In November 2010, the American Public Health Association endorsed the health care home model as an important way that primary care may contribute to meeting the public health goals of increasing access to care, reducing health disparities, and better integrating health care with public health systems. Here we summarize the elements of the health care home (also called the medical home) model, evidence for its clinical and public health efficacy, and its place within the context of health care reform legislation. The model also has limitations, especially with regard to its degree of involvement with the communities in which care is delivered. Several actions could be undertaken to further develop, implement, and sustain the health care home.
The National Center for Disaster Preparedness (NCDP) 2005 survey of the American public's attitudes and views on terrorism, preparedness, and associated issues is the latest in a series of national surveys administered annually beginning in the months after September 11, 2001. The survey was completed in July 2005, just after the London Underground bombings and just before Hurricane Katrina. NCDP commissioned national and New York City public opinion polls in the immediate aftermath of September 11, 2001 to gauge the American public's views and attitudes on a wide range of topics germane to disaster preparedness and emergency events. Since the first polls which were completed 3 and 6-months after September 11, 2001, NCDP has annually commissioned a survey which goes to the field in July-August, just before the anniversary of September 11. The 2005 survey was the fourth annual. Each survey includes trended questions as well as "one-off" questions appropriate to the given time period. Trended questions include confidence in government; willingness and ability to evacuate; personal and family preparedness plans; personal sacrifice; community preparedness; perceptions and engagement of all-hazard preparedness; and other questions thematic with the afore listed. All questions are cross-tabulated with a variety of demographics including race, age, gender, income, region, size of community, political affiliation, and education. Further, select questions establishing a division of respondent (e.g. those having personal and family preparedness plans versus those who do not) are cross-tabulated with other selected questions to observe correlations. (e.g. awareness of community preparedness plans). The surveys are developed by NCDP investigators in conjunction with Marist, who administers the survey, codes the data, and produces the frequency tables. Full data and trend tables are available on request.
Since 2002, the National Center for Disaster Preparedness (NCDP) at Columbia University's Mailman School of Public Health, and The Children's Health Fund (CHF), have conducted annual surveys of public attitudes and personal preparedness in the aftermath of the terror attacks of September 11, 2001. Produced in collaboration with the Marist College Institute for Public Opinion (MIPO), each is a random-dial telephone survey of approximately 1,300 - 1,500 adults stratified according to US Census 2000 data. Current and trend data from these surveys reveal a disjuncture between Americans' awareness and sensitivity to possible natural and man-made threats and their consistently low levels of personal preparedness. Each survey, including the current, have included trended questions as well as "one-off" questions appropriate to the given time period. Trended questions ask about confidence in government; willingness and ability to evacuate; personal and family preparedness plans; personal sacrifice; community preparedness; and perceptions and engagement of all-hazard preparedness. All questions are cross-tabulated with a variety of demographic characteristics including race, age, gender, income, and region, size of community, political affiliation, and education. Further, select questions establishing a division of respondent (e.g. those having personal and family preparedness plans vs. those who do not) are cross-tabulated with other selected questions to observe correlations (e.g. awareness of community preparedness plans). The surveys are developed by NCDP and CHF investigators in conjunction with MIPO, who administers the survey, codes the data, and produces the frequency tables.
The following is a product of The National Center for Disaster Preparedness (NCDP) at Columbia University's Mailman School of Public Health, commissioned in collaboration with The Children's Health Fund (CHF), and conducted by the Marist Institute for Public Opinion. NCDP is a major national and international resource in disaster and terrorism readiness. NCDP includes one of the original Academic Centers for Public Health Preparedness, funded by the Centers for Disease Control and Prevention (CDC) prior to September 11, 2001. This White Paper summarizes the latest in a series of surveys designed to identify trends and public attitudes related to the terror attacks of September 11, 2001. Over time, these surveys have also been useful in monitoring the impact of subsequent events including the crash of American Airlines flight 587, the unresolved anthrax attacks, the ambiguity over smallpox vaccinations, the wars in Afghanistan and Iraq, the issuance of color-coded security alerts and government requests for enhanced public vigilance.
