Disaster Preparedness

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Branden Stone
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Addressing Health Equity Through Social Justice in Public Health Preparedness Assessing

Office of Emergency and Public Health Preparedness Louisville Metro Department of Public Health

supply kit that contains a minimum three-day supply of food and water as an element of

5/27/2008 2 Disaster Preparedness This recommendation is a part of community preparedness

1 Addressing Health Equity Through Social Justice in Public Health Preparedness Assessing Household Food Insecurity for Public Health Preparedness Planning Matthew Groenewold, PhD, MSPH Office of Emergency and Public Health Preparedness Louisville Metro Department of Public Health and Wellness Disaster Preparedness The federal government recommends assembling an emergency supply kit that contains a minimum three-day supply of food and water as an element of household and personal emergency preparedness. 5/27/ Disaster Preparedness This recommendation is a part of community preparedness planning in jurisdictions across the country, including Kentucky and Louisville Metro. Severe weather events Floods Earthquakes Wildfires Chemical releases 5/27/

adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain 1 Estimated prevalence in 2006: 10.9 % of all US households 1.

2 Disaster Preparedness? Not realistic for food insecure families Immediate nutritional needs must be met Cannot stockpile food for future 5/27/ Food Insecurity Exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain 1 Estimated prevalence in 2006: 10.9 % of all US households 1. Life Sciences Research Office, Federation of American Societies for Experimental Biology. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120(Suppl): /27/ Food Insecurity Both a consequence of and a contributor to social and health disparities Inversely correlated with household income Associated with poor self/parent-reported health status Adults Children Can lead to hunger and malnutrition Can also exist in the absence of these conditions Associated with increased risk of obesity 5/27/

Measuring Household Food Insecurity Measured in population surveys using the US Household Food Security Scale (USHFSS) 18-item scale Developed by USDA and HHS Instruments includes items that refer to

Insecurity Validated, six-item short form of USHFSS also available Works equally well for households with and without children Does not distinguish between moderate and severe hunger Classifies

3 Measuring Household Food Insecurity Measured in population surveys using the US Household Food Security Scale (USHFSS) 18-item scale Developed by USDA and HHS Instruments includes items that refer to both children and adults Classifies households as: Food secure Food insecure without hunger Food insecure with moderate hunger Food insecure with severe hunger 5/27/ Measuring Household Food Insecurity Validated, six-item short form of USHFSS also available Works equally well for households with and without children Does not distinguish between moderate and severe hunger Classifies households as: Food secure Food insecure without hunger Food insecure with hunger 5/27/ Health Equity and Disasters Disasters exacerbate existing social inequities Economically disadvantaged more susceptible to the health effects of environmental problems Higher levels of exposure Less access to protective or adaptive resources 5/27/

Health Equity and Disasters The poor during disaster or other

and rescue Disproportionately people of color 5/27/2008 10 Health

food insecure households are inherently inequitable Expectation

days 5/27/2008 11 Health Equity and Disasters Inequitable

public authorities among those most vulnerable Recommendations

4 Health Equity and Disasters The poor during disaster or other acute emergency Most vulnerable Most dependent upon intervention and rescue Disproportionately people of color 5/27/ Health Equity and Disasters Preparedness plans that fail to account for food insecure households are inherently inequitable Expectation that all citizens can or will be self-sufficient for up to three days 5/27/ Health Equity and Disasters Inequitable preparedness plans hamper response efforts Foster mistrust of public authorities among those most vulnerable Recommendations that cannot be carried out undermine trust in government/emergency response agencies 5/27/

5 Project Objectives Examine preparedness plans and policies in light of local household food insecurity data Prevalence Predictors Determine adequacy of plans and policies from social justice and health equity perspective NACCHO funds used to conduct population-based survey of household food insecurity in Louisville Metro 5/27/ Survey 506 Metro Households List-assisted, RDD telephone survey 6-item short form of USHFSS Two-stage, stratified cluster sample Metro census blockgroups with < 90% of population at or above 200% of FPL included (n = 449 of 557 blockgroups) Eligible blockgroups stratified by quintiles of percent of population below FPL 10 blockgroups (clusters) randomly selected from each stratum households surveyed in each cluster, with 1 adult (> 18 yrs) responding to questions for each household 5/27/ Sample v Population Characteristics: Households Sample Households Survey Population n % Number of Households n % Chi-SquareP-Value Total Household Size % % % % % % % % % % % % % % Total Household Income < $15, % % $15,000 - $24, % % $25,000 - $34, % % $35,000 - $49, % % $50,000 - $74, % % $75,000 - $99, % % $100, % % Total /27/

