A Look at Public Health Policy in the U.S.

From the NYTimes:‘It’s Totally Ad Hoc’: Why America’s Virus Response Looks Like a Patchwork. For centuries, the United States has resisted a centralized public health policy. This week, as protective measures against the coronavirus varied county to county

The United States, a nation founded on the notion of individual rights and limited federal power, vests key decisions on public health in state and local government. The last week laid bare a dizzying patchwork of local decision-making, as the largest quarantine in recent American history occurred in a juddering, piecemeal fashion.

Here is another take on the system: From the Guardian: America has no real public health system – coronavirus has a clear run, by Robert Reich. ” Trump’s response has been inadequate but the system is rigged anyway. As always, the poor will be hit hardest.”

New Limitations on Science and Environmental Policy Information

The Diva does not usually deal with national political matters, but a new decision by the Trump administration affects information that is essential to emergency management researchers and practitioners. See this article from the Wash. Post on Jan. 25.

Federal agencies ordered to restrict their communications.   Some excerpts:

Trump administration officials instructed employees at multiple agencies in recent days to cease communicating with the public through news releases, official social media accounts and correspondence, raising concerns that federal employees will be able to convey only information that supports the new president’s agenda.

The new limits on public communications appear to be targeting agencies that are charged with overseeing environmental and scientific policy, prompting criticism from officials within the agencies and from outside groups focused on climate change.

Reuters reported the story with a blunter headline: Trump Administration Seeks to Muzzle U.S. Agency Employees.

Two Recovery Reports from State of VT

English: Vermont State House, December 2005.The state of VT has a number of interesting reports, including two recent ones on recovery which are under the heading Rebuilding Stronger. The titles of the two reports are:

  • Guidance for State Agencies: Vermont State Agency Policy Options
  • Guidance for Municipalities: Disaster Recovery and Long Term Resilience Planning in Vermont

Go this website for the full text and more details. (Updated 2016)

Excellent New Article – in Environment Magazine

Since Michelin ranks restaurants with stars, the Diva has decided to award stars to documents re recovery. Here is the first one I would give 4 stars to:

Making America More Resilience toward Natural Disasters: A Call For Action, by Howard Kunreuther, Erwann Michel-Kerjan and Mark Pauly. From Environment Magazine, July/August 2013.  The title does not really do justice to the wide array of useful content here, so I suggest you download the full article and decide for yourself how you would categorize it.

Some excerpts:

Hurricane Sandy caused an estimated $65 billion in economic losses to residences, business owners, and infrastructure owners. It is the second most costly natural disaster in recent years in the United States, after Hurricane Katrina in 2005, but it is not an outlier; economic and insured losses from devastating natural catastrophes in the United States and worldwide are climbing.

According to Munich Re,2 real-dollar economic losses from natural catastrophes alone have increased from $528 billion (1981–1990), to $1,197 billion (1991–2000), to $1,23 billion (2001–2010). During the past 10 years, the losses were principally due to hurricanes and resulting storm surge occurring in 2004, 2005, and 2008. Figure 1 depicts the evolution of the direct economic losses and the insured portion from great natural disasters over the period 1980–2012.2

There is a wealth of useful information in this article, which makes it hard to summarize. It is thoughtful and clearly writtten. I consider this an essential document, one that I think will be a classic in time.

Congress: take time to think

The western front of the United States Capitol...

A recent editorial in the Washington Post suggests that the nearly $50 B. bill regarding recovery from H. Sandy needs to be carefully thought through and debated.  See: Stopping the Sandy Steamroller, January 5.  The final paragraph states:

If lawmakers are truly concerned with disaster victims, the next thing they will do is act more comprehensively on some of Sandy’s lessons. The National Flood Insurance Program badly requires reform. And Congress will need a more coherent, long-term strategy for the nation’s infrastructure — one passed after due consideration, not under the pressure of time-sensitive disaster aid.

On Jan 7th, from HS Wire, here is more information about what the next Congressional action will be and the politics that accompanies it.

Recovery – NY Style

Here are some useful examples of what “snap back” and resilient recovery plans look like. It remains to be seen how the conflicts and tradeoffs between the two will be addressed.

Short-Term Recovery:

Winter looming, New York rushes to repair homes hit by superstorm Sandy: Hiring private contractors to repair homes quickly, New York responds to disaster relief in its own entrepreneurial way. Will the city be able to get people back in their homes before year’s end? [This article is based in part on the testimony that NY Congressman Nadler gave at a House Committee Hearing on Dec. 4th, part of which was the basis for my posting yesterday.]

