America’s Health Security Preparedness: Are We Ready to Protect Our Elders?

By Alonzo L. Plough

Preparedness for and resilience in the face of emergencies and disasters of many sorts are essential components of well-being and good health. This is particularly true for older Americans. The National Health Security Preparedness Index analyzes 129 measures of preparedness to identify strengths and opportunities for keeping the nation safe. 

What is health security? It is a condition in which a nation and its people are prepared for, pro­tected from and resilient to events that can adversely impact health status.

Measuring Health Security Preparedness

Health security affects day-to-day community health, and determines what happens before, dur­ing and after crises such as natural disasters and disease outbreaks. Using a broad constellation of metrics, the National Health Security Preparedness Index (the Index) demonstrates that many stakeholders across sectors contribute to health security at state and national levels. Key sectors include public health, medical care, emergency management, public safety, nonprofit and volun­tary organizations, businesses, the faith community and others. Due to this complexity, even sea­soned professionals may not be fully aware of health security resources and needs that lie outside their immediate control and responsibility.

The Index supports state efforts to reduce health security inequities by identifying strengths and opportunities for improvement, and it is a tool stakeholders can use to collectively improve health security. A sample of the 129 measures analyzed by the Index include: the percentage of bridges that are in good or fair condition; the number of healthcare providers; vaccination rates for children and adults for different infectious diseases (i.e., flu); and the percentage of state public health labs that test for contaminants, such as lead or asbestos.

Together, such data can inform meaningful discussions and deliberations at the state level, but also in communities, about the importance of health security and how it influences social inequal­ity and healthcare delivery, and how to ensure that any vulnerable population, including many older Americans, has the knowledge and protections they need amid emergencies and disasters.

According to the Index, U.S. preparedness increased by 3.1 percent over the last year, scoring 6.7 on a 10-point scale for preparedness—an improvement of 11.7 per­­cent since the Index began in 2013 and a 3.1 percent improvement over the last year. One area of improvement especially important for older Americans is the area of community engagement and planning strategies that incorporate specific strategies for vulnerable populations.

Areas for Improvement

But gains in community planning and engagement demonstrate that we can still improve in one metric we have historically struggled with, which is developing supportive relationships among government agencies, community organizations and residents to create shared plans for respond­ing to emergencies. Health security in this area improved 17.8 percent between 2013 and 2017—demonstrating that states can improve preparedness; however, performance in this domain de­clined moderately in 2018 to a score of 5.2. 

An important part of community preparedness happens at the neighborhood level. In many emergencies, such as severe floods, tornadoes or earthquakes, traditional first responders might not be able to reach a community for many days. Having neighborhood-level plans in place and en­couraging neighbors to get to know neighbors are key. Neighbors being familiar with one another’s strengths and vulnerabilities can influence survival outcomes, as very often, neighbors will be first responders in an emergency.

Current levels of health security remain less than optimal. One area that needs improvement and that is particularly important for older Americans is coordination between the different com­ponents of the healthcare system. Hospitals, nursing homes and community clinics must coor­dinate their roles in emergency response. However the nation’s lowest score on the Index is in Healthcare Delivery—a 4.9 out of 10.

Performance in this domain remained flat from 2013 to 2015, but has trended up moderately by 6.5 percent. Public officials should have plans that provide guidance and training via exercises to improve coordination during an emergency or disaster. Community organizations should be part of this planning and development so that vulnerable populations’ needs are well understood and incorporated into planning. The Community Resilience Toolkit is a tested approach for community-level engagement in preparedness planning.

Preparedness Supports a Culture of Health

Health extends far beyond traditional healthcare services: clean air, safe communities and access to 21st century telecommunications (such as broadband) all affect health.
America is experiencing multiple threats to health and safety that extend beyond what we typically think of as health. In recent years, we have seen extreme weather events, natural disasters and out­breaks of vaccine-preventable infectious diseases, in addition to the overall aging of our nation’s infra­structure. Strong health security preparedness is a crucial component to help our populations to live longer, healthier lives—regardless of their home state; we call this a culture of health that supports health equity. The Index fosters collaboration between government, communities and across sectors to make the places where Americans live, work and play as healthy as they can be.

Alonzo L. Plough, Ph.D., M.P.H., is chief science officer and vice president at the Robert Wood Johnson Foundation, in Princeton, N.J.