Vulnerable Populations Wingate

Association of Schools of Public Health

Identifying and Protecting Vulnerable Populations in Public Health Emergencies: Addressing Gaps in Education and Training Author(s): Martha S. Wingate, Emily C. Perry, Paul H. Campbell, Prabu David, Elizabeth M. Weist Source: Public Health Reports (1974-), Vol. 122, No. 3 (May - Jun., 2007), pp. 422-426 Published by: Association of Schools of Public Health Stable URL: http://www.jstor.org/stable/20057147 Accessed: 03/10/2009 21:03 Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at http://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at http://www.jstor.org/action/showPublisher?publisherCode=asph. Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission. JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected].

Association of Schools of Public Health is collaborating with JSTOR to digitize, preserve and extend access to Public Health Reports (1974-).

http://www.jstor.org

From

AgPH

the

OF ASSOCIATION

SCHOOLSOF

of

Schools

Public

Health

AND PROTECTING IDENTIFYING VULNERABLE POPULATIONS IN PUBLIC HEALTHEMERGENCIES:ADDRESSING GAPS IN EDUCATIONAND TRAINING Martha

C. Perry, H.

Paul

DrPH

S. Wingate,

Emily

Prabu

ScD

Campbell,

Elizabeth

the

PhD

David,

MA,

MPH

and physical resources During an emergency, material are stretched thin and, often, the needs of those who most need help, namely the vulnerable populations, are left unmet. Vulnerable can be defined populations to

ness

and

race,

include

those

relevant

on

nature

the

2005, Hurricane of

illustration

the

unique

and

class, social,

factors may

of

the

Katrina

provided and

characteristics

be

emergency.

one

vulner

abilities

of specific populations in Louisiana, Missis storm most and Alabama. The struck directly sippi, states the and Alabama, Louisiana, poorest Mississippi, in the country.1 Almost 5,000 children were separated from

75% of all deaths

their families.2 Approximately

in New

Orleans,

occurred

Louisiana,

among

the

elderly,

who represented only 15% of the city's total popula tion before the storm. Of nearly 240 shelters surveyed in the region, less than 30% had access to American interpreters, leaving those who were Sign Language deaf or hard of hearing with little or no access to vital information.3

in In addition, nearly all of the 280 nursing homes full despite the calls for evacu Louisiana remained ation and, as a consequence, 215 of their residents in of school buses were available died.4 Hundreds New

Orleans

as

part

Articles send

evacuation

plan.

the Schools

abstract

(50-100

of Public words)

State

Health via e-mail

suffer

from and

Katrina,

many

elderly

to the Gulf Coast continued health problems, emotional

aggravated

stress.6

psychological

recent

This

the need for illustrates experience in health response, improvements public planning, and recovery. Among other initiatives, the Centers for Disease Control and Prevention (CDC) established academic for Public Health Centers Preparedness and

to assess and

in 2000

health-care

train the public

to better

workforce

to

respond

health threats

to our nation's

the threat of bioter health, including infectious disease and other public rorism, outbreak, health In addition, CDC and Associa emergencies. tion of Schools of Public Health (ASPH) established a nationwide network of CPHP to foster information and

sharing future

reduce and

training

duplication

among

educational

resources.

and

existing

"Collabo

ration groups"?workgroups of CPHP experts and staffed by ASPH?were created key practice partners in 2004 to address issues in various top training ics of preparedness. the ASPH/CDC Consequently, Education for Vulnerable Populations Preparedness on the in 2005-2006 Collaboration focused Group the needs of vulnerable of meeting challenges popula tions?also

to as

referred

special-needs

high-risk,

populations?before,

at-risk,

or

special, and after

during,

a

public health emergency. These vulnerable populations have needs that are not fully addressed by traditional and may require addi emergency preparedness plans tional resources and special attention during and after or

emergencies

disasters.7

an collaboration conducted group Initially, of extensive available survey emergency preparedness training resources for public health that focused on spe cific vulnerable of this Upon completion populations. survey,

