Perceptions of Public Health Preparedness Capabilities

Public health departments tasked with keeping the population safe and healthy face a constantly changing array of public health threats, such as natural disasters, industrial accidents and disease outbreaks. In March 2011, the Centers for Disease Control and Prevention (CDC) outlined 15 preparedness capabilities to help public health departments better organize themselves, prepare for public health threats and more efficiently use funding from the CDC’s Public Health Emergency Preparedness cooperative agreement.

Because public health departments often use these capabilities as guidelines for preparedness and planning, it is important to understand how different departments view the capabilities and what factors are associated with those perceptions. To achieve that, a research team including Jennifer Horney, PhD, MPH, department head and associate professor in the Texas A&M School of Public Health Department of Epidemiology and Biostatistics, surveyed 48 public health departments and held a focus group involving public health experts from a variety of state, local and territorial agencies.

The public health preparedness capabilities cover several tasks that form the foundation of public health preparedness, such as monitoring of disease outbreaks, community preparedness, emergency response, sharing of information with the public and other agencies and management of facilities and volunteers. Horney and colleagues’ study, published in the American Journal of Public Health, found that public health departments identified weak spots in their own use of the capabilities but noted the importance of the capabilities in guiding their efforts in an environment of growing public health threats and shrinking federal funding.

The research team also found several factors associated with perceptions of the capabilities. “A public health department’s leadership was found to be especially important,” Horney said. “Departments that reported strong leadership were more likely to report that their agency took a lead role in capabilities and had a culture that allowed the department not only to meet current standards but also to bring about new ideas when disruptions, like Ebola or Zika, emerged. Those departments also ranked the capabilities as extremely important to effective public health preparedness efforts.”

Another key factor involved was the size and scope of partnerships public health departments had with other agencies. Public health departments face a growing list of threats that go beyond the traditional bounds of public health, making it vital to work with law enforcement, health care providers and other key players. Departments in this study had an average of 14 partners, and departments with more partners had higher levels of perceived preparedness and effectiveness.

“One surprising finding that is worthy of further study is that the organizational structure and size of health departments were also found to affect perception of capabilities,” Horney said. “Larger and more centralized departments were more likely to cite deficiencies despite having more authority over budgets and issuing public health orders.”

Lastly, the level of resources available to public health departments affected views of public health capabilities. Nearly three-fourths of the departments surveyed said they had no additional funding sources for public health preparedness aside from the cooperative agreement with the CDC. This has led to concerns about using limited funds to cover capabilities outside of what many consider to be the scope of public health.

“Further research will likely help clarify the relationships between these factors, guide updates to the capabilities and give public health departments the tools needed to successfully prepare for public health threats,” Horney said.