A City’s Perspective:Boston’s Approach to Vulnerable Populations and Public Health

Emergencies

John AuerbachExecutive Director

Boston Public Health Commission

The Background to Emergency Planning

in Boston

Emergency Planning and Response has a long history

Including responding to public health emergencies

Such planning had certain characteristics

• Reliance on gov’t such as police, fire, EMS

• Reliance on experts such as hospital personnel

• Specialized plans known by few

• Drills and training for few

…but emergencies like Hurricane Katrina prompted us to rethink

this approach

Lessons from Katrina

• Existing societal socio-economic factors may become exacerbated during an emergency

• Poverty, race and health status matter in an emergency

• In many emergencies, needs quickly outpace gov’t’s capacity to respond

• The traditional reliance on gov’t and centralized planning won’t work

Where do we start to change the model to a

more community-focused one?

Focus on Boston Neighborhoods

Allston-Brighton

WestRoxbury

Roslindale

JamaicaPlain

HydePark

Mattapan

SouthDorchester

Roxbury

NorthDorchester

NorthEnd

BackBay/Beacon Hill/West End

Fenway

Charlestown

SouthEnd

East Boston

SouthBoston

Allston

Back Bay

Beacon Hill

Brighton

Charlestown

Chinatown

Dorchester

East Boston

Fenway

Hyde Park

Jamaica Plain

Mattapan

North End

Roslindale

Roxbury

South Boston

South End

West RoxburyBoston population: 589,000

Focus on Special Populations

• Demographic Groups – including racial

and ethnic minorities, elders, children, institutionalized individuals

• Health Conditions Group – including those with physical or mental disabilities

• Source: DPH Center for Emergency Preparedness: Special Populations Guidance for Local Board of Health

Demographic:sub-categories

• Non-English speakers/ethnic minorities

• Low income residents• Homeless• Isolated individuals• Frail or limited mobility elderly• Inmates

Health Conditions:sub-categories

• Residents of licensed health care facilities: nursing homes, hospitals, substance abuse treatment facilities

• Homebound ill • Disabled physically • Disabled mentally

Key Steps

• Identify key neighborhoods and special populations

• Develop education efforts targeted to different populations

• Work with and train local community leaders to establish a disaster plan

• Provide direct resources for vulnerable populations

B o s t o n i s a r a c i a l l y a n d e t h n i c a l l y

d i v e r s e c i t y

O t h e r1 . 7 %

T w o o r M o r e3 . 1 %

A s i a n7 . 5 %

L a t i n o1 4 . 4 %

W h i t e4 9 . 5 %

B l a c k2 3 . 8 %

Boston is a racially diverse City

Boston is a City of Many Ethnicities

O n e i n f o u r B o s t o n r e s i d e n t s w a s b o r n

i n a n o t h e r c o u n t r y

U . S .7 3 . 9 %

A s ia6 . 2 %

O t h e r0 . 6 %

C a r ib b e a n7 . 3 %

A f r ic a2 . 3 %

L a t in A m e r ic a

4 . 8 %

E u r o p e5 . 0 %

Communication Issues Arise Due to Language

In Boston, many Asian and Latino adults speak little or no English

2.6%

23.5%

4.2%

28.5%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

White

Latino

Black

Asian

The Poor in Boston 20% of the Population

Boston Homeless Population

6,365 homeless men, women & children in Boston. An increase of 9% from last year.

Source: City of Boston Report 2005

Boston Disabled

DISABILITY STATUS of the civilian noninstitutionalized population Estimate

Lower Bound

Upper Bound

Population 5 years and over 488,917 474,578 503,256With a disability 67,437 57,891 76,983

Population 5 to 15 years 63,562 58,439 68,685With a disability 7,993 4,980 11,006

Population 16 to 64 years 371,782 360,653 382,911With a disability 37,998 29,949 46,047

Population 65 years and over 53,573 50,366 56,780With a disability 21,446 17,530 25,362

Data Set: US Census Bureau 2004 American Community Survey

In Response Several Local

Initiatives

Identification of Key Community Partners

Grants to Grass Roots Community Groups

• 20 community groups funded to do specialized education & training at the neighborhood level

• Some target specialized groups (e.g. Chinese, Vietnamese)

• Some target geographic issues (e.g. East Boston)

Local Groups Start with Three Easy Tasks

• Attend 3 days of training with City agencies

• Hold two neighborhood or population specific educational mtgs

• Distribute emergency materials

Preparedness for the Homeless

• Training needed for both shelter staff and homeless clients

• Specialized funding to Health Care for the Homeless to work with City’s homeless providers

Training Local Resident Leaders is Prioritized

Planning Grants

Planning Grants to Address Needs of Most

Vulnerable• Grants awarded to

identify need, highlight best practices and establish plans to strengthen preparedness

• Focus on: -homebound patients-nursing homes and

other residential facilities

• v

Direct Resources

Community Health Centers Emergency Preparations

• Grants to 21 Community Health Centers to clarify roles and train community-based employees on their roles in an emergency

Material Assistance for Low Income Families

• City purchased 10,000 emergency kits – with battery-operated radios, first aid supplies, etc.

• Distributed to low incomes families by local community groups

Neighborhood-based Resources

Local Sites for Emergency Relief

• Identified 50+ dispensing sites in each neighborhood to increase accessibility (all within 1 mile)

• Same sites are also used for temporary housing or as evacuation pick-up sites.  

Multi-lingual Emergency Plan

mailed to 280,000 households

Communication Plan

“Personal Responsibility”

• Identified as key both to prepare for and respond to emergencies

• To prepare:– If dependent on

electricity (e.g. ventilator dependent) then Registry is crucial

– Establish personal support network (family, friends, health care providers)

Multi-lingual Guide for Basic Information on:

• Emergency Preparedness

• Emotional Reactions during emergencies

• Possible terrorist agents

• Where to get more information

Low literacy materials 8 Things you can do.

Newspaper Ads

WWW.BPHC.ORG

Areas in Need of Attention

• Involve vulnerable residents (such as people with disabilities) & organizations serving them in planning and fostering personal/collective responsibility

• Promote neighborhood-based practice drills

• Enhance capacity for person-to-person contact before & during emergencies

Further Information: jauerbach@bphc.org

(617)534-5264