Communication about the risks associated with large-scale hazards and emergencies is a critical component of individual preparedness, response, and recovery. While much is known about risk perception and communication generally, these topics have been less well addressed for at-risk populations, particularly as they relate to emergency preparedness. In an effort to better understand what risk communication activities are currently used to reach at-risk populations, to learn from existing emergency preparedness efforts, and to identify which communication strategies, if any, have been successful, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services (HHS), contracted with the RAND Corporation to examine the state of risk communication efforts for at-risk populations. This one-year project provides the groundwork to inform the Secretary’s obligation under the Pandemic and All-Hazard Preparedness Act (PAHPA) to plan for the needs of at-risk populations.
Results of this study, as summarized in this report, are intended to inform policy makers, federal/state/local public information officers (PIOs), others responsible for developing and disseminating risk communication messages, and other interested parties about the most promising activities focused on risk communication for at-risk populations. In our discussion, we also identify challenges to and gaps in the development of risk communication messages and methods of dissemination. This information will assist policy makers in building materials that focus on specific needs of at-risk populations that have not been previously addressed.
The PAHPA (P.L. 109-417), signed by President George W. Bush in December 2006 created the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) and tasked it with new authorities for a number of efforts, including:
Ensuring the integration of the needs of at-risk individuals (sometimes referred to as “special populations,” “special needs populations,” or “vulnerable populations”) on all levels of emergency planning.
Ensuring the effective incorporation of at-risk populations into existing and future policy, planning, and programmatic documents at the federal and state levels.
Establishing a Director of At-Risk Individuals within ASPR.
The full HHS working definition of “at-risk populations” (see box below) adopts a functional approach and establishes a flexible framework that encompasses a broad set of common needs irrespective of specific diagnoses, statuses, or labels (e.g., those with HIV, children, senior citizens). The approach is also designed to be congruent with the definition of special needs as stated in the Department of Homeland Security (DHS) National Response Framework.
HHS Working Definition of At-risk Populations
|Before, during, and after an incident, members of at-risk populations may have additional needs in one or more of the following functional areas:
In addition to those individuals specifically recognized as at-risk in the Pandemic and All Hazards Preparedness Act, (i.e., children, senior citizens, and pregnant women) individuals who may need additional response assistance should include those who have disabilities; live in institutionalized settings; are from diverse cultures; have limited English proficiency or are non-English speaking; are transportation disadvantaged; have chronic medical disorders; and have pharmacological dependency.
Examples. We provide several examples of functional needs of at-risk individuals.
|Example 1: An individual with HIV/AIDS who does not speak English and who contracts influenza could easily find herself in a precarious situation. In addition to treatment for influenza, her functional needs would be medical care (for the HIV/AIDS) and communication (her lack of English may keep her from hearing about where and how to access services). Without addressing these functional needs, she cannot receive health care services.|
|Example 2: The health status of an individual receiving home dialysis treatment and who relies on a local Para-transit system to attend medical appointments and shop for food could quickly become critical when drivers are scarce during a hurricane and transportation is suspended. His functional needs would be medical care (for dialysis) and transportation. Without addressing these functional needs, he cannot receive health care services.|
|Example 3: An individual with early stage Alzheimer’s disease living on a limited income and supported by a part-time caregiver may become fearful and agitated during a bombing attack and unable to access additional care. (is not this a perfectly normal reaction under the circumstances?) Her functional needs would include maintaining independence; she might also need supervision if she decompensates. Without addressing these functional needs, she cannot receive health care services.|
|Example 4: A seven year old child with visual impairments contracts avian influenza and requires hospitalization. In addition to treatment for influenza, his functional needs include communication (due to visual impairment) and supervision (since he is seven). Without addressing these functional needs, he cannot receive health care services.|
These kinds of at-risk individuals, along with their needs and concerns, must be addressed in all federal, state, Tribal, Territorial, and local emergency plans.
Importantly, the HHS definition focuses on the ability to access or receive medical care. However, it is also important to consider other types of needs as they affect the ability to prepare, evacuate, and respond adequately to the risk communication messages. Thus, we propose an expanded definition for the purposes of this report:
At-risk individuals are those who have, in addition to their event-related medical needs, social and structural needs that may interfere with their ability to access or receive medical care, prepare for an emergency, and take appropriate measures (e.g., evacuate, shelter-in-place, etc.) and respond adequately to risk communication messages during an emergency.
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