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TECHNICAL REPORT Building Community Resilience to Disasters A Way Forward to Enhance National Health Security Anita Chandra • Joie Acosta • Stefanie Stern • Lori Uscher-Pines Malcolm V. Williams • Douglas Yeung • Jeffrey Garnett • Lisa S. Meredith Sponsored by the U.S. Department of Health and Human Services HEALTH This work was sponsored by the U.S. Department of Health and Human Services. The research was conducted in RAND Health, a division of the RAND Corporation. Library of Congress Cataloging-in-Publication Data is available for this publication. ISBN 978-0-8330-5195-0 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark. Cover: Survivors of Hurricane Katrina arrive at New Orleans Airport where FEMA's D-MAT teams have set up a medical hospital and where people will be flown to shelters in other states, September 1, 2005. FEMA photo by Michael Rieger. © Copyright 2011 RAND Corporation Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND documents are protected under copyright law. For information on reprint and linking permissions, please visit the RAND permissions page (http://www.rand.org/publications/ permissions.html). Published 2011 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665 RAND URL: http://www.rand.org To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] Preface Community resilience, or the sustained ability of a community to withstand and recover from adversity (e.g., economic stress, influenza pandemic, man-made or natural disasters) has become a key policy issue, which is being embraced at federal, state, and local levels. Given that resources are limited in the wake of an emergency, it is increasingly recognized that resilience is considered critical to a community’s ability to reduce long recovery periods after an emer- gency. The goal of this report is to provide a roadmap for federal, state, and local leaders who are developing plans to enhance community resilience for health security threats. The report describes options for building community resilience in key areas. We provide a definition of community resilience in the context of national health security and a set of eight levers and five core components for building resilience. We describe suggested activities that communities are pursuing and may want to strengthen for community resilience, and we identify challenges to implementation. This research was conducted from October 2009 through October 2010. It was spon- sored by the U.S. Department of Health and Human Services Assistant Secretary for Pre- paredness and Response and was carried out within the RAND Health Public Health Sys- tems and Preparedness Initiative. RAND Health is a division of the RAND Corporation. A profile of the Center, abstracts of its publications, and ordering information can be found at http://www.rand.org/health/centers/preparedness/. More information about RAND is available at www.rand.org. Comments or inquiries should be sent to the report’s lead author, Anita Chandra ([email protected]), or the principal investigator of the larger project of which this report is but one part: Jeffery Wasserman ([email protected]). The mailing address is RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407. More information about RAND is available at http://www.rand.org. iii Contents Preface ........................................................................................................... iii Figures ........................................................................................................... ix Tables ............................................................................................................ xi Summary .......................................................................................................xiii Acknowledgments ............................................................................................ xxi Abbreviations ................................................................................................ xxiii CHAPTER ONE Introduction ..................................................................................................... 1 Focus of This Report ............................................................................................ 2 Approach .......................................................................................................... 3 Literature Review ............................................................................................. 3 Stakeholder Focus Groups .................................................................................... 4 Other Meetings with Subject Matter Experts .............................................................. 4 Integration of Information .................................................................................... 5 Key Limitations to Consider ................................................................................. 5 Using This Report ................................................................................................ 6 CHAPTER TWO Definition and Application of Community Resilience .................................................. 7 Definition of Community Resilience in the Context of National Health Security ...................... 7 Process for Developing the Definition ...................................................................... 7 Definition of Community Resilience ........................................................................ 8 Application of the Definition: Levers .......................................................................... 8 Process for Identifying Levers ................................................................................ 8 Levers for Building Community Resilience ................................................................ 9 CHAPTER THREE Wellness: Promote Population Health Before and After an Incident, Including Behavioral Health .......................................................................................................11 Activities Related to Community Wellness ..................................................................12 Element 1: Activities to Promote Public Understanding of Health and Wellness ....................12 Element 2: Activities to Ensure Sufficient Community Health Resources, Along with the Capability to Leverage Those Resources to Achieve Desired Outcomes ..........................13 v vi Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security CHAPTER FOUR Access: Ensure Access to High-Quality Health, Behavioral Health, and Social Resources and Services ................................................................................................15 Activities Related to High-Quality Health, Behavioral Health, and Social Resources and Services ......................................................................................................16 Element 1: Activities to Ensure Continuity of Healthcare and Related Social Services ..............16 Element 2: Activities