National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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]

RA971

362.1068—dc23

2015029208

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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.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

image

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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.

www.nationalacademies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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

IOM Staff

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

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Consultants

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

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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 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

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Preface

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

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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Sustainability

The Need for an Explicit Focus on Health

The Need for an Integrated Approach

Communities as Systems

A Health in All Policies Approach to Disaster Recovery

Research Needs

Summary of Findings

References

3 A FRAMEWORK FOR INTEGRATING HEALTH INTO RECOVERY PLANNING

The Strategic Planning Process as a Framework

Building on Previous Strategic Planning Processes

A Healthy, Resilient, Sustainable Community Vision for Disaster Recovery

The Critical Role of a Vision

The Importance of Having a Vision and Goals in Place Before a Disaster

Creating a Shared Vision as a First Step in Engaging the Public in Disaster Recovery

Assessments to Inform Recovery Planning

Community Health Assessments

Threat and Hazard Identification and Risk Assessments

Disaster Impact Assessments

Planning for Recovery

Organizing for an Integrated Approach

Using Health-Related Information to Inform Recovery Decision Making

Implementation

Seeking and Applying Recovery Resources

Creating a Learning System

Research Needs

Summary of Findings and Recommendations

References

4 LEVERAGING RECOVERY RESOURCES IN A COORDINATED MANNER TO ACHIEVE HEALTHIER POST-DISASTER COMMUNITIES

Resource Implications of Disaster Declarations

Federal Recovery Programs and Their Applications to Health Recovery

FEMA Funding Programs Authorized Under the Stafford Act

Federal Block Grant Programs for Disaster Recovery

Other Federal Recovery Funding Programs

Nonfederal Resources for Recovery

Private-Sector Resources

Nonprofit and Philanthropic Resources

State and Local Government Funding Mechanisms

Funding Pathways

Challenges in Applying Funding to the Creation of Healthy Communities

Limited Pre-Disaster Recovery Planning Resources

Challenges in the Post-Disaster Context

Overcoming Barriers to Coordination of Funding to Support a Healthy Community Approach to Recovery

Technical Requirements

Financial Incentives

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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Summary of Findings and Recommendation

Annex 4-1: Funding for Disaster Recovery

References

PART II: OPERATIONAL GUIDANCE TO SUPPORT A HEALTHY COMMUNITY APPROACH TO DISASTER RECOVERY

5 PUBLIC HEALTH

Public Health in the Context of a Healthy Community

Disaster-Related Public Health Challenges

Public Health Sector Organization and Resources

The Federal Public Health Enterprise

State and Local Health Departments

Public Health Partners for Healthier Post-Disaster Communities

Pre-Disaster Public Health Sector Priorities

Conduct Community Health Assessments

Engage Community Stakeholders in Pre-Disaster Community Health Improvement and Recovery Planning

Ensure That Public Health Community Programs and Services Are Integrated into Healthy Community and Disaster Recovery Planning Processes

Leverage Pre-Disaster Preparedness Activities in Recovery Planning

The Continuum of Post-Disaster Public Health Response and Recovery Priorities

Early Post-Disaster Public Health Recovery Priorities

Participating in a Shared Communication Effort

Conducting Impact Assessments on the Community’s Health and Medical Needs

Reestablishing Critical Public Health Infrastructure

Delivering Public Health Services to Meet Post-Disaster Needs of the Community

Providing Support to Impacted Health Care Delivery Systems

Intermediate- to Long-Term Recovery: Opportunities to Advance Healthier and More Resilient and Sustainable Communities

Facilitating Health-Informed Recovery Decision Making Through Data

Engaging in Health-Informed Community Rebuilding and Redevelopment Planning

Sharing Lessons Learned with Other Communities to Improve Disaster Recovery Planning