This article covers the inherent conflicts in the recovery process: how to get rapid action on repairs and recovery for homeowners  — in this case in the winter time, in a location where the usual types of temporary housing are not an option. What remains to be determined are ways to mitigate the likely future storm damage.

Long-Term Recovery Plans:

Bravo to Mayor Bloomberg for his understanding of and commitment to a recovery process that results in a more resilient NYC in the future.  On Dec. 6th the Mayor spoke out about long-term recovery intentions:

Does Knowledge + Disaster = Needed Actions?

Right now, the the window of opportunity is open in NY and NJ to orchestrate the recovery from H. Sandy.  The body of knowledge is substantial about risks, vulnerabilities, potential flood control measures, and alternative development patterns. The disaster has occurred, with the expectation of an estimated 50B worth of damage. So, are we at the tipping point for public policy attention and action?

In a remarkable 12 page article, titled Hurricane Sandy Damage Amplified by Breakneck Development of Coast, 4 knowledgable authors cite about 12 recent studies/reports that describe the risks and vulnerabilities of the region that have just been exposed by H. Sandy.  Once again, scientists and other researchers have known for years, even decades, about some of the problems now known by most of the public. H. Sandy exposed the known weaknesses, and added a few new ones. 

I urge you to read the full article. A few excerpts are included here:

Authorities in New York and New Jersey simply allowed heavy development of at-risk coastal areas to continue largely unabated in recent decades, even as the potential for a massive storm surge in the region became increasingly clear.

In the end, a pell-mell, decades-long rush to throw up housing and businesses along fragile and vulnerable coastlines trumped commonsense concerns about the wisdom of placing hundreds of thousands of closely huddled people in the path of potential cataclysms.

Developers built up parts of the Jersey Shore and the Rockaways, a low-lying peninsula in Queens, N.Y., in similar fashion in recent years, with little effort by local or state officials to mitigate the risk posed by hurricanes, experts said. Real estate developers represent a powerful force in state politics, particularly in New Jersey and New York, where executives and political action committees have been major donors to governors and local officeholders.

This coastal growth took place even as public and private sector leaders in both New York and New Jersey began expressing growing concern over the potential for climate change to intensify storms and accelerate already rising sea levels. New York City officials in particular were well aware of the ways in which climate change would make the potentially destructive effects of a major hurricane worse, scientists said.

“It’s just horrendous that there’s been all this research and all this analysis and so little action,” said Suzanne Mattei, former chief of the New York State Department of Environmental Conservation’s New York City regional office. “It’s a shame that we seem never to take the kind of action we need to until something really awful happens.”

Policymakers in New Jersey had their own warnings that a severe storm surge posed a major risk to the state’s densely populated coastline. In a series of reports over the past decade, the state’s Department of Environmental Protection warned in stark terms that increased risk of hurricanes from climate change, coupled with a continued population expansion along New Jersey’s coast, had set the stage for an enormously expensive disaster.

For decades, critics pushed for greater scrutiny of new development by state and local officials along the New Jersey coastline. Yet new construction continued unabated, as state law requires only lenient reviews of smaller developments in coastal areas.

“There’s plenty of information out there about the risk on the Jersey Shore,” said Ken Mitchell, a professor of geography at Rutgers University who has studied hurricane risks in New Jersey and throughout the world. “But it doesn’t seem to have reached deep enough in the public policy system to do anything to handle the magnitude of this storm.”

A more clear-eyed view of the interplay of haphazard development and natural forces would also help, analysts say.Research by Princeton University in 2005 –- seven years before Sandy arrived — found that New Jersey’s rapid population growth in coastal counties was setting the scene for monumental environmental damage and property loss. The report argued that much of the hazards were man-made, and predictable.

“In New Jersey, and the U.S. at large, there remains a significant lack of public understanding of the predictability of coastal hazards,” the report read. “Episodic flooding events due to storm surges are often perceived as ‘natural disasters,’ not failures in land use planning and building code requirements.”

Update on Nov.14th: The HS Wire reports on a 2009 study by the ASCE that warned of pending problems.

Disasters and Big Government – political philosophy

This topic keeps growing, so I will add articles that bring out additional dimensions.

As a continuation of the topics I write about yesterday, I want to share an editorial in NYT today: A Big Storm Requires Big Government. Here is the concluding paragraph:

Does Mr. Romney really believe that financially strapped states would do a better job than a properly functioning federal agency? Who would make decisions about where to send federal aid? Or perhaps there would be no federal aid, and every state would bear the burden of billions of dollars in damages. After Mr. Romney’s 2011 remarks recirculated on Monday, his nervous campaign announced that he does not want to abolish FEMA, though he still believes states should be in charge of emergency management. Those in Hurricane Sandy’s path are fortunate that, for now, that ideology has not replaced sound policy.

