Role for the Public Health System in Creating Sustainable Communities

Global human health threats, such as the ongoing COVID-19 pandemic, necessitate coordinated responses at multiple levels. Public health professionals and other experts broadly agree about actions needed to address such threats, but implementation of this advice is stymied by systemic factors such as prejudice, resource deficits, and high inequality. In these cases, crises like epidemics may be viewed as opportunities to spark structural changes that will improve future prevention efforts. However, crises can also weaken governance and reinforce systemic failures. In this paper, we use the concept of the governance treadmill to demonstrate cross-level dynamics that help or hinder the alignment of capacities toward prevention during public health crises. We find that variation in capacities and responses across local, national, and international levels contributes to the complex evolution of global and local health governance. Where capacities are misaligned, effective local prevention of global pandemic impacts tends to be elusive in the short term, and multiple cycles of crisis and response may be required before capacities align toward healthy governance. We demonstrate that this transition requires broader societal adaptation, particularly towards social justice and participatory democracy. Full article

Climate change-related natural disasters, including wildfires and extreme weather events, such as intense storms, floods, and heatwaves, are increasing in frequency and intensity. These events are already profoundly affecting human health in the United States and globally, challenging the ability of communities to prepare, respond, and recover. The purpose of this research was to examine the peer-reviewed literature on community resilience initiatives in one of the most densely populated and economically important regions, the Northeastern United States, and to identify evidence-based interventions and metrics that had been field-tested and evaluated. This paper addresses two critical gaps in the literature: (1) what strategies or interventions have been implemented to build or enhance community resilience against climate change-related natural disasters; and (2) what metrics were used to measure community resilience as an outcome of those strategies or interventions? This review provides a succinct list of effective interventions with specific health outcomes. Community or state-level health officials can use the results to prioritize public health interventions. This review used existing database search tools to discover 205 studies related to community resilience and health outcomes. Methods set criteria to assess if interventions were able to measure and change levels of community resilience to the health impacts associated with a changing climate. Criteria included: (a) alignment with the United States’ National Preparedness Goal for reducing risks to human health and for recovering quickly from disasters; (b) derived from publicly available data sources; (c) developed for use by communities at a local scale; and (d) accessible to modestly resourced municipalities and county health agencies. Five (5) peer-reviewed, evidence-based studies met all of the selection criteria. Three of these articles described intervention frameworks and two reported on the use of standardized tools. Health-related outcomes included mental health impacts (PTSD/depression), mental stress, emergency preparedness knowledge, social capital skills, and emergency planning skills. The paper recommends the COAST project, COPEWELL Rubric for self-assessment, and Ready CDC intervention as examples of strategies that could be adapted by any community engaged in building community resilience. Full article