**6. Research findings**

The PERRCs, presented in the Introduction of this chapter, were created specifically by US Senate authorization to conduct public health systems research for preparedness and response purposes [52]. A sample of significant findings from the research conducted at nine university-based centers included:

• ensure surge capacity through mutual aid agreements between jurisdictions for epidemiology and surveillance functions


In summary some of the most important findings are the need for adequate surge capacity, communication and information sharing, and closing inequity gaps. Communication is a basic element of coordination and is dependent on strong working relationships between agencies. Research studies have found that institutional relationships are not enough; personal relationships and trust enable effective communication and coordination [53]. Information when responding to public health emergencies is ever-changing, resulting in fragmentation and misalignment of response resources and an absence of coordination. Information must have integrity to adequately assist decision making and coordination. Another study found that stable, accurate, and consistent methods of communication and information sharing is essential [54].

In a case study of challenges in sharing and coordinating information the researcher learned that sharing is dependent on agency, community, and individual factors. Individual responders have been found to be more willing to receive information than to share information with others. This has been related to information overload among those individuals who are responding to the effects of a public health emergency [55]. The following strategies have been proposed to enhance information sharing: a) establishment of institutional incentive mechanisms for interagency information sharing, b) ensure fair distribution of benefits from interagency information sharing, c) knowledge of the operations of other agencies will improve information sharing, d) establish agency norms and standards for information sharing, f) establish an inter-agency information sharing system, and g) integrate the inter-agency information sharing system into the daily operations of agencies [56].

A study of the tsunami disaster of 2004 in Thailand evaluated the response of the health care system [57]. Study findings included that the most factors important for disaster response is: information flow, overall coordination, and leadership. The information flow is critical between public health and governmental agencies, and the population. The study learned that information flow between agencies was not consistent, and was the cause of ineffective response activities. Coordination during the response was adequate, but the health care system was not prepared for the magnitude of the event. Leadership was effective at most levels, except for hospitals were physicians made the decisions without quality information.

It is important not to overlook those who are most severely affected by public health emergencies. Populations, and subpopulations, that are most vulnerable are affected disproportionately. As was mentioned above, one of the foci if the Sendai Framework is to reduce the effect of the social determinants of health. Those that are poor, uneducated, living in substandard housing, lacking access to transportation are the most vulnerable [58]. Those who are vulnerable are marginalized in society [59]. During naturally occurring public health emergencies minority groups in the US experience the greatest negative impact [60]. Poor coordination among

*Coordination of Public Health Response: The Role of Leadership in Responding to Public Health… DOI: http://dx.doi.org/10.5772/intechopen.96304*

governmental agencies, non-profits, and private sector entities, as well as unequal disaster risk, worsens the effect within these vulnerable populations [61]. Health equity issues, created by unjust governmental and health policies, cause unequal negative impacts, as have been seen with the COVID-19 pandemic [62].

Public health, particularly in the US, has established policies and procedures to prepare leaders to respond to public health emergencies. The Association of State and Territorial Health Officials (ASTHO) published preparedness policy and position statements [63]. In preparedness guiding principles, ASTHO recognizes the role of state and territorial agencies in preparation and response to public health emergencies. The guiding principles include a) prevention, mitigation, resilience, and recovery; b) sustained funding; c) optimal preparedness for all populations; d) preparedness science and recognition of emerging emergencies; e) importance of partnerships; f) continual evaluation of preparedness. ASTHO outlines the importance of a collaborative national preparedness response, as well as the roles of federal, state, local, territorial, and tribal agencies.

Healthy People 2020, as a response to the COVID-19 pandemic, created policies for preparedness [64]. The National Health Security Strategy (NHSS) guides objectives for preparedness focused on community resilience, public health emergency response systems, capabilities, and resources. Five strategic objectives are the hallmark of the preparedness policy. Community resilience is the first objective and focuses on local coordination of health and public health agencies. The second objective is the development of countermeasures to address public health emergencies of all types, including infectious disease epidemics. The third objective is focused on continual situational awareness for early detection and coordinated response. The fourth objective establishes the importance of coalitions, and partnerships, of public health and emergency management agencies. The final objective involves global health security. This objective is focused on world-wide public health emergencies, specifically the COVID-19 pandemic.

## **7. Conclusions**

Leadership is essential in coordination of response to public health emergencies. Work leadership is not only ineffective, it results in worsening of the effects of public health emergencies. A characteristic of public health emergencies is uncertainty. In uncertain situations dominant and directive leadership is required. Due to the everchanging nature of public health emergencies, the dominant and directive leader must be flexible to adjust to changes. Effective leadership is dependent on quality data-sharing and communications. Public health response must be carefully and thoroughly planned, considering the need for managing resources across all responding agencies, public and private.

#### **Acknowledgements**

Support for development of this chapter was funded, in part, by the National Institute of Minority Health and Health Disparities of the National Institutes of Health under grant S21MD1007136.

#### **Conflict of interest**

The authors declare no conflict of interest.
