Matthews NACCHO 02 15 06

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Gene W. Matthews, J.D. CDC Foundation Institute for Public Health Law 50 Hurt Plaza, Suite 765 Atlanta, GA 30303 (404) 373-1276 New Orleans A Tale of Two Cities: & Toronto

Business Continuity: Local Public Health and the Law: 

Business Continuity: Local Public Health and the Law A Tale of Two Cities: Toronto & New Orleans Where are we now? What just happened? Where do we go next?

A Tale of Two Cities: 

Where are we now? A Tale of Two Cities

Historical Context: 

Historical Context 100 years ago, lawyers were integral to the practice of public health at the community level Example, Teddy Roosevelt and Long Island polio quarantine of 1890’s Example, in 1905 a Chicago lawyer founded the Rotary Club: --Purchased a horse for the doctor --Built the first public restroom in Chicago

Reasons for Renaissance in PH Law: 

Reasons for Renaissance in PH Law Relatively “quiet” area of U.S. law from the 1950s1990s Growing awareness of BT & EI threats in late 1990s started PH Law Initiative at CDC Anthrax attacks following 9/11/01 fueled U.S. interest in the field International SARS epidemic of 2003 spurred international attention to PH Law


Public Health Law Enforcement Emergency Management Medical Services Agriculture Federal, State and Local “Legal Preparedness”—The Silos

Two “Thought Leaders”: 

Two “Thought Leaders” SARS, Governance and the Globalization of Disease — David P. Fidler, Professor of Law, Indiana University The World Is Flat: A Brief History of the Twenty First Century — Thomas L. Friedman, New York Times

Why should we care?: 

Why should we care? “In an outbreak situation, the private sector cannot afford for government to fail!” Governments are facing multi-level budget deficits—federal, state, & local. In an outbreak, government is going to need the help of the private sector. Answer:


Rediscovery of public health 40 years ago U.S. businesses realized they were in the business of health care. Now, multi-national corporations are learning that they are in the business of public health: Supply chains impacted by international public health events Interruptions of global markets & employees travel New business opportunities & risks A Reminder for the 21st Century


Common sick leave policies Wage replacement & “grace periods” for paying bills Viability of insurance coverage Temporary support for displaced populations Liability protection (individual & entities) helping recovery Compensation for personal injury & property taken Community, national, & international recovery strategies Temporary regulatory waivers Remediation and clean up protection Radiation, chem., & bio. exposure assessment Long range monitoring & health care tracking Revisions to international health regulations Legal & Policy Issues in PH Economic Recovery

A Tale of Two Cities: 

A Tale of Two Cities Where are we now? What just happened?

A Tale of Two Cities: Why?: 

A Tale of Two Cities: Why? Divisiveness Social Panic Cohesion Toronto New Orleans


The Toronto Example of the Red Zone 2003 SARS Divisiveness & panic Toronto experienced a temporary shift increasing social cohesion. Compliance with quarantine directives was substantial. One example of how a culture temporarily changes. More social cohesion 30,000 “voluntary” quarantines over 3 months 27 formal quarantine orders 1 appeal (withdrawn)

A “Tipping Point” for SARS Leadership in Toronto: 

A “Tipping Point” for SARS Leadership in Toronto On the day that the large medical convention cancelled in Toronto, the center of leadership shifted: BECAME A health problem for government leaders to solve An economic problem for business leaders to solve


Air Canada’s Marketing Tools Creation of a web site


Air Canada’s Marketing Tools

Initial Lessons of Toronto : 

Initial Lessons of Toronto The biggest lessons The “Balance of Governance” is significantly (if only temporarily) altered during an emergency. Business and Public Health need to build bridges with each other before a crisis. Lessons from Toronto are readily understandable and are transferable to other settings.


Where Does “Communication” Fit? Maslow’s Hierarchy of Needs

Some Comparisons: Toronto (T) & New Orleans (N.O.): 

Some Comparisons: Toronto (T) & New Orleans (N.O.) N.O. communication systems knocked out. N.O. experienced shortages of food, water, shelter, security, transportation, etc. T had unified health care system directly linked to the public health system. Both had serious problems with leadership linkages at city/state (provincial) /national levels. SARS initially impacted T’s higher socio-economic class: int’l travelers + health care workers. Hurricane displaced all of N.O., but persons w/o resources had limited options to evacuate. Both business communities reacted quickly.

The Green Zone: Normal Times: 

The Green Zone: Normal Times Normally, there is distance between these entities because of different goals, agendas, & strategies

The Red Zone: An Emergency: 

The Red Zone: An Emergency Relationships are altered during an emergency—we need to plan for it…now. Persons are more likely to follow quarantine orders Employees get their information through their employers Businesses engage & lead in economic recovery plans

But…a VERY Severe Disaster Can Become Chaotic: 

But…a VERY Severe Disaster Can Become Chaotic In Certain Extreme Situations Entities May Severely Separate: DIVISIVENESS

Local Public Health and the Law November 21, 2005: 

Local Public Health and the Law November 21, 2005 Where are we now? What just happened? Where do we go next?

New Challenge: 

New Challenge (The law can assist in building bridges!) Rx: Build new bridges

Law/Policy Change in Public Health Emergency: 

Law/Policy Change in Public Health Emergency The Green Zone “normal time” “Emergency” The Red Zone (Culture temporarily changes) “Just fix it, now!” Immediate Aftermath Moment of law & policy change …and… “The blame game” may begin! “Who pays?” (Selective amnesia returns)

What Can Business & Legal Communities Do? : 

What Can Business & Legal Communities Do? 1. Verify that Governments are ready. “Legal & institutional frameworks” 2. Build external preparedness networks. Geographically & industry-wide 3. Prepare for moments of change. Leadership arrangements will shift. Laws & policies will change. Global economies will react.

Why should public health care?: 

Why should public health care? Answer Public health is facing decreasing political traction as measured in appropriated $$. The business community now wants to engage public health in a discussion on preparedness issues. This is an opportunity to develop relationships and alliances that can be of great value to public health on other issues.

Connecting the Dots: 

Connecting the Dots Business seeks PH preparedness discussion PH & biz engage on common preparedness interests Leads to greater understanding and trust on PH issues beyond preparedness New allies in levering legislative changes New opportunities to develop common PH & biz agendas beyond preparedness

What Can Public Health Do to Maximize This Rare Opportunity to Engage Business? : 

What Can Public Health Do to Maximize This Rare Opportunity to Engage Business? 1. Look to historical precedents: “Business Responds to AIDS,” Polio Eradication & Rotary International, etc. 2. Develop PH awareness of this opportunity 3. Train to develop skills to understand and engage the business community 4. Build upon interdisciplinary networks for public health / business exchanges 5. Search for “alignment of interests”

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