Researcher Explores Community Readiness Post 9/11
Michael Stoto, PhD, remembers when his career became a calling. It was when he felt the building he was working in shake, seconds after his colleagues saw passengers looking out of windows on a hijacked airplane that then hit the Pentagon.
Stoto, a professor of health systems administration and population health, was starting the third day of his new job at the RAND Corporation, a nonprofit global policy think tank. With a background in public health, he worked as a senior statistician at the corporation’s Washington office, located close to the Pentagon.
In the days of chaos following 9/11, the RAND Corporation, which had a long history in analyzing defense and security, and in health services research, put those two previously disparate missions together. Soon after, Stoto’s bosses called on him to help examine the U.S.’s ability to deal with health disasters – everything from use of biological weapons within the country to a spreading international outbreak of a pandemic virus. He did so, as associate director for Public Health in RAND’s newly created Center for Domestic and International Health Security.
The job suited Stoto. After graduating from Princeton, he received his PhD in Statistics from Harvard University, and then served in a variety of academic appointments, all geared toward public health: Harvard’s John F. Kennedy School of Government, the George Washington University School of Public Health and Health Services, the Georgetown Public Policy Institute, and the Institute of Medicine.
At RAND, he researched the question of whether public health systems can adequately respond to emergencies. He found out that no one knows the answer. Since 9/11, every town and city in the nation has been diligently working on emergency planning, but, short of testing these preparations in actual emergencies, no one knows if they will work, Stoto says. “A lot of money has gone into homeland security without a lot of evidence that anything anyone is doing is effective,” he says.
And then Stoto came to the School of Nursing & Health Studies at Georgetown University Medical Center in 2006. He found the wealth of expertise University-wide in his chosen field to be unrivaled – “there are people in the medical center who deal with biological agents, a school of foreign service in the university with faculty expertise in terrorism, health systems and health policy experts, law and ethics professionals – the list goes on.”
Stoto is now focused on measuring preparedness from a public health perspective, and his work is part of an $8.6 million, multi-institutional grant from the Centers for Disease Control and Prevention (CDC). “Measurement is critical to research, and there hasn’t been enough research to know what works in emergency health preparedness,” he says.
What he and his colleagues have found so far is that “the question is not whether a town or city has the capacity to carry out preparedness, but whether it has the capability.” Take an infectious disease outbreak as an example: Capacity includes having laboratory facilities to identify the cause, but capability is the health department’s ability to coordinate these facilities with doctors and hospitals in the community and eventually to stop the spread of disease, he says.
“The emphasis has always been on capacities, but our research suggests that it is necessary to move to higher level of outcomes – to understand what communities can do about it,” Stoto says. “Communities vary in the capacities they use to achieve preparedness goals, but the necessary capabilities are the same everywhere.”
He also says his research suggests that communities should be prepared to handle any public health crisis, including the unexpected, instead of set scenarios such as pandemic influenza. “Response to a health crisis is a local activity,” says Stoto, “but the ultimate goal is for the whole country to be prepared.”
By Renee Twombly, GUMC Communications