943706

research-article2020
ARPXXX10.1177/0275074020943706The American Review of Public AdministrationWolf-Fordham

Testing the Size, Scope, Capabilities, Capacities, & Limits of State and Local Governments

American Review of Public Administration

Integrating Government Silos: Local

2020, Vol. 50(6-7) 560­–567
© The Author(s) 2020
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DOI: 10.1177/0275074020943706
https://doi.org/10.1177/0275074020943706

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Emergency Planning and Response

Susan Wolf-Fordham1

Abstract
The United States arguably faces the most serious disaster it has faced since World War II: the COVID-19 pandemic. The
pandemic itself has created further cascading economic, financial, and social crises. To date, approximately 114,000 Americans
have died and approximately 2,000,000 (as of this writing) have become infected. American emergency planning and response,
including for pandemics, begins at the local (city, town, and county) level, close to the individuals and communities most
impacted. During crises like COVID-19, natural and other disasters, best practices include “whole of government” and
“whole community” approaches, involving all parts of the government, community organizations, institutions, and businesses,
with representation from diverse individual community stakeholders. Local emergency management and public health
agencies are at the heart of emergency planning and response and thus warrant further examination. While collaboration
between the two is recognized as a best practice, in reality there appear to be silos and gaps. This Commentary describes the
American emergency planning system and the roles of local emergency management and public health departments. Closer
examination illuminates similarities and differences in practitioner demographics, professional competencies, organizational
goals, and culture. The Commentary reviews the limited research and observations of collaboration efforts and suggests
areas for integrating the two practice areas in future research, education, professional training, and practice. Breaking down
the silos will strengthen local emergency and public health preparedness planning and response, ultimately leading to stronger
community health, well-being, resilience, and more efficient local administration.

Keywords
public health preparedness, emergency management, emergencies, disasters, pandemics, COVID-19, coronavirus, local
government collaboration

The United States arguably faces the most serious disaster
since World War II: the COVID-19 pandemic (Prasad & Wu,
2020). The pandemic itself has created further cascading
economic, financial, human, and social crises. According to
media accounts to date, approximately 114,000 Americans
have died and approximately 2,000,000 (as of this writing)
have become infected (Murphy et al., 2020). Even before the
pandemic, the United States had experienced an increase in
the number and severity of emergencies and disasters (Dolan
& Messen, 2012; Scolobig et al., 2015). Disasters have also
increased in cost; American disasters in 2017 cost $300 bil-
lion (Smith, 2018). In the United States these events, plus the
current pandemic, have led to devastating social and eco-
nomic impacts, particularly to potentially vulnerable popula-
tions, and have highlighted ongoing social inequities (Horney
et al., 2016; Zavattaro & McCandless, 2020).
American emergency response begins at the local (city,
town, and county) level (Haddow et al., 2017). The local
level is closest to the individuals and communities most
impacted by an emergency, can plan in advance with local
resources and respond more quickly than higher government
levels (Haddow et al., 2017). During crises like COVID-19,
natural and other disasters, best practices include “whole
community” and “whole of government” approaches, involv-
ing all parts of the government, community organizations,
institutions, and businesses, with representation from diverse
individual community stakeholders (Kapucu, 2015; U.S.
Department of Health and Human Services Office of the
Assistant Secretary for Preparedness and Response, 2019).
1
Massachusetts College of Pharmacy and Health Sciences, Boston, USA
Corresponding Author:
Susan Wolf-Fordham, Public Health Program, Massachusetts College of
Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA 02115,
USA.
Email: susan.wolf-fordham@mcphs.edu
Wolf-Fordham 561
While collaboration between local public health and emer-
gency management agencies is recognized as a best practice,
in reality there appear to be silos and gaps (Howell, 2020).
This Commentary argues that these silos should be broken
down and the two fields integrated for optimal emergency
planning, response, and local administration.
The Commentary begins with a description of the U.S.
emergency management system and the roles of local emer-
gency management and public health departments. Closer
examination illuminates similarities and differences in practi-
tioner demographics, professional competencies, organiza-
tional goals, and culture between the two agencies. Cross-sector
collaboration is considered a best practice due to its efficiency
and the possibility for leveraging resources (Kapucu, 2015)
but numerous barriers exist. The Commentary reviews the
limited research and observations of collaboration efforts
between the two practice areas. The Commentary concludes
with proposals to integrate the two areas via education and
training, research and professional practice, and issues a call to
action to emergency management, public health and public
administration students, researchers, and practitioners to break
down the silos and remove the barriers.
