Integrating Government Silos: Local Emergency Management and Public Health Department Collaboration for Emergency Planning and Response

Abstract

The United States arguably faces the most serious disaster it has faced since World War II: the COVID-19 pandemic. The pandemic itself has created further cascading economic, financial, and social crises. To date, approximately 114,000 Americans have died and approximately 2,000,000 (as of this writing) have become infected. American emergency planning and response, including for pandemics, begins at the local (city, town, and county) level, close to the individuals and communities most impacted. During crises like COVID-19, natural and other disasters, best practices include “whole of government” and “whole community” approaches, involving all parts of the government, community organizations, institutions, and businesses, with representation from diverse individual community stakeholders. Local emergency management and public health agencies are at the heart of emergency planning and response and thus warrant further examination. While collaboration between the two is recognized as a best practice, in reality there appear to be silos and gaps. This Commentary describes the American emergency planning system and the roles of local emergency management and public health departments. Closer examination illuminates similarities and differences in practitioner demographics, professional competencies, organizational goals, and culture. The Commentary reviews the limited research and observations of collaboration efforts and suggests areas for integrating the two practice areas in future research, education, professional training, and practice. Breaking down the silos will strengthen local emergency and public health preparedness planning and response, ultimately leading to stronger community health, well-being, resilience, and more efficient local administration.

Keywords

public health preparedness emergency management emergencies disasters pandemics COVID-19 coronavirus local government collaboration

The United States arguably faces the most serious disaster since World War II: the COVID-19 pandemic (Prasad & Wu, 2020). The pandemic itself has created further cascading economic, financial, human, and social crises. According to media accounts to date, approximately 114,000 Americans have died and approximately 2,000,000 (as of this writing) have become infected (Murphy et al., 2020). Even before the pandemic, the United States had experienced an increase in the number and severity of emergencies and disasters (Dolan & Messen, 2012; Scolobig et al., 2015). Disasters have also increased in cost; American disasters in 2017 cost $300 billion (Smith, 2018). In the United States these events, plus the current pandemic, have led to devastating social and economic impacts, particularly to potentially vulnerable populations, and have highlighted ongoing social inequities (Horney et al., 2016; Zavattaro & McCandless, 2020).

American emergency response begins at the local (city, town, and county) level (Haddow et al., 2017). The local level is closest to the individuals and communities most impacted by an emergency, can plan in advance with local resources and respond more quickly than higher government levels (Haddow et al., 2017). During crises like COVID-19, natural and other disasters, best practices include “whole community” and “whole of government” approaches, involving all parts of the government, community organizations, institutions, and businesses, with representation from diverse individual community stakeholders (Kapucu, 2015; U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, 2019). While collaboration between local public health and emergency management agencies is recognized as a best practice, in reality there appear to be silos and gaps (Howell, 2020). This Commentary argues that these silos should be broken down and the two fields integrated for optimal emergency planning, response, and local administration.

The Commentary begins with a description of the U.S. emergency management system and the roles of local emergency management and public health departments. Closer examination illuminates similarities and differences in practitioner demographics, professional competencies, organizational goals, and culture between the two agencies. Cross-sector collaboration is considered a best practice due to its efficiency and the possibility for leveraging resources (Kapucu, 2015) but numerous barriers exist. The Commentary reviews the limited research and observations of collaboration efforts between the two practice areas. The Commentary concludes with proposals to integrate the two areas via education and training, research and professional practice, and issues a call to action to emergency management, public health and public administration students, researchers, and practitioners to break down the silos and remove the barriers.

The American Emergency Management System

The American emergency management and public health preparedness system is really a system of systems. The system is structurally complex and in reality is composed of approximately 10 systems for each locality. There are two overarching parallel systems, a public safety system (e.g., the local emergency management department) and a public health system (e.g., the local public health department), present at the federal, state, and local government levels, and at the regional level among and within the states. These systems become even more complex where, as in Massachusetts, almost every city and town has its own local public health and safety emergency systems (in contrast to the county systems operating in most states).

It is a bottom-up system. When a lower government level becomes overwhelmed, that level requests help from a higher level (Haddow et al., 2017). Authority is widely dispersed. The regional systems can be controlled by the federal departments that created them. However, local and state systems are independent of direct federal control, and many local systems are independent of direct state control or share governance with the state (Kapucu, 2015; National Association of County and City Health Officials [NACCHO], 2017). For example, according to NACCHO, in 27 states all local health departments are locally governed. In five states local health departments are part of state government. In three states local health department authority is shared by state and local government. Thirteen states and Washington, D.C. have more than one kind of local health governance. (NACCHO reports that Hawaii and Rhode Island did not participate in this study question.) (NACCHO, 2017). The state emergency management agency generally does not control the local emergency management agency and cannot mandate action, particularly in home rule states (See, e.g., Mass. Gen. Laws, Ch. 43B [2015]. Home Rule Procedures).