Research Needs

Summary of Findings and Conclusions

Public Health Sector Recovery Checklist

References

6 HEALTH CARE

Health Care in the Context of a Healthy Community

Disaster-Related Health Care Challenges

Health Care Sector Organization and Resources

Federal Level

Regional, State, and Local Levels

Pre-Disaster Health Care Sector Priorities

Assessing the Capacity and Vulnerability of the Health Care System

Establishing, Sustaining, and Exercising Health Care Coalitions and Other Coordinating Groups

Developing Continuity of Operations and Recovery Plans

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

Establishing a Resilient Health Information Technology System

Early Post-Disaster Health Care Recovery Priorities

Conducting Post-Disaster Assessments

Restoring Care Delivery Infrastructure and Services

Ensuring Availability of the Required Medical Workforce

Intermediate- to Long-Term Recovery: Opportunities to Advance Healthier and More Resilient and Sustainable Communities

Rebuilding Health Care Facilities After Disasters for Increased Resilience and Sustainability

Improving Health Care System Access and Quality of Care

Research Needs

Summary of Findings and Recommendation

Health Care Sector Recovery Checklist

References

7 BEHAVIORAL HEALTH

Behavioral Health in the Context of a Healthy Community

Disaster-Related Behavioral Health Challenges

Behavioral Health Sector Organization and Resources

Federal Level

National-Level Nongovernmental Resources

State Level

Local Level

Challenges to Coordination and Integrated Planning

Pre-Disaster Behavioral Health Sector Priorities

Strengthening the Existing System with Day-to-Day Responsibility for Promoting Behavioral Health and Delivering Behavioral Health Services

Engaging in Disaster Preparedness and Recovery Planning Activities

The Continuum of Post-Disaster Behavioral Health Interventions

Delivering Early Behavioral Health Interventions

Providing Ongoing Psychosocial Support

Identifying and Treating Behavioral Health Disorders

Special Considerations for Vulnerable Populations

Children and Youth

Community Members with Preexisting Behavioral Health Disorders

Responders, Care Providers, and Recovery Workers

Building a More Resilient and Sustainable Behavioral Health Sector

Research Needs

Summary of Findings and Recommendation

Behavioral Health Sector Recovery Checklist

References

8 SOCIAL SERVICES

Social Services in the Context of a Healthy Community

Disaster-Related Social Services Challenges

Social Services Sector Organization and Resources

Federal Level

State and Local Levels

Cross-Sector Collaboration

Pre-Disaster Social Services Sector Priorities

Establishing Forums for Coordination and Collaboration Before and After Disasters

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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Establishing Mechanisms to Facilitate Record and Information Sharing After Disasters

Planning for Fluctuations in Social Services Workforce Needs

The Continuum of Post-Disaster Social Services Interventions

Early Post-Disaster Social Services Recovery Priorities

Meeting Basic Human Needs

Initiating Disaster Case Management

Providing Psychosocial/Behavioral Health Support for Survivors

Intermediate- to Long-Term Recovery Priorities

Providing Ongoing Psychosocial Support

Building Client Self-Sufficiency and Managing Chronic Medical Conditions

Special Considerations for Children and the Elderly

Children and Youth

The Elderly

Building a More Resilient and Sustainable Social Services Sector

Research Needs

Summary of Findings and Recommendation

Social Services Sector Recovery Checklist

References

9 PLACE-BASED RECOVERY STRATEGIES FOR HEALTHY COMMUNITIES

A Systems View of a Healthy Community

The Impact of Place on Health

A Systems Approach for Health Improvement

Contemporary Approaches to Healthier and More Resilient and Sustainable Communities

Disaster Impacts on Community Systems: Implications for Health and Recovery

Organizational Structures and Resources for Healthy Community Planning and Redevelopment

Federal Level

State and Regional Levels

Local Level

Nonprofits, Philanthropies, and the Private Sector

Collaboration and Coordination

Pre-Disaster Priorities

Creating a Healthy Community Vision for Recovery

Organizing for Disaster Recovery Planning

Conducting Vulnerability and Capacity Assessments

Early Post-Disaster Recovery Priorities

Assessing Disaster Impacts on Community Systems

Restoring Critical Infrastructure and Remediating Immediate Health Threats

Intermediate- to Long-Term Recovery: Opportunities to Advance Healthier and More Resilient and Sustainable Communities

