Reimagining public health emergency governance: Emergency preparedness beyond the rigid limits of law

Governance is critical to public health emergency preparedness, but notions of governance are substantially underdeveloped. Public health governance must be significantly reimagined to meet current and future needs effectively and to preserve social justice during emergencies. This will not be an easy exercise. Emergency preparedness is an inherently complex problem, needing plans and strategies to avert emergencies from both natural and man-made threats. Effective preparedness entails the integration of scientific and medical expertise, good logistical planning, as well as clear laws and policies. Coordinating these interdisciplinary considerations requires more than just strategic planning; it demands thoughtful approaches to emergency governance. Unfortunately, existing understandings of public health governance are not up to the task. Most models of public health emergency governance are based on antiquated command-and-control notions that place significant authority in the hands of specific individuals. An expanding literature on governance proposes a variety of approaches that can be categorized by different levels of legal control and by the governance models created to exert this control (e.g., top down/“command-and-control” governance; New Governance; devolved governance). These various models not only provide new ways in which to consider public health governance; they recognize that multiple approaches may properly be combined and occur simultaneously. This presentation provides an extensive overview of theories of governance and situates public health emergencies within this context according to measures of government control and centralization. Further it makes the case that public health emergency governance can be improved by efforts to enhance systemic resiliency and embrace systemic redundancy.