National health security (NHS) refers to the level of national preparedness and resiliency in the face of health threats or incidents with potentially negative health consequences. Such threats include incidents like severe weather, infectious disease outbreaks, hazardous material exposure, or acts of terrorism, each of which, whether naturally occurring or human-made, can result in widespread devastation impacting the health and safety of multiple communities. Ensuring the health security of our nation depends on the efforts of all Americans and begins at the community level. In 2015, the Department of Health and Human Services (HHS) released the National Health Security Strategy and Implementation Plan (NHSS/IP) 2015-2018, outlining a vision for the nation’s health security. Progress toward achieving and sustaining a high level of NHS is assessed every four years and reported in the Congressionally-mandated National Health Security Review (NHSR). The NHSR serves as a status update for both Congress and the American people on the progress toward the strategic objectives of the NHSS. Additionally, the NHSR indicates key gaps that still need to be addressed related to national health security efforts.

The HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) conducted workshops to solicit feedback from diverse stakeholder groups across the nation (i.e., public health departments, healthcare organizations, emergency management agencies, faith-based organizations, community-based organizations and relief organizations) about their experiences with NHS related topics, specifically preparedness, response, and resiliency. The information collected during these workshop discussions will be used by ASPR to inform the development of NHSR and the 2019-2022 iteration of the NHSS/IP. Through these workshops, ASPR sought to engage diverse stakeholder groups, including across the nation.

In June 2017, NACCHO supported ASPR in facilitating two one-day NHS Stakeholder Workshops, held in separate HHS regions, one in Philadelphia, PA and the other in Portland, OR (pictured on the left). Each workshop explored the progress and challenges of building and maintaining healthy, resilient communities as well as the integration of public health, healthcare, and emergency management systems. Workshop participants represented community-based healthcare providers, public health subject matter experts and other key stakeholders, including state, local, and tribal public health officials from both HHS Region III and Region X.

June’s workshop discussions revealed many alignments between preparedness activities at the local level and the 2015-2018 iteration of the NHSS/IP. Participants also identified a key gap of the NHSS, indicating that while NHSS priorities are reflected in local public health and healthcare preparedness work, these activities are primarily determined by funding rather than the strategy. Additionally, workshop discussions provided a valuable platform for participants to share their ongoing efforts towards increasing the nation’s health security. For example, many participants reported engaging in efforts to increase the integration of preparedness into everyday public health activities, requiring preparedness training for all staff, and providing better education to partner organizations on the role of public health.

Participants also shared “stories from the field” and highlighted best practices to build community resilience and better integrate public health, healthcare, and emergency management. For example, Clark County Washington’s regional emergency response coordinator discussed the agency’s recent contributions towards increased national health security. During an ongoing investigation of a possible hospital acquired Hepatitis C infection, Clark County Public Health (CCPH) partnered with the PeaceHealth Southwest Washington Medical Center (PHSW) to bolster response capacity. The two agencies agreed to facilitate a unified command, an incident management structure used in incidents involving multiple lead jurisdictions or agencies, with command staff and general staff positions provided by a CCPH incident management team (IMT). This was the first time that CCPH and a hospital had responded to an incident using a unified command. The response organizations and cultures were starkly different from each other and the Incident Command System (ICS) planning cycle was unfamiliar to the PHSW members of the unified IMT, which made implementing ICS challenging in the beginning. Given the differences between the two organizations and the implementation of a system unfamiliar to PHSW, the level of progress made during the period of unified command was impressive.

The ICS relationship became smoother toward the end of the incident, however, the After Action Report, a structured review process for analyzing the incident and areas for improvement, highlighted the need for additional ICS training. Washington’s southwest region had already begun the process of launching hospital ICS position-specific training in the region before the event occurred. This incident further reinforced the need for ICS training among community partners in the region. PHSW, specifically, noted their response to the region’s 2017 winter weather and to the influenza outbreak was successful as a result of participation in the ICS training. Implementing this training has helped the region to increase its response capabilities and is a great example of the types of local efforts being made to strengthen NHS.

All of the feedback collected during both workshops will inform decision-makers on the progress of health security and provide input on the strategic direction of the 2019-2022 iteration of the NHSS/IP. Key recommendations identified as a result of these workshop include the following:

• Evaluating the NHSS for areas of alignment with local funding stream requirements;
• Providing additional examples to locals on what successful NHSS adoption looks like;
• Expanding promotional efforts to educate both public health and healthcare stakeholders as well as the broader community; and
• Examining both how the NHSS defines risks and how it addresses health equity issues.

NACCHO plans to continue working with ASPR to assist with the promotion of the NHSS as well as gathering valuable NHS related feedback from local health departments. NACCHO encourages local health department staff to share stories about their agency’s contributions to national health security. Local health officials and partners interested in sharing their story, should contact NACCHO’s preparedness team via email at [email protected] for opportunities to promote accomplishments through national communication channels. Click here for more information about the National Health Security Strategy.