highlight practice-based to Allison Foster, ASPH

422

after

on

the

Unfor

Department and Development's plans had not that hundreds of school bus drivers the city with their families. As abandoned

for From a short

the

the Louisiana

tunately, however, of Transportation taken into account had already

of

months

residents

strain,

(CPHP)

prepared

recovery. Age, a host of other

and psychological

depending

to access

able in disaster

and and

language,

economic,

In August

not

offered

response,

planning,

poverty,

cultural,

are

who

resources

standard

to treat lack of medications including The situation did not improve after

as five

storm,

and other

M. Weist,

broadly use the

a result, many of the vehicles never left the parking out of the city lot.5 The lack of public transportation for the poor; Census data show that created difficulties more than half of the poor households in New Orleans (54%) did not have a car, truck, or van in 2000.l Those to leave New Orleans who managed had to endure many hardships, chronic disease.

CHES

MPH,

HEALTH PUBLIC

O Public

the

resources

activities

at the

Deputy

Executive

Health

were

schools.

Reports

organized

into

an article, at [email protected].

To submit

Director,

/ May-June

2007

a

grid,

faculty

which

should

/ Volume

122

the

From

was subsequently used to identify gaps. The purpose of related to this article is to describe gaps in resources to inform CPHP, public selected vulnerable populations involved in health agencies, and other organizations preparedness-related

studies,

home-bound

(e.g.,

taged

FINDINGS of

review

across

gaps

populations,

some

general

not

they

comprehensive,

as

practice

in the planning

to how

process

courses/training of courses available through the that address the importance of courses few deal populations, exclusively

vulnerable

with the needs of vulnerable populations. Preparedness courses that focus specifically on the needs of popula tions with disabilities were not available. Some courses were found that addressed the specific needs of rural

gaps Policy/planning the overarching in found recommendation to documents include policy special popula tions in the planning and few educational process, resources or on to how training provide tips guidelines at include vulnerable the stage. populations planning

Despite various

populations

these communities

disadvan

economically

Responder-targeted a number Although CPHP have modules

provide

emergency.

in specific

plans, etc.) is resources. For

and policy

minority, evidence-based

surge

requirements,

reunification

or

pediatric

cultural

the

the

along

these

General

consideration

continuum

of

of emergencies of

prevention,

prepared

topics Collaboration

Population

Economically

and

populations

adult

Pediatric Populations

with

Rural populations

X

X X X

disabilities X

Spanish-speaking

populations

NOTE: X indicates

a noted

Public

Health

Reports

information aids

X

X

populations

populations

and drills

oriented

with government or other

Measurement

organizations

evaluation

and

X

racial minority X

Mentally illpopulations Older

for

responders

disadvantaged X

populations Ethnic

available

Planning/ policy

Training exercises

gap

by general

/

May-June

X

X

X

X

X

X

X

X

X

X X

X

X

X

X

X

X

X

X

X

X

X

X

X topic

area.

2007

/

Volume

122

is com

cultural

needs

Consumer

on

course

comprehensive

in the context

However,

petence

A

populations.

competency

available.

and areas to address

Courses

of

needs

resources.

planning

and initial framework for resource development curriculum design to train the public health workforce to meet the needs of vulnerable during populations

Figure. Training gaps

populations,

populations Inclusion of

equipment

and

were

adult

to suggest is little evidence that available are sufficient to actively involve disadvantaged of groups in planning because of limited understanding the culture of poverty and its impact on preparedness. In each of the vulnerable populations targeted by the collaborative group, there was a paucity of policy and

an

an

423

There resources

and efforts, and (6) measurement (5) collaborative inmore detail in the evaluation. Each area is described sections. The Figure provides an overview of following in each population. While these rec the gaps noted are

older resources.

specific

racial

to engage is limited.

under six themes emerged, which may be categorized areas: (1) policy and planning, (2) responder-targeted courses, (3) training exercises and drills, (4) consumer oriented aids and resources for the special population,

ommendations

the

family capacity planning, limited in many planning ethnic,

Upon

in

addressed

children

see http://www cfm.

