The Local Health Department Mandate and Capacity for Community Engagement in Emergency Preparedness: A National View Over Time

Context: Local health departments (LHDs) perform the highly valued, yet time- and staff-intensive work of community engagement in public health emergency preparedness (CE-PHEP) when the Great Recession has had lingering effects on their organizational capacity. Objective: Track the extent to which LHDs still embrace collaborative, whole community approaches to PHEP in a historically low resource environment. Design: National survey in 2015 of LHDs using a self-administered online questionnaire regarding LHD practices and resources for CE-PHEP first fielded in 2012 (The Community Engagement for Public Health Emergency Preparedness Survey). Differences in 2015 survey responses were reviewed, and comparisons made between 2012 and 2015 responses. Setting: Randomized sample of 811 LHDs drawn from 2565 LHDs that were invited to participate in the 2010 National Profile of LHDs and participated in the 2012 CE-PHEP survey. Sample selection was stratified by geographic location and size of population served. Participants: Emergency preparedness coordinators reporting on the LHDs they serve. Main Outcome Measure: Community engagement in public health emergency preparedness intensity as measured by a scoring system that valued specific practices on the basis of the community capacity and public participation they represented. Results: Survey response was 30%; 243 LHDs participated. The CE-PHEP activities and intensity scores remained unchanged from 2012 to 2015. Local health departments that reported having an explicit CE-PHEP policy and experienced CE-PHEP staff member--2 of the top 3 predictors of CE-PHEP intensity--have dropped between 2012 and 2015. The numbers of LHDs with a CE-PHEP budget, also an important predictor of intensity, have not increased in a statistically significant way during that same period. Conclusions: Local health departments appear to be in a CE-PHEP holding pattern, presumably pushed forward by the doctrinal focus on partner-centered preparedness but held back by capacity issues, in particular, limited staff and partner support. Local health departments operating in low-resource environments are encouraged to formalize their CE-PHEP policy to advance performance in this arena.