Frequent drills ensures risk management preparedness.

By Ma Kang-yao
Taiwan News,Supplement Reporter
Photos Courtesy of DOH

On June 13 and 14, the Department of Health (DOH) and Duke University co-hosted a symposium on "Crisis Management and Communication for Public Health: The U.S. Experience" at National Taiwan University Hospital's Convention Center. Around 200 public health workers at the central and local levels participated in the symposium and shared their valuable experience.

In his welcome remarks, Hou Sheng- mou (侯勝茂), the Minister of the Department of Health said: "The crises in these years such as Earthquake 921, SARS, and looming threat of Avian Flu not only cost our people's lives and property but also their mental health. Risk management and communication have become most important issues for public health administration."

"In many situations, governments are forced to take action without clear information, ready man forces or preparation. This is the challenge to our risk management capability."

Meanwhile, Dioxin and Milk Powder Accidents last year revealed the importance of risk communication among governments, media and the public.

"By this symposium, we hope to learn American experience and share our experience with them. I hope this would be a good chance to pave the way for our future collaboration," said Minister Hou.

Five Subjects

Five subjects were discussed in the symposium. These included: "Public Health Risk Anticipatory Strategies and Preparedness" presented by Dr. Leah M. Devlin; "Building on North Carolina Experience: Strategic Defense of Pandemic & Biosecurity" by Dr. Steve Cline; "Communication in the Face of Crises: Effective Management of Media & Public Confidence and Response" by Dr. Gwynn Swinson; "Texas Public Health Challenges in the Aftermath of Hurricane Katrina" by Dr. Eduardo Sanchez and "Protecting Consumers: Challenges of Safeguarding American Food, Citizens, and Industries" by Mr. Louis Carson.

Risk and Perceived Risk

Dr. Hsiu-Hung Wang (王秀紅), the Deputy Minister of DOH said risk refers to one or more incidents that may occur in the process of program implementation that are likely to have negative impact on the goals of organizations or the health, lives and properties of the people.

Mr. Louis Carson, who has devoted more than 30 years of his professional career to the U.S. Food and Drug Administration, (FDA) said that risk is generally regarded as a hazard to health, well-being of self and family, and could be especially troubling when associated with foods.

For different objectives, there are different implications of risk. Mr. Louis Carson said that there are two kinds of risks for food safety. One is the risk with a scientific basis. The other one is a perceived risk that people consider could cause illness but whose reasons can't be discovered scientifically. Both are important and the government needs to take action. On the public side, Dr. Peter Sandman, an outstanding scholar, said that for consumers, risk is hazard plus outrage. There is great emotional component in it. Any time people talk about the certain risk populations such as children, or the unborn, the component of outrage will increase.

Cooperation to Reduce Risk

To decrease the risk as much as possible, a preventive management process to minimize the negative effects of the accidental damages is necessary. This is the so- called risk management.

"Risk management is a day-to-day preparedness. The most basic level is education on the idea of risk management and build this idea up in decision making," said Minister Hou.
"Two concepts need to be clarified. First, the chances and the impact of the incidents can be reduced. Second, we are not pursuing a zero risk. We are to pursue the maximum benefit within acceptable risks," said Dr. Wang.

"Risk management also needs scientific and legal bases; the solutions must be cost effective and practical," said Mr. Carson, "a successful risk management process requires the participation of stakeholders to be part of the solution and it is so important to keep the process transparent and open. Favoring one group of people or another undermines the integrity of the process and the trust of everyone.
Minister Hou said that sometimes, a simple professional decision can be disrupted by political concerns. A decision to cancel an outdated policy could trigger a fierce backlash from the old guards. The old guards may choose to connect with political figures turning the whole decision into a social conflict. "If we deem the decision best serves the people's interest, we should insist on the integrity of the process," he said.

Dr. Devlin, who is the State Health Director of North Carolina, said that in North Carolina, there are 100 counties and 85 local health jurisdictions. 78% of the local health department's funding comes from local expenditures, 18% from federal and 4% from state, which give the local health jurisdictions a huge autonomy to deal with any public health issues. That is why the collaboration among these rganizations is so crucial.

"It is important to include other experts from different professions related to public health such as nursery, doctors or engineers in decision making," said Dr. Devlin. "They come here not only to contribute their expertise but also represent their associations. This is a great opportunity to connect with these opinion leaders and get them into the policymaking."

Another reason the mechanism of cooperation is so crucial is because in the state of North Carolina, local health departments are very involved in providing medical services. They provide a very wide variety of health care such as prenatal care, childcare, immunization, holding activities to motivate people change behaviors and education. State makes policies issue grand guidelines for state rules, implements these policies and deals with the controversial issues among these local departments. In Texas, the structure for emergency preparedness contains three levels. The highest level is the Office of Homeland Security who identifies the threat and conducts analyses on all possible disasters. The second level is the State Emergency Plan who makes sure that fuel is available and roads are passable.

The very local level is the Texas Department of State Health Services. (DSHS)
"Nothing can give us a better lesson than the Hurricane Emily and Rita from July 2005 to September 2005," Dr. Sanchez said, who is a commissioner of the Texas Department of State Health Services (DSHS), "Hurricane Emily made a landfall in Northern Mexico July 20, 2005. We built up strong relationship with Mexican counterparts. Before the hurricane hit, we discussed how to help one another.

Minister Hou said that the cooperation between different levels of government never ends. It is an ongoing process. "You can always find some counties that are doing better than others. In July, we just had an drill called Material Information System (MIS) test," he said, "to be clear, we know how many N95 masks we have in the central, regional, and local levels and estimated that every Taiwanese can have 10 of them and how many from which level of governments. But when asked about the expiration date of those masks. You can find many of them failed the test and were unable to report within an hour."

Besides the hierarchical cooperation, parallel cooperation is also important. In Taiwan's cross-ministerial cooperation, DOH, Council of Agriculture, Coast Patrol Administration, Ministry of Economic Affairs, Ministry of Finance and other ministries of the Executive Yuan worked closely to deal with the issues such as vaccines production, shortage of anti-viral agents, materials and supplies. All of these issues make coordination extremely important.In North Carolina, Dr. Devlin stressed the importance of the non- governmental organizations. They are able to provide laboratories for sample test and some newest research results. The partnership relations with schools, business, communities, media and health care providers are as important as that between other organizations."Cooperation between these bodies requires the credibility built up in the daily operation," Dr. Devlin said.

Implementation exercises come after the build up of risk management. On August 9, 2005, Texas engaged in the National Strategic Stockpile Exercise. It is a cache of medication, medical equipment, and other supplies they can deploy to any state in the Untied States in the event of major public health emergency. Dr. Sanchez said that it is a relatively new system that has not been tested across the United States, but that it had let them understand their capacity when risk arrived.