Community Engagement: Leadership Tool for Catastrophic Health Events
Working Group on Community Engagement in Health Emergency Planning
This 18-page document is an output of three meetings of the United States (US)-based Working Group on Community Engagement in Health Emergency Planning, which is composed of decisionmakers at local and national levels of government; public health practitioners; heads of community-based partnerships for public health and disaster mitigation; and experts in risk, disaster, health, and community management. The result is a consensus-based document which offers a series of recommendations for leaders on why and how to catalyse the civic infrastructure for an extreme health event. The Working Group addresses community engagement as structured dialogue, joint problem solving, and collaborative action among formal authorities, citizens-at-large, and local opinion leaders.
The document describes civic infrastructure as "dynamic assembly of interdependent people, voluntary associations, and social service organisations who can pool their collective wisdom, practical experience, specialised skills, social expectations, and material assets to work on behalf of constituent members and, in many cases, for a larger public good." It gives a number of examples of operating organisations, which are well positioned to work on preparedness, response, and recovery stages of a health-related emergency. Civic infrastructure capacities with examples are listed according to function:
- Multifrequency communications network to reach dispersed and diverse populations, including Flu Wiki (www.fluwikie.com), a moderated information site open to diverse users and contributors, and Salon Voices, a non-governmental organisation (NGO) which engages the hair salon culture of the African-American community and equips cosmetologists with information and internet connections to educate customers on HIV/AIDS, reproductive health, and parenting.
- Social circuitry to energise trust between authorities and communities-at-large, including Collaborating Agencies Responding to Disasters, a training network formed after the Lomas Prieta earthquake as a safety net, and St. Philip of Jesus Parish and the University of the Incarnate Word, who connect nursing faculty, students, and lay community health workers serving through health programmes held at the church hall, neighbourhood barbeques, and subsidised housing for the elderly.
- Collective wisdom to set policy priorities and inform values-laden health policy decisions, including the Public Engagement Project on Community Control Measures for Pandemic Influenza, which sought citizen consensus on nonpharmaceutical measures for a possible pandemic.
- Local knowledge to improve feasibility, reliability, and acceptability of disaster plans, including hazard mapping that incorporates indigenous knowledge about historic environmental transformations from residents of Grand Bayou (Louisiana, United States), a Cajun and Native American ocean-farming community, who partnered with state and local governments, business, the faith community, and university-based experts to tackle mounting coastal dangers.
- Operational support for professional responders during crisis and recovery periods, including the Junior Chamber of Commerce, which in cooperation with health departments launched a mass vaccination programme in the 1960's, and the Harris County (Texas) Citizens Corps, which managed volunteers in setting up a "mini-city" to host evacuees following hurricane Katrina in 2005.
- “Rootedness” in a place that personalises community-wide recovery and amasses resilience, including New Orleans residents' neighbourhood exchanges (labour, expertise, tools and equipment, shelter, and childcare) that have made rebuilding a physical possibility and conveyed social commitments to the future of their communities.
- Tax revenue base and in-kind contributions that help mitigate extreme event losses, including Disaster Resistant Berkeley, a campaign of student-run distribution of disaster readiness door hangers funded by a city tax, and "McReady OK!” - a private-public collaboration for storm survival information available in McDonald’s restaurants in Oklahoma.
The document then examines leadership techniques to catalyse the civic infrastructure. These are categorised as the following:
- Communication, described here as one-way messaging to convey information;
- Consultation, characterised as soliciting opinions through surveys, polls, focus groups, and advisory panels; and
- Community engagement, which "constitutes a two-way flow of information between authorities and community residents, where dialogue helps foster better understanding of a complex issue on all sides, and where the goal is to work together to conceive and implement a policy solution".
The document’s analysis of preparedness gaps recognises that the United States' concept of preparedness is focused on individual and household preparedness, rather than resilient neighbourhoods. The Working Group recognises the achievements of local NGOs in the field of disaster preparedness and emergency service for their volunteer opportunities and lists a number of national groups with local associations that are active. However, the document also enumerates gaps in preparedness, including a lack of federal funding commensurate with rhetoric about homeland security in policy discussions. As stated here, "Local and state authorities’ lack of conviction about the sustainability of federal biodefense dollars, as well as procedural incentives to purchase material rather than hire personnel, inhibit most health agencies from creating positions essential to support community engagement." Beyond the physical organisation and disaster preparation, the Working Group also calls for public-spirited citizens to examine and debate society-wide efforts and the tradeoffs that might be necessary to form a collective resolve to care adequately for one another in catastrophic circumstances.
From the findings of the Working Group, the gains of leaders who engage community partners in preparedness include:
- Greater ability to govern and maintain trust during a crisis;
- More citizen responders to ease burdens on health and safety agencies;
- Fiscal savings through reduced disaster-related losses and expenditures;
- Emergency plans that are feasible because they reflect community values, economic realities, and collective judgment; and
- Constituents who are savvy about, and interested in the success of, public health, public safety, and emergency management agencies.
A chart of the principles and actions that help leaders engage their communities is followed by strategies supporting civic leadership to act on each principle. The principles are:
- "Institutional commitment to community engagement.
- Obtain the support of elected officials and agency heads; build top-down support for each bottom-up effort.
- Develop a common purpose through joint problem assessment by top officials, grassroots leaders, and residents at-large.
- Position an organisational champion who can effectively handle interagency concerns about the community engagement initiative.
- Grant community partners genuine opportunities to affect disaster policies; back them up with real authority and responsibility. Investment in an enduring community engagement structure.
- Plan for sustained community engagement, resisting shortcuts in the form of one-time or sporadic public outreach.
- Assess local civic infrastructure, identify existing networks, and enhance their capacity to take on disaster-resilience goals.
- Set aside a sufficient budget, support staff, meeting space, partner incentives, and other material necessities.
- Recruit trained professionals to facilitate face-to-face interactions, develop leadership skills in community partners, help resolve controversies, and continually improve community engagement capabilities.
- Align expectations between officials and community partners about community engagement scale, scope, process, and time-frames.
- Systematically track community engagement’s impact on improved disaster policymaking; provide evidence to officials and citizens that collaborative efforts do matter. Include input from vocal and reticent communities.
- Consciously recruit and represent groups historically absent in public affairs, including the [economically] poor, working class, less educated, and people of color; equip with leadership skills.
- Enable citizens to juggle home life and civic life better by offering convenient meeting times, travel reimbursement, child care, public recognition, stipends, etc.
- Be receptive to participants’ expressive input, not just their practical advice; people become involved for different reasons: for example, to have a voice, to make a difference, to strike up new friendships.
- Acknowledge that participants’ venting of anger is not an impediment to engagement but a prerequisite as a result of unresolved trauma and grief from past events."
The document concludes by applying these strategies to pandemic influenza planning in the areas of containing the spread of a contagious disease, caring for the sick when facilities are overburdened, and handling the dead with dignity.