The American Emergency
Management System
The American emergency management and public health
preparedness system is really a system of systems. The sys-
tem is structurally complex and in reality is composed of
approximately 10 systems for each locality. There are two
overarching parallel systems, a public safety system (e.g.,
the local emergency management department) and a public
health system (e.g., the local public health department), pres-
ent at the federal, state, and local government levels, and at
the regional level among and within the states. These sys-
tems become even more complex where, as in Massachusetts,
almost every city and town has its own local public health
and safety emergency systems (in contrast to the county sys-
tems operating in most states).
It is a bottom-up system. When a lower government level
becomes overwhelmed, that level requests help from a
higher level (Haddow et al., 2017). Authority is widely dis-
persed. The regional systems can be controlled by the fed-
eral departments that created them. However, local and state
systems are independent of direct federal control, and many
local systems are independent of direct state control or
share governance with the state (Kapucu, 2015; National
Association of County and City Health Officials [NACCHO],
2017). For example, according to NACCHO, in 27 states all
local health departments are locally governed. In five states
local health departments are part of state government. In
three states local health department authority is shared by
state and local government. Thirteen states and Washington,
D.C. have more than one kind of local health governance.
(NACCHO reports that Hawaii and Rhode Island did not
participate in this study question.) (NACCHO, 2017). The
state emergency management agency generally does not
control the local emergency management agency and cannot
mandate action, particularly in home rule states (See, e.g.,
Mass. Gen. Laws, Ch. 43B [2015]. Home Rule Procedures).
The Federal Emergency Management Agency (FEMA)
and Assistant Secretary for Preparedness and Response
(ASPR) cannot issue mandatory regulations that states and
localities must follow (Kapucu, 2015). The state and federal
systems can only provide guidance or make suggestions to
systems at lower government levels. There can be indirect
control via grant funding. In terms of local systems change
efforts to effect greater collaboration, both the local emer-
gency management and public health departments would
have to collaborate to effect a local systems change, but no
state or federal authorization might be needed.
Whole of Government Emergency Management
Despite the fragmented nature of the American emergency
management system(s), coordination and collaboration is
seen as a best practice. The 2019–2020 National Health
Security Strategy includes “whole of government” planning
and response as one of its three major aims (U.S. Department
of Health and Human Services Office of the Assistant
Secretary for Preparedness and Response, 2019). The “whole
of government” approach
refers to public service agencies working across portfolio
boundaries to achieve a shared goal and an integrated government
response. Approaches can be formal and informal and include
government partners at federal, state, tribal/territorial, and local
levels. (U.S. Department of Health and Human Services Office
of the Assistant Secretary for Preparedness and Response, 2019,
p. 9)
The National Association of Counties (2018) maintains that
it is critical for county public health departments to work
closely with local emergency management, among other
partners, to develop successful emergency plans. The organi-
zation states that the critical element of successful disaster
recovery is a close relationship with emergency management
developed prior to the event. Practitioners concur. For exam-
ple, Howell (2020) writes that emergency planning is such a
critical local government function that it requires intragov-
ernmental collaboration. He raises the concern that lack of
collaboration could lead to multiple contradictory plans
within the same jurisdiction, strengthen silos, and increase
intragovernmental competition.
Local Emergency Management and Public Health
Agencies
Because of their critical roles in the American system, local
emergency management and public health departments and
practitioners bear closer scrutiny. The two fields at issue
562 American Review of Public Administration 50(6-7)
have similarities, including goals and the content of formal
statements regarding professional capabilities. The goal of
local emergency management, planning, and response is to
provide protection from the physical, emotional, and social
harms caused by natural or manmade disasters and emergen-
cies (Nelson et al., 2007; Nicholson, 2007). The goal of pub-
lic health is similar: to protect the health and well-being of
the community, although this goal is not limited to emer-
gency situations (Turnock, 2009).
