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>> Welcome to our Public Health Emergency Discussion Series sponsored by HHS and the
Assistant Secretary for Preparedness and response. I'm Lark McCarthy.
Today we're discussing community resiliency before during and after a public health emergency.
There's a lot of discussion when describing resiliency.
Some consider it a trait or characteristic, others refer to it as a process of adaptation.
Still others use it to term describe desired outcome.
Some even use the word to mean preparedness. Let's first mention the core components.
Physical and psychological health of the population. Social and economic well-being of the community.
Effective risk communication and information for all populations, including at risk individuals.
Integration and involvement of government, and non-governmental entities in planning
response and recovery. And finally, social connectedness for resource
exchange, cohesion, response and recovery.
Here to explain are three experts on resiliency. Rachel Abbey, the program manager of the Advanced
Center at the Montgomery County Maryland Department of Health and Human Services; Lieutenant Commander
Jeffrey Goodie, Clinical Health Psychologist with the Uniform Services University; and
Dr. Anita Chandra, Behavioral Scientist at the RAND Corporation.
I want to ask each of you this, but Rachel let me start with you, how do you define and
describe resilience.
>>That’s an excellent question and as you’ll probably find out there's lots of answers.
For me personally I think from a public health preparedness perspective resiliency really
is the community or the individual or organization's ability or capacity to plan for, respond to
and recover from major public health events. And so in a way it helps them to have the
ability to then recover ultimately.
>> Lieutenant Commander Goodie, how do you describe it? What are the key words you would
like to zero in on?
>> I think along the same lines, along the idea of adaptability to a situation and the
individual or community's ability to pull in the resources that are necessary for it
to be able to adapt to get on a positive trajectory of functioning so that while they're functioning
may have been compromised by a disaster or stressor that they're then able to get moving
in a direction towards better functioning after that disaster.
>> And?
>> I agree with Rachel and Jeff. The community's ability to restore health
and social functioning, whether it’s a new normal or some sense of routine functioning.
I think it's also important for communities to be able to acknowledge and address its
vulnerable to the extent it can before disaster ,so it minimizes recovery time.
It's important to note resilience isn't a fixed state, it's an ongoing and developing
capacity set of capabilities and communities should learn from a prior disaster and take
those lessons into the next disaster to be able to rebound quicker.
>> One way to look at it is that it's not fixed, but it's always evolving.
What do we need to know about the difference between individual and community resilience?
>> I could see from our perspective in Montgomery County, Maryland, we have taken a dual approach.
We have looked at the individual preparedness in regards to helping to ultimately recover
or increase resiliency. So we're looking at core kind of components
that individuals can have such as have they made a plan, do they have the social network
of friends, families, neighbors? Do they have some sort of way to keep track
of medications in their family? Do they have a list of primary care providers
that their children or elderly, things like that.
>> So, individual resiliency is a component of community resiliency.
>> Absolutely. They definitely play hand in hand and then
we have looked more at community resiliency more around the lines of organizations and
governments and things like that. More larger kinds of things - whether or not
they're prepared, whether or not they have continuity of operations plans to look at
the key components of their operations, are they able to continue to provide services
during an emergency event. Have they spoken within their employees about
individual and family preparedness? Sort of things like that.
>> Dr. Goodie, talk about the question of resilience and how does it differ from vulnerability?
>> A good question. I think one way to think about vulnerability
is really just the opposite of resilience. So that in a vulnerable individual or community
this is -- or a community who has difficulty accessing the resources they need or if they
can access the resources, they're not able to do it quickly enough in order to be able
to respond to this. So where I talk resilience putting on a positive
trajectory, vulnerability puts you on a more negative trajectory where functioning is more
impaired. >> It's important to identify vulnerabilities
to get to a point of resilience, right?
>> Absolutely, and a lot of that probably has to happen before the that has to happen
before the disaster happens or the stressor happens, so it goes to the preparation discussion
we have had.
>> Dr. Chandra , You have done research on this during your work at the RAND Corporation.