Understanding attitudes, concerns and reactions of individuals and families is critical to emergency planning efforts on all levels. In order to have effective implementation of a disaster plan, people need to be confident in (a) the reliability of information from official sources, (b) the capacity of government to perform effectively in a crisis and (c) the capability of response systems, particularly the health systems and first responders. Absence of confidence in response systems or leadership may undermine the best of crisis plans, leading to unnecessary panic and potential excess loss of life. In August 2003, The National Center for Disaster Preparedness at Columbia University''s Mailman School of Public Health, in collaboration with The Children's Health Fund, commissioned the Marist Institute for Public Opinion to conduct a survey of adults nearly two years after the multiple terrorist attacks on New York, Washington, D.C. and Pennsylvania. The survey included both a national and a New York City representative sample of households contacted by telephone. Questions covered a wide range of issues including people's concern about potential new additional acts of terrorism in the U.S., the government's ability to protect citizens, and the health system's capacity to respond. Throughout, specific questions were asked of a subset of parents of children from four to eighteen years of age. To the extent possible, specific questions were replicated from four previous surveys commissioned by The Children's Health Fund since September 11, 2001 to identify trends in public attitudes and perceptions.
Since 2002, the National Center for Disaster Preparedness (NCDP) at Columbia University's Mailman School of Public Health and The Children's Health Fund (CHF), have conducted annual surveys of public attitudes and personal preparedness in the aftermath of the terror attacks of September 11, 2001. Produced in collaboration with the Marist College Institute for Public Opinion (MIPO), each is a random-dial telephone survey of a representative random sample of the US population (selected consistent with demographic characteristics of the most recent available update of the 2000 census). Each survey, including the current, has included a set of questions repeated every year, which generate trend data, as well as questions specific to events current to each study period. Repeated questions ask about confidence in government; willingness and ability to evacuate; extent of personal and family preparedness; and perceptions of community preparedness. All questions are compared across a variety of demographic characteristics including race, age, gender, income, and region, size of community, political affiliation, and education. Further, the responses to select questions, such as awareness of community preparedness plans, are compared across certain groups of respondents (e.g. those having personal and family preparedness plans vs. those who do not). The surveys are developed by NCDP and CHF investigators in conjunction with MIPO, who administers the survey, codes the data, and produces the frequency tables.
Hurricane Katrina is America's most recent encounter with a megadisaster. But what made it a megadisaster instead of just another category 3 hurricane of the type that seasonally exists in the Gulf of Mexico? Katrina was not the largest or strongest hurricane to strike the United States mainland in the recent past, but its effects were devastating and wide reaching beyond our wildest nightmares, far beyond those of Hurricane Andrew (1992), a category 5 hurricane that scoured much of Florida and the Gulf Coast. Hurricane Katrina's track directly targeted gaping vulnerabilities in infrastructure and society, and set in motion a series of events that culminated in the deaths of nearly 2000 people, resulted in hundreds of missing individuals, and caused a potential economic impact of up to $150 billion. The disruption of people's lives was immeasurable, as was the impact on the long-term physical and mental health of the victims, which continues today. Katrina also led to a substantial decline in the confidence that the public has in its government to provide essential services during a disaster. Children are among the most susceptible members of a community when catastrophes such as these strike because of their dependent nature as well as their physiologic and psychological vulnerability. Children affected by Katrina were no exception. Persistent critical gaps exist in the ability to prepare for and respond to the needs of the youngest victims. These were clearly exposed as children endured an at times ineffectual disaster response followed by a stressful recovery that is still ongoing. An analysis of the issues that faced children during this event and some others from the recent past may help society reduce the impact of such disasters on children in the future. This article focuses on a few of the major shortfalls in the care of children that have become especially apparent in the last few years: Facilitating evacuation; Providing shelter; Caring for those with special medical needs; Addressing mental health needs.
Understanding attitudes, concerns and reactions of individuals and families is critical to emergency planning efforts on all levels. In order to have effective implementation of a disaster plan, people need to be confident in (a) the reliability of information from official sources, (b) the capacity of government to perform effectively in a crisis and (c) the capability of response systems, particularly the health systems and first responders. Absence of confidence in response systems or leadership may undermine the best of crisis plans, leading to unnecessary panic and potential excess loss of life. In August 2003, The National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health, in collaboration with The Children's Health Fund, commissioned the Marist Institute for Public Opinion to conduct a survey of adults nearly two years after the multiple terrorist attacks on New York, Washington, D.C. and Pennsylvania. The survey included both a national and a New York City representative sample of households contacted by telephone. Questions covered a wide range of issues including people's concern about potential new additional acts of terrorism in the U.S., the government's ability to protect citizens, and the health system's capacity to respond. Throughout, specific questions were asked of a subset of parents of children from four to eighteen years of age. To the extent possible, specific questions were replicated from four previous surveys commissioned by The Children's Health Fund since September 11, 2001 to identify trends in public attitudes and perceptions.
