Adaptive management: a paradigm for remediation of public facilities following a terrorist attack

Integrating Public Health into Climate Change Policy and Planning: State of Practice Update

Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: “Co-benefits” to health help underpin greenhouse gas reduction strategies, while safeguarding health—particularly of the most vulnerable—is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health’s role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts—governance, implementation and adjustment—that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.

Risk-Based Decision Making for Reoccupation of Contaminated Areas Following a Wide-Area Anthrax Release

This article presents an analysis of postattack response strategies to mitigate the risks of reoccupying contaminated areas following a release of Bacillus anthracis spores (the bacterium responsible for causing anthrax) in an urban setting. The analysis is based on a hypothetical attack scenario in which individuals are exposed to B. anthracis spores during an initial aerosol release and then placed on prophylactic antibiotics that successfully protect them against the initial aerosol exposure. The risk from reoccupying buildings contaminated with spores due to their reaerosolization and inhalation is then evaluated. The response options considered include: decontamination of the buildings, vaccination of individuals reoccupying the buildings, extended evacuation of individuals from the contaminated buildings, and combinations of these options. The study uses a decision tree to estimate the costs and benefits of alternative response strategies across a range of exposure risks. Results for best estimates of model inputs suggest that the most cost-effective response for high-risk scenarios (individual chance of infection exceeding 11%) consists of evacuation and building decontamination. For infection risks between 4% and 11%, the preferred option is to evacuate for a short period, vaccinate, and then reoccupy once the vaccine has taken effect. For risks between 0.003% and 4%, the preferred option is to vaccinate only. For risks below 0.003%, none of the mitigation actions have positive expected monetary benefits. A sensitivity analysis indicates that for high-infection-likelihood scenarios, vaccination is recommended in the case where decontamination efficacy is less than 99.99%.

Factors influencing recovery and restoration following a chemical incident

Chemicals are an important part of our society. A wide range of chemicals are discharged into the environment every day from residential, commercial and industrial sources. Many of these discharges do not pose a threat to public health or the environment. However, global events have shown that chemical incidents or accidents can have severe consequences on human health, the environment and society. It is important that appropriate tools and technical guidance are available to ensure that a robust and efficient approach to developing a remediation strategy is adopted. The purpose of remediation is to protect human health from future exposure and to return the affected area back to normal as soon as possible. There are a range of recovery options (techniques or methods for remediation) that are applicable to a broad range of chemicals and incidents. Recovery options should be evaluated according to their appropriateness and efficacy for removing contaminants from the environment; however economic drivers and social and political considerations often influence decision makers on which remedial actions are implemented during the recovery phase of a chemical incident. To date, there is limited information in the literature on remediation strategies and recovery options that have been implemented following a chemical incident, or how successful they have been. Additional factors that can affect the approach taken for recovery are not well assessed or understood by decision makers involved in the remediation and restoration of the environment following a chemical incident. The identification of this gap has led to the development of the UK Recovery Handbook for Chemical Incidents to provide a framework for choosing an effective recovery strategy. A compendium of practical evidence-based recovery options (techniques or methods for remediation) for inhabited areas, food production systems and water environments has also been developed and is included in the chemical handbook. This paper presents the key factors that should be considered when developing a recovery strategy with respect to how these may impact on its effectiveness. The paper also highlights the importance of these factors through an evaluation of recovery strategies implemented following real chemical incidents that have been reported in the literature.

Integrating climate change adaptation into public health practice: using adaptive management to increase adaptive capacity and build resilience

BACKGROUND

Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems.

OBJECTIVES

We explored possible explanations for the lack of work on adaptive capacity, outline climate-health challenges that may lie outside public health's coping range, and consider changes in practice that could increase public health's adaptive capacity.

METHODS

We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity.

DISCUSSION

There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health's adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting.

CONCLUSIONS

Increasing public health capacity will be necessary for certain climate-health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change.

Petroleum and health care: evaluating and managing health care's vulnerability to petroleum supply shifts

Petroleum is used widely in health care-primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies-and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services.