September Is National Preparedness Month
As Congress recognizes National Preparedness Month in September, policymakers face many challenges in public health emergency preparedness. These include the H1N1 pandemic, the continuing health effects of Hurricanes Katrina and Rita, the recent national outbreaks of food-borne diseases, and the ongoing threat of terrorism. RAND has an extensive and robust body of work to help policymakers and the nation prepare for public health emergencies on the local, state, and national levels.
Yesterday, Christopher Nelson was on Capitol Hill briefing The H1N1 Pandemic: Lessons Learned from the Cities Readiness Initiative
RAND research on emergency preparedness and response
Less Than Half of U.S. Adults Received the Recommended Flu Vaccination During 2008-2009 Flu Season
The Centers for Disease Control and Prevention (CDC) recommends annual influenza vaccinations for members of several population groups, including adults over 50, health care workers, individuals with high-risk health conditions or those who come in contact with them, and adults caring for young children. These individuals constitute roughly 70 percent of U.S. adults. To gauge the extent to which adults in these groups received vaccinations, RAND researchers surveyed a nationally representative sample of more than 5,000 U.S. adults at the end of the 2008-2009 flu season. The survey found that only 47 percent of adults recommended for vaccination had received it. Uptake rates among particular subgroups varied widely. Almost seven in ten adults age 65 and older received the vaccine. Roughly half of adults between the ages of 50 and 64 and half of all health care workers received the influenza vaccine. By contrast, only about one-third of high-risk individuals ages 18-49 and one-third of those in close contact with high-risk individuals received the vaccine.
Among unvaccinated adults, the most commonly cited reason (mentioned by 25 percent of the sample) for not being vaccinated was the belief that it was not needed. Other common reasons: "I didn't get around to it (16 percent), "I don't believe in flu vaccines" (15 percent), and "I might get sick" (15 percent). The results of this survey will inform planning by public health officials and other stakeholders seeking to improve vaccination rates in the upcoming influenza season.
How Prepared Are State and Local Health Departments for Emergency Risk Communication?
Risk communication means presenting accurate, credible, actionable, and timely information to the public during public health emergencies. The recent H1N1 ("swine flu") outbreak in April 2009 provided an opportunity to test state and local public health department capabilities for risk communication. In April, 2009, the Secretary of the Department of Health and Human Services declared a public health emergency in response to the outbreak of H1N1. RAND researchers assessed how effectively state and local health departments communicated information via the Web about this emergency to their constituents within 24 hours of the declaration.
The analysis found that nearly all state health departments delivered timely, accessible information to their constituents, covering all the necessary topics. Forty-seven state-level public health department sites provided at least some information specific to the H1N1 outbreak within 24 hours of the alert. Forty-three state-level sites presented information about how individuals could protect themselves and their families. By contrast, only 34 percent of local public health department Web sites (52 out of 153) provided specific information about H1N1 within 24 hours of the alert. One important limitation that many sites at both levels shared was a lack of information in multiple languages.
The researchers subsequently identified three policy implications. First, the variability across local jurisdictions may result from a lack of consensus about the role of public health departments, which suggests that public health departments should work with state and community agencies to clarify their respective roles. Second, public health departments need to be able to communicate with limited-English-proficiency populations, suggesting a role for standards to determine when multilingual information is needed. Finally, given that many public health emergency preparedness activities are supported by federal funding, the federal government needs to continue to provide adequate support to maintain or strengthen states' ability to conduct timely and effective risk communication in the future.
Jeanne S. Ringel
Jeanne S. Ringel PhD, is a senior economist and the deputy director of the Public Health Prepared-
ness program at RAND. She has conducted research on a variety of topics related to public health preparedness, substance abuse, and health care financing and organization. In the area of public health emergency preparedness, Ringel's work has focused on pandemic influenza preparedness. The RAND team recently completed an analysis to identify and document the policy decisions that need to be made now in order to facilitate an effective pandemic response and those that will have to be made in real time during a pandemic. In addition, Ringel led a study considering key issues and options for the development and implementation of a global pandemic vaccine stockpile.
Read more work by Ms. Ringel »
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