Dyson College of Arts and Sciences
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of disaster management processes that involve sustained preparation, response, recovery, and rebuilding. This reflection is a continual process. As Dimitruk (2005) noted, "Fortunately, the lessons learned from Katrina and Rita are being collected in an unprecedented effort to capture and disseminate hard-won know-how" (p. 64). These lessons from the past strengthen best practices of today. Public Health In their response to disasters, nurses exemplify the concept of public health. Public health is "the science and art of protecting and improving the health of communities through education, promotion of healthy life styles, and research for disease and injury prevention" (Association of Schools of Public Health, n.d., par.1). An essential component of public health is the protection of the public. So what does this very broad statement mean, and how are these statements embodied with particular reference to disaster management? Building on lessons learned from past disasters, much work over the past decades has been committed to efforts to build a safer and healthier population. One outcome of this work was the development of the "Ten Essential Public Health Services," by the Public Health Functions Steering Committee (U.S. Department of Health and Human Services [DHHS] Public Health Functions Steering Committee, 1994). This framework outlines the responsibilities of local public health systems and strategies for building a stronger, integrated public health system capable of ensuring sustained public health even in times of disaster. Each of the 10 essential services falls under one of the "three core functions" of public health: assessment, policy development, and assurance (Institute of Medicine [IOM], 1988). Assessment includes skills needed for the systematic collection of data and analysis of data for early identification of health problems and/or the identification of potential problems. Policy development, based on evidence, serves to facilitate the correction of issues or problems. Finally, assurance requires that public health agencies provide services directly or through other private or public agencies (Truglio-Londrigan, 2011). Figure 1 provides a visual representation of these three core functions and the corresponding essentials of public health. This framework emphasizes improving the health of the population and also protecting people from natural and human-made disasters. If prevention is not successful, then the emphasis is to implement a disaster management process to limit harm and to rebuild. In the 21st century, there has been recognition that our nation's ability to respond and protect the public may not be as comprehensive, integrated, and seamless as needed. Building upon past practice, the National Health Security Strategy (NHSS) was developed to enhance our nation's capabilities, response, and recovery (U.S. Department of Health and Human Services/Public Health Emergency, 2011a). The NHHS has two key goals: • Build a community of resilience; • Strengthen and sustain health and emergency response systems. Ten objectives are defined to move the U.S. disaster response capability toward the achievement of these goals (U.S. Department of Health and Human Services/Public Health Emergency, 2011b). These ten objectives are listed in Box 1. The Ten Essential Public Health Services and the Three Core Functions serve as a guiding framework for the health agenda known as "Healthy People 2020." Healthy People 2020 is a continuation of a previous initiative launched in 1979 when the Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention 47