Bridging the Gap: To What Extent Do Socioeconomic Barriers Impede Response to Emerging Public Health Threats?

Don Neuert


The basis for this thesis and research topic stems from certain local and state Public Health Emergency Preparedness grant activities—managed by the Centers for Disease Control and Prevention (CDC)—focused on jurisdictions’ ability to dispense life-saving medications and medical supplies to 100 percent of an impacted population within 48 hours of a bioterrorism incident.[1] Managing the state emergency medical countermeasure program for many years, the researcher felt it was important to examine barriers that local and state public health practitioners face in their missions to provide emergency medications, healthcare, or other services as a result of widespread infectious disease outbreaks and bioterrorism incidents.

He questioned how it would be possible for health practitioners to reach entire impacted populations within 48 hours when socioeconomic barriers, fear, and distrust of government exist in communities. The purpose of the research was to understand better the extent of these barriers—the significance and relevancy of the barriers—and how they impede response to emerging health threats. Many socioeconomic barriers and affiliated challenges need to be considered but this research was based on three primary “pillars” associated to the social determinants of health, which are (1) language, (2) culture, and (3) historical trauma.[2] His findings centered around the barriers—along with contributing factors, such as fear and distrust of government—to understand better their connection or disconnection to health emergencies. The results gathered and data analyzed presented a much larger problem space than anticipated.

Before researching this topic, when considering the CDC’s model of providing medications and healthcare to 100 percent of a population within 48 hours of a dire health emergency, the researcher predicted a more realistic percentage would be the ability to reach 80–90 percent of a population in that timeframe. After researching barriers across the United States that language, culture, and historical trauma present—along with fear and distrust of government—the percentage significantly dropped. It became more realistic that reaching 60 percent of community populations within the critical time period for emergency antibiotics to be effective is more accurately the baseline from which public health and healthcare practitioners should work. It became more and more apparent as he researched this subject matter that both the gaps—and the impacts that stem from these gaps—have been vastly underestimated in this nation’s current operational and strategic planning and response practices.

This research is based on the argument that socioeconomic barriers have significant impacts in an event requiring emergency medication dispensing to 100 percent of a population in 48 hours. Before researching the event, the researcher had no idea that the gap to be bridged would be so expansive and far-reaching. Changes will not happen overnight, but with dedicated policy and strategy level efforts—what seem like daunting, impossible tasks—can be achieved and the socioeconomic gap can be bridged. The following recommendations aim to assist practitioners with these efforts.


  1. Community Outreach

To help mitigate against differential rates of morbidity and mortality in future health emergencies, it is critical that the entire U.S. public, including specific subgroups, have access to credible, accessible, and meaningful information that enables them to make appropriate use of potentially lifesaving emergency medical countermeasures.

  1. Building Trust through Community Resilience

Building community resilience to disasters is essential and is commonly described as “the ability to mitigate and rebound quickly.”[3] Viewing preparedness through a community resilience lens provides a foundation to work from for improving community engagement and outreach efforts that will strengthen community relationships and improve both communication strategies and trust with entire populations across the homeland.

  1. Using Appropriate “Whole Community” Risk Communications to Bridge the Gap

Effective risk communications serve as the basis emergency response missions to varied health emergencies.[4] The researcher has learned that emergency messaging needs to be developed in a “culturally appropriate manner” to ensure “whole community” populations adhere to emergency messaging and safety recommendations put forth by health and healthcare practitioners as a result of an emerging health threat.[5]


Efforts and emphasis placed on activities to “bridge the gap” will further reduce fear, distrust, and misperceptions of preferential treatment among populations. As a result, lower mobility and morality rates could be expected and the risk of rioting, civil unrest, and community divisiveness lessened across the homeland.


[1] “Cities Readiness Initiative Strategic National Stockpile,” accessed February 20, 2016, http://www.

[2] “Social Determinants of Health: Know What Affects Health,” last updated October 13, 2016, http://

[3] Alonzo Plough et al., “Building Community Disaster Resilience: Perspectives from a Large Urban County Department of Public Health,” American Journal of Public Health 103, no. 7 (2013): 1190–97, doi: 10.2105/AJPH.2013.301268.

[4] Plough et al., “Building Community Disaster Resilience: Perspectives from a Large Urban County Department of Public Health,” American Journal of Public Health, 1190–97.

[5] Randy Rowel et al., A Guide to Enhance Risk Communication among Low-Income Populations (Baltimore, MD: Morgan State University School Community Health and Policy, Department of Behavior Health Sciences 2009),

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