So, what kind of measures can we use to evaluate community resilience and do you need a disaster
before you can test whether or not you are resilient?
>> Sure. We need to measure whether a community has
been able to restore some of that routine functioning that we talked about earlier.
So, we need to look at whether the physical health, the psychological well being of the
population has come back to normal or healthy state.
We need to look at whether there's been a rebuilding, a restoration of social institutions
like schools and churches. We need to look at whether there's been an
overall sense of community and economic vitality. So we can learn a lot from prior disasters
of what made some communities more or less resilient and who recovered quicker or in
a healthier way? We need to take every new event, whether the
current oil spill or communities affected by economic hard times and look at what factors
matter to tease apart the resilient factors. >> Are there factors that help predict whether
or not a community is likely to be resilient in the event of a public health emergency?
>> We think the core components you talked about at the start of our discussion are really
critical. Does that community have plans in place to
effectively communicate information to its population about risk, how to prepare, how
to respond and recover. Are organizations working together so they
can deploy resources to populations in need? Do they have those plans in place?
Are non-governmental organizations, the civic organizations, the volunteer organizations
working in partnership with government entities? You can learn a lot from just looking at the
plans and whether those plans have been exercised even before a disaster.
>> We should make it clear the ideal answer is yes, they all ought to be working together.
>> Absolutely. That's what we think we need to understand
what are the best -- the right partnerships and how does that look?
And we're dealing with a period of learning about community resilience and what matters
the most.
>> Lieutenant Commander Goodie, We were defining community resilience but does it matter how
you define community, you know, to help you get to a better definition of community resilience?
>> Absolutely. I mean, there's lots of different ways to
define community. Some people think of their community as being
people throughout the country, throughout the world that really when it comes time for
responding to a disaster, communities are often defined by some sort of geographical
boundaries or geopolitical boundaries that are set up.
And those -- and also what resources are shared by a group of individuals.
So whether it's financial resources or communication resources or transportation resources and
all these things go together to define a community, particularly in time of particular stressor
>> Rachel Abbey, would you agree it has to have a geographic component for public health
emergency purposes?
>> Right. I would say that's very true and from a local
government perspective we definitely look at it that way in particular because of funding
and how it comes down to our community mostly on a local or county level.
So we definitely look at that as being more of our community being the entire county.
>> Dr. Chandra, we touched on it. How do you believe community resiliency can
be fostered prior to that adverse event - let's zero in on that.
>> One of the things that's important is to think about who are your communities and who
are your populations and your communities who might be at greater risk whether those
with chronic health conditions those who might have limited social support and figuring out
ways to address their needs early. To make sure they have the information and
tools to prepare. That's one way to ensure that the recovery
is a little bit more seamless and quicker than if those populations weren't attended
to. Some things we talked about earlier in terms
of making sure the service organizations are on board, the volunteer and civic organizations,
that's critical to fostering not only a sense of resilience but a sense of community once
a disaster is hit. We know that disasters really affect the social
fabric of a community, the psychological well being of its individuals, and those organizations
can be critical for fostering resilience and resilient attitudes before, during and after
a disaster.
>> Dr. Goodie, talk about what research does, tell us about community resilience.
>> As Dr. Chandra was alluding to, this is a relatively new area, so we're always getting
new information with each new disaster. I think some of the things that we seem to
think we know is that it's important to decrease the amount of risk and resource disparities
that might exist within a community, I think, thinking about what are the ways in which
individuals can -- we can ensure there's good social support networks during a disaster
so that might be how can people get tangible support, the things they need as well as the
emotional support that they need during these times, I think also to what degree have communities
had this time to develop these interagency relations between non-governmental agencies
and governmental agencies. These are some of the things that seem to
predict those communities that are going to be able to demonstrate resiliency, but we're
learning more with every disaster that we face.
>> So Rachel Abbey, the perspective from Montgomery County, since literally you're the person
monitoring, the boots on the ground. So, there's always great concern about especially the
needs of at risk individuals, you know, seniors, pregnant women, children.
So what are some specific factors that help these at-risk individuals be more resilient?