O

Health

or case including best practices proposals, could be useful. Specific plans for noninstitu

tionalized, not

course

and

training,

planning,

For both documents, development. . asph. org/ cphp/ CPHP_ResourceReport.

Concrete

of Public

Schools

424

O

ness,

response,

and

more

deserves

recovery

Health

attention.

to need for more training related serve to better the needs of ethnic competence

cultural racial

focus

of Public

Schools

is a clear

There and

the

From

on

In

minorities.

more

summary,

courses

information

preparedness-related

that to

specific

such as people with disabilities, populations, ethnic and racial minori economically disadvantaged,

vulnerable

ties,

and

pediatric,

rural

are

populations,

needed.

detailed resources instructions. Also, Spanish-language are available on the Internet. Members of the group that preparedness materials with illustra suggested tions and pictorial presentations that target Spanish would fill a gap. Such pictorial speaking populations be effective in reaching a diverse may representations of population Spanish-speaking people, with different levels of literacy and differences in Spanish language across

and drills Training exercises Members of the group highlighted the need for differ ent types of courses that are tailored to the learning objectives and the skill level of public health practitio ners. The collaboration the lack of group highlighted

cies

recovery

the

response,

planning,

that

organizations

spectrum.

resources

and

aids

for

The

ment

of

One

lesson

are

populations matrix comprehensive consists

group

of

information disseminated

number

of

and

plans

the

learned

through cannot

be

accessed

easily

is a need

resources

for

are

that

by

access

able populations, which may not have Internet. For economically disadvantaged there

laboration the

context

of

ill populations,

For mentally consumers

medications are

essential.

are

preparedness

meeting

and

to be

caregivers

to

the

Standard

and

during Also

in the aftermath

required

are

resources

necessary

account

for the low literacy among the mentally of their caregivers. Checklists that focus on older adult

ill and

are

a

available

on

the

Internet.

However,

some

are

owners

business

and

responsiveness rural are

populations. critical

a

play

of the vulnerable

pieces

and

response,

consequently,

Col of

recovery role

pivotal

in

populations.

and metrics

evaluation the measurement

for

and

evaluation

is no

there

Specifically,

consensus

measure

increased

and

measures

evaluative

improved,

for

the individuals within the populations, the responders, to provide a and the system will have to be developed

populations

of the older adult audience may proportion access to the Internet or may not be able

community

preparedness,

the needs

resources.

of a disaster that

local

of organizational and individual cultural competence. In the absence of established measures, it is difficult to evaluate the effectiveness of the training. For mentally measures ill populations, of post-disaster functioning of the individual and the system of care are limited. As trainings specifically related to vulnerable populations

that prepare

to obtain

even

of successful training that addresses the needs of vulner are not widely discussed able populations in the current

needed.

able

and in

and,

Measurement

populations, sensitive

resources

emergency

messages.

pre-event

to the

to meet poor and those who are struggling working Hurricane survival needs. As apparent during daily Katrina, understanding poverty is imperative. Resources that are sensitive to the needs of daily survival within the

nongovernmental

of

crafting

among particularly and communication

infrastructure

vulner

popula

with disabilities, among national

in 2005 from Hurricane Katrina as such groups, Rotary Club, faith

organizations, assets valuable

recovery,

consumer-oriented

resources, which are primarily of the Internet. The majority

aids and

resources

these

a vast

created by the collaboration

agen

that communityand faith-based organiza an role in the develop instrumental play

recognized tions could

based

vulnerable

and

organizations

among

vulnerable

serve people with disabilities on which organizations, a day-to-day basis. A similar gap was for the recognized ill populations, mentally specifically with the National Alliance for the Mentally and Abuse 111, Substance Mental Health Services Administration, and the Ameri can Psychological Association. members Committee

is that community Consumer-oriented

serve

For populations gaps were identified

and

agencies

rently available through the CPHP network; however, there is an urgent need for more drills and exercises the needs of vulnerable that address populations. Also required are exercises that cover issues related to across

origin.

on how to foster collaboration

and

communication

curriculum. A vulnerable is a component population some are cur of of drills exercises the and that part

populations

of

regions

tions are insufficient.

to address and advanced courses needed and Inclusion of the and needs application practice. in drills and exercises are issues of special populations of paramount in a comprehensive training importance

and

and

Collaboration Guidelines

intermediate

vulnerable

countries

more

significant

comprehensive and recovery response,

not have to follow

Public

Health

Reports

assessment of

of

the

vulnerable

/ May-June

preparedness,

populations.