The Federal Emergency Management Agency (FEMA) and Assistant Secretary for Preparedness and Response (ASPR) cannot issue mandatory regulations that states and localities must follow (Kapucu, 2015). The state and federal systems can only provide guidance or make suggestions to systems at lower government levels. There can be indirect control via grant funding. In terms of local systems change efforts to effect greater collaboration, both the local emergency management and public health departments would have to collaborate to effect a local systems change, but no state or federal authorization might be needed.

Whole of Government Emergency Management

Despite the fragmented nature of the American emergency management system(s), coordination and collaboration is seen as a best practice. The 2019–2020 National Health Security Strategy includes “whole of government” planning and response as one of its three major aims (U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, 2019). The “whole of government” approach

refers to public service agencies working across portfolio boundaries to achieve a shared goal and an integrated government response. Approaches can be formal and informal and include government partners at federal, state, tribal/territorial, and local levels. (U.S. Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, 2019, p. 9)

The National Association of Counties (2018) maintains that it is critical for county public health departments to work closely with local emergency management, among other partners, to develop successful emergency plans. The organization states that the critical element of successful disaster recovery is a close relationship with emergency management developed prior to the event. Practitioners concur. For example, Howell (2020) writes that emergency planning is such a critical local government function that it requires intragovernmental collaboration. He raises the concern that lack of collaboration could lead to multiple contradictory plans within the same jurisdiction, strengthen silos, and increase intragovernmental competition.

Local Emergency Management and Public Health Agencies

Because of their critical roles in the American system, local emergency management and public health departments and practitioners bear closer scrutiny. The two fields at issue have similarities, including goals and the content of formal statements regarding professional capabilities. The goal of local emergency management, planning, and response is to provide protection from the physical, emotional, and social harms caused by natural or manmade disasters and emergencies (Nelson et al., 2007; Nicholson, 2007). The goal of public health is similar: to protect the health and well-being of the community, although this goal is not limited to emergency situations (Turnock, 2009).

The emergency management and public health preparedness fields are also guided by similar core concepts. FEMA’s National Preparedness Goal describes 32 emergency core capabilities needed to fulfill the emergency management mission for all levels of government (U.S. Department of Homeland Security/Federal Emergency Management Agency [U.S. DHS/FEMA], 2015). The Centers for Disease Control and Prevention (CDC) developed 15 capabilities for public health preparedness personnel at all levels (CDC, 2018). Both emergency management and public health preparedness capabilities overlap and both call for coordination and collaboration with government and community partners. The CDC’s capabilities specifically refer to coordination between public health and emergency management departments (CDC, 2018). FEMA’s Developing and Maintaining Emergency Operations Plans guide, known as CPG 101, is the foundational document for emergency planning at the local, state, and federal levels. This guidance document instructs that planning “must” include all community stakeholders, including government agencies, and notes the potential existence of more than one government agency plan which overlaps with those of emergency management departments (U.S. DHS/FEMA, 2010). Operationally, both fields utilize the same emergency response management frameworks known as the National Incident Management System (NIMS) and the Incident Command System (ICS) (U.S. DHS/FEMA, 2018). The NIMS framework is used to manage specific incidents, and the ICS framework is used to manage the personnel who respond to an incident.

Practitioner Demographics

Public health and emergency management practitioner demographics share some similarities. Survey results indicate that the majority of government emergency managers are male and Caucasian (approximately 81% male and 94% Caucasian, n = 1058) (Weaver et al., 2014). The workforce is aging, and 72% of managers studied were over 45 years old (n = 1,058). Most respondents were highly educated; approximately 78% (n = 1,058) reported being college educated (Weaver et al., 2014). Like emergency managers, government public health workers are overwhelmingly Caucasian (de Beaumont Foundation & Association of State and Territorial Health Officials [ASTHO], 2019). However, the vast majority of public health workers are female and tend to be younger than emergency managers (only 42% are over age 50, n = 90). Like emergency managers, public health workers are well educated, with 68% (n = 90) reporting that they have a college degree or higher (de Beaumont Foundation & ASTHO, 2019).

