Vulnerable people experiencing homelessness are often not included in preparedness planning for WASH-related emergencies. NACCHO worked with five local health departments to update their emergency plans to address this gap and captured their lessons learned.
The number of people experiencing homelessness (PEH) in the United States continues to increase every year, with an estimated 582,450 PEH during a point-in-time count in 2022. PEH often have limited access to sanitation facilities and face barriers with engaging in hygiene behaviors, placing them at a higher risk for WASH-related emergencies, such as Shigella outbreaks, hepatitis A, group A streptococcal skin infections, infectious diseases, and natural disasters. Local health departments (LHDs) are leaders in responding to public health emergencies, but PEH are often missing from emergency preparedness plans. Few resources currently exist to support local jurisdictions in planning for WASH-related emergencies among PEH.
Read the article in JPHMP
To address this gap, in 2022, the National Association of County and City Health Officials (NACCHO), with support from the Centers for Disease Control and Prevention (CDC), provided funding and technical assistance to five LHDs to update and exercise their emergency preparedness plans to address the needs of PEH. These five LHDs spent one year updating their plans, connecting with each other through peer-to-peer sharing sessions, and receiving technical assistance from NACCHO and CDC. At the end of this technical assistance program, NACCHO conducted key informant interviews with the five LHD grantees to capture their experiences and findings from this work. The findings from these interviews are captured in our new article in the March/April 2024 issue of the Journal of Public Health Management and Practice, “Lessons Learned From Local Health Departments: Updating Preparedness Plans to Address People Experiencing Homelessness During WASH-Related Emergencies.”
Our Findings
- Partnerships were a common benefactor for project grantees, though some cited that their relationships could be stronger. Local partners, such as community-based organizations (CBOs) and nonprofits, were able to connect grantees to additional data and resources for PEH within the community. Grantees were able to share their plans with partners, including city council members, to gain visibility and buy-in. Partners were also helpful in identifying gaps in plans, participating in tabletop exercises, identifying roles and responsibilities, and forming lived experience advisory boards.
- Most LHDs found it more useful to create an annex specifically for WASH-related emergencies among PEH, rather than amending their whole emergency preparedness plan. This allowed for a more targeted procedure between the health department and its partners.
- Grantees shared the most useful and burdensome aspects when updating their plans.
- Useful aspects included seeing their peers’ plans, reviewing CDC background information, and using partnerships for information sharing and delegation of tasks.
- Burdensome aspects included updating plans from scratch, inability to use potentially helpful partnerships if they have negative relationships with PEH, establishing new partnerships and communication networks, and partner capacity and scheduling.
- Grantees’ next steps focus on program sustainability, including building community trust, garnering consistent funding and support, and strengthening community partnerships. Grantees also mentioned the need for expanded staff capacity, increased peer sharing for plans and program resources, and larger quantities of supplies for future emergencies.
Next Steps
It is critical that local preparedness programs across the United States address the needs of people experiencing homelessness during WASH-related emergencies when developing, training, updating, and exercising their emergency plans. This project emphasized how crucial it is to connect with individuals and organizations with lived experience in this space to ensure sustainability and to better understand unique local landscapes. However, to address the current gaps in this space, LHDs need dedicated time, capacity, funding, and strong partnerships.
To learn more, read our article, “Lessons Learned from Local Health Departments: Updating Preparedness Plans to Address People Experiencing Homelessness During WASH-Related Emergencies,” in the March/April 2024 issue of the Journal of Public Health Management and Practice.
Acknowledgements
I would like to gratefully acknowledge my co-authors and colleagues at NACCHO for their work on this project and article: Rashel Rabinovich, MSPH: Deise Galan, DrPH, MPH; and Chloe Garofalini, MPH.
About the Author
- Rebecca Rainey is an Environmental Health Program Analyst at the National Association of County and City Health Officials in Washington, D.C. Her work concentrates on water, sanitation and hygiene (WASH) topics, including wastewater surveillance, aquatic health, and WASH emergency preparedness.
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