The emergency management and public health prepared-
ness fields are also guided by similar core concepts. FEMA’s
National Preparedness Goal describes 32 emergency core
capabilities needed to fulfill the emergency management
mission for all levels of government (U.S. Department of
Homeland Security/Federal Emergency Management
Agency [U.S. DHS/FEMA], 2015). The Centers for Disease
Control and Prevention (CDC) developed 15 capabilities for
public health preparedness personnel at all levels (CDC,
2018). Both emergency management and public health pre-
paredness capabilities overlap and both call for coordination
and collaboration with government and community partners.
The CDC’s capabilities specifically refer to coordination
between public health and emergency management depart-
ments (CDC, 2018). FEMA’s Developing and Maintaining
Emergency Operations Plans guide, known as CPG 101, is
the foundational document for emergency planning at the
local, state, and federal levels. This guidance document
instructs that planning “must” include all community stake-
holders, including government agencies, and notes the poten-
tial existence of more than one government agency plan
which overlaps with those of emergency management
departments (U.S. DHS/FEMA, 2010). Operationally, both
fields utilize the same emergency response management
frameworks known as the National Incident Management
System (NIMS) and the Incident Command System (ICS)
(U.S. DHS/FEMA, 2018). The NIMS framework is used to
manage specific incidents, and the ICS framework is used to
manage the personnel who respond to an incident.
Practitioner Demographics
Public health and emergency management practitioner
demographics share some similarities. Survey results indi-
cate that the majority of government emergency managers
are male and Caucasian (approximately 81% male and 94%
Caucasian, n = 1058) (Weaver et al., 2014). The workforce
is aging, and 72% of managers studied were over 45 years
old (n = 1,058). Most respondents were highly educated;
approximately 78% (n = 1,058) reported being college edu-
cated (Weaver et al., 2014). Like emergency managers, gov-
ernment public health workers are overwhelmingly
Caucasian (de Beaumont Foundation & Association of State
and Territorial Health Officials [ASTHO], 2019). However,
the vast majority of public health workers are female and
tend to be younger than emergency managers (only 42% are
over age 50, n = 90). Like emergency managers, public
health workers are well educated, with 68% (n = 90) report-
ing that they have a college degree or higher (de Beaumont
Foundation & ASTHO, 2019).
Organizational Culture
A major difference between the two fields can be found in
their respective organizational cultures. Botoseneanu et al.
(2010) found differences in public health and emergency
practitioner understanding of their legal mandates and
authority, which in turn impacted their ideas about joint col-
laboration. Through qualitative interviews, the researchers
determined that public health personnel were uncertain about
the scope of their legal authority to perform both routine and
emergency public health tasks, and reported that this impeded
their work and constrained their behavior (Botoseneanu
et al., 2010).
The local public health personnel interviewed expressed
concerns about collaboration (Botoseneanu et al., 2010).
They reported that this lack of clarity about their authority
extended to collaboration; they reported feeling that other
agencies would not recognize their department’s position.
The researchers reported that public health personnel
remained concerned even when their agency’s authority was
clear (Botoseneanu et al., 2010). Kennedy et al. (2019) also
identified public health personnel concerns about decision-
making authority and status. In semistructured interviews
with emergency and public health preparedness planners and
other responders, these researchers found that while public
health officials were represented at meetings, they ques-
tioned whether their participation was really meaningful.
One respondent reported concern that public health ideas
were not taken seriously and felt that public health participa-
tion did not influence actual emergency plans (Kennedy
et al., 2019).
Botoseneanu et al. (2010) found that public health person-
nel were concerned about agency and personal liability
which led to a second concern, that collaboration with emer-
gency management could lead to increased liability. Perhaps
at least in part because of this concern, respondent public
health personnel reported that their preferred type of collabo-
ration included a process with many stakeholders and deci-
sion making based on consensus (Botoseneanu et al., 2010).
Emergency managers held different views. Botoseneanu
and colleagues’ respondent emergency managers appeared
less concerned about their specific legal authority and
expressed a broader view of their legal mandates (Botoseneanu
et al., 2010). They seemed to take an “ask for forgiveness
instead of seeking permission” attitude and reported believ-
ing that action based on ethics (ie. someone was in need of
rescue), rather than legal authority, would eclipse potential
legal liability during an emergency.
