The Expanding Role of Sanitarians in Public Health Emergencies

The Institute of Medicine defines public health as the sum of what society does collectively to assure the conditions for people to be healthy. The past decade has already provided an early preview of the many public-health challenges the United States will be facing in the foreseeable future – e.g., disease outbreaks, natural disasters, accidental events, and terrorist attacks, all of which possess the potential for large-scale health consequences. Preparing for and responding to these threats not only requires the commitment of, and cooperation among, all segments of society but also clearerentification of the core public-health professionals who can be developed to serve as first responders of the future.

For state and local health agencies across the United States, being prepared to prevent, respond to, and promptly recover from major public health threats is critical for protecting and securing the public’s health. Generally speaking, the role of public health professionals in any emergency is an extension of the core missions of the public health community. However, an effective public health response begins with a prepared and effective public health system (local and state) staffed by trained and committed professionals.

Building Public Health Preparedness Capabilities 

The Atlanta-based U.S. Centers for Disease Control and Prevention (CDC) recognized that, to use the congressionally appropriated preparedness funding more prudently, there remains a need for prioritization of activities assigned to state and local preparedness planners. More specifically, the CDCentified the following six “domains” (italicized below) and 15 public health preparedness capabilities as the basis for: (a) state and local public health preparedness; and (b) a new five-year Public Health Emergency Preparedness cooperative agreement scheduled to go into effect in August 2011:

  • Biosurveillance: Public Health Laboratory Testing; and Public Health Surveillance and Epidemiological Investigations;
  • Community Resilience: Community Preparedness; and Community Recovery;
  • Countermeasures and Mitigation: Medical Countermeasures Dispensing; Medical Material Management and Distribution; Non-Pharmaceutical Interventions; and Responder Safety and Health;
  • Incident Management: Emergency Operations Coordination;
  • Information Management: Emergency Public Information and Warnings; and Information Sharing; and
  • Surge Management: Fatality Management; Mass Care; Medical Surge; and Volunteer Management.

The above-mentioned public health preparedness capabilities represent a national public health standard, for state and local preparedness activities, that would help state and local health departments across the nation to respond more effectively to public health emergencies and threats while also supporting the 10 essential public health services that form the basis for the CDC’s own national public health performance standards program (NPHPSP). In the modern public health environment, NPHPSP is a collaborative effort to enhance the nation’s public health systems as a whole.

Sanitarians’ Everyday Tasks Transfer to Emergency Situations 

In most states, a “sanitarian” is a credentialed practitioner in the environmental, sanitary, and public health sciences whose daily work involves the evaluation and management of the numerous factors and systems that directly affect public health, quality of life, and determinants of risk. Sanitarians already play a vital role in the daily life of most communities: monitoring food, milk, and water safety, for example; conducting disease surveillance and monitoring; carrying out basic sanitation functions such as the evaluation of sewage disposal systems; providing vector control; or assisting in the management of shelter operations. Sanitarians usually are able to successfully achieve a fine balance between being the enforcers of public health laws and being educators for and about public health.

These same public health professionals may be the most critical component of the public health infrastructure responsible for developing and maintaining linkages within various organizations and sectors – and, therefore, in connecting people to resources. Unfortunately, the American Public Health Association has projected that 23 percent of the current public health work force will be eligible for retirement by 2012. Studies show, though, that: (a) sanitarians appear to be somewhat more satisfied and secure in their positions than their public-health counterparts; and (b) job satisfaction frequently results in a lower turnover of sanitarians than is typical of public health professionals in several other fields, even though the sanitarian positions are often underpaid.

Another factor to consider is that the role of sanitarians has traditionally been viewed as consultative, facilitative, and supportive (as opposed, for example, to being among the first responders called upon for public health emergencies). Over the past decade, however, sanitarians – in state and local health departments across the nation – have been more involved than ever before in various threat preparedness and response activities.

