But what happens when those services and assets are no longer able to function? Over the past few years, we have witnessed a litany of natural disasters that have clearly demonstrated the importance of infrastructure in protecting and maintaining public health.
“In a public health emergency, infrastructure really acts as a multiplier of the public health professional’s capability,” said Dan Tuten, Associate Director for Information Resources at the Office of Public Health Preparedness and Response, one of the centers within the Centers for Disease Control and Prevention (CDC). “Roads allow health professionals to reach a wider population, hospitals serve as collection points for the sick or wounded, and communications infrastructure allows health professionals to communicate needs to the outside world.”
What worries public health professionals therefore is any event that may disrupt the ability of infrastructure to fulfill this role. “The ones we most worry about from a public health perspective are those acute events – usually weather related – that provide little to no time for preparation; floods, heat waves, forest fires, earthquakes and tsunamis tend to happen without much warning and therefore create very severe public health outcomes,” noted Dr. Perry Kendall, Chief Public Health Officer of the Canadian Province of British Columbia.
Examining the symptoms
While infrastructure may play a critical role in the ability of a city, region or nation to resist and respond to public health emergencies, there is often little actual coordination or communication between public health authorities and planning officials during the infrastructure planning, design and engineering phase. Most markets rely solely on building codes and standards to ensure that infrastructure assets will respond appropriately in a crisis.
“Few public health authorities have the capability or capacity to review and evaluate each new piece of infrastructure, so building codes offer a very clear route to ensuring the right standards and redundancies are being incorporated to allow these facilities to maintain operations during an emergency,” added Dr. Kendall. “But that sometimes doesn’t work for the bigger infrastructure pieces like nuclear facilities or hospitals where public health authorities will want – and need – to have greater input into resilience planning.”
For the US CDC, one solution is to provide tools and guidance to other levels of government in order to build a stronger understanding of the need for resilience and emergency planning. “The Office of Public Health Preparedness and Response recently put together a series of capabilities related to public health preparedness,” noted Dan Tuten. “Basically, we’ve looked at the various public health emergencies that we’ve responded to and found that the communities that have these types of capabilities in place tend to be more resilient and can reduce the time in which it takes to respond to – and eventually recover from – these events.”
A key imperative for many public health authorities is to enhance the resilience of infrastructure to help the communities themselves. “Making a community more resilient is key to supporting public health,” noted Dr. Kendall. “If they have safe access to clean water, some form of transportation, consistent access to power or simply a place to go when things are being swept away; these are the things that really help to mitigate the impact of a public health emergency.”
For the CDC’s Mr. Tuten, the link between community resilience, public health and societal cohesion is clear. “If people don’t have access to the basics they need to sustain themselves, they won’t be able to focus on achieving any of the better things that their society has to offer. I think city, regional and national leaders really need to consider what some of the bigger risks are specific to their cultures and plan to mitigate accordingly.”
There are some signs that more focus on public health impacts and requirements are starting to work their way into the infrastructure planning process. For example, we have recently started to see a growing trend towards the application of health impact assessments alongside other more traditional planning and approval steps such as environmental impact and adherence to building codes.
“In British Columbia there are a number of infrastructure project types where both environmental and health impact assessments should be required such as coal ports, waste to energy generating plants or mine infrastructure,” added Dr. Kendall. “But it’s a relatively new concept and so there aren’t a lot of infrastructure developers or construction companies with experience navigating through them yet.”
Not surprisingly, both Dr. Kendall and Mr. Tuten strongly argue that the best way to ensure infrastructure remains resilient – and effective – during a public health crisis is to carefully assess the risks and then practice the response.
“Each community – regardless of where they are in the world – should really be doing frequent risk analyses that takes a more holistic look at all of the public health-related risks and starts to prioritize which are the most important ones to be mitigated,” suggested Mr. Tuten.
“It’s important to remember that the risks and hazards that a particular city or region faces changes with time and, as population centers continue to grow and move into more at-risk locations, the risk profile of some of these hazards will need to be closely monitored from a public health perspective,” added Dr. Kendall.
A prescription for resilience
For those responsible for public health, the CDC’s Mr. Tuten suggests that particular focus should be placed on ensuring that communication tools, processes and relationships are in place. “Communication is key to building resilience; it helps speed decision making when time is not available and helps teams identify those unexpected surprises before it is too late to plan for them,” added Mr. Tuten. “And if there isn’t open communication between public health authorities and infrastructure planners, you’re more likely to get an ‘us versus them’ situation that will only hamper resilience planning and disaster response.”
Dr. Kendall agrees that greater collaboration is key to creating more resilient communities in the face of public health emergencies. “I think that infrastructure developers, funders and governments need to be thinking much more carefully about the health implications of their assets and how they facilitate greater health resilience within communities,” added Dr. Kendall. “As a public health authority, I would certainly welcome the opportunity to work alongside the infrastructure sector to help make their developments more resilient; it’s a win-win for everyone.”
All of which makes Mr. Tuten’s final plea so much more critical: “It’s the lessons we learn today that will help us to respond more effectively tomorrow so please – whatever you do – document your experiences and share those lessons.”
A sentiment well-shared by the authors of this publication.