Another take on the topic of the disaster policies of Romney and Obama, from the Wash. Post on October 28. This one includes quotes from nationally known researchers, such as Kathleen Tierney.

One more perspective, from NBC News.

Rebuttals to the NY Times editorial:

(1) The Heritage Foundation’s response to the NYT article. Matt Mayer commented on October 30 as noted here.

(2) The Wall St. Journal’s article was titled: A Big Storm Requires Big Bird? Necessary government doesn’t justify         extravagant government.

(3) A neutral commentary from the Christian Science Monitor.


An example of bad consequences for failure to use federal money for flood mitigation. Romney is now taking the heat for a 2004 decision in Massachusetts.

The view that politicizing a disaster is normal, is the theme of this article in NY magazine, October 30.

Dems Continue to Hammer at Republicans’ Proposed Cuts to Disaster Funding

The red "GOP" logo used by the party...

You have to admit that when the week of the GOP convention is also the week of  H. Isaac, with its uncanny resemblance to H. Katrina, it’s the perfect opportunity to discuss positions on disaster aid and relief.  The Huff Post notes: GOP Convention Under Storm Threat Creates Opening For Democrats On Disaster Relief Cuts;8/27/2012

A new online ad campaign launched Monday targets Republicans for proposed cuts to disaster relief funding and weather monitoring systems. The ads, launched by the Progressive Change Campaign Committee, coincided with Tropical Storm Isaac’s pass over the southwest of the state, where it caused widespread power outages and forced the GOP to cancel the first day of the Republican National Convention.

As of Monday morning, the storm had moved back over the Gulf of Mexico, where meteorologists expect it to build strength before slamming into the Gulf Coast on Tuesday night as a Category 1 hurricane. The storm is currently headed straight for New Orleans, where it’s expected to reach land on or before Wednesday, seven years to the day afer Hurricane Katrina destroyed much of the city.

The ad, which will appear on hundreds of thousands of computer screens across the state, features images of Mitt Romney and his running mate, Rep. Paul Ryan (R-Wis.), flanked by …Sen. Marco Rubio.

“Republicans voted against disaster relief,” it reads. “Thank them here.” A click-through web page cites Ryan’s budget, which the ad says would have “cut billions from disaster relief funding.”

Some additional details about the positions of the two parties are in this HuffPost article today.

Pakistan – disaster recovery under extreme conditions and great scrutiny

As noted here many times, the recovery process is a complex one and one that is hard to accomplish in the U.S.  When the U.S. participates in the international response to a major to catastrophic disaster in another sovereign nation – especially underdeveloped ones,  such as Haiti or Pakistan — the problems grow almost at a logarythmic  rate.  Added to all of the elements of recovery are issues of morality, strategic significance, and existential concerns.  An opinion piece in the Wash. Post highlights some of these added concerns. Pakistan flood relief is in America’s strategic interest, Sept. 1, 2010.

The challenge for the Obama administration and other governments is to develop new mechanisms — similar to those, perhaps, that the United Nations has devised for rebuilding Haiti after its earthquake in January — that would enable relief and reconstruction with maximum transparency and honesty. If this is done successfully, the Pakistani government and its international allies, the United States included, could gain prestige in the eyes of a skeptical people. The alternative is a vacuum that extreme Islamist groups are already attempting to fill.  The American people must be there when the floodwaters recede. The moral justification is compelling enough. But the strategic rationale is real, too.

A related report, well written and compelling, was issued by the U.S. Institute of Peace, on August 17th, titled: Flooding Challenges Pakistan’s Government and the International Community. It makes a somewhat different case for the U.S. aid to Pakistan, highlighting the link between disaster recovery and peacebuilding.  A notable observation in that report is:

Unfortunately, disaster management priorities are often focused on immediate visible results rather than the less tangible and long-term goals of stable peace, good governance, and sustainable development. Saving lives is undoubtedly essential. At the same time, how disasters are managed can have a long-term impact on the conflict context. Disaster managers must ensure that short-term interventions also carry positive long-term impacts on societies that have already experienced considerable suffering.

Additional article, posted on Sept. 2, is well worth reading.  It deals primarily with the digital media and the mechanics of providing assistance to Pakistan, providing a very interesting contrast with the Haiti catastrophic earthquake earlier this year. See A Month In, Pakistan Flood Relief Efforts Stuck at 1.0, in Wired magazine .