Public health preparedness as democratic practice: Civic deliberation and resilience

Public health emergency preparedness planning has become an important part of public health practice, and disruptions that overwhelm normal infrastructure will likely become more frequent due to factors such as the potential for global pandemics and weather related emergencies due to climate change. Two serious limitations mark the area of preparedness planning at this time. First, the lack of explicit attention to the ethical goals of the field. Second, the relatively elitist and expert-driven orientation of much of the preparedness planning that is being done, even at the local level. Drawing on examples and cases of local planning practice, this paper argues that public health emergency preparedness planning is an important opportunity to apply practices from other areas of public health involved with community cooperation, and public engagement. The connecting threads between these areas of the field are the concept of community resilience and the values of civic empowerment. Effective and just public health planning must perceive the actual needs and capacities of local neighborhoods and communities. It must also maintain the public trust and legitimacy necessary to gain behavioral compliance with emergency response plans. Public health emergency preparedness planning should be reconceptualized as a deliberative democratic and civic empowerment practice. One of it principal goals is, and should be, the building of communities that are resilient in their response to disaster situations, and in the way they can recover from disaster events in virtue of their cultural solidarity, institutional equity, and ethical commitments to human dignity and social justice.