to address the community’s health needs and identified issues. A variety of tools and processes may be used to conduct a community health assessment; the essential ingredients are community engagement and collaborative participation (PHAB, 2013, p. 10).|
|Disaster||A serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources (United Nations, 2009).|
|Hazard mitigation||Cost-effective action taken to prevent or reduce the threat of future damage to a facility (FEMA, 2007, p. 24).|
1Community health assessment is also sometimes referred to as a community health needs assessment.
|Health impact assessment||A systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. Health impact assessment provides recommendations on monitoring and managing those effects (NRC, 2011, p. 1).|
|Health in All Policies||An approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity (WHO, 2013).|
|Healthy community||One in which a diverse group of stakeholders collaborate to use their expertise and local knowledge to create a community that is socially and physically conducive to health. Community members are empowered and civically engaged, assuring that all local policies consider health. The community has the capacity to identify, address, and evaluate their own health concerns on an ongoing basis, using data to guide and benchmark efforts. As a result, a healthy community is safe, economically secure, and environmentally sound, as all residents have equal access to high quality educational and employment opportunities, transportation and housing options, prevention and health care services, and healthy food and physical activity opportunities (HRIA, 2013).|
|Population health||The health outcomes of a group of individuals, including the distribution of such outcomes within the group (Kindig and Stoddart, 2003).|
|Resilience||The ability to prepare and plan for, absorb, recover from, and more successfully adapt to adverse events (NRC, 2012, p. 1).|
|Social determinants of health||The conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels (WHO, 2014).|
|Sustainability||The ability of communities to consistently thrive over time as they make decisions to improve the community today without sacrificing the future (McGalliard, 2012).|
FEMA (Federal Emergency Management Agency). 2007. Public assistance guide. Washington, DC: FEMA.
HRIA (Health Resources in Action). 2013. Defining healthy communities. http://hria.org/uploads/catalogerfiles/defining-healthy-communities/defining_healthy_communities_1113_final_report.pdf (accessed October 21, 2014).
Kindig, D., and G. Stoddart. 2003. What is population health? American Journal of Public Health 93(3):381. McGalliard, T. 2012. Reframing the sustainability conversation from what to how. Public Management 94:2.
NRC (National Research Council). 2011. Improving health in the United States: The role of health impact assessment. Washington, DC: The National Academies Press.
NRC. 2012. Disaster resilience: A national imperative. Washington, DC: The National Academies Press.
PHAB (Public Health Accreditation Board). 2013. PHAB acronyms and glossary of terms version 1.5. http://www.phaboard.org/wp-content/uploads/FINAL_PHAB-Acronyms-and-Glossary-of-Terms-Version-1.5.pdf (accessed October 30, 2014).
Rudolph, L., J. Caplan, K. Ben-Moshe, and L. Dillon. 2013. Health in All Policies: A guide for state and local governments. Washington, DC, and Oakland, CA: American Public Health Association and Public Health Institute.
United Nations. 2009. UNISDR terminology on disaster risk reduction. Geneva, Switzerland: United Nations Office for Disaster Risk Reduction.
WHO (World Health Organization). 2013. Health in All Policies. http://www.healthpromotion2013.org/healthpromotion/health-in-all-policies (accessed December 4, 2014).
WHO. 2014. Social determinants of health. http://www.who.int/social_determinants/en (accessed October 30, 2014).
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