A legal network analysis of state public health emergency preparedness and response systems

The Public Health System (PHS) is an interdependent network of public and private agencies, institutions, and individuals. Each agent of this system however, is directed by and accountable to a set of laws that are unique to that organization's contribution to the PHS. Acknowledging that the real power of a system lies in the way the parts come together and become interconnected to fulfill a specific purpose, this study sought to identify the extent to which state PHS agents are directed by law to function as interconnected and efficient preparedness and response systems. To determine this, 10 states were selected for study based upon size, population, urban/rural mix, region of the country and prior public health emergency experience. Applying qualitative research methodology and traditional legal research tools, the laws directing the emergency preparedness and response activities of 27 PHS agents in each state were identified. The text of each statute was then coded as to the agent being directed, the action to be taken, the purpose of the action, the goal to be accomplished, the timeframe for completion, and the condition that triggered the action. Utilizing SPSS and UNICET software, network analyses of legal relationships were conducted. The analyses demonstrated remarkable variability in the preparedness and response direction legislators have given the various PHS agents, across and within states, particularly regarding the actions being ordered and the purposes for doing so. These gaps and inconsistencies in statutory direction indicate opportunities to improve preparedness and response capacity through comprehensive policy reform.