UC Berkeley

While public health threats have always existed, federal investment in preparedness has surged in the past decade. Interested in evaluating return on their investments in public health preparedness, congressional and public stakeholders have pushed for the development of assessment, accountability, and improvement measures. However, the evidence base to support this priority has lagged behind. There is still little agreement on how to measure, let alone improve, public health response performance. A number of challenges have been cited as barriers to research advancements in this field, including the infrequent nature of large-scale public health emergencies, heterogeneity of emergency events and of public health delivery structures, and difficulties gaining access to incident leadership during real-world emergencies. Limitations in our knowledge pose significant barriers to public heath authorities who seek to evaluate their own response capacity and direct resources towards evidence-based improvements. They also hinder stakeholders' ability to develop valid, reliable, and realistic measures to evaluate how well health public health systems are performing. In the case of acute events, the quality of public health performance can make a difference in the number of lives saved, illnesses or injuries averted, and the economic and social costs to a community. Consequently, it is of utmost importance to ensure that the evidence base used to guide the development of standards and measures is the best possible.

This dissertation includes examples of three research initiatives that seek to: (1) improve the public health emergency response evidence base by characterizing key structural and functional dimensions of the response systems during real-world urgent and emergency events, (2) identify factors which influence variation in this system, and (3) demonstrate that advancements in conceptual models of public health response operations are both possible and relevant.