2007

/ Volume

122

From

for

preparedness

and

will

to

response

pub

and the informed emergencies effort of many people and organizations. officials and agencies have an government

lic health combined Although

to

role

important

play,

take

is not

preparedness

ernment

Individual

citizens

a

solely

gov

activities. community-based neighbor-helping-neighbor local faith-based organizations, Nonprofit including and community-based will be critical organizations, to successfully and protecting identifying, reaching, our

most

vulnerable of

network

The

service,

and

advocacy,

can be effectively

zations of

citizens.

successful

resources

utilized.

education,

The

organi

development

and

training,

to involving

is critical

U.S.

longstanding faith-based

informational

all of these organiza

tions and individuals. The work described

previously by the 2005-2006 for Vulnerable Education Preparedness Collaboration Populations Group produced specific for CPHP, as well as other organizations guidance involved in preparedness-related planning, training, and course development. First, public health prepared

ASPH/CDC

ness,

response,

should

recovery

and

strategies

For

example,

an

during

or

emergency

of mentally ill populations. for emergency preparedness measures lar

relevant

should

guidance.

Finally,

Dr. Dan

training

to vulnerable

strengthened of Inclusion

in general

and

in

populations particu ensure evidence-based

to

be

efforts

these

resources

nerable populations in additional is training agendas an immediate need. It should be noted that the col laboration group is continuing itswork, and the needs of additional vulnerable populations will be addressed in fiscal year 2007.

Health,

Harvard School listed) :Dr. Paul Campbell, Harvard for Public Health Center Preparedness;

Barnett, of Public

Dr. Joe Coulter, University of Iowa College Preparedness; for Public Health Center Health, Upper Midwest Dr. Prabu David, Ohio School State University of Preparedness;

Health

of Public

Dr. Ohio Center for Public Health Health, Preparedness; Center for Hispanic Disaster of Miami, Espinel, University for Disaster Center Training, Joshua Frances, Epidemiology; Harvard for School of Public Health, Harvard Center University Public Health Dr. The Goldman, Preparedness; Lynn Johns Hop kins University School of Public Health, The Johns Bloomberg Public Zelde

Hopkins

Center

for Public

Health Ana-Marie Preparedness; Jones, at Berkeley School of Public Health, for Infectious Disease Dr. Michael Preparedness;

of California

University

Center Berkeley of Pittsburgh of Public Health, Graduate School Meit, University of Pittsburgh for Public Health Center University Preparedness; Gilbert Nick, Harvard of Public Health, School University for Public Health Harvard Center Preparedness; Emily C. Perry, of Medicine and Dentistry University of Public Health, School New Jersey at UMDNJ; Preparedness of Public Health, School Dr. Randy Preparedness;

of New Center

Jim

Rowel,

of Texas Roush, University for Biosecurity and Public Health State University and The Morgan School

Training,

of Public

Health, Dr. Preparedness; for Hispanic Disaster

Health

of Miami, Center University Center for Disaster and, Dr. Martha Epidemiology; at Birmingham of Alabama School of Public University

Shultz,

Wingate,

Jersey (UMDNJ) for Public Health

Dr. Robert Center

Johns Hopkins University Bloomberg The Johns Hopkins Center for Public

South Central Center for Public Health Health, Preparedness. In addition, the following external reviewers provided helpful on final drafts of the resource guidance group's grid: Dick Bohrer and Robert Kidney from the National Association of Community Health