Developing Transportation and Land Use Strategies

Developing Community Development Strategies

Developing Environment Management Strategies

Incorporating Hazard Mitigation, Resilience, and Sustainability Planning

Complementary Approaches

Research Needs

Summary of Findings and Recommendations

Place-Based Recovery Strategies Checklist

References

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

10 HEALTHY HOUSING

Housing in the Context of a Healthy Community

Housing Standards That Promote Health

Green Housing Standards and Health

Disaster-Related Housing Challenges

Disaster-Related Health Hazards

Strain on Capacity

Displacement and the Need for Healthy Temporary Housing

Loss of Affordable Housing

Housing Sector Organization and Resources

Federal Level

State and Local Levels

Nongovernmental and Philanthropic Organizations

Private Businesses

Partnering Organizations and Cross-Sector Collaboration

Engaging the Community in Housing Recovery

Pre-Disaster Housing Sector Priorities

Establishing a Disaster Housing Task Force

Conducting Vulnerability and Capacity Assessments

Planning for Siting of Temporary Housing

Early Post-Disaster Housing Recovery Priorities

Assessing Housing Needs

Preventing Unnecessary Displacement

Protecting Homeowners and Recovery Workers Against Health Risks

Providing Short- and Long-Term Temporary Housing That Meets Health and Human Service Needs

Special Considerations for Vulnerable Populations

Survivors with Disabilities and Special Medical Needs

The Homeless

Intermediate- to Long-Term Recovery: Opportunities to Advance Healthier and More Resilient and Sustainable Communities

Incentivizing the Use of Green and Healthy Housing Standards

Strengthening the Resiliency of Housing

Ensuring Adequate Affordable Healthy Housing

Providing Financial Incentives

Research Needs

Summary of Findings and Recommendation

Housing Sector Recovery Checklist

References

PART III: APPENDIXES

A The Federal Policy Environment Influencing Disaster Recovery

B Disaster Recovery Funding: Achieving a Resilient Future?

C Additional Resources

D Measures and Tools for Healthy Communities

E Committee-Identified Research Needs

F Key to Select Terms Used to Describe Primary Actors and Key Partners in Chapter 5–10 Checklists

G Public Committee Meeting Agendas

H Committee Biosketches

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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3-3 Recovery Support Functions

3-4 Recovery Planning on a Regional Scale

3-5 Leveraging Social Networks After Disasters

3-6 Integrating Health Impact Assessment into Recovery Decision Making and Planning

4-1 Voluntary and Community Organizations Active in Disaster

4-2 Challenges in Merging Funding Streams for Disaster Recovery Projects

4-3 Rebuild by Design

5-1 Core Public Health Functions

5-2 Core Mission Areas for Health-Related Emergency and Recovery Support Functions

5-3 Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance on Community Recovery

5-4 Public Health Sector Assets to Leverage in Disaster Recovery Planning for Optimal Health Outcomes

5-5 Promising Practice: Recovery Support Function Advisory Committees

5-6 Los Angeles County Community Disaster Resilience Project

5-7 New Orleans After Hurricane Katrina: A New Approach to Public Health

6-1 Optimal Coordinated Care Systems

6-2 Capability Targets for the Health and Social Services Recovery Support Function

6-3 Health Care Coalitions

6-4 Hospital Preparedness Program (HPP) Guidance on Health Care System Recovery

6-5 Community Paramedicine

6-6 Key Features of Hospital and Health Care Coalitions

6-7 Health Information Technology as a Critical Resource for Health Care System Recovery: Lessons from the U.S. Department of Veterans Affairs (VA) After Hurricane Katrina

