In this interview, RWJF’s Alonzo Plough, PhD, MPH, and the National Health Security Preparedness Index’s (NHSPI) National Program Office Director Glen Mays, PhD, MPH, discuss ways NHSPI can be used to guide change, the role geographic differences play in preparedness levels, how the COVID-19 pandemic has exposed health inequities and much more.

This interview has been edited for clarity and length.

Glen Mays: From your perspective, why is preparedness important to building and creating a culture of health across the United States?

Alonzo Plough: Preparedness is at the core of building a Culture of Health and health equity—one that ensures everybody, regardless of neighborhood or income group, has a good and fair opportunity for a healthy life, particularly when you have a disaster like the coronavirus pandemic.

We know that no individual, community, organization or initiative can change the trajectory of America’s health alone. This remains true for preparing states and the nation for emergencies. The Index is a way for us to convey what it means to be prepared and the kind of connectivity between sectors required for national preparedness. We’re all in this together.

Glen: The Index lets us focus on specific states and understand how preparedness capabilities vary across the country and change over time. How can that information about geographic variation and differences in protections be used to help us respond to new and emerging threats?

Alonzo: There are many important regional nuances and context-specific factors that have different health security implications across states and regions.

We’ve seen this play out during the COVID-19 pandemic—even the difference in broadband access from region-to-region tells us the kind of things we have to do to achieve the fairness in outcomes and resilience that’s at the core of what we try to do and monitor with the Index. In an urban area with 5G service emerging, for instance, parents at home trying to take care of their kids and keep them schooled will have reasonable broadband access. Those in rural areas likely don’t have this same access, which can really affect the family’s ability to shelter in place and be safe during the pandemic.

Glen: We’ve got a number of measures in the Index that relate to populations and population groups that typically are disproportionately affected by large scale hazards and emergencies like the COVID-19 pandemic. How can we best use this tool as an instrument for improving health equity and closing gaps in health across the country?

Alonzo: Given the data right now, I think it’s fair to say we have a ways to go as a nation, but I think the Index will play a very important role in our learning as to how we improve from this baseline of our COVID-19 response.

I think some of the things that we’re measuring in the Index help us understand areas that we really need to improve, particularly around vulnerable populations. The Index has been very sensitive in trying to understand those contexts, how they vary regionally, and what policies are needed to promote equity so that your state, your neighborhood, or your income bracket doesn’t determine whether you’re going to have a resilient outcome in a disaster.

With COVID-19, for instance, we know that in spite of the good work we are trying to do, there are  tragic inequities in the outcomes we are seeing among different populations, such African Americans and Latinos, isolated elders in nursing homes, and incarcerated populations, to name a few. The Index can help us prioritize these populations and their unique needs and risks as we formulate equitable solutions like distribution of vaccines, therapeutics, and other health interventions.

Alonzo Plough, PhD, MPH, is the vice president of Research-Evaluation-Learning and chief science officer at the Robert Wood Johnson Foundation. Glen Mays, PhD, MPH, is the director of the NHSPI Program Office and chair of the Department of Health, Management, and Policy at the Colorado School of Public Health.

The post How Preparedness Builds a Culture of Health and Health Equity appeared first on NHSPI.

The Colorado Department of Public Health and Environment (CDPHE) is exemplary in its use of Index data to communicate the importance of preparedness across government agencies and with community stakeholders. The CDPHE team leverages Index data to establish priorities, identify gaps, and galvanize support for community wide preparedness across Colorado.

The CDPHE used Index data to create preparedness goals, and incorporated the data into its Implementation Plan and overall Strategic Plan. Through an analysis of the measures and data sources, the CDPHE is targeting areas of improvement within the department and identifying measures where more data are needed from community partners, such as hospitals, businesses, and school districts.

We asked Dane Matthew, director of CDPHE’s Office of Emergency Preparedness and Response, how the Index was helpful to his agency’s work, and he said, “Measuring preparedness is extremely difficult because there are a number of factors, but you can’t improve what you haven’t measured. The Index has done the hard work for us. We know where we need to improve and have a starting point to build upon.”

Seeing this practical application of the Index is exciting and we are eager to follow CDPHE’s progress as the staff apply it to their work. Stay tuned for blog updates to learn more about how CDPHE is integrating measures into their strategic goals in our upcoming interview with Dane Matthew.

Glen P. Mays PhD, MPH is the Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health. His research examines delivery and financing systems for health services, with a focus on estimating their effects on population health and economic efficiency.

The post Colorado Rises to the Challenge as the Preparedness Index Innovator for 2017 appeared first on NHSPI.

Community Planning and Engagement

The Index is organized around six broad areas or domains, one of which is community planning and engagement. The role of community planning and engagement is vital to health security since it represents the extent to which there are supportive relationships among government agencies, community organizations, and individual households that are developing shared plans for responding to hazards. Relationships that connect people and organizations make communities more resilient to disasters and can accelerate recovery after events occur. This domain stood out as the nation’s weakest area of preparedness in the first Index released in 2013, but it improved by 16.3 percent as of 2016—more than any other domain monitored in the Index. If maintained over time, improvements in collaboration may help states and communities acquire new resources and expertise that strengthen other domains of health security. Accordingly, an important research and policy question is, “why do some states perform better than others in the domain of community planning and engagement?”  Understanding the underlying reasons for a state’s higher performance can suggest options for other states.

