Community resilience…now what?: Implications and opportunities

for public health systems research

Anita Chandra

April 22, 2015

PHSSR Keeneland Conference

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Presenter Disclosure

No conflicts of interest to disclose

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Today’s presentation

• Brief overview of community resilience

• What have we learned, what does this mean

• Opportunities for public health systems research

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So how did we arrive at community resilience?

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Community Resilience is Continually Developing

The ongoing and developing capacity of the community to account for its vulnerabilities and develop capabilities that aid in:

1) preventing, withstanding, and mitigating the stress of a health incident

2) recovering in a way that restores the community to a state of self-sufficiency and at least the same level of health and social functioning after a health incident

3) using knowledge from a past response to strengthen the community's ability to withstand the next health incident

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Strengthening community resilience is critical in a changing world

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We pursued resilience thinking when traditional disaster response models

were not enough

Resilience vs. Preparedness

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Community resilience acknowledges the intersection between individuals

and organizations

EMS

Tribal Health

Schools

Animal Services

Law Enforcement

Corrections

Faith Based

NGOsLabs

Social Services

City Planners

Transit

Fire

Civic Groups

Employers

Drug Treatment

Elected Officials

Mental Health

Health

center

Public Health Dept

Parks and Rec

Nursing Homes

NeighborhoodOrgs.

Home Health

ADAPTED FROM: NACCHO (MAPP website): http://www.naccho.org/topics/infrastructure/MAPP/index.cfm

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Community resilience requires building neighbor to neighbor reliance

and organizational connection

Individuals/families have the knowledgeto prepare for and respond to disaster

There are enough volunteers to help in a disaster

Organizations are ready and preparedto respond and recover

There are strong relationships between organizations

People can rely on each other (neighbor to neighbor)

RESILIENT COMMUNITIESRESILIENT COMMUNITIES

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Resilient communities drive residents towards a resilience

mindsetCommunity Resilience Mindset

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Community resilience has represented the intersection of Community Health Promotion and

Emergency Preparedness

Community Health Promotion Community Resilience Emergency

Preparedness

Routine surveillance Assessment of population, structural vulnerabilities and assets

Emergency risk assessment

Community education Education about ongoing mitigation

Risk communication

Provision of direct health services (e.g., immunizations, home visiting)

Ongoing assurance of health service access; skill building (e.g., PFA)

Provision of shelters, evacuation plans, mass prophylaxis

Policy support re: health impact

Policies that prepare for routine and emergency conditions

Policy support re: disaster response and recovery

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National resilience efforts have aligned around common principles in

community well-beingNational Preparedness Effort

Language Specific to “Community Well-Being”

National Health Security Strategy (2009 , 2014)

Community resilience is supported by the promotion of healthy lifestyles, disease prevention, and access to culturally informed, timely and high-quality health care.

National Disaster Recovery Framework (2011)

Organizing principles of empowerment, resilience, emotional and psychological recovery (among others)

Presidential Policy Directive-8 (PPD-8) (2011)

Maximize the coverage of the U.S. population that has a localized, risk informed mitigation plan developed through partnerships across the entire community

FEMA Whole Community Engagement (2011)

Greater empowerment and integration of resources across the whole community

CDC Guidance (2011) Create and implement strategies for ongoing engagement with community partners who may be able to provide services to mitigate identified public health threats

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Resilience links other global initiatives with public health roles

LivabilitySustainability

Wellbeing

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Fostering cross sector collaboration to

improve wellbeing

Creating healthier, more equitable communities

Strengthening integration of health

services and systems

Making health a shared value

Acti

on

Are

as

Improved population health, wellbeing

and equity

Ou

tcom

es

Resilience is an overlay to Culture of Health

Resilience-sense of

community

Government 2.0

Environmental

sustainability

Age Friendly

Initiatives, senior

villages

Civic wellbeing

Resilience-govt-NGO engageme

nt

Patient centered medical home ,

ACO

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Today’s presentation

• Brief overview of community resilience

• What have we learned, what does this mean

• Opportunities for public health systems research

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Why does resilience thinking matter?

