Beginning in the late 1990s and lasting through much of the next decade, the Arkansas Department of Health underwent multiple changes to its organizational structure. Part A of "A State of Flux" recounts how, after a brief period in which the director of health replaced traditional hierarchical leadership with team-based management, several findings of administrative shortcomings helped prompt Governor Mike Huckabee and the state legislature to merge the department with the Arkansas Department of Human Services. Supporters of the merger argued that not only would it force the health division to adopt the highly regarded administrative practices of human services, it would also result in substantial cost savings for the state budget. However, the public health community quickly grew frustrated with the new arrangement, arguing that instead of being the marriage of two equals, the merger had resulted in the subordination of health to human services. Soon a movement to end the merger emerged, and Part B of the case explores how public health officials and their political allies rallied both publicly and behind the scenes to reverse course and reestablish a fully autonomous health department. An epilogue to the case portrays the main tasks and challenges public health leaders encountered as they worked to rebuild a reconstituted Arkansas Department of Health after this tumultuous period of organizational change. Case number 2129.0
On October 29, 2012, Superstorm Sandy made landfall near Atlantic City, New Jersey. Sandy's massive size, coupled with an unusual combination of meteorological conditions, fueled an especially powerful and destructive storm surge, which caused unprecedented damage in and around New York City, the country's most populous metropolitan area, as well as on Long Island and along the Jersey Shore. This two-part case study focuses on how New York City prepared for the storm's arrival and then responded to the cascading series of emergencies - from fires, to flooding, to power failures - that played out as it bore down on the city. Profiling actions taken at the local level by emergency response agencies like the New York City Fire Department (FDNY), the case also explores how the city coordinated with state and federal partners - including both the state National Guard and federal military components - and illustrates both the advantages and complications of using military assets for domestic emergency response operations. Case number 2124.0
Supplement to case KS1253. On April 19, 2015, Freddie Gray, a young African American male, died while in the custody of the Baltimore Police. In response to his death, which occurred less than a year after a similar incident in Ferguson, Missouri, protestors mobilized daily in Baltimore to vocalize their frustrations, including what they saw as law enforcement's long-standing mistreatment of the African American community. Then, on April 27, following Gray's funeral, riots and acts of vandalism broke out across the city. Overwhelmed by the unrest, the Baltimore police requested assistance from other police forces. Later that evening, Maryland Governor Larry Hogan declared a state of emergency and activated the Maryland National Guard. At the local level, Baltimore Mayor Stephanie Rawlings-Blake issued a nightly curfew beginning Tuesday evening. "Into Local Streets" focuses on the role of the National Guard in the response to the protests and violence following Gray's death, vividly depicting the actions and decision-making processes of the Guard's senior-most leaders. In particular, it highlights the experience of the state's Adjutant General, Linda Singh, who soon found herself navigating a complicated web of officials and agencies from both state and local government - and their different perspectives on how to bring an end to the crisis. Case number 2116.0
Epilogue to case KS1242. In summer and fall of 2014, thousands of individuals in Liberia, Sierra Leone, and Guinea contracted the Ebola virus. This outbreak of the deadly disease, which until then had been highly uncommon in West Africa, prompted a major (albeit delayed) public health response on the part of the international community, including an unprecedented commitment made by the United States, which sent almost 3,000 active military soldiers to Liberia. "Mission in Flux" focuses on the US military's role in the Ebola response, emphasizing the Michigan National Guard's eventual involvement. In particular, it provides readers with a first-hand account of the challenges the Michigan Guard faced as it prepared for and then deployed to Liberia, just as the crisis had begun to abate and federal officials in Washington began considering how to redefine the mission and footprint of Ebola-relief in West Africa. Case number 2107.0
In summer and fall of 2014, thousands of individuals in Liberia, Sierra Leone, and Guinea contracted the Ebola virus. This outbreak of the deadly disease, which until then had been highly uncommon in West Africa, prompted a major (albeit delayed) public health response on the part of the international community, including an unprecedented commitment made by the United States, which sent almost 3,000 active military soldiers to Liberia. "Mission in Flux" focuses on the US military's role in the Ebola response, emphasizing the Michigan National Guard's eventual involvement. In particular, it provides readers with a first-hand account of the challenges the Michigan Guard faced as it prepared for and then deployed to Liberia, just as the crisis had begun to abate and federal officials in Washington began considering how to redefine the mission and footprint of Ebola-relief in West Africa. Case number 2107.0
On April 19, 2015, Freddie Gray, a young African American male, died while in the custody of the Baltimore Police. In response to his death, which occurred less than a year after a similar incident in Ferguson, Missouri, protestors mobilized daily in Baltimore to vocalize their frustrations, including what they saw as law enforcement's long-standing mistreatment of the African American community. Then, on April 27, following Gray's funeral, riots and acts of vandalism broke out across the city. Overwhelmed by the unrest, the Baltimore police requested assistance from other police forces. Later that evening, Maryland Governor Larry Hogan declared a state of emergency and activated the Maryland National Guard. At the local level, Baltimore Mayor Stephanie Rawlings-Blake issued a nightly curfew beginning Tuesday evening. "Into Local Streets" focuses on the role of the National Guard in the response to the protests and violence following Gray's death, vividly depicting the actions and decision-making processes of the Guard's senior-most leaders. In particular, it highlights the experience of the state's Adjutant General, Linda Singh, who soon found herself navigating a complicated web of officials and agencies from both state and local government - and their different perspectives on how to bring an end to the crisis. Case number 2116.0
