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State Role in Public Health Emergencies – Division of Communicable Disease Control

State Role in Public Health Emergencies – Division of Communicable Disease Control Jessica M. N úñ ez de Ybarra, MD, MPH Public Health Medical Officer III CA Department of Public Health (CDPH) Division of Communicable Disease Control (DCDC) Office of Workforce Development

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State Role in Public Health Emergencies – Division of Communicable Disease Control

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  1. State Role in Public Health Emergencies – Division of Communicable Disease Control Jessica M. Núñez de Ybarra, MD, MPH Public Health Medical Officer III CA Department of Public Health (CDPH) Division of Communicable Disease Control (DCDC) Office of Workforce Development All Hazards Workshop – San Joaquin County August 2008

  2. Purpose Provide a basic understanding of the State communicable disease control role as part of the overall State Public Health Emergency Preparedness and Response system in California.

  3. PUBLIC HEALTH While health care is vital to each of us some of the time, public health is vital to all of us all the time. C. Everett Koop, M.D., former U.S. Surgeon General • Mission: The fulfillment of society’s interest in assuring conditions in which people can be healthy. Institute of Medicine. • Functions: Assessment, Policy development & Assurance.

  4. Columbia University Center for Public Health Preparedness The Public Health System Process • a continuous cycle of gathering information, deciding, acting, evaluating • Public health is always evaluating the health of the community

  5. “System” • More than just the public health agency • “Public health system” • All public, private, and voluntary entities that contribute to public health in a given area. • A network of entities with differing roles, relationships, and interactions. • All entities contribute to the health and well-being of the community.

  6. The Public Health System Police EMS Corrections MCOs Health Department Philanthropist Churches Community Centers Nursing Homes Home Health Parks Doctors Schools Elected Officials Hospitals Mass Transit Environmental Health Civic Groups CHCs Fire Tribal Health Employers Laboratory Facilities Economic Development Drug Treatment Mental Health

  7. Columbia University Center for Public Health Preparedness Public Health in America • Prevent epidemics and spread of disease • Protect against environmental hazards • Prevent injuries • Promote and encourage health behaviors • Assure the quality and accessibility of health services • Respond to disasters and assist communities in recovery

  8. Workforce Information Systems Communication Epidemiology/surveillance Laboratory Policy and Evaluation Preparedness and Response Columbia University Center for Public Health Preparedness Public Health Preparedness Threats and Emergencies7 Core Capacities

  9. California

  10. Definitions

  11. Columbia University Center for Public Health Preparedness Workforce The public health system maintains a public health workforce capable of delivering the Essential Public Health Services during routine and emergency operations

  12. Monitor health status Diagnose and investigate health problems Inform and educate Mobilize communities to address health problems Develop policies and plans Enforce laws and regulations Link people to needed health services Assure a competent health services workforce Evaluate health services Conduct research for new innovations The Essential Public Health Services (1994)

  13. Columbia University Center for Public Health Preparedness Information Systems Public Health Systems establish and maintain secure accessible information systems for rapid communication, analysis and interpretation of health data, and public access to health information.

  14. Columbia University Center for Public Health Preparedness Communication Public Health systems maintain communication mechanisms to: • Routinely translate scientific and health information for communities and policy makers • Provide timely, accurate public information and advice to policy makers during emergency events • Coordinate logistical communication within the response community.

  15. Columbia University Center for Public Health Preparedness Epidemiology/Surveillance Public health systems monitor health events to identify changes or patterns and to investigate underlying causes and factors.

  16. Columbia University Center for Public Health Preparedness Laboratory Public health systems maintain the ability to produce timely and accurate laboratory results for diagnostic and investigative public health coverage.

  17. Columbia University Center for Public Health Preparedness Policy and Evaluation Public health systems use community assessment findings to establish priorities and improve the effectiveness of programs and policy decisions.

  18. Columbia University Center for Public Health Preparedness Preparedness and Response Public health systems maintain the ability to effectively detect and respond to public health threats and emergencies.

  19. Columbia University Center for Public Health Preparedness Communication with Your Family • Your family may be concerned, involved and/or have their routines changed. • Do you have a: • Family Disaster Plan? • Personal Emergency Plan?