Organizational Culture

A major difference between the two fields can be found in their respective organizational cultures. Botoseneanu et al. (2010) found differences in public health and emergency practitioner understanding of their legal mandates and authority, which in turn impacted their ideas about joint collaboration. Through qualitative interviews, the researchers determined that public health personnel were uncertain about the scope of their legal authority to perform both routine and emergency public health tasks, and reported that this impeded their work and constrained their behavior (Botoseneanu et al., 2010).

The local public health personnel interviewed expressed concerns about collaboration (Botoseneanu et al., 2010). They reported that this lack of clarity about their authority extended to collaboration; they reported feeling that other agencies would not recognize their department’s position. The researchers reported that public health personnel remained concerned even when their agency’s authority was clear (Botoseneanu et al., 2010). Kennedy et al. (2019) also identified public health personnel concerns about decision-making authority and status. In semistructured interviews with emergency and public health preparedness planners and other responders, these researchers found that while public health officials were represented at meetings, they questioned whether their participation was really meaningful. One respondent reported concern that public health ideas were not taken seriously and felt that public health participation did not influence actual emergency plans (Kennedy et al., 2019).

Botoseneanu et al. (2010) found that public health personnel were concerned about agency and personal liability which led to a second concern, that collaboration with emergency management could lead to increased liability. Perhaps at least in part because of this concern, respondent public health personnel reported that their preferred type of collaboration included a process with many stakeholders and decision making based on consensus (Botoseneanu et al., 2010).

Emergency managers held different views. Botoseneanu and colleagues’ respondent emergency managers appeared less concerned about their specific legal authority and expressed a broader view of their legal mandates (Botoseneanu et al., 2010). They seemed to take an “ask for forgiveness instead of seeking permission” attitude and reported believing that action based on ethics (ie. someone was in need of rescue), rather than legal authority, would eclipse potential legal liability during an emergency.

Botoseneanu and colleagues’ most concerning finding, however, was related to public health and emergency management personnel attitudes toward each other. The researchers observed

a tenuous, antagonistic and competitive relationship between PH [public health] and EM [emergency management] respondents. Representative statements include: “PH is a toothless tiger when it comes to preparedness . . .” [EM respondent], “EM people walk around like cowboys and would pull the guns . . .” and “. . . it [EM] reminds me of children playing soldiers . . .” [PH respondents] (2010, p. 365)

These attitudes and cultural differences, indicative of distrust and likely political infighting, are serious challenges to collaboration. It should also be noted that an additional factor may be the nature of their respective professional responsibilities. While the sole responsibility of many emergency managers is generally only emergency management or emergency management plus another public safety responsibility (e.g., a local fire chief who is also the community emergency manager), public health professionals generally have many roles due to the broad nature of public health (see, e.g., a description of the 10 essential public health services; CDC, 2020).

Collaboration Between Public Health and Emergency Management Departments

There are few reports on the intersection of public health and emergency management work (Rose et al., 2017), but there are certainly examples of successful local collaboration efforts. For example, local media reported a COVID-19 planning collaboration to prepare for patient surge, among other issues, in a North Carolina region (The Transylvania Times online edition, 2020). There is also research that indicates the existence of professional connections between local public health and emergency management. For example, NACCHO’s (2018b) 2018 Public Health Preparedness Landscape survey reports that 93% of respondent local public health departments reported having a “good” or “excellent” partnership with local emergency management, an improvement over 2015 results (NACCHO reported the n for this response as a range, n = 375–387). The same study found that 88% (n = 371) of local public health department respondents reported local emergency management participation in federally funded regional public health preparedness coalitions in which the public health department also participated.

Collaboration Barriers

There are numerous barriers to successful collaboration between the two local departments. The demographic and organizational differences identified by Botoseneanu et al. (2010), and Kennedy et al. (2019), described above, illuminate barriers, as does the enmity expressed by Botoseneanu and colleagues’ (2010) research participants. A professional with HealthCare Ready, an organization that strengthens health care supply chains, wrote that since public health professionals look to understand the scientific evidence in the field, their interpretation becomes political and thus shapes their emergency response (Baker, 2020). While she argues that emergency managers are also political, she feels that their views are based on acting as government representatives.

