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Environmental Health and Pandemic Flu

Posted on: Wednesday, 1 November 2006, 06:00 CST

By Fabian, Nelson

Hope is not a strategy.

Our board of directors often gets into discussions that prompt sometimes one and sometimes all of our directors to say yet again, "NEHA represents all of environmental health." I mention this because whatever issue is tugging at the time for our attention, we never forget that all of the other issues comprised by environmental health remain important to our association.

It is true, though, that different concerns within the profession will at different times vie for our attention and resources. Today, the issue that is arguably doing the most tugging is the issue of emergency and all-hazards preparedness. In fact, with the world becoming a more dangerous place by the day, it can hardly be surprising that our board has denned emergency preparedness as our foremost strategic direction. Our profession can play a huge role in response, recovery, and restoration. We must therefore be both aware of our roles and competent in our responsibilities.

Within the overall topic of emergency preparedness, specific concerns range from natural disasters to terrorism and to even large- scale infectious-disease outbreaks. While the education that has developed around some of these concerns now has some traction, it has only been within the last year or so that environmental health has even begun to talk about-let alone plan for-a role in a pandemic- flu scenario. Yet our profession could have a significant impact on this issue that has the potential to wreak so much morbidity, mortality, and economic disruption. Little wonder, then, that NEHA has been spending time both investigating this issue and reporting back to the membership on what we are learning.

We have featured stories on this issue in our Journal, we've developed online learning opportunities on the subject, and we've devoted a substantial track of our annual conference education this year to the topic of pandemic flu. At our conference, we also sponsored a series of focus groups whose purpose was to explore what an environmental health role in response to a pandemic flu might look like. Because so many good ideas and recommendations surfaced in these energetic discussions and because we're looking for ways to get this good information out to our members as quickly as possible, I thought I would devote my column this month to a summary of some of the comments that came from our focus groups. I hope you find these notes thought provoking and helpful:

* All of public health will be called upon; therefore it is important that environmental health professionals be aware that they will have pandemic-response roles to play.

* Environmental health people know about food, housing, available community resources, and so forth. Therefore, they can be expected to lend their professional and community knowledge to overall efforts to ensure that the community's viability can be maintained during a pandemic situation.

* Environmental health should play a role in helping to educate a community about preparedness, especially before any emergency such as a pandemic.

* Environmental health personnel should be prepared to take on new roles ranging from setting up emergency morgue facilities to supervising traffic flow in mass-vaccination centers.

* To ensure that environmental health services can be provided during an emergency situation, business continuity plans- specifically for environmental health-should be developed beforehand. These plans should also be practiced so that they can be easily implemented if they need to be activated.

* Environmental health departments need to be talking to and coordinating with other elements of their communities now so that appropriate plans utilizing the expertise of environmental health can be developed before an emergency situation occurs.

* Since community needs and circumstances will vary across the nation, it is to be expected that the environmental health response in one area may look somewhat different from the environmental health response in another.

* Environmental health should contribute to appropriate public health messaging both now and during an episode. Press releases that address basic public health principles (such as handwashing, limiting hand-to-face motions, and cough etiquette) should be prepared beforehand, and environmental health should be involved in whatever public health messages go out. Environmental health should also write the passages that pertain to safeguarding food, making water safe, disposing of wastewater without electricity, and so forth.

* To ensure that environmental health services can be provided when absenteeism is high, cross-training now is important. Cross- training will enable programs to better stretch their staff resources.

* Efforts should be made to translate preparedness educational materials into the appropriate languages of a community, and the messages need to be oriented to the ways in which disadvantaged communities understand them. In this way, important information can penetrate a community and be put to good use.

* Educational information also should advise citizens on how a health department in general and environmental health in particular can be helpful to them.

* Environmental health people have backgrounds and expertise in emergency scenarios. They need, therefore, to impress upon other resources in the community that they (meaning we) have an important role to play during a pandemic. For example, environmental health people know how to disinfect water. If water supplies were to ever become compromised, environmental health people would need to be involved in community advisories that demonstrate how people can safeguard their water supplies.

* Environmental health people should also be involved in community education efforts encouraging individuals and families to develop household emergency supplies that would get them through a short-term period when supplies may not be available.

