1. 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

4. Including responding to public health emergencies

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 v

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

39. WWW.BPHC.ORG

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 jauerbach@bphc.org