>> Right. There's some -- you'll ask each community
will define vulnerable populations differently, depending upon the event, but in regards to
providing those services and making sure that key organizations are still sustainable during
that type of event, that we are able to use those same mechanisms during an event.
So organizations that we use to communicate daily with daily types of information that
we use those same mechanisms during an emergency then are critical.
In Montgomery County, for example, we developed gatekeepers. We have identified gatekeepers,
such as home health agencies, home visiting programs, other things such as health promoters.
People that are really involved with their at risk populations.
Because we want to be able to use that same pathway to communicate messages during an
emergency event. Also Seattle King County uses a similar model
in regards to connecting the community-based organizations, so that they can then provide
direct communication during an emergency event to those vulnerable populations.
>> Something that counties or governments may not have thought about in the past, identifying
the gatekeepers.
>> Absolutely. Yes.
>> What are some of the challenges that you found getting to the gatekeepers or getting
people to foster this idea of resilience, which is a new way of thinking, isn't it?
>> Definitely. I think it's definitely a shift in looking
at a more positive way of -- >> We think about response.
>> Exactly. >> Not resilience.
>> Exactly.
And so really helping them to understand that these messages are critical to get out to
the populations that they serve and also encouraging them to also reach out to those populations
within their own specificity or their own populations they haven't been able to reach
those that might be isolated. Things like that, during an emergency which
will be critical.
>> So Dr. Chandra, what is the role of public health in trying to foster community resilience?
Is there resistance to it or people embracing this idea?
Where are we in terms of trying to integrate these idea?
>> It's an exciting time for public health. Community resilience really embraces full
community engagement and I think kind of turns us to some of the traditional public health
roles we once had and combining to the new emergency preparedness terminology.
Resilience is going to require the full participation of government and non-governmental organizations.
But public health in partnership with some of those organizations can take two key roles.
First they can help monitor and evaluate how communities are responding and recovering.
And making sure that we have the information that we need to know if the community is getting
back on its feet in terms of health and well being.
The other area is to make sure that the population has the risk information that it needs before,
during and after a disaster. So really helping to tailor appropriate and
accessible information is a key role still for public health.
>> What are limits what public health can do? And I wanted to get each of you to weigh
in on that.
>> Public health is not doing heavy public service provision so it take it is role of
some non-profit organizations, as well as the for-profit sector to help in the health
and social service provision, the economic recovery of the community, and also making
sure people have the sense of community well-being. Is my community back? Does it feel like home
or at least a new normal again? Those are vital and public health can't do it alone.
>> Lieutenant Commander Goodie, the role of public health and limits of public health.
>> I think there's -- we can focus on the community as a whole, there's always going
to be individuals within that community that aren't going to do the things that we would
like them to be able to do and are going to continue to be at risk.
And so we need to think about how are we going to target those individuals as well, because
we're talking about the population as a whole and we can't forget that there are going to
be individuals who despite all the best efforts are still not going to do the things that
they may need to do to be able to be resilient in a disaster.
>> Thank you. Rachel, give you the last one.
>> I have to echo my colleagues in the sense that, yes, I think from a local public health
perspective, we're going to be doing many different things during an emergency event
so we're going to really rely heavily on our partners, our community-based organizations,
our other folks to really step up to the plate and assist us.
>> Thank you all. We appreciate it.
I want to thank our guests for shedding light on this topic of community resiliency, Rachel
Abbey, the Program Manager of the Advanced Practice Center the Montgomery County Maryland
Department of Health and Human Services; Lieutenant Commander Jeffery Goodie, Clinical Health
Psychologist with the Uniform Services University; and Dr. Anita Chandra, Behavioral Scientist
at the RAND Corporation. It's obvious that resiliency is an important
factor in a community returning to normalcy after a public health, or really, any kind
of disaster. So thank you again to our guests and for more
information please visit www.PHE.gov. If you have questions call ABC.info@HHS.gov.
I'm Lark McCarthy, and thank you for watching, and please browse the PHE.gov website for
others in our Public Health Emergency Discussion series.