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Vulnerable Populations Wingate

Vulnerable Populations Wingate

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Association of Schools of Public Health
Identifying and Protecting Vulnerable Populations in Public Health Emergencies: AddressingGaps in Education and TrainingAuthor(s): Martha S. Wingate, Emily C. Perry, Paul H. Campbell, Prabu David, Elizabeth M.WeistSource:
Public Health Reports (1974-),
Vol. 122, No. 3 (May - Jun., 2007), pp. 422-426Published by: Association of Schools of Public HealthStable URL:
Accessed: 03/10/2009 21:03
Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available athttp://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unlessyou have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and youmay use content in the JSTOR archive only for your personal, non-commercial use.Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained athttp://www.jstor.org/action/showPublisher?publisherCode=asph.Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printedpage of such transmission.JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new formsof scholarship. For more information about JSTOR, please contact support@jstor.org.
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IDENTIFYINGNDPROTECTINGVULNERABLEPOPULATIONSINPUBLICHEALTHEMERGENCIES:ADDRESSINGGAPSINEDUCATIONANDTRAINING
MarthaS.Wingate,DrPHEmily C.Perry,MPH,CHESPaulH.Campbell,ScDPrabuDavid,PhDElizabeth M.Weist, MA,MPH
Duringanemergency,materialandphysicalresourcesarestretched thinand, often,theneeds of those whomostneedhelp, namelythe vulnerablepopulations,areleftunmet.Vulnerablepopulationscanbedefined
broadlytoinclude thosewhoarenotabletoaccessandusethe standardresourcesoffered in disasterpreparednessandplanning,response,andrecovery.Age,class,race,poverty,language,andahost ofothersocial,
cultural, economic,andpsychologicalfactorsmaybe
relevantdependingonthenatureoftheemergency.
InAugust2005,Hurricane Katrinaprovidedone
illustrationoftheuniquecharacteristicsandvulner
abilities ofspecific populationsinLouisiana,Mississippi,andAlabama. Thestorm mostdirectlystruckMississippi,Louisiana,andAlabama,thepooreststatesinthecountry.1Almost5,000childrenwereseparatedfrom theirfamilies.2Approximately75%of alldeaths
inNewOrleans, Louisiana,occurredamongtheelderly,
whorepresentedonly15%ofthecity'stotalpopulation before thestorm.Ofnearly240shelterssurveyedintheregion,lessthan30%hadaccesstoAmericanSign Languageinterpreters, leavingthose whoweredeaforhard ofhearingwithlittleor no accesstovital
information.3
Inaddition,nearlyall of the280nursinghomesinLouisiana remainedfulldespitethecallsforevacuationand,asaconsequence,215oftheir residentsdied.4Hundreds of school buseswereavailablein
New Orleansaspartofthe evacuationplan.Unfor
tunately,however,theLouisianaStateDepartmentofTransportationandDevelopment's planshadnottaken intoaccountthat hundreds ofschoolbus drivershadalreadyabandonedthecitywiththeir families.As
From theAgPHSchoolsofPublicHealth
ASSOCIATIONF
SCHOOLSOF
PUBLICEALTH
ArticlesforFromthe SchoolsofPublic Healthhighlightpractice-basedactivitiesattheschools.Tosubmitanarticle,facultyshouldsendashort abstract(50-100 words)viae-mailtoAllisonFoster,ASPHDeputyExecutiveDirector,atafoster@asph.org.
422O PublicHealth Reports/May-June2007/Volume122aresult,manyofthevehiclesneverlefttheparkinglot.5The lack ofpublictransportationoutofthecitycreated difficultiesfor thepoor;Censusdatashowthatmorethan halfofthepoorhouseholdsinNew Orleans(54%)didnothaveacar,truck,or vanin2000.lThosewhomanagedtoleave NewOrleanshadtoenduremanyhardships,includinglack ofmedicationsto treatchronicdisease.Thesituationdidnotimproveafter
thestorm,asfivemonths afterKatrina,manyelderly
and otherresidentsontheGulfCoastcontinuedtosuffer fromaggravatedhealthproblems,emotional
strain,andpsychologicalstress.6
Thisrecentexperienceillustratestheneedforimprovementsinpublichealthplanning,response,andrecovery.Amongotherinitiatives,theCentersforDiseaseControl andPrevention(CDC)establishedacademicCentersforPublicHealthPreparedness(CPHP)in2000toassessandtrain thepublichealth
andhealth-careworkforcetobetterrespondtothreats
toournation'shealth,includingthethreatofbioterrorism,infectious diseaseoutbreak,and otherpublichealthemergencies.Inaddition,CDC andAssociationofSchools of Public Health(ASPH)establishedanationwide network ofCPHPtofoster informationsharingandreduceduplicationamongexistingand
futuretrainingand educationalresources."Collabo
rationgroups"?workgroupsof CPHPexpertsandkeypracticepartnersstaffedbyASPH?werecreatedin2004toaddresstrainingissuesinvarioustopics ofpreparedness.Consequently,theASPH/CDCPreparednessEducation for VulnerablePopulationsCollaborationGroupfocusedin2005-2006onthechallengesofmeetingthe needsof vulnerablepopula
tions?also referredtoashigh-risk,at-risk,special,orspecial-needspopulations?before, during,andaftera
publichealthemergency.Thesevulnerablepopulationshaveneedsthatarenotfullyaddressedbytraditionalemergencypreparedness plansandmayrequireadditionalresourcesandspecialattentionduringandafter
emergenciesordisasters.7
Initially,the collaborationgroupconductedanextensivesurveyofavailableemergencypreparednesstrainingresourcesforpublichealth that focusedonspecific vulnerablepopulations.Uponcompletionofthis
survey,theresourceswereorganizedintoagrid,which
 