6-8 Continuity of Care for Veterans

6-9 Retaining the Medical Workforce Through a Talent-Sharing Program: St. John’s Regional Medical Center in Joplin, Missouri

6-10 Rebuilding Health Care Infrastructure for Increased Resilience and Sustainability

6-11 Transforming Health, Social Welfare, and Economic Stability in Pinellas County, Florida

6-12 Redesigning Health Care for Increased Access in the Wake of Hurricane Katrina

6-13 Community Health Workers

6-14 A Continuum of Care Model: Gulf Coast Center

7-1 The Red River Resilience Project

7-2 Expert Consensus on Disaster Behavioral Health Interventions

7-3 Canterbury’s “All Right?” Social Marketing Campaign

7-4 Project Fleur-de-lis™: A Tiered Intervention Approach for Children

7-5 Lasting Investments: Sustaining Mental Health Capacity After a Disaster

7-6 Increasing Resilience Through Integrated, Sustainable Mental Health Services

8-1 Considerations for Coordination of Long-Term Recovery Committee Activities

8-2 Information Systems in Social Services Recovery

8-3 Example of Collocation: Multi-Agency Resource/Relief Center

8-4 Chronic Disease Management Assistance from The Jesse Tree, Galveston, Texas

8-5 The Role of School Systems in Recovery: Case Study of Joplin, Missouri

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

9-1 Place- Versus People-Based Interventions

9-2 Building the Community Nexus

9-3 Transit-Oriented Development and Zoning and Planning in Mission Bay, San Francisco

9-4 New Orleans’ C.J. Peete Public Housing Redevelopment

9-5 Managed Retreat: Benefits and Challenges Related to Buyouts

9-6 Rebuild by Design Case Study: Living with the Bay, Nassau County, New York

9-7 Cedar Rapids: Complementary Post-Disaster Investments for Improved Health, Resilience, and Sustainability

9-8 Complementary Approaches to Achieving Resilience and Sustainability in Sendai City, Japan

10-1 Example of Agency-Specific Responsibilities in a Post-Disaster Housing Task Force: Marin County, California

10-2 Health and Safety Checklist for Temporary Housing

10-3 Rebuilding in Greensburg, Kansas

10-4 Post-Hurricane Sandy Requirements for “Green” Rebuilding

FIGURES

S-1 Leveraging the products of pre-disaster planning processes to support a healthy community approach to disaster recovery

1-1 Federal expenditures on disaster recovery over the past decade

1-2 Average life expectancy as a function of spending on health care

1-3 Relative expenditures on health care and social services in the United States in the context of other peer nations

1-4 The recovery continuum: Description of activities by phase

1-5 Key stakeholders in the disaster recovery process

2-1 Model for the combinatorial effects of health determinants on population health outcomes

2-2 Illustration of the systems perspective of a community when contemplating options after a disaster

2-3 Application of a health lens across sectors during the recovery planning process

3-1 Leveraging the products of pre-disaster planning processes to support a healthy community approach to disaster recovery

3-2 Model for aligning organizations and programs with the federal National Disaster Recovery Framework (NDRF) structure

4-1 The Stafford Act process for declaring a major disaster

4-2 Recovery planning timeline

4-3 Comparison of Federal Emergency Management Agency (FEMA), Community Development Block Grant (CDBG), and Social Services Block Grant (SSBG) expenditures for disaster recovery for recent disasters

4-4 Funding pathways for disaster recovery

5-1 Linked community health improvement and disaster recovery cycles with associated core public health functions

5-2 Key stakeholders in a healthy community

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

7-1 Federal roles in behavioral health preparedness, response, and recovery

7-2 A 3-tiered public health model for behavioral health interventions after disasters

9-1 Geographic information systems data from King County, Washington, show clustering of vulnerabilities from the convergence of health risk factors

10-1 Alternative arrangements of post-disaster temporary housing

B-1 Disaster recovery assistance network

B-2 Horizontal and vertical integration typology

TABLES

S-1 Key Stakeholders Involved in Leading the Implementation of the Committee’s Recommendations

