1. Boston Public Health Commission
A City’s Perspective: Boston’s Approach to Vulnerable Populations and Public Health Emergencies
John Auerbach
Executive Director
Boston Public Health Commission

2. The Background to Emergency Planning in Boston

3. Emergency Planning and Response has a long history
And of course, this is one of our horse drawn ambulances from that era.
A rather romantic view, but somehow I can’t imagine trying to explain response times that are effected by carrot sticks, sugar cubes and the prospect of a trip to the glue factory.

4. Including responding to public health emergencies
Small-Pox Boston 1873:
At this time, smallpox was in many places in the city, and we soon came to the conclusion that additional hospital accomodations were at once needed. There was no alternative for us but to take the old Roxbury Almshouse, on Marcella Street, for a hospital, and we did so; it was soon fitted up, and smallpox patients were in it that day.

5. Such planning had certain characteristics
Reliance on gov’t such as police, fire, EMS
Reliance on experts such as hospital personnel
Specialized plans known by few
Drills and training for few

6. …but emergencies like Hurricane Katrina prompted us to rethink this approach

7. Lessons from Katrina
Existing societal socio-economic factors may become exacerbated during an emergency
Poverty, race and health status matter in an emergency
In many emergencies, needs quickly outpace gov’t’s capacity to respond
The traditional reliance on gov’t and centralized planning won’t work

8. Where do we start to change the model to a more community-focused one?

9. Focus on Boston Neighborhoods
Allston
Back Bay
Beacon Hill
Brighton
Charlestown
Chinatown
Dorchester
East Boston
Fenway
Hyde Park
Jamaica Plain
Mattapan
North End
Roslindale
Roxbury
South Boston
South End
West Roxbury
Boston population: 589,000

10. Focus on Special Populations
Demographic Groups – including racial and ethnic minorities, elders, children, institutionalized individuals
Health Conditions Group – including those with physical or mental disabilities
Source: DPH Center for Emergency Preparedness: Special Populations Guidance for Local Board of Health

11. Demographic: sub-categories
Non-English speakers/ethnic minorities
Low income residents
Homeless
Isolated individuals
Frail or limited mobility elderly
Inmates

12. Health Conditions: sub-categories
Residents of licensed health care facilities: nursing homes, hospitals, substance abuse treatment facilities
Homebound ill
Disabled physically
Disabled mentally

13. Key Steps Identify key neighborhoods and special populations
Develop education efforts targeted to different populations
Work with and train local community leaders to establish a disaster plan
Provide direct resources for vulnerable populations

14. Boston is a racially diverse City

15. Boston is a City of Many Ethnicities

16. Communication Issues Arise Due to Language

17. The Poor in Boston 20% of the Population

18. Boston Homeless Population
6,365 homeless men, women & children in Boston. An increase of 9% from last year.
Source: City of Boston Report 2005

19. Boston Disabled
Data Set: US Census Bureau 2004 American Community Survey

20. In Response Several Local Initiatives

21. Identification of Key Community Partners

22. Grants to Grass Roots Community Groups
20 community groups funded to do specialized education & training at the neighborhood level
Some target specialized groups (e.g. Chinese, Vietnamese)
Some target geographic issues (e.g. East Boston)

23. Local Groups Start with Three Easy Tasks
Attend 3 days of training with City agencies
Hold two neighborhood or population specific educational mtgs
Distribute emergency materials

24. Preparedness for the Homeless
Training needed for both shelter staff and homeless clients
Specialized funding to Health Care for the Homeless to work with City’s homeless providers

25. Training Local Resident Leaders is Prioritized

26. Planning Grants

27. Planning Grants to Address Needs of Most Vulnerable
Grants awarded to identify need, highlight best practices and establish plans to strengthen preparedness
Focus on:
-homebound patients
-nursing homes and other residential facilities

28. Direct Resources

29. Community Health Centers Emergency Preparations
Grants to 21 Community Health Centers to clarify roles and train community-based employees on their roles in an emergency

30. Material Assistance for Low Income Families
City purchased 10,000 emergency kits – with battery-operated radios, first aid supplies, etc.
Distributed to low incomes families by local community groups

31. Neighborhood-based Resources

32. Local Sites for Emergency Relief
Identified 50+ dispensing sites in each neighborhood to increase accessibility (all within 1 mile)
Same sites are also used for temporary housing or as evacuation pick-up sites.  

33. Multi-lingual Emergency Plan mailed to 280,000 households

34. Communication Plan

35. “Personal Responsibility”
Identified as key both to prepare for and respond to emergencies
To prepare:
If dependent on electricity (e.g. ventilator dependent) then Registry is crucial
Establish personal support network (family, friends, health care providers)

36. Multi-lingual Guide for Basic Information on:
Emergency Preparedness
Emotional Reactions during emergencies
Possible terrorist agents
Where to get more information

37. Low literacy materials 8 Things you can do.

38. Newspaper Ads

40. Areas in Need of Attention
Involve vulnerable residents (such as people with disabilities) & organizations serving them in planning and fostering personal/collective responsibility
Promote neighborhood-based practice drills
Enhance capacity for person-to-person contact before & during emergencies

41. Further Information: jauerbach@bphc.org (617)534-5264