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As an alternative to standard quality improvement approaches and to commonly used after action report/improvement plans, we developed and tested a peer assessment approach for learning from singular public health emergencies. In this approach, health departments engage peers to analyze critical incidents, with the goal of aiding organizational learning within and across public health emergency preparedness systems. We systematically reviewed the literature in this area, formed a practitioner advisory panel to help translate these methods into a protocol, applied it retrospectively to case studies, and later field-tested the protocol in two locations. These field tests and the views of the health professionals who participated in them suggest that this peer-assessment approach is feasible and leads to a more in-depth analysis than standard methods. Engaging people involved in operating emergency health systems capitalizes on their professional expertise and provides an opportunity to identify transferable best practices.

The Harvard School of Public Health Center for Public Health Preparedness exercise program has two aims: ( 1) educating the public health workforce on key public health system emergency preparedness issues, and ( 2) identifying specific systems-level challenges in the public health response to large-scale events. Rigorous evaluation of 38 public health emergency preparedness (PHEP) exercises employing realistic scenarios and reliable and accurate outcome measures has demonstrated the usefulness of PHEP exercises in clarifying public health workers' roles and responsibilities, facilitating knowledge transfer among these individuals and organizations, and identifying specific public health systems-level challenges.

The Washington metropolitan area was closely examined to understand how these regional preparedness structures have been organized, implemented, and governed, as well as to assess the likely impact of such regional structures on public health preparedness and public health systems more generally. It was found that no single formal regional structure for the public health system exists in the Washington metropolitan area, although the region is designated by the Department of Homeland Security as the National Capital Region (NCR). In fact, the vast majority of preparedness planning and response activities in this area are the result of voluntary self-organization through both governmental and nongovernmental organizations. Some interviewed felt that this was an optimal arrangement, as personal relationships prove crucial in responding to a public health emergency and an informal response is often more timely than a formal response. The biggest challenge for public health preparedness in the NCR is incorporating all federal government agencies in the area in NCR preparedness planning.

Objectives. The purpose of this study was to review instruments that assess the level of preparedness of state and local public health departments to respond to health threats such as bioterrorism. Methods. The authors examined 27 published population-based instruments for planning or evaluating preparedness that were mostly unavailable in the peer-reviewed literature. Using the Essential Public Health Services framework, the instruments were evaluated for ( 1) clarity of measurement parameters, ( 2) balance between structural and process measures, ( 3) evidence of effectiveness, and ( 4) specification of an accountable entity. Results. There was a great deal of overlap but little consistency in what constitutes “preparedness” or how it should be measured. Most instruments relied excessively on subjective or structural measures, lacked scientific evidence for measures assessed, and failed to clearly define what entity was accountable for accomplishing the task or function. Conclusion. Strategies for improvement include measure standardization, better interagency communication, and investment in public health practice research to develop the underlying evidence base required for developing quality measures and assessments.

A group convened by the Board on Health Promotion and Disease Prevention of the Institute of Medicine (IOM), in conjunction with the Board on Children and Families of the Commission on Behavioral Social Sciences and Education and the IOM, met to assess the state of the art and science regarding social marketing concepts and strategies in adolescent and minority populations. In summary, the group recognized the importance of promoting healthful behaviors in these populations, but the effectiveness of implementing social marketing approaches to facilitate and sustain behavioral change specific to these two populations remains disappointingly unproven. Despite two decades of empirical research in this area, there remains no firm foundation of scientific theory and empirical research to understand and validate the efficacy of various social marketing programs for these populations. Several research questions emerged from the review of the papers on social marketing in adolescent and minority populations. The Board on Health Promotion and Disease Prevention suggests that these research issues be addressed in future social marketing studies.