Environmental Resilience and Public Health

1. Environmental Resilience and Public Health Bernard D. Goldstein, MD University of Pittsburgh

2. SUSTAINABILITY U.S. Environmental Protection Agency and the THE NATIONAL ACADEMIES

3. What is the Relation Between Public Health; Prevention; Resilience and Sustainability? • Definitions are primarily important because they can impact on actions. • Planning is the mediator between definitions and actions • Definitions impact on both the geographical and the temporal dimensions of disaster planning

4. Public Health • Resilience • Sustainability • Prevention

5. Relation Between Sustainability and Resilience(Joseph Fiksel – Ohio State University) • Sustainabilityis the capacity for long-term realization of health & well being, economic prosperity, & environmental protection • However, unforeseenconditions can lead to unintended and/or undesired consequences • Resilienceis the capacity to survive, adapt, and flourish in the face of changing conditions and potential disruptions • In a complex and turbulent world, resilience is a prerequisitefor achieving sustainability

6. Resilience Concepts • Robustness: the ability to withstand a given level of stress or demand without suffering loss of function. • Redundancy: the extent to which systems are substitutable. • Resourcefulness: capacity to identify problems, establish priorities, and mobilize resources when conditions exist that threaten to disrupt. • Rapidity: the capacity to meet priorities and achieve goals in a timely manner in order to contain losses, recover functionality, and avoid future disruption. Bruneau and Reinhorn. (2007). Exploring the concept of seismic resilience for acute care facilities. Earthquake Spectra, Volume 23, No. 1, pages 41-62.

7. Definitions • “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” • World Health Organization • “Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs.” • Brundtland Commission of the United Nations, 1987

8. Attributes of Sustainability that Public Health does well (or should do well) • Multi-disciplinary approaches to problem solving • Developing models and metrics that facilitate trade-off analyses and synergies among the three sustainability pillars of the environment, the economy, and the social/health aspects of society • Incorporating a temporal, multi-generational dimension that should lead to a focus on maternal / child health and wellbeing • Incorporating a global dimension.  • Anticipating disasters, including considering disaster relief as a means to lessen the impact of the next disaster

9. Role of Resilience in Sustainability

11. Gulf State Health Indicator Rankings

12. Gulf Region Health Outreach Program($105 million/5 years)

14. Gulf Region Health Outreach Program Talking Points June 12, 2013

15. Summary and Background Facts • GRHOP is a series of four integrated, five-year projects to strengthen healthcare in specified Gulf Coast communities in Louisiana, Mississippi, Alabama, and Florida. • GRHOP was developed jointly by BP and the Plaintiffs’ Steering Committee as part of the Deepwater Horizon Medical Benefits Class Action Settlement, approved by the U.S. District Court in New Orleans on Jan. 11, 2013 and is now on appeal. The Outreach Program is supervised by the court, and is funded with $105 million from the Medical Settlement. As of June 2013, $53.9 million has been paid to the four projects • The target beneficiaries of the Outreach Program are residents, especially the uninsured and medically underserved, of 17 coastal counties and parishes in Alabama, Florida, Louisiana and Mississippi.

16. The Outreach Program will: • inform residents about their own health and provide access to skilled frontline providers supported by networks of specialists who can address physical, environmental, behavioral and mental health needs, • improve the resilience of the targeted communities to future health challenges. • be embedded in and complement existing efforts being undertaken by the public health community. • involve local communities, seek input from the community, and build capacity tailored to their special needs. • focus on activities that produce sustainable benefits to the communities lasting beyond its five year duration

17. Four Integrated Projects • The program consists of four projects to: • build the capacity of primary care community health clinics in the region, • increase the mental and behavioral health expertise of health professionals in the targeted communities and increase awareness by local communities of mental and behavioral health issues, • increase the environmental health expertise of health professionals in the targeted communities and the health literacy of local communities, • train community health workers who will help residents navigate the healthcare system and access needed care.

18. Four Integrated Projects • The Outreach Program is a collaboration among: • Alliance Institute, • Louisiana Public Health Institute (“LPHI”), • Louisiana State University Health Sciences Center (“LSUHSC”), • Tulane University, • University of South Alabama, • University of Southern Mississippi, and • University of West Florida.

19. Two Recent Ongoing Disasters • 100,000-200,000 deaths • 1.5 million homeless