6 Sample v Population Characteristics: Respondents Sample Respondents Survey Population n % Population n % Chi-Square P-Value Total Gender Male % % Female % % Total <0.001*** Race White % % Black % % Latino % % Other % % Total Age % % % % % % Total <0.001*** Marital Status Single % % Married % % Divorced % % Widowed % % Total <0.001*** Educational Attainment No School % % 8th Grade or Less % % Some High School % % High School Grad % % Some Post-Secondary % % Bachelor's Degree % % Any Post-Grad % % Total <0.001*** Employment Employed % % Unemployed % % 5/27/ Total * Analysis Sample weighting Mixed weighting to adjust for: Scale Unequal selection probabilities due to complex sampling design Product of inverse probabilities of inclusion from each sampling stage Complex sample design accounted for in calculation of standard errors of proportion estimates SAS 9.1 PROC SURVEYFREQ Rao-Scott design-adjusted chi-square used for tests of association 5/27/ Results Food Security Status Households (Wt d est.) % 95% C.I. (%) Secure Insecure Insecure w/hunger Total /27/

7 Results Food security status significantly associated with: Income Chi-square , P < Household Size Chi-square , P = Race Chi-square , P = /27/ Forthcoming Analyses Multivariable regression analyses adjusting for effect of numerous covariates Confounding Interaction Cartographic modeling to produce risk maps Identify high-risk areas Preparedness planning Intervention Mitigation Spatial association with food deserts 5/27/ Conclusions Equitable preparedness planning requires that officials take all peoples circumstances into account, including the poor Significant levels of food insecurity and hunger in Jefferson County Preparedness plans should address the needs of food insecure households 5/27/

Multnomah County Health Department Incorporating Social Justice Principles & Addressing Health Equity Through Public Health Preparedness Pandemic Influenza Planning

us May 27 th, 2008 5/27/2008 22 Presentation overview Context of project Issues of equity and social justice specific to pandemic influenza Project start up and

8 Multnomah County Health Department Incorporating Social Justice Principles & Addressing Health Equity Through Public Health Preparedness Pandemic Influenza Planning Jessica Guernsey Camargo, MPH May 27 th, /27/ Presentation overview Context of project Issues of equity and social justice specific to pandemic influenza Project start up and immediate outcomes Next steps 5/27/ The Work: Community Based Organizations African America Health Coalition Asian Health and Service Center El Programa Hispano-Catholic Charities Hacienda Community Development Corporation Immigrant and Refugee Community Organization 5/27/

9 Project goals Ensure two-way way communication between culturally-specific populations and response organizations Raise awareness around the issue of public health emergency preparedness Incorporate learning from communities around what may constitute an emergency in their community 5/27/ Project foundation Regional Hospital Preparedness Program- Cultures Uniting for Emergency Preparedness Project (CUEP)-evolution of project Parallel process with pandemic flu planning for use of community mitigation strategies Parallel process and synergy of local Health Equity Initiative 5/27/ Pandemic flu planning The resiliency of those who would need to stay home during a pandemic will depend on their level of preparedness. (Emer Infect Dis-May 2008) 5/27/

10 Pandemic flu planning Community mitigation measures could cause particular problems for persons from low-income families and for racial and ethnic minorities. With these problems in mind, communities should plan for the needs of vulnerable populations who may be adversely affected during a pandemic. (Emer Infect Dis-May 2008) 5/27/ Project roll out Offered to all CBOs involved in CUEP Convened 5 planning meetings to; Identify community leaders and recruitment process Identify exercise objectives Design exercise Exercise held April 23 rd, /27/ Project findings Who s s emergency is it anyway? Primary role of CBO s-need for building capacity Homogeneity of emergency preparedness as a field and how that is reflected in the work 5/27/

11 Project findings Moving beyond translation and communication-access access to power and different ways of doing the work Emergency preparedness should build on priorities in the community Need an economic framework for community compliance with community mitigation measures 5/27/ Immediate outcomes Preliminary outcomes were used to prioritize 3 year strategic goals for Oregon Public Health Preparedness 5/27/ Next steps Finish final report-report back out to community Present to decision-makers Bridge health equity and PHEP State and county strategic planning- advocate for equitable structure and funding 5/27/

