Assumption 1: Prepared, Self-Reliant Citizens Are the Foundation of a Resilient Community

The newly released National Health Security Strategy from the US Department of Health and Human Services (HHS) has two overarching goals. One is to “foster community resilience.”8 Communities comprise individuals as well as organizations; thus, the actions of individuals should be as relevant to the HHS vision of community resilience as citizen involvement is to FEMA's emergency management pyramid. However, while the literature on community resilience gives a passing nod to individual preparedness and self-reliance (eg, one definition makes a vague reference to community resilience as an “attitude”),Reference Pfefferbaum, Pfefferbaum and Norris9 few resilience experts have explicitly incorporated efforts to foster citizen preparedness into their conceptual models and frameworks.Reference Chandra, Acosta and Meredith10Reference Norris, Stevens, Pfefferbaum, Wyche and Pfefferbaum11 Thus, the proper role of citizen preparedness within a “resilient community” is unclear, even at the most basic conceptual level. As a result, the literature on community resilience and the concrete advice posted on www.ready.gov are not integrated in any obvious way.

Citizen preparedness is not only ignored in much of the academic work on resilience; it may not even be recognized as a valuable strategy when it is considered. For example, in 2008 a group of experts representing multiple disciplines was asked to rank a variety of activities in terms of their effectiveness for building community resilience. Mass marketing of individual readiness was ranked well below most preparedness activities. A sizable minority (25%) of experts judged the activity to be “ineffective.”Reference Schoch-Spana, Courtney, Franco, Norwood and Nuzzo12 The authors of this study asserted that there has been an overemphasis on citizen preparedness, when community rebound and recovery must rest on the connections between individuals. They also took issue with government initiatives that stress private citizens acting alone rather than in civic groups.Reference Schoch-Spana, Courtney, Franco, Norwood and Nuzzo12 In their view, stressing individual-level preparedness rather than concerted neighborhood action hinders community resilience rather than enhances it.

The tension here is that the community resilience literature views “social capital” (manifested in organized social networks such as faith communities and community partnerships) as hallmarks of a resilient community. In the view of these experts, urging individuals to look after themselves, and fielding surveys that promote stockpiling rather than maintenance of neighborhood linkages undervalues (and may even undermine) community networks. From their perspective, prepared groups, rather than prepared individuals, should form the foundation of the emergency management pyramid.

Assumption 2: With So Many Disasters, It Is Irrational Not to Prepare

According to the Red Cross, slightly more than one-half of all Americans have experienced at least one significant emergency that forced them to evacuate their homes, to live without utilities for at least three days, or to provide first aid to others.6 In 2008 alone, there were 75 FEMA-declared major disasters in the United States.13 At the global level, during the past decade, natural disasters have affected over two billion people.14 Thus, one might consider it obvious that every individual should prepare and that those who do not are living in denial. This assumption ignores several rational reasons why an individual citizen may make a different choice.Reference Helsloot and Ruitenberg15 First, messaging about citizen preparedness does not consistently reach Americans. As a result, many are uninformed about the magnitude of risk and appropriate protective behaviors. A recent report that contrasted the culture of preparedness in the United States vs Israel noted that national campaigns in the United States predominantly rely on Web-based programming. The authors observed, “This approach not only favors those with access to Internet, but also places a required initiative on the public to seek the necessary information.”Reference McGee, Bott, Gupta, Jones and Karr4 In addition, a recent review of online preparedness materials revealed that the majority of Web sites with preparedness information were set at too high a reading level and were not suitable for diverse audiences.Reference Friedman, Tanwar and Richter16 The limitations of this medium might explain why FEMA's Citizen Corp surveys found that public outreach and education campaigns did not significantly expand awareness from 2007-2009.5 Second, although disasters frequently occur, the risk to any single individual that they will be affected by a disaster in a particular year is quite small. Third, despite public warnings to the contrary, many citizens cling to the belief that they will receive swift assistance in an emergency. According to the 2009 Citizen Corp survey, 30% of Americans are not prepared because they believe that emergency responders will help them. More than 60% expect emergency responders will arrive within the first 72 hours following a major disaster.5 Finally, many low-income individuals—those who typically bear the brunt of any disaster—simply lack the resources to meet government recommendations for preparedness. Research has shown that many low-income urban residents lack sufficient funds or even the storage space to maintain an adequately stocked disaster kit.Reference Eisenman, Glik, Maranon, Gonzales and Asch17

Assumption 3: Promoting Individual Preparedness Is Constructive

Emergency managers assume that encouraging citizens to prepare is constructive, because preparing requires little time and effort and has no obvious down side. However, even if the individual costs of citizen preparedness are modest for some Americans, encouraging citizens to devote resources to this activity may not be risk free. First, families whose daily lives are dominated by concerns about poverty, unemployment, and violence may consider government exhortations to prepare for an earthquake or terrorist attack as misguided at best, and out of touch at worst. There are also hypothetical reasons to worry that fostering individual preparedness could engender a false sense of security and encourage some families to ignore official guidance to evacuate because they can “ride out” the disaster. Highly self-reliant individuals may be inclined to make their own decisions rather than deferring to the advice of authorities.Reference Helsloot and Ruitenberg15

The focus on stockpiling three days of supplies and understanding evacuation routes may produce another unintended consequence; it may inadvertently foster the expectation that preparedness is all about planning for a few days of hardship. In reality, preparedness should include planning for both the immediate response phase and a far longer period of recovery. Major events such as Hurricane Katrina and the Deepwater Horizon oil spill have shown that disasters can disrupt daily life for extended periods of time. While promoting self-sufficiency may be useful for the immediate phase of a response, it may impede the rapid community mobilization required for recovery. Also, because, ultimately, recovery determines how quickly a community will return to normalcy after a disaster, preparedness messages should address actions that extend beyond the period of immediate response.

