commentary

(United Press International )

December 30, 2004

Prepare the Public

by Nicole Lurie and Jeffrey Wasserman

If Osama bin Laden sends terrorists instead of a videotaped speech as his next message to the United States, the hospitals, clinics, doctors, nurses and other elements of our public health system in targeted cities will not have time to draw up plans to respond. Instead, they will have to rely on actions already taken and plans in place to save lives and help the injured.

A big part of emergency preparedness — whether dealing with a terrorist attack, natural disaster or a disease outbreak — involves purchasing equipment, training first responders and public health officials and bolstering disease investigation and laboratory capacity long before disaster strikes.

But it is also important for all parts of the public health system to prepare customized plans to deal with health emergencies among different population groups. Typical disaster response measures can evoke a multitude of fears from a population as diverse the United States', so a “one size fits all” plan will not be effective for all groups.

One example of an instance where a customized disaster response plan would be required could involve a "dirty bomb" or other radiological or chemical event. This could require mass decontamination, creating a need for large numbers of people to take off their clothes so they could shower in outdoor emergency response bays or other public places. Cultures and religions that emphasize modesty would likely resist situations in which women in particular are fully or partially disrobed.

Another example would be a bio-terrorist attack or a large-scale infectious disease outbreak that might require mandatory mass vaccinations. Some minority group members are fearful that such campaigns would really be designed to harm rather than help them, as evidenced by the durability of the discredited myth that white doctors created the AIDS virus to kill black people.

Further evidence of minority distrust of the health care system comes from a recent telephone survey by the RAND Corporation and the Los Angeles County Department of Public Health. The survey found that 63 percent of African Americans in the county believe the public health system would operate fairly to everyone in a bio-terrorist attack — regardless of race, ethnicity, income and other characteristics. In contrast, nearly 77 percent of whites believe the public health system would operate fairly under such an attack.

A third example of the need for a customized disaster response plan would involve immigrants living in the United States illegally or uncertain about their immigration status. Fearing arrest and deportation, and unable to speak English in many cases, many would be hesitant to register and participate in treatment plans after a terrorist attack or disease outbreak.

A key priority in all the efforts to customize disaster plans for particular population groups would be to build ties and work out emergency response plans with respected members of groups where difficulties are anticipated.

State and local health departments could recruit representatives of minority groups — clergy, leaders of neighborhood organizations and respected healthcare providers — who can communicate a message. Minority groups will be more likely to trust information coming from members of their own community than a generalized and widely disseminated public health warning.

Health departments could also use a portion of the funds they receive from the federal bio-terrorism preparedness program to issue small grants to community groups, supporting minority outreach and educational efforts. Health officials could ask churches, synagogues and mosques that often serve as the epicenters of religious communities to designate themselves as official points of contact for their communities during a terrorist attack or health crisis.

Specialized media sources are an excellent way to reach out to minority groups. Newspapers, radio and TV programs aimed at black, Latino, Jewish, Asian and Muslim groups are often the most-trusted news source within a minority community. By developing ties with these media in advance and then using all trusted media within an area, public health officials will reach more residents than through traditional, mainstream sources.

By anticipating and preparing for the special difficulties with certain population groups, the public health system can lay the groundwork today to make emergency response to terrorist attacks far more effective tomorrow. Just as the terror attacks of Sept. 11, 2001, struck without warning, another terrorist attack, natural disaster or disease outbreak will most likely come suddenly and unexpectedly, making adequate preparedness a matter of life or death for potentially vast numbers of people.

© United Press International

(United Press International's "Outside View" commentaries are written by outside contributors who specialize in a variety of important issues. The views expressed do not necessarily reflect those of World Peace Herald or United Press International. In the interests of creating an open forum, original submissions are invited.)


Nicole Lurie is a senior natural scientist and Jeffrey Wasserman is a senior policy researcher at the RAND Corporation, a nonprofit research organization.

This commentary originally appeared in United Press International on December 30, 2004. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.