1. Recovery Damage Assessment PTSD Therapy Creating the next wave of public health nursing leadership in emergency preparedness: A call for holistic primary prevention and health promotion Carolyn García, PhD, MPH, RN and Linda Halcón, PhD, MPH, RN Integrative, Global, and Public Health Co-operative School of Nursing, University of Minnesota BACKGROUND The threat of pandemic avian flu and the possibility of bio-terrorist attacks in the U.S. have raised everyone’s awareness level, and public health nurses are actively engaged in emergency preparedness initiatives in communities across the U.S. Below is a conceptual framework and description of needed resources, and an example of how food availability can be addressed by public health nurses. Current initiatives focus predominantly on strategies such as strategic national stockpiling, mass dispensing, risk communication, management of on-site volunteers, and enforcement of a mass quarantine. Health promotion and primary prevention strategies are limited while most primary prevention efforts focus on specific protection such as ‘Go kit' preparation as described in emergency preparedness plans and websites. Public health nurses are in a unique position to inform emergency preparedness initiatives using a holistic nursing approach that includes health promotion strategies. These have the potential to empower the public in preparing for emergencies of any kind. RECOMMENDATIONS The following recommendations add a primary prevention health promotion element currently missing in today’s emergency preparedness plans. Public health nurses can: Examine dependence on large chain grocery stores which would be unavailable if there were disruption of the current food transport system Educate on and advocate for sustainable food sources Encourage awareness of local food producers who would be accessible in a catastrophe Identify local/regional food sources for yourself Lead partnership development with extension services, volunteer retirees, or others to teach food growing and safe food storage practice ISSUES In an emergency, there is a need for communities and individuals to access and utilize external and internal resources. However, current preparedness efforts may not provide optimal or/even adequate preparation. Examples of external and internal resources include: External ResourcesInternal Resources Source of foodProblem solving Clean waterSelf care Communication Top-down reactive strategies do not foster individual or community empowerment, leaving the public unable to access their needed external and internal resources. Public health nurses can be examples and leaders in promoting proactive grassroots preparedness strategies that will not only be helpful in the event of a catastrophe but will also result in improved overall health. Using food sources as an example, conventional preparedness wisdom tells us that grocery store shelves will be empty in 2-3 days in any emergency that includes transportation interruption. Phn's can help people reduce dependence on long distance food by promoting the expansion and use of local food sources. RESOURCES Hunger and environmental nutrition (www.HENdpg.org) Kingsolver, Barbara. Animal Vegetable Miracle National Cooperative Grocers Association (www.ncga.coop) Planck, Nina. Real Food: What to Eat and Why Pollen, Michael. Omnivore’s Dilemma: A Natural History of Four Meals Schlosser, Eric and Wilson, Charles. Chew on This: Everything You Didn’t Want to Know About Fast Food Singer, Peter and Mason, Jim. The Way We Eat: Why Our Food Choices Matter www.slowfoodusa.org www.sustainlane.org Primary Prevention Secondary Prevention Tertiary Prevention Health Promotion Specific Protection Early Diagnosis Prompt Treatment Disability Limitation Rehabilitation Education Communication Connectedness Leavell, H. & Clark, E. (1965). Preventive Medicine for the Doctor in His Community. New York: McGraw-Hill Book Company CONCEPTUAL FRAMEWORK Immunizations Stockpiling Go-Kits Stay-Kits Screening Mass Dispensing Risk Communication Figure 1. Conceptual framework listing examples of conventional strategies National Stockpile Resources Victory garden poster from WWII FOOD AVAILABILITY EXEMPLAR Health Promotion Strategies Victory gardens-20 million Americans planted small gardens in World War II, supplying half vegetables produced in the U.S. Connecting urban/suburban families with farmers: - Regional sustainable farming groups - Community supported agriculture shares - Farmers’ markets - Buying clubs School lunch legislation promoting home cooked and locally grown food