Botoseneanu and colleagues’ most concerning finding,
however, was related to public health and emergency
Wolf-Fordham 563
management personnel attitudes toward each other. The
researchers observed
a tenuous, antagonistic and competitive relationship between
PH [public health] and EM [emergency management]
respondents. Representative statements include: “PH is a
toothless tiger when it comes to preparedness . . .” [EM
respondent], “EM people walk around like cowboys and would
pull the guns . . .” and “. . . it [EM] reminds me of children
playing soldiers . . .” [PH respondents] (2010, p. 365)
These attitudes and cultural differences, indicative of distrust
and likely political infighting, are serious challenges to col-
laboration. It should also be noted that an additional factor
may be the nature of their respective professional responsi-
bilities. While the sole responsibility of many emergency
managers is generally only emergency management or emer-
gency management plus another public safety responsibility
(e.g., a local fire chief who is also the community emergency
manager), public health professionals generally have many
roles due to the broad nature of public health (see, e.g., a
description of the 10 essential public health services; CDC,
2020).
Collaboration Between Public Health and
Emergency Management Departments
There are few reports on the intersection of public health and
emergency management work (Rose et al., 2017), but there
are certainly examples of successful local collaboration
efforts. For example, local media reported a COVID-19
planning collaboration to prepare for patient surge, among
other issues, in a North Carolina region (The Transylvania
Times online edition, 2020). There is also research that indi-
cates the existence of professional connections between local
public health and emergency management. For example,
NACCHO’s (2018b) 2018 Public Health Preparedness
Landscape survey reports that 93% of respondent local pub-
lic health departments reported having a “good” or “excel-
lent” partnership with local emergency management, an
improvement over 2015 results (NACCHO reported the n for
this response as a range, n = 375–387). The same study
found that 88% (n = 371) of local public health department
respondents reported local emergency management partici-
pation in federally funded regional public health prepared-
ness coalitions in which the public health department also
participated.
Collaboration Barriers
There are numerous barriers to successful collaboration
between the two local departments. The demographic and
organizational differences identified by Botoseneanu et al.
(2010), and Kennedy et al. (2019), described above, illumi-
nate barriers, as does the enmity expressed by Botoseneanu
and colleagues’ (2010) research participants. A professional
with HealthCare Ready, an organization that strengthens
health care supply chains, wrote that since public health
professionals look to understand the scientific evidence in
the field, their interpretation becomes political and thus
shapes their emergency response (Baker, 2020). While she
argues that emergency managers are also political, she feels
that their views are based on acting as government
representatives.
The 2019 National Health Security Preparedness Index
provides further evidence of a gap (Center for Business and
Economic Research, University of Kentucky, 2018). The
Index measures “community [emergency] planning and
engagement” which relates to the ability to form collabora-
tive relationships among government departments, house-
holds, and local organizations. The Index finds the U.S.
national average to be 5.2 on a scale of 0–10, with 10 being
the highest preparedness level based on collaboration (Center
for Business and Economic Research, University of
Kentucky, 2018). The Index report notes that forming col-
laborative relationships has been the country’s weakest pre-
paredness indicator, although the report states that there has
been improvement over time.
Local government agency siloing is a barrier which Bashir
et al. (2003) describe as being historic in nature. Howell
(2020) writes about emergency management siloing due to a
view that emergency planning is the sole province of local
emergency managers and planners. He argues that this atti-
tude creates an unstable situation and notes that silos cause
lost opportunities for collateral benefits inside and outside
the emergency management department (Howell, 2020).
Department budget issues present further barriers to col-
laboration. Without the appropriate financial and personnel
resources, there may not be enough staff and/or time for col-
laboration. According to a NACCHO (2018a) survey, the vast
majority of local health departments reported providing emer-
gency services (92%, n = 555). But the survey also found that
21% of local health departments experienced budget cuts in
their current fiscal year and 19% anticipated cuts in the next
fiscal year (for both fiscal years NACCHO reported the n for
this response as a range, n = 552–567; NACCHO, 2018a). It
is unclear if local emergency management departments are
also losing funding. Budget issues can, of course, happen to
any government department at any time, and not just to public
health or emergency management agencies. Other barriers to
collaboration that might impact any government departments
include the time, effort, leadership, and commitment needed
to establish successful collaborations (International City/
County Management Association [ICMA], 2013).
