Public Health vs. Emergency Management: Dissonant Views Regarding Federal and State Law on Public Health Preparedness

The study examines how public health agencies (PHAs) and emergency management agencies (EMAs) approach federal and state laws on public health preparedness and to suggest strategies for improving public health preparedness. Comparative case studies in 10 states (Pennsylvania, Nevada, Connecticut, Michigan, New Mexico, Florida, California, Oregon, Iowa, and Colorado) were conducted to determine how local and state public health and emergency management officials interpret and implement applicable state and federal laws. Between January 2008 and March 2009, we conducted 180 interviews with state and local public health and emergency management officials. Respondents included heads of the two agencies and their attorneys.

Two conflicting approaches emerge. The PHA approach is characterized by: (1) perceived uncertainty regarding legal authority over preparedness planning tasks; (2) expectation for guidance on interpretation and application of existing laws; (3) concern about potential individual and organizational liability because of perceived unclear legal mandates. The EMA approach reveals: (1) perception of broad legal authority over preparedness tasks and circumstances; (2) dynamic and broad interpretation of existing laws; (3) ethical concerns over infringement of individual freedoms and privacy.

Federal and state legal initiatives have established the legal structure for preparedness planning and management. Yet each agency's distinct interpretation of the legal structures, requirements, and mandates impedes their effective participation in preparedness planning and management. Our findings highlight the need for: (1) clarification of legal authority mandates; (2) clear designation within laws of each agency's scope of preparedness activities; (3) guidance on interpretation of current federal and state laws.