Northeast Texas Public Health District
Emergency Preparedness and Recovery: A Tool Kit for Rural Communities
Northeast Texas is home to just over 1.5 million people, half of whom live in a rural area. Relative to Texas overall, the Northeast Texas population is slightly older and has a larger proportion of white and black residents. Although the unemployment rate in the region is slightly lower than in Texas overall, every county in Northeast Texas has a median household income below that of Texas.
On April 29, 2017, seven tornadoes ripped through Van Zandt County in Northeast Texas, causing over nine million dollars in property damage, and four fatalities. Two of the seven tornadoes were found to have caused the most damage, and were rated an EF-3 and EF-4. The areas that were affected the most were immediately to the East and immediately to the West of Canton, Texas.
The goals of the Planners4Health project focused on disaster recovery from a Social Determinants of Health perspective, specifically targeting small and/or rural communities. The two objectives of the project were to host a round table event with the emergency management coordinators, public health and planning professionals responsible for disaster preparedness in their communities; and to create a tool kit designed specifically to address the unique concerns of rural communities in Texas. The Planners4Health Team performed an evaluation summary of disaster planning from a planning and public health perspective; prepared a disaster preparedness and recovery toolkit, designed specifically for rural areas; and conducted a stakeholders' round table event at the conclusion of the project to disseminate the preliminary information in the tool kit.
The results of this project have been much more extensive than the team originally envisioned. All of the objectives of the project were met. The round table event was a success, and spurred additional interest in continuing the conversation about disaster preparedness in rural areas all across the state of Texas. The specific factors that led to the success of this project were the two main deliverables of the grant: the tool kit and the round table event. Those two things, combined with the timeliness of the topic, were the team's recipe for success. The Planners4Health team is confident that the impact of this project on public health will be significant in the years to come, as it is certain that disasters will continue to strike, most certainly affecting rural areas and cities alike. https://www.planners4healthtxapa.com/
The public health problem that the Planners4Health project addressed was centered around the tornado outbreak in Van Zandt County in April of 2017. On April 29, seven tornadoes ripped through Van Zandt County in Northeast Texas, causing over nine million dollars in property damage, and four fatalities. Two of the seven tornadoes were found to have caused the most damage, and were rated an EF-3 and EF-4. The areas that were affected the most were immediately to the East and immediately to the West of Canton, Texas. Unfortunately, Van Zandt County did not hit their damage threshold that would allow the Federal Emergency Management Agency (FEMA) to step in and assist the affected residents of Van Zandt County. This created a problem because 60-65% of residents in that county are uninsured. Not having access to FEMA funds to help with recovery created a consequential burden on those families who are uninsured.
The population most affected by the tornadoes was the residents of Van Zandt County, so that is the area where this project was most closely focused. Van Zandt County is a rural county in Northeast Texas. As of 2016, the population of the county was approximately 54,355. Its county seat is Canton, Texas. Canton's estimated population is 3,581. The population density per square mile is approximately 62.40. As of 2016, the reported per capita income is $34,859, and the percentage of people living in poverty is approximately 14.8%.
The population targeted for intervention with the toolkit and round table event included emergency management personnel, first responders, public health professionals, and planning professionals. The idea was to reach those professionals who were the decision-makers for disaster planning and recovery to equip them to better prepare the residents in their counties for future disasters, thus allowing the deliverables of the project to reach the entirety of the population.
The main reason that the Planners4Health team chose to create a rural disaster planning toolkit was because the feedback from the public health professionals in Van Zandt County was that there was nothing available specifically for rural communities to prepare and recover from disasters. There is a plethora of information available for large cities, but none specifically for rural communities. Consequently, the Planners4Health team felt like there was a niche to be filled with this project. The proposed practice in this project provides a solution to the problem of not having information specifically designed for rural counties to be well-prepared in advance of a disaster.
Historically, Van Zandt County has had four declared disasters since May 2015. A recovery group was formed and disbanded after donations were distributed eighteen months after the first tornado in 2015. The same situation occurred in 2005 and 2008 after massive sheltering operations for Hurricanes Katrina, Rita, Gustav and Ike.
The current practice of creating a disaster recovery group is significantly improved by factoring health outcomes, social determinates of health, life safety protections, and economic concerns to help the recovery organization set priorities and determine how projects will be funded. The toolkit is flexible enough to allow local jurisdictions to factor those data into a plan to manage the resources available, and create a logistical train customized to the needs of rural counties.
The Planners4Health team believes the toolkit is innovative in that it provides the local communities a practical way of guiding a recovery group through strategic planning during formation of the organization. Operationally the toolkit will inform recovery groups on best practices, assets, and outside partners that can be brought to bear on the process of recovery from many types of disasters.