The 2019 National Health Security Preparedness Index provides further evidence of a gap (Center for Business and Economic Research, University of Kentucky, 2018). The Index measures “community [emergency] planning and engagement” which relates to the ability to form collaborative relationships among government departments, households, and local organizations. The Index finds the U.S. national average to be 5.2 on a scale of 0–10, with 10 being the highest preparedness level based on collaboration (Center for Business and Economic Research, University of Kentucky, 2018). The Index report notes that forming collaborative relationships has been the country’s weakest preparedness indicator, although the report states that there has been improvement over time.

Local government agency siloing is a barrier which Bashir et al. (2003) describe as being historic in nature. Howell (2020) writes about emergency management siloing due to a view that emergency planning is the sole province of local emergency managers and planners. He argues that this attitude creates an unstable situation and notes that silos cause lost opportunities for collateral benefits inside and outside the emergency management department (Howell, 2020).

Department budget issues present further barriers to collaboration. Without the appropriate financial and personnel resources, there may not be enough staff and/or time for collaboration. According to a NACCHO (2018a) survey, the vast majority of local health departments reported providing emergency services (92%, n = 555). But the survey also found that 21% of local health departments experienced budget cuts in their current fiscal year and 19% anticipated cuts in the next fiscal year (for both fiscal years NACCHO reported the n for this response as a range, n = 552–567; NACCHO, 2018a). It is unclear if local emergency management departments are also losing funding. Budget issues can, of course, happen to any government department at any time, and not just to public health or emergency management agencies. Other barriers to collaboration that might impact any government departments include the time, effort, leadership, and commitment needed to establish successful collaborations (International City/County Management Association [ICMA], 2013).

Breaking Down Silos

While the COVID-19 pandemic has had devastating effects and will continue to do so in the future, it also presents opportunities for innovation and systems change. Coordinated local public health and emergency management response is critical to community recovery, successful future disaster planning, and strengthening community resilience. This Commentary has highlighted a number of organizational and attitudinal barriers to successful collaboration. Local emergency management and public health departments are already burdened, but can expect these burdens to worsen. Experts note that climate change leads to increased disasters and pandemics (U.S. Global Change Research Program, 2016), which means more emergencies that call for a response. It is also possible that the United States will experience multiple disasters at the same time in the same location, for example, ongoing coronavirus response during the upcoming hurricane season, adding to the burdens of the two agencies (Kann et al., 2020). These potential additional stressors provide impetus for systems change efforts.

Public administrators, emergency managers and public health preparedness planners have the opportunity to work together now to break down the silos and integrate the emergency management, public health preparedness, and public administration fields, to the mutual benefit of all three. Both government emergency managers and public health preparedness planners are also public administrators. Areas for potential change efforts include: (a) education and professional development; (b) research; and (c) practice.

Education and Professional Development

Education and professional development could broaden student and practitioner knowledge and capacity. Currently, the NACCHO Preparedness Summit (http://www.preparednesssummit.org/home) is a national conference which brings together emergency managers, public health preparedness planners, and others interested in emergency planning and response. If similar joint efforts do not exist, others could be created. For example, the American Society for Public Administration (ASPA) Annual Conference (https://www.aspanet.org/ASPA/Events/Annual-Conference/Annual-Conference.aspx), with leadership from the Section on Emergency and Crisis Management (SECM), could offer sessions related to the intersections of local public health, emergency management, and public administration. Likewise, university public administration departments, particularly those which already offer emergency management courses, could consider developing a blended public health/emergency management/public administration program focused on public health emergency management (ie. a combination of the two fields). Professional collaborative work groups could be developed, for example, between ASPA’s SECM and the American Public Health Association’s (APHA) Injury Control and Emergency Health Services Section and the new APHA Disasters and Emergency Preparedness (D & EP) Topic Group (https://www.apha.org/) to facilitate knowledge sharing.

Research

Comfort et al. (2012) write that in the 1980s, there was a joint FEMA-National Association of Schools of Public Affairs and Administration (NASPAA) collaboration to develop a research community. Perhaps such a community could be developed to include FEMA, the U.S. Department of Health and Human Services ASPR, and the CDC, the latter two of which focus on public health and health care in emergencies. As stated above, there are few reports on the intersection between public health preparedness and emergency management (Rose et al., 2017), so this area might be fruitful for future research. An additional research area might be the optimum departmental organizational structure to foster successful collaboration. Finally, researchers and practitioners should develop best practice guidelines, along with a plan for broad scholarly and professional dissemination of research findings.

