Bioterrorism Preparedness
Lessons for Research
Carmen Rita Nevarez,
MD, MPH
Vice President for
External Relations
and Medical Director
Definition
Definition of public health systems research
“…a field of inquiry examining the organization, financing,
and delivery of public health services and the impact of
these activities on population health.”
Mays GP, Halverson PK, and Scutchfield DF. Behind the curve? What we know and need to learn from
public health systems research. Journal of Public Health Management and Practice 2003; 9(3):179182.
Organization
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Preparedness Models
= 62 in California
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61 Local Health Departments
3 City Health Jurisdictions
1 State of California
Organization Cont.
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Overlapping jurisdictional authority (extent of
police powers of health officer/jurisdiction:
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resolution of jurisdictional authorities between
health/police/fire (FBI, Office of Homeland Security,
other national governments)
As a result of 9-1-1 CDC uses Unified Incident
Command System – evidence
Organization cont
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Evidence for effectiveness of “regionalization” as an
organizational model
“Best” parameters used to determine boundaries
Communication systems
Natural boundaries (geographic & transportation)
Social organization boundaries/unifiers
Language, culture, social status???
Population density
Organization cont
How often should plans be revised
 Impact of immigratiuon
 Globalization
 Economy
 Growth parameters (housing starts,
redevelopment..
 Plans coordinated with other planning entities
(housing & redevelopmnent, city planning
(jurisdictions are mostly county jurisdictions, only
3 city LHDs
Financing
Impact of population based funding distribution
formulas on integrity of LHD
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Do PBF formulas further fragment
functioning of small population counties
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How does jurisdiction hire .25FTE
epidemiologist?
Financing
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Measures of improvement over time
How does the roll-out of federal funding to state
to LHJ
Delivery
Key players-RELATIONSHIPS
 Government institutional
 Health Depts, other “police power/public safety”
depts.- law enforcement, fire, toxics, emergency
operations
Delivery
Key players-RELATIONSHIPS
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Non-government institutions
Voluntaries
Traditional – Red Cross
Non traditional – Food programs
serving homeless, church, HIV/AIDS
Impact on Population Health
Vulnerable populations
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Language, age, geography, transportation,
proximity distance, weather systems, corridors,
social corridors, homeless, disabled
Disenfranchised- knowing and unknowing vectors
of communicable disease
Impact on Population Health

What is the impact of improved response systems
on chronic disease
Positives
New methods of bilateral communication, improved
social marketing tehcnologies
- Negatives
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