Assumption 4: Citizen Preparedness Campaigns Are Informed by Evidence

It would be reasonable to presume that a body of evidence (eg, from retrospective studies of previous disasters) informs the content of citizen preparedness campaigns, but this is not the case. According to one review of citizen preparedness guides, “Although federal and state planning documents speak to the importance of citizen engagement, this emphasis did not result from an evidence base. In addition, the literature does not quantify or provide an evidence base or best practices for citizen engagement in preparedness.”Reference Delestienne18 If no universal definition of individual preparedness exists, it follows that the specifics on what to do (ie, beyond stockpile generic supplies and develop a plan) to be prepared vary.Reference Ablah, Konda and Kelley7 When recommendations are made regarding the optimal content of a disaster kit, they are typically the product of an expert panel discussion, rather than empirical evidence. Even core tools for measuring citizen preparedness, such as the Public Readiness Index, were developed through focus groups and expert consensus rather than evidence.19 Before future tools are endorsed by governments and published for widespread use, we should be confident that they are valid.

Assumption 5: Surveys of Buying and Planning Behavior Are Useful for Gauging Citizen Preparedness

Various organizations, including the federal government, collect survey data on citizen preparedness. Most track only planning and buying behaviors. Citizen Corp, for example, maintains a database of 134 household preparedness surveys.20 Numerous studies have aimed to identify predictors of preparedness (ie, individuals with higher incomes and better health are more likely to prepare).5Reference Ablah, Konda and Kelley7Reference Murphy, Cody, Frank, Glik and Ang21Reference Eisenman, Zhou, Ong, Asch, Glik and Long22 Clearly, many organizations and authors believe that surveying the public is constructive. The assumption in seeking out “predictors” of certain behaviors seems to be that these activities are valuable and should be encouraged. It is unclear, however, how the results of these surveys are used, what they reveal, and how accurately they track progress over time. For example, how should a local public health official interpret a 5% change in the number of people who report they are trained to perform cardiopulmonary resuscitation or own a first-aid kit?

Typically, the measures included in these surveys are those that are the easiest to collect and have, on their face, a putative link to preparedness. But it is far from clear that the behaviors these surveys purport to measure are the most salient measures of citizen preparedness.

CONCLUSION

One assumption that we do not question is that the actions of individual citizens are critical to supporting disaster preparedness and response. Experts have noted that even in catastrophic terrorist attacks, individuals can take simple, concrete steps to save their own lives and the lives of those around them.Reference Davis, LaTourrette, Mosher, Davis and Howell23 Also, evidence from numerous disasters suggests that most vital rescue work, including the immediate provision of first aid, transportation of casualties to hospitals for treatment, and the provision of food and shelter, is done by friends and neighbors who are themselves victims of the disaster.Reference Helsloot and Ruitenberg15Reference Jacob, Mawson, Payton and Guignard24Reference AufderHeide25 According to Craig Fugate, administrator of FEMA, “Neighbors are almost always the most effective and most immediate first responders.”Reference Fugate2 Statements like this suggest that efforts to promote citizen preparedness should extend beyond personal planning and buying behaviors to promote bystander involvement and community action in the face of shared threats.

Bystander engagement has the potential to save lives but it poses two potential problems. First, improvised responses can complicate the official response. Second, in certain situations our natural instinct to come to the aid of others can put our own survival at risk.Reference Davis, LaTourrette, Mosher, Davis and Howell23 Furthermore, although productive bystander responses are common, research suggests they are not inevitableReference Helsloot and Ruitenberg15; thus, disaster preparedness planners should support research on how best to encourage community engagement and effective bystander response as core components of citizen preparedness. For example, we need to understand how to cultivate a robust bystander response that supports rather than undermines the parallel activities of first responders. At a minimum, we need to rethink the current approach to citizen preparedness, which is doing little to affect widespread public apathy. We should explore whether the current goal of promoting individual self-sufficiency for three days is the best approach to citizen preparedness, especially because local recovery from disasters requires community mobilization and civic engagement as neighbors care for each other.

Community resilience experts recognize that preparedness is only part of the battle; swift recovery requires more. The growing attention to community resilience in academic as well as policy circles provides a window of opportunity to critically examine the current approach to fostering citizen preparedness to ensure its continued relevance. Going forward, we need actual data to inform our recommendations for citizen preparedness, and meaningful, consistent measures to monitor citizen preparedness on an ongoing basis. For example, planners would benefit from case studies on what supplies and training help individuals and communities respond to actual events. We need empirical data about which aspects of bystander response are most helpful and which may be counterproductive. Evidence and measurement, combined with a critical examination of long-held assumptions, offer us the surest path to preparedness.