Breaking Down Silos
While the COVID-19 pandemic has had devastating effects
and will continue to do so in the future, it also presents
opportunities for innovation and systems change. Coordinated
564 American Review of Public Administration 50(6-7)
local public health and emergency management response is
critical to community recovery, successful future disaster
planning, and strengthening community resilience. This
Commentary has highlighted a number of organizational and
attitudinal barriers to successful collaboration. Local emer-
gency management and public health departments are
already burdened, but can expect these burdens to worsen.
Experts note that climate change leads to increased disasters
and pandemics (U.S. Global Change Research Program,
2016), which means more emergencies that call for a
response. It is also possible that the United States will experi-
ence multiple disasters at the same time in the same location,
for example, ongoing coronavirus response during the
upcoming hurricane season, adding to the burdens of the two
agencies (Kann et al., 2020). These potential additional
stressors provide impetus for systems change efforts.
Public administrators, emergency managers and public
health preparedness planners have the opportunity to work
together now to break down the silos and integrate the
emergency management, public health preparedness, and
public administration fields, to the mutual benefit of all
three. Both government emergency managers and public
health preparedness planners are also public administra-
tors. Areas for potential change efforts include: (a) educa-
tion and professional development; (b) research; and (c)
practice.
Education and Professional Development
Education and professional development could broaden stu-
dent and practitioner knowledge and capacity. Currently, the
NACCHO Preparedness Summit (http://www.preparedness-
summit.org/home) is a national conference which brings
together emergency managers, public health preparedness
planners, and others interested in emergency planning and
response. If similar joint efforts do not exist, others could be
created. For example, the American Society for Public
Administration (ASPA) Annual Conference (https://www.
aspanet.org/ASPA/Events/Annual-Conference/Annual-
Conference.aspx), with leadership from the Section on
Emergency and Crisis Management (SECM), could offer ses-
sions related to the intersections of local public health, emer-
gency management, and public administration. Likewise,
university public administration departments, particularly
those which already offer emergency management courses,
could consider developing a blended public health/emergency
management/public administration program focused on pub-
lic health emergency management (ie. a combination of the
two fields). Professional collaborative work groups could be
developed, for example, between ASPA’s SECM and the
American Public Health Association’s (APHA) Injury
Control and Emergency Health Services Section and the new
APHA Disasters and Emergency Preparedness (D & EP)
Topic Group (https://www.apha.org/) to facilitate knowledge
sharing.
Research
Comfort et al. (2012) write that in the 1980s, there was a
joint FEMA-National Association of Schools of Public
Affairs and Administration (NASPAA) collaboration to
develop a research community. Perhaps such a community
could be developed to include FEMA, the U.S. Department
of Health and Human Services ASPR, and the CDC, the lat-
ter two of which focus on public health and health care in
emergencies. As stated above, there are few reports on the
intersection between public health preparedness and emer-
gency management (Rose et al., 2017), so this area might be
fruitful for future research. An additional research area might
be the optimum departmental organizational structure to fos-
ter successful collaboration. Finally, researchers and practi-
tioners should develop best practice guidelines, along with a
plan for broad scholarly and professional dissemination of
research findings.
Practice
Local public health and emergency management practitioners
have the opportunity to innovate on the ground and in real
time. They might assess different ways to combine and inte-
grate both areas of interest. For example, Vielot and Horney
(2014) describe a model for a “public health preparedness
coordinator” position shared among the two local agencies in
each of six North Carolina counties. The coordinators had
responsibilities among emergency management, emergency
medical services, hospital and public health preparedness ser-
vices. The researchers conducted semistructured interviews
with the individuals then holding the new position. Respondents
reported that their specific job tasks differed according to
which department supervised them (Vielot & Horney, 2014).
They reported that due to strong coordination, most of their
duties were well defined within the supervising department,
although there was an implication that duties across agencies
were less well defined. Respondents also reported feeling at
ease working within the two domains because they were able
to consult with colleagues in either department to fill any
knowledge gaps and because they felt that they received sup-
port from both departments (Vielot & Horney, 2014).