12 P.L.A.N. Preparedness through Linking All Neighbors Addressing Emergency Preparedness through Social Capital Theory Jennifer Weitzel Public Health Madison and Dane County Madison, WI Objectives Participants will be introduced to Social Capital theory and how it relates to emergency preparedness Participants will be introduced to how this theory is being applied to emergency preparedness in 3 specific Madison neighborhoods. 5/27/ Social Capital Theory 5/27/

13 Chicago Heat Wave /27/ North Lawndale South Lawndale 5/27/ Project history PLAN: Preparedness through Linking All Neighbors PLAN Resource Guide A guide to creating neighborhood emergency plans Public Health Madison and Dane County 5/27/

Similar Programs All Together Now Neighbors helping neighbors create a resilient New York City

html SNAP: Seattle Neighborhoods Actively Prepare http://www.seattle.

Get Strong for 5/27/2008 40 any potential emergency Allied Drive Neighborhood: Demographics

less than poverty level: 716 Disabilities (number of people) Sensory disability: 64 Physical

14 Similar Programs All Together Now Neighbors helping neighbors create a resilient New York City building by building, block by block et/atn/index.html SNAP: Seattle Neighborhoods Actively Prepare mergency/programs/snap/ Seattle s s own neighborhood initiative to Get Ready, Get Connected and Get Strong for 5/27/ any potential emergency Allied Drive Neighborhood: Demographics Neighborhood Summary Total population: 3,663 Households without a vehicle: 185 Households with income less than poverty level: 716 Disabilities (number of people) Sensory disability: 64 Physical disability: 172 Mental disability: 156 Self-care disability: 104 5/27/ Allied: Project description Welcomer program Improving inter-agency communication 5/27/

15 Allied: Successes Agency phone tree Neighborhood champions identified 5/27/ Allied: Challenges Preconceived notions regarding ability of residents to plan Immigration issues 5/27/ Allied: Next Steps Community Health Worker model Continue to develop Welcomer program 5/27/

Meadowood: Demographics Majority are home-owners owners

5/27/2008 46 Meadowood: Project description August 16,

Officials About Crime August 10, 2007: West Side Eyes

Side Residents Voice Crime Concerns To Police Chief,

16 Meadowood: Demographics Majority are home-owners owners Elderly Change in demographics over the last 10 years 5/27/ Meadowood: Project description August 16, 2007: West Side Residents Aim To Keep Pressure On City Officials About Crime August 10, 2007: West Side Eyes Next Steps In Fight Against Crime August 9, 2007: West Side Residents Voice Crime Concerns To Police Chief, Mayor 5/27/ Meadowood: Successes Diversity to the table! 5/27/

Meadowood: Challenges Progress will take time Safety is the main priority 5/27/2008 49 Meadowood: Next Steps Contact information collected Community Garden 5/27/2008 50 Triangle: Demographics Total

17 Meadowood: Challenges Progress will take time Safety is the main priority 5/27/ Meadowood: Next Steps Contact information collected Community Garden 5/27/ Triangle: Demographics Total Population: 350 Number of Households: 339 Renter occupied, low income subsidized housing Percent of Households with a member with diagnosed disability (physical, cognitive, and/or mental): /27/

residents social interaction skills and mental health 5/27/2008 53 Triangle: Challenges Operating in a

18 Triangle: Project description Personal Safety and Security Fire safety Health Welfare, and Communication Weather and Environmental Safety 5/27/ Triangle: Successes Fully engaged partners Improvement in residents social interaction skills and mental health 5/27/ Triangle: Challenges Operating in a neighborhood with a large number of agencies providing services Impact of neighborhood events on residents 5/27/

19 Triangle: Next Steps Floor captain training Fire drill Policy development Registration of residents in the Dane County Disaster Assistance Voluntary Registry 5/27/ Lessons Learned Must be comfortable conceptualizing at the community and systems levels Facilitation skills a must Political will and timing crucial Patience! 5/27/ Questions? Thank you for your participation! 5/27/

Community Development Division: Funding Process Study Update

Community Development Division: Funding Process Study Update Background and Context Two key research studies the Race to Equity Report and a study of Madison s Social Sector by Joiner Sandbrook LLC--highlighted