There are a number of reasons, including the following, why sanitarians are now viewed – not only by their co-workers but also by the general public – as particularly valuable assets:

(a) They are readily available and often already trained in the particulars of incident command structure;

(b) They usually incorporate various emergency essentials – e.g., planning, logistics, and security – into their routine work;

(c) They help enforce state and local public health laws;

(d) They often participate in several epidemiological activities – including but not limited to disease surveillance, outbreak investigations, and quarantines;

(e) They usually are knowledgeable, because of their daily work in local communities, of not only local vulnerabilities but also the local infrastructure and the availability of such resources as water, food, sewage, vector control, and medical wastes;

(f) They frequently not only respond to such local emergencies as chemical leaks, mining incidents, and weather-related incidents but also support various countermeasure dispensing and mitigation efforts;

(g) They typically have established helpful networking relationships at the local level (an important factor that improves not only outreach efforts to educate community members but also information sharing during an event); and, last but not least,

(h) They work effectively with post-disaster responder communities toentify and monitor public health, medical, and behavioral health system recovery needs.

Sanitarians’ Contribution to H1N1 Pandemic in Kanawha County 

When responding to a public health emergency, the combination of well coordinated efforts by local, state, and federal agencies and robust community responses usually results in improved health outcomes. Indeed, locally organized and coordinated community partnerships serve as the firm foundation for many successful preparedness and response efforts. In recognition of this fact, the recently released National Health Security Strategy (NHSS) has been structured to achieve two primary goals: (a) build community resilience; and (b) strengthen and sustain both health and emergency response systems.

During the 2009 H1N1 influenza pandemic, sanitarians in Kanawha County, West Virginia, played an essential role in the ability of the Kanawha-Charleston health department to launch successful response and recovery efforts. Following are some of the critical functions performed by field sanitarians during that difficult period:

  • Worked at clinics (130 clinics held from October 2009 to May 2010) offered at the health department: managed vehicular traffic control; managed vaccination queues and crowd control; and managed both security and volunteers.
  • Provided outreach and education to organizations (information sharing): state and city governments; local businesses; faith-based organizations; county schools and higher education institutions; law enforcement agencies; emergency management personnel; shelters and other facilities, permanent or temporary, occupied by high-risk populations.
  • Assisted in modified school-based vaccination clinics (over 150 clinics conducted from October 2009 to March 2010): provided logistical support; acted as liaison for nurses/school officials/parents/volunteers; supported the set-up of school clinics; assisted in cold storage transport of vaccine; facilitated the flow of children scheduled to be vaccinated at each clinic.
  • Offered post-vaccination assistance: inventory management; vaccine storage (in cold storage for transport); accounted not only for sharps containers but also for medical waste disposal (sharps, bloody bandages).
  • Played a major support role in recovery operations and community resilience:entified priorities and services designed to improve and maintain public health, medical, and behavioral health in the post-pandemic phase of the virus; assisted in coordination of recovery efforts; played a critical role in community resilience through participation in the county’s MPAC (Multi-agency Planning and Advisory Committee) operations.

Quick Prediction: An Increasingly Significant Role 

Sanitarians are frequently undervalued for their role in public health emergency preparedness and response operations. Among the more important lessons learned from the 2009 H1N1 pandemic influenza was that sanitarians can and often do play a critical role in the response operations of state and local health departments across the nation.

Whether it is the overall task of determining the best methods to reduce or prevent conditions that are detrimental to the health of the public, or the act of taking steps to prevent the further spread of disease (and/or additional injuries) during an ongoing event or disaster, sanitarians are a well equipped and willing group of public health workers providing these important services within their home communities.

As state and local health departments remain committed to strengthening preparedness efforts, it is important to recognize the evolving role of sanitarians as first responders in public health incidents. Sanitarians are already heavily involved in most of the CDC’s 15 specifically designated public health preparedness capabilities. Proper and timely recognition – and the appropriate investment of additional resources – into this field as a work force development priority would almost assuredly yield significant and consequential long-term results.

It is particularly important to ensure that, as agencies proceed to align their public-health preparedness capabilities planning model with that of the CDC, the exceptional and expanding role of sanitarians be not only recognized but also incorporated into the development and completion of their short-term and long-term goals. As these agencies build such capabilities, demonstrate additional performance successes, and ultimately help sustain even more capabilities and functions, it is appropriate that the sanitarians be recognized for the key roles they play in public health preparedness and response activities – and also be considered, therefore, as an appropriate investment in specific human capital available within state and local jurisdictions.

Rahul Gupta

Dr. Rahul Gupta is the Health Officer and Executive Director of the Kanawha-Charleston Health Department; he also serves as clinical faculty at West Virginia University’s School of Medicine and the University of Charleston’s School of Pharmacy in Charleston, West Virginia. Dr. Gupta is one of the only two full-time local health officers in West Virginia and, as such, leads the largest local health department in the state.



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