The respondents reported a number of advantages to the
position. For example, the merged position led to greater effi-
ciency for some departments (Vielot & Horney, 2014). Most
respondents reported local public health preparedness emer-
gency operations plans were stronger after the merger due to
input from both departments. Barriers reported included a
challenge prioritizing equipment purchases for one or the
other department and addressing funding that was split
between the two departments (Vielot & Horney, 2014). While
reporting many positives, the respondents were uncertain
whether this new structure could work in a large county. They
reported that it was important for the shared staffer to have
previous experience in both domains, that both departments
Wolf-Fordham 565
shared the same goals, and that funding was split evenly
between the two departments to ensure equal priority would
be given to both (Vielot & Horney, 2014). While the sample
size for this research was small, this practice seems promising
and is worth further exploration.
One challenge with all emergency planning and response
is that it becomes important during a time of crisis but
becomes less so when there is no disaster in sight. Public
health and emergency management departments could con-
sider strategies for making their emergency planning and
response activities more public facing. This might be an
effective strategy to gain government leadership support,
which would hopefully lead to additional funding and other
resources, as well as enhanced departmental status. One
emergency management department representative from
Florida reported that their department publicizes the work of
its governmental and other partners and provides free topi-
cal mini-trainings during normal times, to maintain stake-
holder interest (anonymous emergency manager, personal
communication, October 11, 2019). This strategy could also
call additional public attention to the departments.
Another potential strategy would be to incorporate public
health preparedness and emergency management into cli-
mate change, sustainability, and/or community resilience
efforts popular with local government agencies and commu-
nity members. This would provide additional support for
emergency-related activities and potential for efficiencies,
such as increased opportunities for leveraging local resources.
A related, but perhaps more challenging strategy to imple-
ment, would be to advocate for a local “health in all policies”
(HIAP) approach to policymaking. Such an approach would
mean that local government decisions would be implemented
only if there were a neutral or positive impact on community
health (Kennedy et al., 2019). Emergency management and
public health preparedness policies could be considered part
of health promotion or prevention efforts and subject to
HIAP scrutiny as such. Collaboration and breaking down
silos are keys to this approach, which would include a phi-
losophy of “building back better” after an emergency. Such a
direction is supported by the National Academy of Medicine,
formerly the Institute of Medicine of the National Academies
(2015), which recommends using disaster recovery to redress
inequities due to the social determinants of health.
A Call to Action
Americans will continue to experience disasters, emergen-
cies, and pandemics in the future. The number and severity
of these events are increasing and will increasingly strain
local governments, including public health and emergency
management departments. COVID-19 has further exposed
social, economic, and health inequities and is likely to con-
tinue to do so. In addition, there is potential for the United
States to face simultaneous crises (e.g., ongoing COVID-19
challenges alongside a natural disaster), further straining
already stressed systems. It is clear that local emergency
management and public health preparedness departments are
on the front lines of responding to these disasters and must
work in tandem for efficient and effective emergency plan-
ning and response.
Public administration has an important role to play in
integrating the silos and filling the gaps. It is well known and
accepted that people whose physical, emotional, and social
needs are met are generally healthier than those with unmet
needs. Addressing those needs via government policies and
services is a function of public administration. The public
administration community must lead the charge to integrate
local emergency management and public health prepared-
ness actions and policies with innovations in education and
professional development, research, and practice. A goal of
public administration is to advance the public interest and
social equity (ASPA, n.d.). This can be accomplished by
breaking the silos and closing the gaps between local emer-
gency management and public health preparedness. To do so
would lead to more effective and efficient emergency plan-
ning and response, which in turn would strengthen commu-
nity health and well-being. Americans are now enduring a
horrible pandemic. The public administration field should
take the opportunity to act in the public’s interest and lead
critical change efforts to create a stronger, healthier, and
more resilient nation.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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Author Biography
Susan Wolf-Fordham, JD, MPA, is adjunct faculty, Massachusetts
College of Pharmacy and Health Sciences, Master of Public Health
Program, where she teaches public health law. She also advises and
consults with federal, state, and local government agencies and
national, nonprofit, and health care organizations. She develops cur-
ricula, delivers trainings, provides technical assistance, and conducts
research related to emergency planning and public health prepared-
ness for and with populations with access and functional needs.