  20. Family Disaster Plan Materials Source: FEMA: www.fema.gov

  21. Example Personal Emergency Plans: Columbia University Center for Public Health Preparedness During Working Hours After Working Hours NYC-DOH School Health Program Draft, August 2001

  22. Columbia University Center for Public Health Preparedness Remember…… • Make provisions for: • Child(ren) • Spouse/Partner • Parents • Pets • Others

  23. Columbia University Center for Public Health Preparedness COMPETENCY A complex combination of knowledge, skills and abilities demonstrated by organization members that are critical to the effective and efficient function of the organization (Center for Public Health Practice, Emory University)

  24. Columbia University Center for Public Health Preparedness Core Public Health Worker Competencies for Emergency Preparedness and Response Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert. Mastery of the Core Public Health Worker Emergency Preparedness and Response Competencies is the first step for the public health team.

  25. Columbia University Center for Public Health Preparedness In order to respond to any emergency/disaster, ALLpublic health workers should be able to: • IDENTIFY & LOCATE the emergency plan • DESCRIBE the role of Public Health • DESCRIBE the Chain of Command • DESCRIBE & DEMONSTRATE one’s functional role • RECOGNIZE deviations from the norm • IDENTIFY limits to own authority • DESCRIBE communication roles • DEMONSTRATE use of communication equipment • APPLY creative problem solving skills

  26. Columbia University Center for Public Health Preparedness Role of the State Public Health Agency in Emergency Response • Collaborate with other agencies in policy decisions and actions (e.g., request to Feds for Strategic National Stockpile) • Surveillance • Investigation • Public information

  27. Columbia University Center for Public Health Preparedness Role of the State Public Health Agency in Emergency Response (cont’d) • Medical provider information • Reference laboratory support • Public health interventions (e.g. mass vaccinations)

  28. Columbia University Center for Public Health Preparedness Role of the State or Local Office of Emergency Services (OES) Plans, monitors and coordinates all inter-agency activities for potential or actual emergency situations.

  29. Federal State Columbia University Center for Public Health Preparedness Local Example of a Common Multi-level Scheme for Disaster Communication and Coordination PRESIDENT DHS FEMA HHS CDC GOVERNOR’S OFFICE STATE OES STATE DOH Office of Local Elected Official LOCAL OES LOCAL DOH Fire Police Other

  30. Federal State Local Federal, State and Local Coordination in California DISASTERS for Public Health PRESIDENT DHS/FEMA HHS/CDC/VA etc. GOVERNOR’S OFFICE Governor’s OFFICE OF EMERGENCY SERVICES (OES) SOC CDPH/EMSA JEOC OES/REOC Admin & Mutual Aid Regions RDMHC Local Official’s OFFICE OPERATIONAL Area EOC’s Cities, Counties, Special Districts MHOAC LHJ Incident Command Voluntary Health Sector FIRE-EMS Police Media Voluntary Agencies (ARC, etc.)

  31. Columbia University Center for Public Health Preparedness EMERGENCY PREPAREDNESS COMPETENCY • IDENTIFY limits to own knowledge/skills/authority and.. • IDENTIFY key system resources for referring matters that exceed these limits

  32. Role of Local Health Officershttp://www.cdph.ca.gov/programs/dcdc/Pages/default.aspxHealth Officer Practice Guide for Communicable Disease Control in California

  33. Columbia University Center for Public Health Preparedness Examples • LIMITS TO OWN SKILLS OR AUTHORITY • Communication with media • Legal authority • Supervision of others • Allocation of resources • Clinical skills or decision making • Policy decision • KEY SYSTEM RESOURCES • Agency chain of command • Web resources • Logistics Officer • Policy and procedure manual • Disaster plan / protocols

  34. Columbia University Center for Public Health Preparedness ExamplesPublic Health Nurse in the Shelter Setting: • Limits • Treatment of the seriously ill • Providing information to the media • Re-assigning roles of other shelter staff • Resources • Local Emergency Room • DOH Public Relations (or Public Affairs Dept.) • Shelter manager

