April is National Minority Health Month. The theme for NMHM this year is 'Bridging Health Equity Across Communities.' On April 5, Health Equity Day, we're pleased to share a blog highlighting the need to incorporate health equity into disaster preparedness and response as an important component of achieving community resilience.
The broader public health community has begun to embrace the notion that systemic failures over time have resulted in disparate health outcomes across race, gender and socioeconomic status. This shift has resulted in a call for health equity (and “health in all policy”), which strives to create programs and support policies that redress failures and promote health in historically disadvantaged communities. Research has proven that “place” (where you live) can be the primary determination in your access to healthcare and health outcomes. However, as LaViest et al point out, most neighborhoods in the United States are heavily segregated, which accounts for the link between location, health outcomes and race. If health outcomes, like vulnerability to (natural) disaster, are tightly linked to where one lives, it is important to factor these realities into policy and practice.
Across public health policy, there has been a push to ensure funding allocations match policy priorities. To that end, allocating funding in a more equitable manner also requires that communities of greatest need receive public health (and infrastructure) funding and resources that match the need to redress the disinvestment that produced disparate outcomes. Making the shift to a community-based approach by addressing the root causes of health disparities could also result in a residual effect - communities that are more prepared for disasters, improving their health outcomes during and after disasters.
The public health preparedness and response field recognizes that certain communities are more vulnerable to disaster based on location, pre-existing resources, and emergency response infrastructure. Also, there are communities which will experience more deleterious health outcomes following an event, and many of these will be the same communities which already experienced poor health outcomes and health disparities.
Public health must set a goal to strengthen community capacity and resilience through the use of organic community networks, in order to strengthen community capacity sustainably. In the past, public health practice has imposed an additional structure or worked at a high-level to surge resources into a community with the expectation that this would fix the core problem and improve community health. As we have seen in the aftermath of several disasters, the reality is that an approach that does not include community networks is more likely to exacerbate disparities instead of eliminating them.
Especially in the case of disaster preparedness and response, understanding community linkages and recognizing those who hold power and trust in a community is critical to proper planning and an effective response. Building an emergency plan without the input and active involvement of the community which will be impacted often results in a response that does not address the needs of that community, or addresses them too late, and at higher cost. What’s worse, the response effort might never be adopted or trusted by individuals in the community, which slows evacuations, impacts risk communication, and exposes other vulnerabilities. Developing a preparedness and response strategy with health equity in mind requires that planners consider who is accountable to the community and is trusted and empowered by the community to make critical decisions which will directly impact the community during a disaster and the subsequent response. Those factors, in addition to analyzing the present need of the community, have to be understood by practitioners before public health practitioners and emergency management planners can determine the resources necessary to ensure that the community is sufficiently prepared for possible events.
Resources are not solely material. The reality is that building relationships, sustaining networks, identifying needs, and meeting them takes time and funding. If we expect communities who are already experiencing disinvestment to also find the wherewithal to invest in this without external support, preparedness efforts are bound to fail. That expectation also ensures that resilience will not be integrated into the fabric of the community nor accepted as a component of a healthy community.
If the goal is to build community resilience in a community-driven way, this work requires that the community is at the center of the strategy development, which might demand a lot of hard work and coalition building on the part of public health and the community. Incorporating health equity into disaster preparedness and response is not an easy task, but is necessary to account for the systemic challenges that affect health outcomes, and to build true community resilience.