A City’s Perspective:Boston’s Approach to Vulnerable Populations and Public Health
Emergencies
John AuerbachExecutive Director
Boston Public Health Commission
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
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
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
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
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
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
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
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.
“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
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
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