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Over the last several years, resilience learning has been

captured in several areasPlanning and

strategy development

Quality implementatio

n

Evaluation and

monitoring

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Resilience has given us a window into how communities organize

and plan cross-sectorally

Planning and strategy

development

Quality implementati

on

Evaluation and

monitoring

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Planning and strategy development reflects multi-level efforts

National strategy

City-wide plans

State-wide plansLouisiana’s Master Coastal Plan

Resilience strategic plan for Washington DC

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New models explore synergy and alignment approaches to

resilience strategy

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Strategic planning models build on levers of community resilience

From RAND, Chandra et al. 2011

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Resilience strategy have highlighted issues of governance

Create participatory, stakeholder processes

Consider adaptive management models

Explore range of network and risk governance models

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Planning tools have integrated public health and related action areas

• Assets

• Long-Term Recovery

• Climate Change

• Behavioral Health

• Social & Economic Impacts

• Data Systems

• Sustainable Development

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Resilience has informed implementation sciences

Planning and strategy

development

Quality implementati

on

Evaluation and

monitoring

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Quality implementation must be supported by several approaches

• Communication

• Mapping assets, needs and vulnerabilities

• Leveraging government, military, and non-state actors

• Assessments and decision supports

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Resilience has provided a new way to engage community

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Resilience requires new thinking in education and mobilization

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Asset mapping must be broader and usable for resilience

LA Community Resilience Mapping

Tool (Sahana)

Special Needs Population Mapping

Tool

Youth Resilience Corps Mapping Tool

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Integration of government and NGO is critical

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Tabletop exercises can be used to test what is working in resilience capacity

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What will future conditions be?

What is the best near-term decision?

How sensitive is the decision to the conditions?

“Predict Then Act”

Using decisionmaking under deep uncertainty models can be used for conceptually messy

areas like resilience

Develop strategy adaptations to

reduce vulnerabilities

Identify vulnerabilities of

this strategyProposed strategy

RDM Process

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1. Decisionstructuring

2. Casegeneration

3. Scenariodiscovery

4. Trade-offanalysis

Scenarios that illuminate vulnerabilities

Robust strategies

New options

RDM is iterative; analytics facilitate stakeholder deliberation

RDM uses analytics to facilitate new conversations between decisionmakers

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Resilience requires use of multiple forms of evaluation

Planning and strategy

development

Quality implementatio

n

Evaluation and

monitoring

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Surveys assess resilience knowledge and capacities

• Coalition and community surveys to chart progress along resilience levers

• Household survey to map changes in resilience understanding and activity

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Social and organizational network analysis explore

strength and quality of ties

EMS

Tribal Health

Schools

Animal Services

Law Enforcemen

t

Corrections

Faith Based

NGOsLabs

Social Service

s

City Planners

Transit

Fire

Civic Groups

Employers

Drug Treatme

nt

Elected Official

s

Mental Health

Health

center

Public Health Dept.

Parks and Rec

Nursing Homes

Neighborhood

Orgs.

Home Health

Developed to monitor:• Hospital

preparedness program

• Hurricane Sandy disaster recovery in NYC

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Case studies provide comparative and global analyses

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Systems analysis follows chain of response and recovery

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Financial analysis allows for discussions of creative financing and resilience ROI

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Local analyses like LACCDR offer community change insight

• 16 Los Angeles County Neighborhoods – 8 Preparedness, 8 Resilience

Usual Preparedness

Usual coalition with traditional emergency planners

Use of preparedness tools (e.g., “brown book”)

Community Resilience

Resilience Team with diverse array of community organizations

Use of community resilience toolkit

Concerted focus on vulnerable populations

Use of enhanced asset mapping tools

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Today’s presentation

• Brief overview of community resilience

• What have we learned, what does this mean

• Opportunities for public health systems research

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Why will resilience continue to “stick” and what are the public health

systems questions?

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Reason 1: Resilience requires being more nuanced about partner “response reliability”

• Whole of community is intrinsic to resilience

• New and unique partnerships required for resilience strategyQuestion: Are there particular partner

capacities that are relevant during acute vs. chronic response?

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Reason 2: Resilience requires new ways of considering data regimes

• Government 2.0, Web 3.0

• Integration of data systems

Questions:What constitutes public health data?How are data systems being used for

ongoing adaptive capacity?

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Reason 3: Resilience requires consideration of people and

planet together• Intersection of social and

natural sciences; infrastructure and human

• Social change theory central (much like in Culture of Health) Question:

What models fully incorporate these disciplines and systems, and where does

PH fit?

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Reason 4: Resilience requires reconsideration of government,

public-private • Government role as safety net,

or promoter of wellbeing

• Which P3 models will work for ongoing resilience development

Question:

Where should public health departments position themselves in resilience

strengthening?