3-1 Collaborative Roles of Sector and Community Stakeholders in the Integration of Strategic Planning Processes to Achieve Healthier and More Resilient and Sustainable Post-Disaster Communities

3-2 Health Implications of Nonhealth Recovery Support Functions

4-1 Funding for Disaster Recovery

5-1 Lists of Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) Capabilities, with Rows Showing Alignment

5-2 Alignment of 10 Essential Public Health Services, Public Health Accreditation Board Standards, and Interrelated Preparedness and Recovery Functions

5-3 Public Health Roles in the Comprehensive Planning Process

6-1 ACA Provisions That Could Potentially Affect Medical and Public Health Preparedness Activities

6-2 Potential Members of Health Care Coalitions to Address Recovery Considerations

6-3 Potential Applications of an Information Exchange Portal in a Disaster

7-1 Incidence of Psychiatric Diagnoses After Oklahoma City Bombing

8-1 Mechanisms by Which Social Services Programs Influence Health Outcomes

9-1 Summary of Strategies for Healthy Community Planning

10-1 Examples of Green Building Criteria

10-2 Summary of Literature Showing Improvements in Health Due to Green Housing Interventions

10-3 Hillsborough County, Florida, Pre-Disaster Housing Recovery: Primary Plans, Programs, and Procedures

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×

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
Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×
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
IT information technology
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
Page xxiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
×
NACCHO National Association of County and City Health Officials
NDRF National Disaster Recovery Framework
NEN Neighborhood Empowerment Network
NEPA National Environmental Policy Act
NGO nongovernmental organization
NHSS National Health Security Strategy
NHTSA National Highway Traffic Safety Administration
NIH National Institutes of Health
NRF National Response Framework
PA Public Assistance
PAHPA Pandemic and All-Hazards Preparedness Act
PCCI Parkland Center for Clinical Innovation
PCMH patient-centered medical home
PDM Pre-Disaster Mitigation
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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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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Glossary

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.

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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).

REFERENCES

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.

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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press. doi: 10.17226/18996.
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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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In the devastation that follows a major disaster, there is a need for multiple sectors to unite and devote new resources to support the rebuilding of infrastructure, the provision of health and social services, the restoration of care delivery systems, and other critical recovery needs. In some cases, billions of dollars from public, private and charitable sources are invested to help communities recover. National rhetoric often characterizes these efforts as a "return to normal." But for many American communities, pre-disaster conditions are far from optimal. Large segments of the U.S. population suffer from preventable health problems, experience inequitable access to services, and rely on overburdened health systems. A return to pre-event conditions in such cases may be short-sighted given the high costs - both economic and social - of poor health. Instead, it is important to understand that the disaster recovery process offers a series of unique and valuable opportunities to improve on the status quo. Capitalizing on these opportunities can advance the long-term health, resilience, and sustainability of communities - thereby better preparing them for future challenges.

Healthy, Resilient, and Sustainable Communities After Disasters identifies and recommends recovery practices and novel programs most likely to impact overall community public health and contribute to resiliency for future incidents. This book makes the case that disaster recovery should be guided by a healthy community vision, where health considerations are integrated into all aspects of recovery planning before and after a disaster, and funding streams are leveraged in a coordinated manner and applied to health improvement priorities in order to meet human recovery needs and create healthy built and natural environments. The conceptual framework presented in Healthy, Resilient, and Sustainable Communities After Disasters lays the groundwork to achieve this goal and provides operational guidance for multiple sectors involved in community planning and disaster recovery.

Healthy, Resilient, and Sustainable Communities After Disasters calls for actions at multiple levels to facilitate recovery strategies that optimize community health. With a shared healthy community vision, strategic planning that prioritizes health, and coordinated implementation, disaster recovery can result in a communities that are healthier, more livable places for current and future generations to grow and thrive - communities that are better prepared for future adversities.

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