A Q&A with RWJF’s Alonzo Plough and NHSPI’s Glen Mays

In this interview, RWJF’s Alonzo Plough, PhD, MPH, and the National Health Security Preparedness Index’s (NHSPI) National Program Office Director Glen Mays, PhD, MPH, discuss ways NHSPI can be used to guide change, the role geographic differences play in preparedness levels, how the COVID-19 pandemic has exposed health inequities and much more.

This interview has been edited for clarity and length.

Glen Mays: From your perspective, why is preparedness important to building and creating a culture of health across the United States?

Alonzo Plough: Preparedness is at the core of building a Culture of Health and health equity—one that ensures everybody, regardless of neighborhood or income group, has a good and fair opportunity for a healthy life, particularly when you have a disaster like the coronavirus pandemic.

We know that no individual, community, organization or initiative can change the trajectory of America’s health alone. This remains true for preparing states and the nation for emergencies. The Index is a way for us to convey what it means to be prepared and the kind of connectivity between sectors required for national preparedness. We’re all in this together.

Glen: The Index lets us focus on specific states and understand how preparedness capabilities vary across the country and change over time. How can that information about geographic variation and differences in protections be used to help us respond to new and emerging threats?

Alonzo: There are many important regional nuances and context-specific factors that have different health security implications across states and regions.

We’ve seen this play out during the COVID-19 pandemic—even the difference in broadband access from region-to-region tells us the kind of things we have to do to achieve the fairness in outcomes and resilience that’s at the core of what we try to do and monitor with the Index. In an urban area with 5G service emerging, for instance, parents at home trying to take care of their kids and keep them schooled will have reasonable broadband access. Those in rural areas likely don’t have this same access, which can really affect the family’s ability to shelter in place and be safe during the pandemic.

Glen: We’ve got a number of measures in the Index that relate to populations and population groups that typically are disproportionately affected by large scale hazards and emergencies like the COVID-19 pandemic. How can we best use this tool as an instrument for improving health equity and closing gaps in health across the country?

Alonzo: Given the data right now, I think it’s fair to say we have a ways to go as a nation, but I think the Index will play a very important role in our learning as to how we improve from this baseline of our COVID-19 response.

I think some of the things that we’re measuring in the Index help us understand areas that we really need to improve, particularly around vulnerable populations. The Index has been very sensitive in trying to understand those contexts, how they vary regionally, and what policies are needed to promote equity so that your state, your neighborhood, or your income bracket doesn’t determine whether you’re going to have a resilient outcome in a disaster.

With COVID-19, for instance, we know that in spite of the good work we are trying to do, there are  tragic inequities in the outcomes we are seeing among different populations, such African Americans and Latinos, isolated elders in nursing homes, and incarcerated populations, to name a few. The Index can help us prioritize these populations and their unique needs and risks as we formulate equitable solutions like distribution of vaccines, therapeutics, and other health interventions.

Alonzo Plough, PhD, MPH, is the vice president of Research-Evaluation-Learning and chief science officer at the Robert Wood Johnson Foundation. Glen Mays, PhD, MPH, is the director of the NHSPI Program Office and chair of the Department of Health, Management, and Policy at the Colorado School of Public Health.