Nieratko Centers; Jennifer tion of State and Territorial Health

to vul

related

425

The Johns Hopkins University Bloomberg for Public Center The Johns Hopkins Health, Dr. Mark A. Brandenburg, of Health Preparedness; University of Public Health, Oklahoma Center Southwest for Public College School

disaster,

evaluation

O

is the one

affiliation of Public

activities

the mental needs of the gen health or psychosocial eral population different from the needs be may very

Health

ASPH/CDC staff, ASPH staff, and the following for Vulnerable Education Collaboration Preparedness Populations members members have affiliations, (while may Group multiple their relevant Centers for Public Health [CPHP] Preparedness

include

vulnerable in defining needs.

and

a strong focus on the needs of specific Second, care should be taken populations. vulnerable and their specific populations

of Public

Response

and families

responsibility. will continue to play a central role and organized efforts and nongovernmental by both government agencies to encourage must be directed and facilitate informal

Schools

forces to produce this and organizations joined Many people the Division of State and Local Readiness resource, including at the Centers for Disease and Prevention Control (CDC), Office for Terrorism and Emergency Coordinating Preparedness

CONCLUSIONS Improving

the

Mensah Disease

at the Associa colleagues and Dr. George Officers; Center for Chronic National and

at CDC's and colleagues Prevention and Health Promotion.

to: Martha Address S. Wingate, DrPH, correspondence at Birmingham of Alabama School of Public Health, University RPHB 330, 1530 Third Ave. South, Birmingham, AL 35294-0022; tel. 205-934-6783; fax 205-934-3347; e-mail <[email protected] .uab.edu>.

Martha

at Birming is with the University S. Wingate of Alabama of Public Health, School Alabama; Birmingham, Emily C. of Medicine and Dentistry Perry is formerly with the University of New Jersey School of Public Health, New Brunswick, New is with the Harvard of Public School Jersey; Paul H. Campbell ham

Health, University Elizabeth Health

Public

Prabu

Boston, Massachusetts; School of Communications, M. Weist

is with

the Association

(ASPH), Washington,

Health

David

Reports

is with

the Ohio

REFERENCES 1.

State

and Columbus, Ohio; of Schools of Public

2.

DC

/ May-June

2007

/ Volume

122

Sherman A, Shapiro I. Essential facts about the victims of Hurri cane Katrina, Global Center on Budget and Policy Priorities. First on the CGPP website on 2005 published Sep 19 [cited 2006 Dec from: URL: www.cbpp.org/9-19-05pov.htm 13]. Available National Center for Missing & Exploited Children. Last of unac children in Katrina shelters reunited with families [press companied

426

O

release];

3.

4.

From

the

2005 Oct

Schools

10 [cited

of Public

2006 Dec

19]. Available

Health

5.

from: URL:

http://www.ncmec.org/missingkids/servlet/NewsEventServlet? LanguageCountry=en_US&PageId=2150 on Special Needs on Disability. National Report Organization for Katrina Evacuees Assessment [cited 2006 Dec (SNAKE) project from: URL: http://www.nod.org/Resources/PDFs/ 19]. Available katrina_snake_report.pdf after Katrina: who was left behind. Global B. Six months Quigley on Aging, New York. Based on article in CommonDreams Action from: URL: www .org, 2006 Feb 21 [cited 2006 Oct 2]. Available

6.

7.

.globalaging.org

Public

plan for elderly faulted. Global Spenser S. Pre-Katrina emergency on Aging, New York. Based on article in the Washington Action from: URL: www Post, 2006 Jan 31 [cited 2006 Oct 2]. Available .globalaging.org Leifer R. "It has disrupted my entire life." Global Action on Aging, 2006 Feb New York. Based on article in the Hattiesburg American, from: URL: www.globalaging.org 2 [cited 2006 Oct 2]. Available E. Com S, Tinker TL, Vaughan M, Frank LL, Tipton McGough in a and other emergencies the risks of bioterrorism municating in North Dakota. diverse society: a case study of special populations Biosecur Bioterror 2005;3:235-45.

Health

Reports

/ May-June

2007

/ Volume

122