Competing cultures in public health disaster preparedness and response: Military versus collaborative organizational models

Since 2002, public health agencies have received over $5 billion in emergency preparedness funds. Moreover, the National Response Plan has institutionalized the Incident Command Structure as a governance framework and delineated an expansive series of roles that public health will be expected to play in the course of a disaster. This emerging role for public health has led to state, regional, and local public health restructuring; to shifting priorities; and to the emergence of a new type of public health workforce, one proficient in emergency response structures and services. The consequences of this federal mandate have been manifest in both emergency and non-emergency settings. Based upon analyses of interviews conducted with over 50 state and local public health officials in Louisiana and Mississippi as part of a Robert Wood Johnson Foundation-funded Katrina Oral History Project, we identified two competing cultures. One may be characterized as the vertically-oriented “military” model, in which authority is centralized and tasks distributed in linear fashion. The second and more prevalent is the traditional horizontally-focused “collaborative” model, in which public health officials serve a convening function and problem-solving is valued over task assignment. During the disaster response and recovery work associated with Hurricane Katrina organizational conflicts between these cultures arose periodically, threatening the efficient and effective delivery of public health services. We will examine the nature and consequences of these competing organizational models, and consider potential policies and strategies for bridging the two models.