Figure. Traininggapsinspecificpopulationsandareastoaddresstheseneeds
Population
Planning/policy
GeneraltopicsCoursesavailable forrespondersTrainingexercises
anddrills
ConsumerorientedinformationaidsCollaboration
with
governmentorotherorganizationsMeasurementandevaluationEconomicallydisadvantagedpopulationsXEthnic and racialminoritypopulationsX
MentallyillpopulationsX
Older adultpopulationsXPediatricpopulationsXPopulationswith disabilitiesXRuralpopulationsXSpanish-speakingpopulationsXXXXXXXXXXXXXXXXXXXXXXXXXXXNOTE:Xindicatesanotedgap by generaltopicarea.PublicHealth Reports/May-June2007/Volume122
wassubsequentlyusedtoidentifygaps.Thepurposeofthis articleistodescribegapsinresourcesrelatedtoselected vulnerablepopulationstoinformCPHP,publichealthagencies,andotherorganizationsinvolvedin
preparedness-related planning,training,andcourse
development.For bothdocuments,seehttp://www.asph. org/ cphp/CPHP_ResourceReport.cfm.
FINDINGS
Uponreviewofgapsacrosspopulations,somegeneral
themesemerged,whichmaybecategorizedunder sixareas:(1)policyandplanning,(2)responder-targetedcourses,(3)trainingexercises anddrills,(4)consumeroriented aids andresourcesfor thespecial population,(5)collaborativeefforts,and(6)measurementandevaluation.Eachareaisdescribedinmoredetailinthefollowingsections. TheFigure providesanoverviewofthegapsnotedin eachpopulation.Whiletheserec
ommendationsarenotcomprehensive,theyprovide
aninitial framework forresourcedevelopmentandcurriculumdesigntotrain thepublichealth workforceto meetthe needs ofvulnerablepopulationsduring
anemergency.
Policy/planninggapsDespitetheoverarchingrecommendationfoundinvariouspolicydocumentstoincludespecial populationsintheplanningprocess,feweducationalandtrainingresourcesprovidetipsorguidelinesonhowtoincludevulnerablepopulationsattheplanningstage.FromtheSchoolsofPublicHealthO423Concreteproposals,includingbestpracticesor casestudies,could be useful.Specific plansfor noninstitu
tionalized,home-bound older adultpopulationswerenotaddressedintheresources.Inclusion of needsofchildren(e.g., specificequipmentrequirements,surge
capacity planning,familyreunificationplans,etc.)islimitedinmanyplanningandpolicyresources.For
ethnic,racialminority,andeconomicallydisadvantaged populations,evidence-basedpracticeastohow
toengagethese communities in theplanningprocessis limited.Thereislittle evidencetosuggestthat availableresources aresufficienttoactivelyinvolvedisadvantagedgroupsinplanningbecauseoflimitedunderstandingofthe culture ofpovertyanditsimpactonpreparedness.Ineach of thevulnerablepopulations targeted bythecollaborativegroup,therewasapaucityofpolicyand
planningresources.
Responder-targetedcourses/trainingAlthoughanumber ofcoursesavailablethroughtheCPHP have modules that address theimportanceofvulnerablepopulations,fewcoursesdealexclusivelywith the needs of vulnerablepopulations. Preparednesscoursesthatfocusspecificallyonthe needs ofpopulationswith disabilitieswerenotavailable. Somecourseswerefound thataddressedthespecificneeds of rural
orpediatricpopulations.Acomprehensivecourseon
culturalcompetencyinthecontextofemergenciesis
available.However,the consideration of culturalcompetencealongthe continuum ofprevention,prepared

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