1. What is national health security?
National health security is a state in which the Nation and its people are prepared for, protected from, and resilient in the face of health threats or incidents with potentially negative health consequences. 2. What are the most serious threats and risks to national health security?
Incidents can be unpredictable, and some are very unlikely but highly consequential. They may be caused by a broad range of problems—“hazards”—that can threaten national health security.. Therefore, the Federal Government has adopted an “all-hazards” approach to national health security.
Examples of threats include: natural disasters and major storms (e.g., Superstorm Sandy, Colorado wildfires); epidemics and pandemics (e.g., H1N1), including zoonotic diseases (infectious diseases that originate from animals and transmitted to humans); biological or chemical food contaminations; chemical or radiological releases (e.g., BP Deepwater Horizon oil disaster); and attacks with chemical, biological, radiological, nuclear, and/or explosives (e.g., anthrax mailing, Boston Marathon bombing). 3. What is the National Health Security Strategy (NHSS)?
The National Health Security Strategy (NHSS) provides strategic direction for the coordination of the Nation’s health security system. The 2009 NHSS defines and describes a vision for national health security. It contains two goals, ten strategic objectives, and 50 draft operational capabilities necessary to achieve that vision. The NHSS is a national, not a federal, strategy. National health security is a shared responsibility among all sectors and levels of government and society. It specifies that community resources and efforts must be leveraged and coordinated. The first NHSS was released in 2009, and it will be followed by an update in 2014. 4. How are national and global health security related?
All countries face many threats with the potential for large-scale health consequences, such as disease outbreaks, natural disasters, and terrorist attacks. Given that many of the threats faced by the Nation do not recognize geographic boundaries, the interdependence of national public health communities around the world and the international organizations that support them must be acknowledged. Existing global partnerships allow the Nation to access information about threats outside our borders, from the health, diplomatic, defense, intelligence, and law enforcement communities, as well as from human and animal surveillance networks. These global partnerships strengthen the Nation’s health security by allowing sharing and comparing of experiences and strategies for prevention, protection, mitigation, response, and recovery.
5. What are the goals of the 2009 NHSS?
The NHSS has two overarching goals: (1) build community resilience and (2) strengthen and sustain health and emergency response systems. 6. What are the Strategic Objectives of the 2009 NHSS?
The ten detailed Strategic Objectives that support the two national health security goals are:
- Foster informed, empowered individuals and communities;
- Develop and maintain the workforce needed for national health security;
- Ensure situational awareness;
- Foster integrated, scalable health care delivery systems;
- Ensure timely and effective communications;
- Promote an effective countermeasures enterprise;
- Ensure prevention or mitigation of environmental and other emerging threats to health;
- Incorporate post-incident health recovery into planning and response;
- Work with cross-border and global partners to enhance national, continental, and global health security; and
- Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods.
In addition, the NHSS defines fifty operational capabilities needed to achieve the Strategy’s two goals and ten objectives.7. Why was an NHSS developed?
One common national vision was needed to achieve national health security; however, prior to the NHSS, one did not exist. The Pandemic and All Hazards Preparedness Act (PAHPA) was enacted in 2006 (Public Law 109-417) to improve the nation’s ability to detect, prepare for, and respond to a variety of public health emergencies. Among other things, PAHPA mandated HHS to develop an NHSS, presented to Congress in December 2009, and to submit, every four years, a Strategy, an implementation plan, and an evaluation of progress. The statutory authority and requirements for the NHSS are provided under section 2802 of the Public Health Service Act (42 U.S.C. § 300hh-1). 8. How was the NHSS developed?
ASPR convened intra- and inter-departmental working groups to shape the NHSS 2009. This was particularly important because national health security is dependent on a broad range of skill sets, disciplines, and knowledge beyond traditional health and social services. Regional workshops were held to obtain non-federal stakeholder input. Additionally, the Institute of Medicine convened a two-day workshop in 2009 focused on NHSS implementation. Presentations and listening sessions were held at national meetings. As the NHSS 2014 is being developed, engagement with federal, state, local, tribal, territorial, private, community and other stakeholders will continue in similar fashions. For example, HHS/ASPR convened two NHSS stakeholders meetings in November 2013 to raise awareness about the 2014 NHSS and to facilitate in-depth discussions and solicit public input on the strategy’s strategic objectives. Participants from non-governmental organizations, academic and research institutions, as well as local, state, and federal governments attended the meeting. In addition, HHS/ASPR will engage stakeholders to provide public comments on a draft of the 2014 NHSS.
Implementation and Resources
9. How will the NHSS goals and objectives be achieved?
Achieving national health security is a responsibility that must be broadly shared throughout society by individuals, families, all sectors of communities, and across governments. The NHSS strategic objectives provide a common framework. The NHSS Implementation Plan (IP) provides prioritized activities to facilitate coordinated efforts to build and sustain the operational capabilities necessary for national health security. While certain implementation plan activities might be more relevant to particular agencies, sectors, communities, or disciplines, the NHSS’ philosophy applies to everyone.