Practice

Local public health and emergency management practitioners have the opportunity to innovate on the ground and in real time. They might assess different ways to combine and integrate both areas of interest. For example, Vielot and Horney (2014) describe a model for a “public health preparedness coordinator” position shared among the two local agencies in each of six North Carolina counties. The coordinators had responsibilities among emergency management, emergency medical services, hospital and public health preparedness services. The researchers conducted semistructured interviews with the individuals then holding the new position. Respondents reported that their specific job tasks differed according to which department supervised them (Vielot & Horney, 2014). They reported that due to strong coordination, most of their duties were well defined within the supervising department, although there was an implication that duties across agencies were less well defined. Respondents also reported feeling at ease working within the two domains because they were able to consult with colleagues in either department to fill any knowledge gaps and because they felt that they received support from both departments (Vielot & Horney, 2014).

The respondents reported a number of advantages to the position. For example, the merged position led to greater efficiency for some departments (Vielot & Horney, 2014). Most respondents reported local public health preparedness emergency operations plans were stronger after the merger due to input from both departments. Barriers reported included a challenge prioritizing equipment purchases for one or the other department and addressing funding that was split between the two departments (Vielot & Horney, 2014). While reporting many positives, the respondents were uncertain whether this new structure could work in a large county. They reported that it was important for the shared staffer to have previous experience in both domains, that both departments shared the same goals, and that funding was split evenly between the two departments to ensure equal priority would be given to both (Vielot & Horney, 2014). While the sample size for this research was small, this practice seems promising and is worth further exploration.

One challenge with all emergency planning and response is that it becomes important during a time of crisis but becomes less so when there is no disaster in sight. Public health and emergency management departments could consider strategies for making their emergency planning and response activities more public facing. This might be an effective strategy to gain government leadership support, which would hopefully lead to additional funding and other resources, as well as enhanced departmental status. One emergency management department representative from Florida reported that their department publicizes the work of its governmental and other partners and provides free topical mini-trainings during normal times, to maintain stakeholder interest (anonymous emergency manager, personal communication, October 11, 2019). This strategy could also call additional public attention to the departments.

Another potential strategy would be to incorporate public health preparedness and emergency management into climate change, sustainability, and/or community resilience efforts popular with local government agencies and community members. This would provide additional support for emergency-related activities and potential for efficiencies, such as increased opportunities for leveraging local resources.

A related, but perhaps more challenging strategy to implement, would be to advocate for a local “health in all policies” (HIAP) approach to policymaking. Such an approach would mean that local government decisions would be implemented only if there were a neutral or positive impact on community health (Kennedy et al., 2019). Emergency management and public health preparedness policies could be considered part of health promotion or prevention efforts and subject to HIAP scrutiny as such. Collaboration and breaking down silos are keys to this approach, which would include a philosophy of “building back better” after an emergency. Such a direction is supported by the National Academy of Medicine, formerly the Institute of Medicine of the National Academies (2015), which recommends using disaster recovery to redress inequities due to the social determinants of health.

A Call to Action

Americans will continue to experience disasters, emergencies, and pandemics in the future. The number and severity of these events are increasing and will increasingly strain local governments, including public health and emergency management departments. COVID-19 has further exposed social, economic, and health inequities and is likely to continue to do so. In addition, there is potential for the United States to face simultaneous crises (e.g., ongoing COVID-19 challenges alongside a natural disaster), further straining already stressed systems. It is clear that local emergency management and public health preparedness departments are on the front lines of responding to these disasters and must work in tandem for efficient and effective emergency planning and response.

Public administration has an important role to play in integrating the silos and filling the gaps. It is well known and accepted that people whose physical, emotional, and social needs are met are generally healthier than those with unmet needs. Addressing those needs via government policies and services is a function of public administration. The public administration community must lead the charge to integrate local emergency management and public health preparedness actions and policies with innovations in education and professional development, research, and practice. A goal of public administration is to advance the public interest and social equity (ASPA, n.d.). This can be accomplished by breaking the silos and closing the gaps between local emergency management and public health preparedness. To do so would lead to more effective and efficient emergency planning and response, which in turn would strengthen community health and well-being. Americans are now enduring a horrible pandemic. The public administration field should take the opportunity to act in the public’s interest and lead critical change efforts to create a stronger, healthier, and more resilient nation.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biography

Susan Wolf-Fordham, JD, MPA, is adjunct faculty, Massachusetts College of Pharmacy and Health Sciences, Master of Public Health Program, where she teaches public health law. She also advises and consults with federal, state, and local government agencies and national, nonprofit, and health care organizations. She develops curricula, delivers trainings, provides technical assistance, and conducts research related to emergency planning and public health preparedness for and with populations with access and functional needs.

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