A public health emergency is a natural or human-made event that negatively affects the health of a population and creates the conditions for widespread illness or disability. Public health emergencies disrupt lives, families, and communities. They fall into three categories: natural disasters, such as hurricanes, tornadoes, wildfires, floods, and earthquakes; Emerging or significant outbreaks of diseases, such as Covid-19, Zika virus, Ebola, and pandemic influenza; and human-caused disasters, such as nuclear accidents, bioterrorist attacks, and war.

For any public health emergency, there are four cyclical and recurring phases of management: mitigation, preparedness, response, and recovery.

Mitigation: Actions taken to prevent and reduce the overall cause and impact of disasters including, but not limited to: constructing levees or other permanent barriers to control flooding, tying down buildings with ground anchors to withstand high winds, and buying insurance policies.

Preparedness: Planning, training, and education for disaster events that cannot be mitigated or prevented, such as participating in disaster drills and tabletop exercises, and developing preparedness plans for what to do in case of a disaster.

Response: Actions taken in the duration or immediate aftermath of a disaster, including implementing disaster response plans, addressing public health concerns such as disease spread and food contamination, and conducting search and rescue missions.

Recovery: Efforts occurring when regular operations and activities are re-established. The recovery period can often be prolonged and includes activities such as preventing or alleviating financial burden, rebuilding damage structures, and starting mitigation activities to lessen vulnerability during future disasters.

In this video clip (3:38), Dr. Wanda Barfield, Director of the Division of Reproductive Health at the CDC, addresses the importance of centering women of reproductive age – specifically pregnant and postpartum people, and infants – in emergency preparedness and response. She provides poignant examples of successes and unique challenges for these populations that surfaced during multiple types of recent emergencies.

Other reasons why we choose to center these populations include:

• Federal legislation identifies pregnant and postpartum women and infants as populations with special clinical considerations in public health emergencies;
• People who are pregnant or postpartum may experience higher rates of poor reproductive outcomes during and after disasters, such as miscarriages, premature deliveries, cases of intrauterine growth restriction (IUGR), low birth weight infants, sexual violence, and lack of access to contraception²;
• Pregnant, postpartum, and breastfeeding people and infants may be uniquely impacted by public health issues resulting from disasters, such as contaminated food and water sources²; and
• Focusing on the specific circumstances experienced by birthing people and infants contributes to an “all hazards approach” by ensuring that health and other systems have the capacity to address the broadest possible range of emergency needs. This includes preventing excess adverse outcomes and exacerbations of existing health disparities in pregnancy-related morbidity and mortality.

Disasters occur within a specific context based on a community’s geographic, cultural, demographic, political, and historical characteristics, which produce unique considerations for each¹. They require tailored solutions. As an example, the Stafford Act requires FEMA assistance be delivered in an equitable manner without discrimination on the grounds of race, color, religion, nationality, sex, age, disability, language accessibility, or economic status. However, this cannot be done through a one-size-fits-all approach.

Executive Order 13985 (January 20, 2021) defines equity as “the consistent and systematic fair, just, and impartial treatment of all individuals, including individuals who belong to underserved communities that have been denied such treatment, such as Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders and other persons of color; members of religious minorities; lesbian, gay, bisexual, transgender, and queer (LGBTQ+) persons; persons with disabilities; persons who live in rural areas; and persons otherwise adversely affected by persistent poverty or inequality.”

Watch this video clip (2:30) that describes the critical need to apply equity frameworks across all phases of emergency management. This perspective is reinforced by federal entities, such as the Federal Emergency Management Agency (FEMA). Pages 9-13 of their strategic plan identifies opportunities to “instill equity as a foundation of emergency management,” such as:

• Understand the factors that affect a community’s resilience and vulnerability to disasters;
• Proactively and continuously engage state, local, tribal, and territorial partners, local community leaders, and other community representatives to gain insight into how programs can better serve them;
• Make space to invite and elevate diverse voices, and to foster mutual understanding and respect for [different] perspectives and experiences;
• Deliberately [define] what success looks like for each user of each program in a manner that can be consistently measures;
• Routinely evaluate programs and policies for disparities in outcomes; and
• Conduct ongoing equity-based evaluations across programs, as well as partner with external organizations experienced in this work.

This video clip (6:22 of total content) was excerpted from a presentation delivered by Gerrit Bakker, the former Senior Director of Preparedness at the Association of State and Territorial Health Officials (ASTHO). It aims to establish a baseline of understanding about the critical role that PHEP has played and can play in addressing maternal and infant health priorities before, during, and after emergencies. Topics covered in the video clip include:

• The origins of PHEP in the United States
• What prompted the development of the PHEP Capabilities
• The legislative underpinnings of PHEP
  • Pandemic and All-Hazards Preparedness Act (PAHPA)
  • Public Health Emergency Preparedness Program (CDC)
  • Hospital Preparedness Program (HHS/ASPR)
• Health department responsibilities for capacity building within the PHEP capabilities
• Emergency response infrastructure at each level of government

This video clip (8:55) aims to establish a baseline of understanding about the services and systems (specifically those established by Title V of the Social Security Act) that specifically address the health needs of women, children, and families. It provides critical information about and access points for these special populations in preparing for and responding to emergencies. Presenter: Ben Kaufman, Associate Director for Workforce Development and Capacity Building, AMCHP.

The following video clips (7:03 of total content) were excerpted from a presentation delivered by Romeo Galang, MD, MPH, Medical Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. This team aims to establish women of reproductive age, especially pregnant and postpartum people, and infants as priority populations in all phases of the emergency management cycle.

What are the disaster effects and concerns specific to women of reproductive age, pregnant and postpartum people, and infants in public health emergencies?	Start at 6:07 and end at 12:31
Why is it important to integrate EPR and maternal and infant health (MIH) at the jurisdictional level? Prioritizing special populations Building capacity before disasters Cultivating sustainable partnerships	Start at 15:19 and end at 15:58

WATCH: This video clip (4:47) connects gains in individual knowledge, skills, and abilities to collective emergency response capability. It references two federal guidance documents from the fields introduced above that learners are encouraged to explore in greater depth. Presenter: Mikayla Frye, Program Manager for Workforce Development and Capacity Building, AMCHP.

• Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health, 2018 Update (Centers for Disease Control and Prevention)
• Maternal and Child Health Leadership Competencies, Version 4.5 (Health Resources and Services Administration)

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