Learning from Natural Disasters: Public Health Reaching Across Sectors (PHRASES)

By Karen DeSalvo and Soledad O’Brien

First comes wind, then water, then the snap, crackle, pop of the trees and the rooftops. A storm is blowing through.

Finally, after days of breathless weather reports, the damage begins as waters rise and power systems fail. From Louisiana and Texas to Miami and Puerto Rico, our country has already faced-off against repeated hurricanes this fall– and the season is not yet over.

Both of us have been in the thick of those kinds of deadly storms before — Soledad standing in the elements to tell the story of ordinary people struggling to survive; Karen working as a city public health official to prepare, rescue, and rebuild. Along the way, we both learned the critical role the public health community plays in minimizing catastrophe.

A dozen years ago, Hurricane Katrina roared ashore, causing destruction that inundated New Orleans and killed more than 1,800 people, most of them over age 65. Paper medical records were reduced to wet blobs, preventing many more from getting proper medical treatment; some people could not even be found.

Six years later, when Hurricane Isaac rattled Louisiana, it was clear that public health officials had gotten the message. Paper records had been replaced by electronic ones, and a new database made it easier to locate vulnerable people in need of care. Although more than half the population lost power, the health care system remained opened for business.

So, too, in Houston. In 2001, nearly every local hospital lost power after Tropical Storm Allison. By the time Hurricane Harvey made landfall this September, the hospitals had spent years coordinating with community leadership to prepare for a repeat event. Generators had been moved to higher ground, a central operations center tracked evacuations, and lives were saved.

None of that happened by accident. They were the result of close collaboration between public health and many other sectors, and a commitment to sharing data and lessons learned. We need to do more of that.

Although disasters focus our attention, health and well-being are much more likely to be influenced by the communities in which we live than by a disaster-natural or otherwise. A host of social and economic factors determine our prospects. Do we have clean air and water? Access to nutritious food and opportunities to exercise? Is our housing safe and affordable? Does the health care system emphasize prevention, or simply wait for sick patients to arrive?

Just as public health officials need partners to mitigate disasters, so too must they engage with other sectors to build a healthier future for all. That’s why the de Beaumont Foundation and the Aspen Institute’s Health, Medicine and Society Program are launching PHRASES — Public Health Reaching Across Sectors. The idea is to support public health practitioners with the tools and training to share their expertise with people who make decisions on education, housing, business, and other areas where public health has a critical impact — not only at times of disasters, but every single day. To do that, they will need to learn new languages and the ability to explain concepts in ways that others will embrace.

If they succeed, public health can advance cooperative opportunities at every turn. Some strategies are straightforward –partnering with schools to make sure children have eyeglasses, working with hospitals to move generators to higher floors, advocating for workplace-based drug treatment programs. Others are more complex — redesigning cities to encourage walking and reduce obesity, confronting the health-damaging impact of segregated housing.

But all of it happens best with teamwork, which is why the PHRASES Advisory Committee that we chair is made up of leaders from many sectors. We have already begun to articulate a few guiding principles for our work: understand the motivations and aspirations of other sectors, and seek common ground; honor a nonpartisan approach to maximize partnerships and avoid hot buttons that lose opportunities; and eliminate jargon and use terms understood outside the scientific world.

We don’t yet know how loud the winds will howl or how high the water will rise during the next storm. We can’t predict when the next infectious disease will strike, and we have much more to learn about curbing the health-damaging impacts of poverty. But we know enough to forge links with other sectors so we can prepare for the worst, even as we aspire to be the healthiest. A strong public health system, fully engaged with partners, is the best way forward.

Karen DeSalvo, MD, MPH, MSc, Former Acting Assistant Secretary for Health at the U.S. Department of Health and Human Services and Former Health Commissioner of the City of New Orleans, and Soledad O’Brien, CEO of Starfish Media Group and Host of Matter of Fact with Soledad O’Brien. They are co-chairs of the PHRASES’ Advisory Committee.

Communicating Our Vision for a Healthier Nation

By Ed Hunter, President and Chief Executive Officer of the de Beaumont Foundation

When Ebola reared its head in West Africa in 2014, the world’s public health authorities rushed to control its spread. My CDC colleagues and others from around the globe scrambled to build field laboratories and treatment facilities as well as implement tracking and surveillance protocols — all necessary but insufficient responses to the emerging threat. Equally important were skills in communicating with affected communities about cultural norms like caregiving and burial practices. The lesson was clear: public health officials needed to speak in the right languages through credible leaders in the community, as well as with a keen understanding of the history and culture that drove behaviors.

Back in the U.S., public health officials struggle with some of the same challenges in achieving broad health gains. Our understanding of the role that fundamental social and economic factors play in determining our opportunities for good health is deepening, and the need to reach outside traditional public health circles is more apparent. Yet we often lack the languages and connections needed to help set a health agenda in our communities. In many cases, public health science and data alone fail to spur action by elected officials, business leaders, school superintendents, and housing authorities.

Language and connection are central to the Public Health Reaching Across Sectors (PHRASES) Initiative. The de Beaumont Foundation and the Aspen Institute’s Health, Medicine and Society Program are launching PHRASES to help public health leaders effectively collaborate and communicate with other sectors. PHRASES is a multiyear project designed to provide public health practitioners with the tools and training they need to effectively engage, communicate, and work with key local partners, like mayors and city council members, housing commissioners, hospital CEOs, and school superintendents.

PHRASES’ goal is to ensure that the value of public health — the expertise of professionals, and the approaches and solutions they offer — is better understood and can play a greater role in the decision-making of other sectors. We want to connect with previously untapped, but much-needed, allies to address not only control of infectious illnesses but also the chronic disease challenges facing public health officials across the country. We plan to support public health professionals in their efforts to learn how to speak the “language” and understand the needs and priorities of the other sectors so vital to the ultimate health and well-being of the public.

Over the course of the initiative, PHRASES will:

  • Create a “go-to” and easily accessible web resource that compiles and synthesizes high-quality published research that documents the ways in which public health provides value to other sectors;
  • Identify core elements of a communications strategy that describes public health in ways that resonate within and across sectors;
  • Develop a toolkit that ties the evidence for public health’s contributions across sectors to what is learned from the project’s message research and testing; and
  • Conduct outreach and training for the public health community to ensure effective use of the project’s web resource and toolkit.

The public health community must work with other sectors to meet their needs. Take the education sector for example. A local public school knows that its performance is measured by its test scores. Absentee rates can affect these scores. Public health professionals know that asthma causes many of these absences. Therefore, if we find ways to address the underlying asthma problem, we can address the absentee problem and then hopefully raise test scores.

Similarly, it does not make sense to treat acute episodes of childhood asthma repeatedly in the emergency room when we can address the source of the asthma triggers in these children’s homes. This requires working closely with public and private housing officials — speaking their language and understanding their programs, and financing structures and priorities.

PHRASES will equip public health professionals with strategies for framing these conversations with our colleagues in the education and housing sectors as well as others, so that together, we can serve all our goals and objectives.

Join us as we connect leaders across sectors and drive towards a healthier, more robust America. For more information on PHRASES, go to phrases.org.