Challenging structural foundations: How well do buildings, health systems, and public health pearls of wisdom hold up against hurricanes and other disasters?

This study aims to explore how public health leaders set priorities based on the accumulation of didactic training and experiential knowledge and to what extent changes in the local context may influence the evolution of these priorities. The National Center for Disaster Preparedness (NCDP) at Columbia University has developed strong collaborative partnerships with regional public health practice partners, including Nassau County Department of Public Health. Changes in local context were demonstrated by considering public health priorities of a single county health department at three distinct time periods which temporally varied around regionally significant natural disasters: (1) before any recent storms (Hurricane Ivan in 1999), (2) immediately after a mild storm (Tropical Storm Irene in 2011), and (3) after major category 3 hurricane (Hurricane Sandy in 2012). Investigators used a longitudinal qualitative interview approach to explore the public health decision making and to provide insights into how the public-health priority setting used by ten senior leadership staff who had over 250 years of combined experience in the local health department. Thematic content from initial pre-disaster interviews conducted as part of a previous study, was used to generate 10 key pearls of public health wisdom for the health department.  Content from interviews conducted in the two post-disaster timeframes were each analyzed for thematic content around public health decision-making and priority setting in the setting of the disasters and were compared to the pre-disaster circumstance. The findings were used to generate a modified public health pearls-framework, and highlight the dynamic influence of the local context that must be considered when setting public health priorities.