This toolkit is new to the field of public health. It is the first time the Planners4Health team is aware of that a professional organization has taken the lead role in helping a jurisdiction set policy and procedure for disaster recovery.
Northeast Texas Public Health District (The District) had been searching for a meaningful way to impact Community Recovery as described in the Public Health Emergency Preparedness (PHEP) capabilities. When the tornadoes affecting Van Zandt County Texas occurred on April 29, 2017 there had been some experience gained of the years from hurricane response and small-scale disease response. The District had for been training and preparing to activate a Recovery Strike Team to respond in the twenty-one county service area of East Texas, however the program wasn't ready when the destruction occurred. The District, after the initial response volunteered to assist Van Zandt County with the recovery and immediately started assembling community partners to accomplish this activity in the most expedient way possible. It was decided that representation would come from the County (4 precinct reps) and Cities (8 city reps). The Chairman and Director of the PHEP was appointed by the County Judge as a non-voting member. Members were selected with backgrounds in the areas of Legal, Banking, Construction, Nursing and City Government.
As the Long Term Recovery Group (as it became known) began setting goals and objectives it became clear that there was much that we didn't know. It was also apparent that there was an opportunity to change some of the ways that people had previously thought about their health. This area of Texas has become locally known as the 51st State, due to the poor health outcomes. A report published by the University of Texas Northeast hospital system showed the dire need to address obesity, diabetes, maternal mortality, and other poor outcomes too numerous to list. The LTRG recognized that it could not meet the needs of the local population and address the health concerns at the same time. The Chairman had a chance meeting with a Texas Department of State Health Service employee who was able to recommend that the LTRG reach out to the University Of North Texas School Of Public Health (UNT). The two groups were quickly able to determine a plan of action that would include the Texas chapter of the American Planners Association (APA). The initial meeting took place and funding was quickly secured from the Centers for Disease Control to create a toolkit to assist jurisdictions in creating recovery groups that would be flexible, effective and lasting. The toolkit would integrate social determinates of health and health outcomes into the rebuilt environment. The toolkit was designed to be applicable to all rural jurisdictions. The timeframe for implementation was approximately 14 weeks.
The District arranged a meeting with local politicians, real estate and insurance representatives, state health department officials, code enforcement offices, city planners and engineers, Forest Service officials, emergency managers, law enforcement, physicians, school districts and local residents. The success of the recovery efforts is a vital link to collaboration with these partners to instill trust and transparency in the survivors of the tornadoes and the donors who gave so generously. The District continues to assist Van Zandt County with efforts from the WIC and PHEP departments. Actions are now taking place to create recovery groups in the other counties within The District.
Budget Breakdown: Personnel: $27,500; Supplies: $5,000; Travel (in and out of state) $25,500; Event Expenses $12,000. BUDGET TOTAL: $70,000.
The two objectives of the project were to host a round table event with the emergency management coordinators, public health and planning professionals responsible for disaster preparedness in their communities; and to create a toolkit designed specifically to address the unique concerns of rural communities in Texas. The Planners4Health team discovered through the information in a post-round table event participant evaluation that not only was the event helpful to the participants, they also reported that they would be interested in continuing the disaster preparedness conversation for other parts of the state. The consensus of the participants was that they were very excited to be able to see the toolkit and be able to put it to good use in their communities.
Modifications were made to the toolkit after the round table event. Since the toolkit was not completed by the time the round table event was held, the Planners4Health team was fortunate to be able to take information learned at the event and add it to the contents of the toolkit.
One of the lessons the Planners4Health team learned during this process was that it is especially important to get the input of the community members who will be affected by the proposed intervention. The team met with the Van Zandt County Long Term Recovery Group (LTRG) early on in the round able event planning process, and learned many things that otherwise would not have been considered not only in terms of planning the event, but also in terms of the culture of rural towns in Texas. The team also learned that there were many aspects to the toolkit that had not been considered that the insights of the LTRG helped to uncover. This was incredibly helpful in the development of the toolkit.
What was most evident, however, is that this project was successful because of the collaboration between planners and public health professionals. If this had only been a public health project or a planning project, it would have ended up being rather one-dimensional. Instead, perspectives from both professions were including, making this a more well-rounded, complete project, grounded in the Social Determinants of Health.
The team did not do a cost/benefit analysis.
There is total commitment on the part of all the stakeholders to sustain the work we have been doing together. The Planners4Health Project Manager, the Executive Administrator of the American Planning Association Texas Chapter, and the Director of the Northeast Texas Public Health District are continuing to search for funding to support the projects that need to be addressed as a result of this project. Additionally, students from the Environmental Health track at the University of North Texas Health Science Center School of Public Health have committed to continue to work with the Northeast Texas Public Health District to move this work forward while funding is being sought out.
Colleague from another public health agency