* Environmental health might also consider becoming involved in the development and even sale of emergency preparedness kits. In this way, environmental health helps to enhance community awareness of emergency preparedness and how it can be achieved.

* Environmental health should also create linkages between itself and utilities, the food industry, county and city public information officers, ham radio operators, port authorities, police and fire departments, and the local media.

* Risk communication skills should be developed among environmental health staff so that they can better communicate to the public on how serious (or not serious) an emergency situation might be.

* Training in incident management systems is also encouraged for environmental health professionals.

* Another organization that environmental health people should be linking to is the Red Cross.

* Preparedness in one's region should be coordinated with preparedness activities in adjacent regions of one's state.

* Environmental health needs to recognize that in many cases it forms the bulk of a health department's activities. As a result, if a health department is called upon to play a role in a response, environmental health professionals are likely to have to pick up a significant share of this work.

* Environmental health needs to have its own pandemic response plan-apart from (though coordinated with) other plans for other programs of a health department. In this way, each environmental health function can more quickly become involved in the response. Also, having such a plan makes other community elements more aware of what environmental health capabilities are.

* An environmental health plan should specify what environmental health professionals should be doing at three stages: prepandemic, pandemic, and post-pandemic.

* Environmental health people should be prepared to understand that if a pandemic hits, the public will think of all health department employees as public health staff and that environmental health people will need to respond as such.

* Environmental health needs to be writing messages now so that once birds start showing up with the virus in our country, we can properly educate our communities on what this presence means and what steps citizens should take if they come across an infected dead bird.

* It's also important to begin educating the community now about the types of services health departments can provide so that if a pandemic hits, people know what they can expect of health department staff.

* Environmental health will most likely have some role to play should public health agencies start using measures such as quarantines and isolations.

* Since many environmental health people are involved in housing, this expertise could be tapped in some way should quarantine and isolation measures be implemented.

* Environmental health needs to maintain its contacts with the many elements of the community it either works with or regulates in order to contribute wherever possible to the ongoing functioning of these various community components and businesses. In fact, businesses may turn to environmental health professionals for guidance on how they can continue their operations.

* Environmental health needs to contribute in whatever way it can to the maintenance of normalcy in a community. The more the public be\lieves that its community can get through such an event, the more likely that is to happen.

* Environmental health will likely have a role to play in mass food centers to ensure that food provisions are safe and that the distribution process for food supplies works.

* Environmental health needs to stay up on all of its connections with noncommunity water supplies. If public water supplies are threatened, it is important that environmental health help people find reliable sources of potable water.

* Environmental health may play a role in helping to set up and possibly even manage alternative care centers. Environmental and public health people can give advice on how such centers should be designed and operated.

* Environmental health people can act as gobetweens for various sectors of the community such as public and private water suppliers.

* Environmental health can already start to plan for its own staff shortages and how it would continue its programs and take care of its staff.

* If the pandemic is serious and spreads throughout an area, it is likely that the Red Cross would also be overwhelmed. Environmental health can therefore help the Red Cross with the safe sheltering of people.

This list is not meant to be a formula or script, or a substitute for an environmental health plan. It should, however, convey the intensity of the discussions our focus groups had. It should also help identify the various considerations that environmental health people everywhere might want to keep in mind about as they go through the process of thinking out how their program could respond in a pandemic situation.

As many who are involved in pandemic planning are quick to say, we all hope that a serious pandemic doesn't materialize-or at least not until we have perfected alternative ways of developing vaccines. Hope is not a strategy, however. Moreover, the type of preparedness that we are talking about for a pandemic also applies to a host of other emergency situations. Wouldn't it be great if we could transform just the threat of a pandemic into a motive to become a vastly more prepared nation? I recently heard Health and Human Services secretary Mike Leavitt say that ultimately, our goal is to make preparedness much more a part of our culture. I think that many in NEHA would agree with the secretary's wise words.

To the extent that NEHA can help advance this cause-which is our foremost strategic direction-we are happy to look at an environmental health role in a pandemic and make as much information about it as possible available to the environmental health community.

Nelson Fabian, MS.

Copyright National Environmental Health Association Oct 2006

Source: Journal of Environmental Health

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