Currently various sectors and levels of government are implementing the NHSS 2009 through activities identified in the NHSS Implementation Plan (2012); the Public Health Emergency Preparedness (PHEP) and the Hospital Preparedness Program (HPP) cooperative agreement awardees, administered by CDC and ASPR respectively, help strengthen public health and medical response systems and enhance community preparedness; and the HHS is engaging stakeholders to gather input about activities they might undertake to help achieve health security. The NHSS evaluation of progress will be submitted to Congress in 2014 and it will evaluate progress toward national health security.10. Since there is no appropriation that is specific to NHSS, how will it make a difference in national health security among the states and localities?
The NHSS serves as a national framework to drive health security capability initiatives, and sets the stage for creating a culture of resilience. It drives policies and programs, including those that fund state and community efforts; facilitates coordinated planning and activities; and is a guide for prioritizing investments at all levels of government and across sectors. 11. How is the government ensuring that progress is made?
12. Where can I find resources (e.g., tools, best practices) related to national health security?
|Achieving national health security will require
commitments to measurement, accountability and continuous quality
improvement. HHS is required to submit a NHSS to Congress every four
years, along with an implementation plan and evaluation of progress.
NHSS planning, implementation, and evaluation are iterative and
overlapping phases that involve a broad range of stakeholder engagement
at the federal and non-federal level. Initial priority implementation
actions include the development of valid, reliable, and feasible
performance measures. ASPR will release the Evaluation of Progress (EOP)
report and it will discuss progress made in achieving national health
security, including key factors that contributed or hindered progress.
ASPR also will develop an evaluation framework to guide future
evaluations of progress.
Resources related to national health security can be found in our Resource Library.13. How does the NHSS relate to and impact other policy and programs?
The NHSS provides strategic guidance to inform programs, policies, budgets, and activities. Thus, resources and evidence-based activities are leveraged through policies and programs to facilitate and maximize progress toward national health security. The NHSS complements and supports key national security documents and policies such as the National Security Strategy (May 2010); Quadrennial Homeland Security Review (QHSR) Report: A Strategic Framework for a Secure Homeland (February 2010); and Presidential Policy Directive-8: National Preparedness (March 2011). In recent years, the U.S. Department of Health and Human Services (HHS) has aligned its two major grant programs— the PHEP grant administered by CDC and HPP administered by ASPR. Alignment of the HHS programs has included such efforts as working with a common set of preparedness capabilities, aligning the grant application process, and use of common performance indicators.
14. Will there be another NHSS?
Yes, section 2802 of the Public Health Service Act (42 U.S.C. § 300hh-1) requires the U.S. Secretary of the Department of Health and Human Services to submit a NHSS every four years to Congress, along with an accompanying IP. The next strategy will be released in 2014 and it will build on progress that the Nation has already made towards achieving national health security since 2009. It will address gaps and new potential threats to the Nation’s health security. The 2014 NHSS will be shaped by current policy, systems and environmental changes. For example, updates will reflect the changing threat environment and/or strategic approaches to disaster management based on a growing base of evidence and experience. 15. How will the 2014 NHSS be different from the 2009 NHSS?
The NHSS 2009 laid a firm foundation to guide national health security implementation efforts; however, it did not identify specific priorities for action. The NHSS 2014 will include priorities, which are areas of focus within a strategic objective to help guide stakeholders’ implementation efforts and direct resources to the most critical activities. It is possible that there may be substantial changes to the current NHSS goals, objectives, and/or capabilities.16. What is the process for developing the next NHSS?
The NHSS is created through iterative phases of evaluation, planning, and implementation. The Nation is currently implementing the 2009 NHSS and HHS is collecting implementation data from stakeholders to retrospectively evaluate what progress has been made—and what gaps remain—in the Nation’s preparedness efforts. The evaluation findings are used to prospectively inform the planning phase of the next Strategy and its Implementation Plan. These phases are carried out through extensive consultation with stakeholders and subject matter experts. 17. What are the most pressing challenges to achieving public health security in the short- and long-term?
The greatest challenges to health security are being ready and able to address any health-related incident that may arise, whenever and wherever it may occur. Preparing for the known and unknown requires resourcing; national guidance; an enabling environment; broader involvement across society; an ability to measure and improve all aspects of our national health security infrastructure; and sustainability and adaptability into the longer term. It means being ready and able every day to address routine challenges so that we are better ready for extraordinary ones.
Join the Conversation
18. How can I be involved in the development of the 2014 NHSS and Implementation Plan?
HHS is committed to obtaining broad public input on national health security. Input from members of the general public, citizens groups, parents, physicians, nurses, and other health care providers, public health practitioners, academics, and policy makers will help inform the development of the NHSS and Implementation Plan. You may submit your comments via the NHSS Comment Form.
19. How does NHSS affect me?
While government agencies carry major responsibilities for preparing for, responding to and helping to recover from disasters, everyone has a stake in health security, and everyone can become involved. The first thing is to understand the NHSS and its IP so you can get some initial ideas about where you might fit in. For example, if you work for or with a government agency at any level, you can consult with that agency for ideas and suggestions. If you are affiliated with a community group or social service organization, you can collaborate with them—you might even have ideas for how you and that organization can help. If you are an interested individual, you can learn more, talk to your family, friends and neighbors about ways they can better prepare themselves for potential disasters, and how they can help one another if a disaster strikes.