Rural Public Health Preparedness: Setting the Agenda for Change

Michael Meit, MA, MPH, Director, University of Pittsburgh Center for

Rural Health Practice; Co-Director for Rural Preparedness,

University of Pittsburgh Center for Public Health Preparedness

Developing an Agenda for Change

Topics & Facilitators:

Building Capacity

Barbara Quiram, PhD, Texas A&M School of Rural Public Health

Research

Michael Meit, MA, MPH, University of Pittsburgh Center for Rural Health Practice

Advocacy

Janet Place, MPH, University of North Carolina School of Rural Public Health

Setting an Agenda for ChangeBuilding Capacity

Issues: Limited human and financial resources to build

necessary infrastructure Limited understanding of “rural public health”

and how it is practiced Absence of leadership

Recommendations: Workforce and Leadership Development

Integration of rural PH preparedness knowledge into all health professions training

Educational development beginning in K-12 Workforce development that extends beyond health professionals Identify and engage stakeholders in the rural preparedness dialogue Identify model training/leadership development programs

Educational Outreach Direct educational initiatives toward government agencies and

personnel to enable them to make informed decisions Inform policy-makers on best practices that demonstrate importance

and value of strategies utilizing rural resources

Setting an Agenda for ChangeBuilding Capacity

Initial work for the research topic was taken from the Rural PH Research Agenda, developed in 2004.

Preparedness was one of 6 topics in this report, which formed the basis for the research discussion in St. Paul.

Setting an Agenda for ChangeResearch

Issues: Lack of state and local PH response capacities in

some rural areas Lack of uniformity in state and local PH systems for

planning consistency Identification of the expanded rural PH system for PH

response Identification of necessary competencies in rural PH

response Perceived low threat of rural PH emergencies Need for model practices in rural PH response Lack of an organized rural PH constituency

Setting an Agenda for ChangeResearch

Setting an Agenda for ChangeResearch

Priority Research Questions

1. How is government organized (i.e., different state/regional/local models) across the U.S. to assure accountability for preparedness in rural areas and what are the implications for incident command, allocation of funding, cross-jurisdictional response, etc.?

2. What components/functions of preparedness are currently and should be provided by rural communities? How are rural communities mobilizing and organizing resources (including people to fulfill those roles and responsibilities?

3. Who comprises the response network and what competencies are necessary for readiness? What are the most effective training methods?

4. Is the perception of the likelihood of bioterrorist and other public health emergency threats different in rural vs. non-rural (urban, suburban) areas? Between rural areas? Does the perception of threat affect the level of preparedness?

5. What lessons have been learned from previous public health response experiences/events that are applicable to our currents efforts to strengthen rural preparedness? How can those lessons influence/inform models of preparedness, readiness evaluation tools, training strategies, etc?

Setting an Agenda for ChangeResearch

Priority Research Questions

Recommendations: Development of Infrastructure to Support Research

Need for dedicated funding to support “Rural Public Health” research activities, both from federal agencies and foundations

Specific CDC focus on rural public health issues; specific focus among agencies such as FEMA, DHS, DOJ and others on rural PH preparedness

Enhance “prestige” of rural research through development of dedicated rural public health journal and encouraging existing RH and PH journals to include more rural PH content, creation of a national rural PH conference, and enhanced funding opportunities for rural PH researchers.

Setting an Agenda for ChangeResearch

Setting an Agenda for ChangeResearch

Recommendations (Cont.): Research Strategies

Demonstration projects, including across jurisdictions Highlighting case studies and best practices Developing adaptable templates for program implementation Focusing on community-participatory strategies Increasing linkages among researchers, and between researchers and

community partners, including elected officials “Mining” current data sets and summarizing current information Conducting research that can be easily translated into policy Enhancing communications among researchers with an interest in rural

PH – creating a network of rural PH reseachers Creating measurable objectives for rural PH research with easily

identifiable goals

Setting an Agenda for ChangeResearch

Recommendations (Cont.): Research Advocacy

Need to advocate for rural PH research as a unique and necessary priority area within the field of public health

Work with the Federal Office of Rural Health Policy to advocate within the federal government

Work with national RH and PH organizations to create a strong legislative recognition of (and focus on) rural PH issues. Create a rural PH constituency/voice.

Educate legislators, the rural caucus, agency heads, and PH researchers themselves on rural health issues

Ensure a particular focus on CDC, which should be a much stronger voice for rural PH

Setting an Agenda for ChangeAdvocacy

Issues: Lack of an organized rural PH constituency Rural citizens are a large, disparate group Lack of understanding of PH in general, much

less how it can be applied in rural settings

Setting an Agenda for ChangeAdvocacy

Recommendations: Need for broad focus on rural PH, with preparedness as a subset of

that focus – e.g., highlight general surveillance and epidemiology challenges in rural areas, highlighting implications for preparedness

Broadly define preparedness to include infectious disease, food safety, and natural disasters.

Do not create an “us vs. them” mentality Focus on unique rural concerns such as water and food supply,

access to healthcare, energy sources, etc. Highlight challenges related to the public health workforce, including

recruitment and retention issues Enhance general understanding of public health among policy makers

– if they don’t understand PH, there’s little opportunity to educate about rural PH

Create a grass-roots rural public health movement – from there create and organized constituency at the local, state and federal levels

Use business models to frame importance of investing in rural PH

For more information contact:

Michael MeitDirectorUniversity of Pittsburgh Center for Rural Health Practice300 Campus DriveBradford, PA 16701

Phone: (814) 362-5050Fax: (814) 362-5044Email: meit@pitt.edu

www.upb.pitt.edu/crhp