  35. Cultural and Linguistic COMPETENCE “A set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations.” Terri Cross, 1989 [From March 2005 Presentation by Dr. Melanie Tervalon, MD, MPH, Education Director, COE Nutritional Genomics]

  36. Rationale for Cultural Competence • Responding to demographic changes • Eliminating disparities in the health status of people of diverse, ethnic & cultural backgrounds • Improving quality of services and outcomes Cohen E, Goode T. Policy Brief 1:Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural Competence. Washington DC, 1999. [From March 2005 Presentation by Dr. Tervalon]

  37. Rationale for Cultural Competence (cont.) • Meeting legislative, regulatory, and accreditation mandates • Gaining a competitive edge in the marketplace • Decreasing the likelihood of liability/malpractice claims Cohen E, Goode T. Policy Brief 1:Rationale for cultural competence in primary health care. Georgetown University Child Development Ctr, National Center for Cultural Competence. Washington DC, 1999.

  38. Cultural Humility • Self-reflection and life long learner • Patient-focused interviewing and care • Community-based care and advocacy • Institutional consistency [From March 2005 Presentation by Dr. Tervalon]

  39. Columbia University Center for Public Health Preparedness Public Health for Emergency Preparedness and Response Effective public health emergency preparedness and response depends upon the coordinated efforts of multiple people from many different agencies, working in concert.

  40. Voters State Columbia University Center for Public Health Preparedness Agencies State of California – Executive Branch Voters GOVERNOR’S OFFICE Health and Human Services Depts. CDPH

  41. California Dept. of Public Health www.cdph.ca.gov

  42. CDPH • VISION: Healthy individuals and families in healthful communities • MISSION: Dedicated to optimizing the health and well-being of the people in California.

  43. Executive Centers Columbia University Center for Public Health Preparedness Divisions CDPH Director’s Office • OWH • OMH • OBBH • EPO • CCLHO • Advisory Cmte Center for Chronic Disease Center for Environmental Health Center for Infectious Disease Center for Family Health Center for Healthcare Quality • Chronic Disease • & Injury Control • Environmental & • Occupational • Disease Control • Food, Drug & • Radiation Safety • Drinking Water • & Environmental • Mgmt. • Communicable • Disease Control • Office of AIDS • Licensing • & Certification • Laboratory Field • Services • WIC • Maternal, Child • & Adolescent • Health • Genetic Disease

  44. CDPH through DCDC is responsible for investigating and controlling all communicable disease and conditions in the State of California.

  45. DCDC DCDC, through its Branches, works in partnership with local, national and international health officials, health care providers, and the public to: • monitor health, • identify and investigate existing and potential health problems, • develop and implement prevention strategies, • conduct research, • provide education and training, • and formulate and advise on public health policy

  46. DCDC Branches • Infant Botulism Treatment and Prevention Program • Infectious Diseases Branch • Immunization Branch • Sexually Transmitted Disease Control Branch • Tuberculosis Control Branch • Microbial Diseases Laboratory Branch • Viral & Rickettsial Disease Laboratory Branch

  47. Columbia University Center for Public Health Preparedness Epidemiology/SurveillanceRoles and Responsibilities in Emergency Response • Provide background info on emergency surveillance data • Conduct field epidemiological investigations (prn) • Monitor existing surveillance systems • Establish new surveillance system - Assemble field teams - Establish databases - Develop questionnaires/forms - Enter data - Liaison with hospital/field personnel - Analyze data - Collect data - Develop recommendations for policy

  48. Columbia University Center for Public Health Preparedness LaboratoriesRoles and Responsibilities in Emergency Response • Provide recommendations for specimen types and handling • Accept specimens for testing • Ensure rapid transports to reference labs • Perform testing • Coordinate with epi/surveillance re: data entry • Liaison with Laboratory Response Network (LRN) i.e., outside labs re: testing and data reporting

  49. Columbia University Center for Public Health Preparedness OperationsRoles and Responsibilities in Emergency Response • Provide resources to facilitate others’ activities • Transportation • Communication • Facilities • Security • Personnel • Printing • Coordinate hotlines for public & • providers

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