To strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from incidents with negative health effects.
National health security is a state in which the Nation and its people are prepared for, protected from, and resilient in the face of incidents with health consequences. The National Health Security Strategy (NHSS) provides strategic direction to ensure that efforts to improve health security nationwide are guided by a common vision; based on sound evidence; and carried out in an efficient, collaborative manner. NHSS guides the development of the Healthy People Preparedness objectives through a framework for stakeholders of national health security to build community resilience, strengthen and sustain health emergency response systems, improve capabilities, and prioritize resources.
Core stakeholders of national health security include:
- Individuals and families
- The emergency management workforce
- The public health workforce
- The health care workforce
The core stakeholders are supported by partners who play a key role in achieving and sustaining national health security. These partners include:
- The scientific and academic community
- Community-based organizations
- The non-profit sector
- The private sector
- Federal, state, local, tribal, and territorial governments
NHSS identifies 5 strategic objectives with approaches (see Understanding Preparedness below) and activities that stakeholders and partners in national health security may perform to promote security and resilience in the face of diverse incidents with health consequences.
Why Is Preparedness Important?
The negative health consequences of deliberate attacks, accidents, and natural disasters impact communities across the Nation. Communities should prepare for these incidents through a comprehensive approach that includes NHSS in addition to the other Healthy People 2020 objectives.
NHSS serves as a framework to help guide the Nation and facilitate collaboration and coordination among community organizations and businesses, as well as local, state, tribal, territorial, and federal agencies in their pursuit of advancing national health security. Communities are making contributions to national health security every day. For example, the Hospital Preparedness Program (HPP) and the Public Health Emergency Preparedness (PHEP) cooperative agreements, administered by the HHS Assistant Secretary for Preparedness and Response (ASPR) and the Centers for Disease Control and Prevention (CDC) respectively, are key federal investments that facilitate the community’s role in national health security. The programs provide both financial and technical help to strengthen public health and medical response systems and enhance community preparedness by improving targeted capabilities.
NHSS’s strategic objective structure is helpful for understanding preparedness within a health context.
Strategic Objective 1: Community resilience is the sustained ability of communities to withstand, adapt to, and recover from adversity. NHSS’s approach to building and sustaining healthy, resilient communities focuses on connecting individuals and communities, enhancing coordination of health and human services, and building a culture of resilience.1,2,3
Strategic Objective 2: Countermeasures are used to protect communities from the adverse health impacts of chemical, biological, radiological, and nuclear attacks, outbreaks of infectious diseases, and other incidents. NHSS describes a vision for preventing and mitigating adverse health consequences that includes sustaining medical countermeasures and strengthening the use of non-pharmaceutical interventions within the Nation’s countermeasure capability.4,5
Strategic Objective 3: Active and timely situational awareness provides the foundation for decisions and actions that may result in early detections and better resource utilization; successful prevention and mitigation of emerging threats; and improved security for the Nation. The vision for improving decision-making in disaster events is focused on strengthening health situational awareness. This vision includes the development of innovative and compatible technologies, the identification and integration of relevant data (to include human, environmental, and zoonotic), and better approaches to coordinating health situational awareness.6
Strategic Objective 4: Public health, health care, and emergency management systems represent a cornerstone of national health security. NHSS outlines an approach to public health, health care, and emergency management systems that includes both integration, through the continued sustainment of health care coalitions and the alignment of routine systems and services, and effectiveness, through management and training of the public health, health care, and emergency management workforce. Additionally, these systems should address access for and functional needs of at-risk individuals.7,8,9,10
Strategic Objective 5: As the movement of people, goods, and services across borders increases, our national health security is increasingly dependent on global health security. NHSS identifies ways to strengthen global health security by supporting international capacity and capability to detect, prevent, and respond to disasters and public health emergencies.11
Emerging Issues in Preparedness
Over the coming decade, the Nation and its communities will face a variety of emerging issues in preparedness. Stakeholders can:
- Plan for the increased prevalence of emerging and re-emerging infectious diseases
- Incorporate Disaster Risk Reduction as an approach to preparedness
- Focus on health disparities and variations in preparedness across geographies, communities, and demographics
- Analyze how demographic trends are changing the vulnerability of populations during public health emergencies
- Increase opportunities for public-private partnerships
- Protect against threats to Electronic Health Record systems
- Identify how to take advantage of trends in technological innovation
- Increase transparency and flexibility in supply chain management
1Institute of Medicine, Committee on Post-Disaster Recovery of a Community’s Public Health, Medical, and Social Services. Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery. Washington, DC: The National Academies Press; 2015. Available from:
2Wulff K, Donato D, Lurie N. What Is Health Resilience and Can We Build It? Annu Rev Public Health. 2015;36:361-74. Available from: http://www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-031914-122829
3Chandra A, Acosta J, Howard S, et al. Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security. RAND Health Quarterly. 2011;1(1):6. Available from: https://www.rand.org/pubs/periodicals/health-quarterly/issues/v1/n1/06.html
4Office of the Assistant Secretary for Preparedness and Response [Internet]. Public Health Emergency Medical Countermeasures Enterprise. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. [updated 2016 Dec; cited 2017 Jul 10]. Available from: https://www.phe.gov/Preparedness/mcm/phemce/Pages/default.aspx
5Centers for Disease Control and Prevention [Internet]. Non-pharmaceutical Interventions. [updated 2017 Jan 25; cited 2017 Jul 10]. Available from: https://www.cdc.gov/nonpharmaceutical-interventions/index.html
6Office of the Assistant Secretary for Preparedness and Response. The National Public Health and Medical Situational Awareness Strategy Implementation Plan (2015-2018). Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response; 2015 Sep. Available from: https://www.phe.gov/about/OPP/Documents/phm-sa-ip-sept2015.pdf
7Office of the Assistant Secretary for Preparedness and Response [Internet]. Hospital Preparedness Program. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. [updated 2017 Apr; cited 2017 Jul 10]. Available from: https://www.phe.gov/Preparedness/planning/hpp/Pages/default.aspx
8Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response. Public Health Preparedness Capabilities: National Standards for State and Local Planning. Atlanta; CDC; 2011 Mar. Available from: https://www.cdc.gov/phpr/readiness/00_docs/DSLR_capabilities_July.pdf
9Office of the Assistant Secretary for Preparedness and Response and Centers for Disease Control and Prevention/Agency for Toxic Substance and Disease Registry. Hospital Preparedness Program - Public Health Emergency Preparedness - Funding Opportunity. CDC-RFA-TP17-1701. 2017 Feb [cited 2017 Jul 10]. Available from: https://www.grants.gov/web/grants/view-opportunity.html?oppId=290860
10Office of the Assistant Secretary for Preparedness and Response and Centers for Disease Control and Prevention/Agency for Toxic Substance and Disease Registry. Hospital Preparedness Program - Public Health Emergency Preparedness – Supplemental Guidelines. CDC-RFA-TP17-1701. 2017 Feb [cited 2017 Jul 10]. Available from: http://www.kalhd.org/wp-content/uploads/2012/10/2017-HPP-PHEP-FOA-Supplemental-Documents-1.pdf
11Global Health Security Initiative. Global Health Security Initiative: 10 Years of Collaborative Action. c2011 [cited 2017 Jul 10]. Available from: http://ec.europa.eu/health/sites/health/files/preparedness_response/docs/ghsi_anniversary_en.pdf