Taking a public health approach to emergencies: building on trusted relationships with the community
As seen with Canada’s responses to mpox and devastating wildfires, strong community ties built on trust can make all the difference in averting crisis situations
Emergencies are increasingly becoming part of our daily lives – and the health impacts, in addition to socio-economic impacts, can continue long after the immediate crisis has passed. Public health professionals are increasingly being called on to respond to complex and compounding crises, from climate-related emergencies such as wildfires and extreme heat to infectious disease outbreaks like mpox and the Covid-19 pandemic. What we must remember is that the exposure, vulnerability and capacity to respond to emergencies are not the same for everyone.
Around the world, we are experiencing wildfires with increased severity and frequency, and the physical and mental health impacts are vast, particularly for those in closer proximity to the wildfires, evacuees and those who have pre-existing health conditions. The Canadian wildfire season in 2023 was the most destructive and widespread on record. Nearly 250,000 people across 12 of Canada’s 13 provinces and territories were forced to evacuate. Indigenous communities in Northern and remote regions in Canada are disproportionately affected by emergency events, facing more than 1,300 emergencies that have resulted in over 580 evacuations in the past 13 years. These events damage not only property, but also homes, livelihoods and shared community spaces that support resilience.
Working with communities
Understanding affected communities, including both their assets and challenges, is critically important. It requires us to cultivate trusted partnerships between sectors and communities to remove structural barriers, advance community-led priorities and build supportive environments. Integrating an equity-informed and community-centred approach throughout the emergency management cycle – from prevention and mitigation, through to preparedness, response and recovery – is key.
In Canada’s province of Newfoundland and Labrador, in an effort to reach populations facing vulnerabilities during the Covid-19 pandemic, an intersectoral task group was struck that built on pre-established relationships between the province’s Department of Health and Community Services and approximately 60 representatives of community organisations. Successful actions included striking provincial helplines for food security, opioid treatment and domestic violence.
Public health can contribute to efforts to build healthier, more resilient communities that are better equipped to prevent, withstand and recover from emergencies. In the summer of 2021, during the pandemic, the province of British Columbia experienced a deadly heat dome, with temperatures at 20°C above normal that led to 619 confirmed deaths from heat-related causes. Many of those who died were older adults, or had chronic mental and physical health conditions. More than half of those who died lived alone. And deaths that occurred at home were concentrated in neighbourhoods of lower socio-economic status that lacked green space and air conditioning.
Following the heat dome, in response to requests from community partners, the regional health authority of Vancouver Coastal Health developed the Heat Check-in Supports Project to increase community wellness checks on people most at risk for heat-related emergencies and provided evidence-based resources and training. The resources were developed in close partnership with community organisations to ensure they were addressing local needs.
City building by-laws were changed to require all new multi-unit residential buildings to have mechanical cooling capable of maintaining an indoor temperature of 26°C or less by 2025.
Establishing trusted relationships before emergencies
In 2022, several cities in Canada experienced an outbreak of mpox that disproportionately affected men who are gay, bisexual or have sex with men. However, by the fall, the number of cases had declined significantly, largely due to behaviour change and supported by vaccination efforts. The success of the response was due to strong community-led responses and the efforts of trusted leaders. Collaborative and trusted relationships between public health and community organisations, built over more than 30 years to respond to HIV, provided a solid foundation for this work.
For example, the Gay Men’s Sexual Health Alliance co-created a community-informed mpox prevention campaign in partnership with the provincial Ministry of Health in Ontario, infectious disease experts and front-line community agencies. GMSH launched a social media-based public health campaign about reducing risk and accessing vaccination and created education materials for clinical care settings. GMSH’s existing relationships and credibility with the community were invaluable in implementing timely and tailored outreach efforts, allowing front-line community agencies and local public health units to concentrate on other critical work, such as vaccine distribution.
A path forward: reorienting emergency management
The inequitable impacts of the Covid-19 pandemic showed us we must do better. We achieved more when we worked across sectors to bring our collective expertise and tools to the table and supported trusted community organisations to reach diverse populations. Now is the time to apply these lessons to emergency management more broadly.
Public health must be included at multisectoral emergency management tables to ensure evidence-informed health promotion approaches are incorporated into planning and prioritisation efforts. Public health can also add value by championing support for research that reflects the unique perspectives and needs of specific communities, including multidisciplinary research with an equity lens and promoting Indigenous science.
Principles of health promotion provide ways to work with communities and partners to advance health equity, strengthen social supports, and build trusted relationships that can foster social cohesion before any emergencies occur. From climate-related emergencies to disease outbreaks – we must shift the narrative to build a stronger and more equitable society that prioritises health and well-being before, during and after emergencies.