Evidence-Based Policymaking

A January 2017 assessment of state-level policymaking practices by The Pew Charitable Trusts and the MacArthur Foundation shows wide variation among the states with respect to use of evidence-based policymaking.[i] Looking for six actions of evidence-based policymaking (e.g., does the state compare program costs and benefits or otherwise incentivize agencies to engage in evidence-based policymaking) within four broad policy areas (i.e., behavioral health, child welfare, criminal justice, and juvenile justice), the research team categorized each state and DC into one of four groups: leading (5 states), established (11), modest (28), or trailing (7). The leading states, which include Washington, Utah, Minnesota, Connecticut, and Oregon, have developed “processes and tools that use evidence to inform policy and budget decisions across the areas examined.” Conversely, the seven trailing states take “very few evidence-based policymaking actions.”

Our analysis shows that states with higher levels of evidence-based policymaking tend to perform better on the Health Security Index’s community planning and engagement domain (see Figure 1).[ii] Standing in stark contrast to the adage that “good politics beats good policy every time,” evidence-based policymaking is about government marshalling information to formulate policies that are efficient and effective, and represents “the systematic use of findings from program evaluations and outcome analyses (“evidence”) to guide government policy and funding decisions.”

There is a statistically significant relationship between the extent to which a state demonstrates actions toward evidence-based planning and how it performs in the community planning and engagement domain in the 2017 Health Security Index.[iii]  And the relationship is robust,[iv] with the effect of evidence-based planning remaining strong while holding constant the overall wealth of a state (as measured by a state’s 2016 per capita personal income),[v] its fiscal health (as measured by the percentage of a state’s long-term financial obligations, e.g., debt, unfunded pension costs, and unfunded retiree health care costs, as a percentage of the state’s total personal income),[vi] and its experience with disasters (as measured by number of disaster declarations for state since 1953).[vii]

The slope in Figure 2 represents the estimated relationship between the prevalence of evidence‐based policymaking in a state and its Health Security Index Score in the Community & Planning Engagement Domain while holding per capita income, state fiscal health, and disaster experience constant. As a state moves along the horizontal axis—which reflects the four evidence-based planning categories (i.e., trailing, modest, established, and leading)—a state’s estimated Community Planning and Engagement Health Security Index score increases in a substantively and statistically significant way—from below the U.S. average (Trailing), to within the U.S. average (Modest & Established), to above the U.S. average (Leading). This estimate shows that a state imbued with a culture of evidence-based policymaking—residing in the upper reaches of the “established” category or fully embedded in the “leading” category—would likely score above the U.S. average in the Community Planning & Engagement Domain.

These results suggest that health security can be enhanced by creating a culture of evidence-based policymaking at the state level. The authors of How States Engage in Evidence-Based Policymaking offer some guidance on how to build support for it, such as actively championing its adoption, creating a strong data infrastructure to leverage outcome data, and ensuring there are staff members who have the necessary analytical and technical skills to implement it. There are clearly many benefits accruing to states that have a culture of evidence-based policymaking, including, but not limited to, better policy outcomes, more efficient use of government resources, and enhanced health security.

Michael T. Childress is a research associate at the Center for Business and Economic Research, Gatton College of Business and Economics, at the University of Kentucky. He is part of the program management office for the National Health Security Preparedness Index.

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[i] How States Engage in Evidence-Based Policymaking: A National Assessment, The Pew Charitable Trusts & MacArthur Foundation, January 2017.

[ii] The research team awarded points to states on the basis actions taken toward evidence-based policymaking. An advanced action garnered 2 points, a minimum action 1 point, and no action zero points. An example of an advanced action within the category of “comparing program costs and benefits” is whether a state produces a report on the costs and monetized benefits of multiple related programs (2 points) while a similar report focused on non-monetized outcomes is indicative of a minimum action (1 point).

[iii] The evidence-based policy coefficient = 0.04744, t-value = 2.74.

[iv] The evidence-based policy coefficient barely changes (b=0.04892, t=2.9) even after adding per capita income, strength of state finances, and experience with disasters to the equation.

[v] Bureau of Economic Analysis data available at https://www.bea.gov/.

[vi] PEW data available at http://www.pewtrusts.org/en/multimedia/data-visualizations/2014/fiscal-50#ind4.

[vii] FEMA data available at https://www.fema.gov/data-visualization-disaster-declarations-states-and-counties. We use the logged value, base 10.

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Diving into the data and using it to guide action and partnerships won’t happen overnight. Officials and experts on the ground will need to explore state data, identify areas for improvement, cultivate alliances, and develop creative solutions for closing preparedness gaps. Now in its third release, the Index has seen its data sources and methodology refined and adjusted to encourage its use as a tool for collaboration and improvement in states.

Last fall, we held a webinar featuring national and state officials to share some ideas about how to use the Index. Experts including Former Assistant Secretary for Preparedness and Response Nicole Lurie, Washington state Secretary of Health John Wiesman, Centers for Disease Control and Prevention Office of Public Health Preparedness and Response Director Stephen Redd, and Index Program Management Office Director Glen Mays shared practical examples of how the Index is being put into action.

We are excited to launch the Preparedness Innovator Challenge that we hope will yield creative grassroots solutions from the frontlines of health security and preparedness. Individuals and teams are invited to share their stories of how they are using or plan to use the Index to improve health security, preparedness, and resiliency at a local, state, or national level. Entries will be accepted through July 31, 2017. Winners will receive national recognition for their work, along with opportunities to share their approaches and results with other experts across the country.

As Former Assistant Secretary Lurie noted on the webinar, measures only improve if they are used. To this end, please spend some time exploring in detail the Index data, which can be downloaded via the website Toolkit page, and identifying ways that findings can inform your efforts to improve health security and preparedness in your own state. Always working to make the Index more useful and practical for you, we are proud of all that has already been accomplished and eager to continue moving this work forward.

Alonzo L. Plough, PhD, MPH, is vice president, Research-Evaluation-Learning and chief science officer at the Robert Wood Johnson Foundation.

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