Public Health Systems and Preparedness Initiative

Helping the Nation Prepare for and Respond to Public Health Emergencies

Today's public health threats–from bioterrorism to pandemic flu–have the potential for swift and widespread harm to the health and well-being of Americans. The nation's public health infrastructure is not fully prepared for a timely and appropriate response to such emergencies: This was dramatically brought home by the September 11, 2001, terrorist attacks, the subsequent anthrax attacks, and Hurricane Katrina. During the last half of the 20th century, the capacity of state and local public health systems seriously declined. These systems were underresourced and often ignored by federal policymakers. However, since 2001, Congress and the Department of Health and Human Services have responded vigorously to these shortcomings by dedicating several billion dollars to strengthen the public health infrastructure to meet and respond to the challenges of the 21st-century world.

Although state and local agencies entrusted with keeping communities safe and healthy have made notable advances in their ability to prepare for and respond to health emergencies, gaps still remain. Helping the nation fill those gaps is the mission of the RAND Public Health Preparedness Initiative.

Our research focuses on:

  • Overarching public health systems issues
  • Exercises, drills, and tools
  • Quality improvement and measurement
  • Lessons learned
  • The Strategic National Stockpile

What We Do

Our work is supported by grants and contracts from state and federal agencies as well as from private organizations. For example, we have worked with the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response, over several years to develop resources and to prepare analyses to describe and enhance key aspects of state and local public health emergency preparedness and to determine the adequacy of the goals, objectives, and performance indicators that HHS uses to foster such local and state readiness. We are also working with the Centers for Disease Control and Prevention to develop metrics for public health preparedness to improve accountability and facilitate performance improvement. Below, we highlight the range of RAND Public Health Systems and Preparedness work.

Overarching Public Health Systems Issues

Development of a National Health Security Strategy. We are currently supporting HHS efforts to develop and implement a National Health Security Strategy that is designed to minimize the adverse consequences associated with a wide range of public health emergencies.

Defining Public Health Preparedness. We convened an expert panel in to develop a clear and widely applicable definition of public health emergency preparedness that can provide common terms for discussion and establish a basis on which to develop a small core of critical standards and measures.

Public Health System Structure. We examined the factors influencing the particular ways in which state and local public health systems are organized, examined alternative structures from service industries (public education and banking), and recommended strategies to improve public health preparedness.

Review of National Pandemic Influenza Plan. We reviewed the HHS government-wide plan to prepare for the next influenza pandemic, highlighted strengths and gaps, and made suggestions for improving preparedness.

Review of International Influenza Surveillance Programs. We systematically reviewed the HHS international influenza surveillance programs in order to describe opportunities for optimizing the quality, timeliness, and efficiency of surveillance, and to enhance integration across HHS and the federal government as well as with key international partners.

Exercises, Drills, and Tools

Pandemic Influenza Tabletop Exercise. We developed a fully customizable template for a tabletop exercise for pandemic influenza preparedness that can be used by state and local health agencies and their health care and governmental partners as an exercise in training, in building relationships, and in evaluation.

Proficiency Tests for 24/7 Reporting Systems. We developed a suite of exercises, based on simulated case reports, to help local public health agencies and their state counterparts test and monitor their around-the-clock capability to respond to emergency case reports.

Influenza "Look Back" Tool. We designed and tested a new tool that public health agencies can adopt to regularly "look back" at each routine annual influenza season to systematically institutionalize knowledge from one flu season to the next and incorporate lessons into preparedness activities for pandemic influenza and other public health emergencies.

GIS Tool for Mapping Vulnerable Populations. We are developing an interactive Web-based geographic information system (GIS) tool that will aid state and local communities in identifying and locating vulnerable populations in their jurisdiction. The tool is designed to enhance the community's ability to address the needs of vulnerable populations in its public health emergency planning and response activities.

POD Location Tool. We are developing a tool to allow local health departments to select a pattern of point-of-distribution (POD) locations for distributing medical material from the Strategic National Stockpile to their community in an efficient and equitable manner.

Quality Improvement and Measurement

Learning Collaborative. We organized a pilot quality improvement (QI) learning collaborative designed to assist public health organizations to apply QI methods originally developed in manufacturing to public health, specifically in the context of preparing for an influenza pandemic.

Preparedness Measures. We are developing a standardized and robust set of measures of state and local public health emergency preparedness that build on past efforts to develop measures of capacity (e.g., planning, training, infrastructure), which also include measures of operational capability and actual response.

Laboratory Surge Capacity Measurement. We have created a performance measurement tool for public health laboratory surge capacity to determine if a laboratory can accurately perform a test and that it can accurately perform a high volume of tests under stress.

Lessons Learned

Lessons for Bioterrorism Preparedness. We assessed the response of state and local health departments to the 1999 to 2003 outbreaks of severe acute respiratory syndrome (SARS), monkeypox, West Nile virus, and hepatitis A to gain insight into challenges that may also be presented by a bioterrorist attack.

Exemplary Practices Repository. We compiled a repository of exemplary practices in responding to bioterrorism and other public health emergencies at state and local levels.

Lessons from Hurricane Katrina. We collected and synthesized the key lessons learned from the public health response to Hurricane Katrina to help public health agencies improve their response the next time a disaster (natural or man-made) strikes.

The Strategic National Stockpile

Strategic National Stockpile Assessment Drills. We developed a set of easy-to-use drill-based tools to assess the ability of state and local public health agencies to request, receive, and dispense medications and other medical materials from the Strategic National Stockpile in the event of a large public health emergency.

Mass Antibiotic Distribution Standards. In support of the Cities Readiness Initiative, we developed a set of minimal standards for timely mass antibiotic distribution in response to a bioterrorist attack or other public health emergency.