The National Association of County and City Health Officials (NACCHO), representing the nation’s nearly 3,000 local health departments, hosted its 2019 Preparedness Summit on March 26-29 in St. Louis. More than 1,900 gathered to hear presentations from experts representing the healthcare and emergency management fields, in addition to public health preparedness professionals, to address the gaps between these life-saving industries in an effort to work more collaboratively and efficiently in the face of emerging threats.
Cody Minks is an Environmental Safety, Security and Emergency Preparedness Specialist with SSM Health in St. Louis, focusing the majority of his time on healthcare preparedness. His background focuses primarily on public health emergency preparedness, having served as the CDC’s Cities Readiness Coordinator (CRI) for the St. Louis region for five years. Minks is a graduate of Southeast Missouri State University, the University of Missouri, and the Naval Postgraduate School, earning a BS degree in Environmental Health, a Master of Public Health (MPH) in Veterinary Public Health, and a Master of Arts in Security Studies. He is currently pursuing a Doctor of Public Health (DrPH) at the Johns Hopkins University Bloomberg School of Public Health in Baltimore, MD. Cody is also a fellow in the Johns Hopkins Center for Health Security’s Emerging Leaders in Biosecurity fellowship program.
Minks conducted research on the integration between fusion centers and public health agencies and their potential to close gaps and enhance collaboration. According to the guidelines, a fusion center is defined as “a collaborative effort of two or more agencies that provide resources, expertise, and/or information to the center, with the goal of maximizing the ability to detect, prevent, apprehend, and respond to criminal and terrorist activity.”
Q: Mr. Minks, thank you for talking to us today about your research on improving collaboration between public health practitioners and law enforcement. You say in your research that “despite incidents that demonstrate the importance of collaboration, law enforcement agencies rarely work closely with public health agencies on public health issues, and the same can be said regarding public health practitioners working with law enforcement.” Can you talk to us about how fusion centers are designed to bridge this gap in service? What is their history?
A: The 9/11 Commission Report suggested expanding information sharing in the homeland security enterprise. In response to this call to action, fusion centers were created to share information that, in my opinion, is vital in maintaining situational awareness. Fusion centers are primarily a law enforcement function, but they include disciplines from across the homeland security landscape. These disciplines include law enforcement, fire services, emergency medical services, medicine, public health agencies from local, state, federal and tribal levels of government, and private-sector partners.
Fusion centers can facilitate collaboration with all disciplines within the homeland security enterprise, including public health, a discipline that may not always be viewed as a collaborating partner for law enforcement agencies. This collaboration can go further than just the fusion center and provide insight into the capabilities that each discipline may offer. Knowing these capabilities before an event occurs provides the opportunity to not only respond to a crisis together, but to also identify and prevent a crisis before it occurs.
Q: Can you talk to us about the information silos in fusion centers that you discovered in your research?
A: I first want to acknowledge that silos are hard to overcome, and I do not want to oversimply silos by implying that they are easy to remove. I believe there are both intentional and unintentional informational silos. There was a surprising amount of indifference toward public health agencies from fusion center responses, and the same can be said for public health practitioners towards law enforcement. However, I feel that the majority of these silos are due to what I call a lack of ‘reciprocal awareness.’ The two disciplines seem to be unaware of each other and their respective capabilities. Also, while these silos are not ideal, they’re most likely a symptom of having a wide range of responsibilities with limited personnel.
When researching this topic, I found several accounts in which silos obstructed a timely response, including a 2003 white-powder incident where law enforcement officials refused to include public health officials in their response. They wanted to use their criminal lab to test the substance for anthrax, but unbeknownst to them, their lab was not equipped to conduct this test. However, the state public health laboratory was equipped, but unfortunately, law enforcement senior leadership was unaware of this capability. This ultimately delayed the response and potentially put lives in danger.
Q: What surprised you about your research results, if anything?
A: The most surprising aspect to me was the lack of reciprocal awareness between public health and law enforcement. Fusion centers have been around for more than a decade and public health agencies have existed for decades. With that said, the survey responses often noted a lack of knowledge about their counterparts. For instance, those in law enforcement often equated public health to medicine. While medicine and public health are certainly related, each discipline has its own defining characteristics.
Also, I was surprised by the hesitancy from public health officials to initiate the contact with fusion centers. In the surveys, they indicated that they had an interest in working with the fusion centers, but when asked if they had contacted the fusion center, the answer was often ‘no.’ A fusion center response detailed how they worked to include public health in their operations, and when they were ready for the public health practitioner to work in their office, the health agency stopped communicating with them.
Q: Are there examples of fusion centers where the communication between local public health staff and law enforcement work better than others?
A: As in any situation, there are strong relationships and weaker relationships; often, I’ve found the strength of these partnerships rely on a number of factors, one of which is funding, or lack thereof. While each fusion center has a basic, defined structure, no two fusion centers are alike. Relationships in one may be dependent upon unique community factors, such as biosafety labs, while others focus more on this traditional idea of critical infrastructure and general public safety concerns. I think it ultimately comes down to the respective leadership and their attitudes toward working together in this domain.
Q: What are your recommendations to improve communications between local public health department staff and law enforcement?
A: A major obstacle that prevents collaboration is funding, so restoring the grant programs that fund fusion centers and public health programs is vital to ensure that collaboration occurs. However, I recognize that this is a lofty goal and one that requires congressional approval. With that said, I have an alternate strategy to propose.
The overarching Public Health Emergency Preparedness (PHEP) grant also funds the CDC’s Cities Readiness Initiative (CRI) program in 72 metropolitan areas. CRI coordinators foster collaboration among the various health departments they serve, and this collaboration may be extended to other disciplines, depending on their project needs. I propose that these coordinators work with the local fusion center and spend a portion of their time there every week. Using the regional coordinator is helpful, because this individual understands the regional public health issues, and can also disseminate information due to their wide network of contacts throughout the public health community. This approach conserves costs when it comes to personnel, but the cost of a security clearance must still be considered when pursuing this option.
Q: Mr. Minks, do you have any final thoughts?
A: There is a desire for collaboration between public health and law enforcement from both disciplines, but funding is often a major obstacle for this collaboration to occur. Compared to the original Public Health Emergency Preparedness (PHEP) grant budget from 2002, today’s PHEP grant is 52 percent of what it once was. The State Homeland Security Grant Program (SHSGP), which most of the fusion centers rely on, is now 27 percent of what it once was in 2003. These cuts in funding have been detrimental to PHEP programs in local and state health departments and the same can be said for fusion centers, due to cuts to SHSGP. One of the fusion centers that responded to my survey detailed how these cuts impacted their operations. While they desired to include public health integration in their fusion center, SHSGP cuts required them to lay off 75 percent of their staff. Working in a fusion center requires a security clearance and a salary for that individual to spend at least a portion of their time at the fusion. Given the cuts in both PHEP and SHSGP, it is difficult to find funding to cover these costs. For future collaboration, we need to find more funding opportunities and perhaps increase these grant programs to what they once were.
The Preparedness Summit is the first and longest-running national conference on public health preparedness. Since its beginning in 2006, the National Association of County and City Health Officials (NACCHO) has taken a leadership role in convening a wide array of partners to participate in the Summit; presenting new research findings, sharing tools and resources, and providing a variety of opportunities for attendees to learn how to implement model practices that enhance the nation’s capabilities to prepare for, respond to, and recover from disasters and other emergencies.