On April 15, 2013, Dzhokhar and Tamerlan Tsarnaev placed and detonated two homemade bombs near the finish line of the Boston Marathon, killing three bystanders and injuring more than two hundred others. This case profiles the role the Massachusetts National Guard played in the complex, multi-agency response that unfolded in the minutes, hours, and days following the bombings, exploring how its soldiers and airmen helped support efforts on multiple fronts - from performing life-saving actions in the immediate aftermath of the attack to providing security on the region's mass transit system and participating in the search for Dzhokhar Tsarnaev several days later. It also depicts how the Guard's senior officers helped manage the overall response in partnership with their local, state, and federal counterparts. The case reveals both the emergent and centralized elements of the Guard's efforts, explores the debate over whether or not Guard members should have been armed in the aftermath of the bombings, and highlights an array of unique assets and capabilities that the Guard was able to provide in support of the response. Case number 2089.0
This case (Parts A&B) takes students behind the scenes at the Indiana State Department of Health (ISDH) as it struggles to recognize and manage an unusual outbreak of HIV in a poor, rural community. As ISDH learns, illegal injection of prescription drugs, mainly opioids, is spreading the disease. Users are sharing needles and thus exposing the second, third, or subsequent users to infection with HIV from potentially contaminated blood residue. ISDH recognizes that "needle exchange" is one method generally found effective in other states in reducing infections among injection drug users. Drug users can bring used needles to a clinic or other exchange location and receive fresh ones without fearing that they will be subject to arrest or other sanctions. However, Indiana, with a conservative legislature and governor, has by law long banned needle exchanges because it perceives these to encourage drug use. In reading and discussing this case study, students will learn about how Indiana Governor Mike Pence, Indiana Health Commissioner Jerome Adams, and the legislature all sought to balance public health concerns against long-held beliefs about how best to fight the war against drugs.
This epilogue accompanies case number 2080.0. This case (Parts A&B) takes students behind the scenes at the Indiana State Department of Health (ISDH) as it struggles to recognize and manage an unusual outbreak of HIV in a poor, rural community. As ISDH learns, illegal injection of prescription drugs, mainly opioids, is spreading the disease. Users are sharing needles and thus exposing the second, third, or subsequent users to infection with HIV from potentially contaminated blood residue. ISDH recognizes that "needle exchange" is one method generally found effective in other states in reducing infections among injection drug users. Drug users can bring used needles to a clinic or other exchange location and receive fresh ones without fearing that they will be subject to arrest or other sanctions. However, Indiana, with a conservative legislature and governor, has by law long banned needle exchanges because it perceives these to encourage drug use. In reading and discussing this case study, students will learn about how Indiana Governor Mike Pence, Indiana Health Commissioner Jerome Adams, and the legislature all sought to balance public health concerns against long-held beliefs about how best to fight the war against drugs.
This case (Parts A&B) takes students behind the scenes at the Indiana State Department of Health (ISDH) as it struggles to recognize and manage an unusual outbreak of HIV in a poor, rural community. As ISDH learns, illegal injection of prescription drugs, mainly opioids, is spreading the disease. Users are sharing needles and thus exposing the second, third, or subsequent users to infection with HIV from potentially contaminated blood residue. ISDH recognizes that "needle exchange" is one method generally found effective in other states in reducing infections among injection drug users. Drug users can bring used needles to a clinic or other exchange location and receive fresh ones without fearing that they will be subject to arrest or other sanctions. However, Indiana, with a conservative legislature and governor, has by law long banned needle exchanges because it perceives these to encourage drug use. In reading and discussing this case study, students will learn about how Indiana Governor Mike Pence, Indiana Health Commissioner Jerome Adams, and the legislature all sought to balance public health concerns against long-held beliefs about how best to fight the war against drugs.
Throughout the summer of 2010, Pakistan experienced severe flooding that overtook a large portion of the country, displacing millions of people, causing extensive physical damage, and resulting in significant economic losses. This case focuses on the role of the National Guard (and of the U.S. military, more broadly) in the international relief effort that unfolded alongside that of Pakistan's government and military. In particular it highlights how various Guard and U.S. military assets that had been deployed to Afghanistan as part of the war there were reassigned to support the U.S.'s flood relief efforts in Pakistan, revealing the successes and challenges of transitioning from a war-footing to disaster response. In exploring how Guard leaders partnered with counterparts from other components of the U.S. government, Pakistani officials, and members of the international humanitarian community, the case also examines how they navigated a set of difficult civilian-military dynamics during a particularly tense period in US-Pakistan relations.
This epilogue accompanies case number KS1160. In September 2014, as several West African countries continued to battle a deadly outbreak of the Ebola virus, Dallas, Texas emerged as ground zero for the disease in the U.S. This case recounts how, over the course of three days, Thomas Eric Duncan, who had recently arrived in the city from Liberia, reported twice to Dallas Presbyterian Hospital exhibiting signs of illness. Having sent him home after his first visit, the hospital admitted him after his second; and with his symptoms worsening rapidly, tests soon revealed everyone's worst fear: he had Ebola. "Fears and Realities" describes how local, state, and federal public health authorities, along with elected officials and hospital administrators, responded to the alarming news - a hugely difficult task made all the more challenging by confusion over Duncan's background and travel history, and, eventually, by the intense focus and considerable concern on the part of the media and public at large. Efforts to curtail the spread of the disease were further complicated when two nurses who had cared for Duncan also tested positive for Ebola, even though they apparently had followed CDC protocols when interacting with him. With three confirmed cases of the disease in Dallas - each patient with their own network of contacts - authorities scrambled to understand what was happening and to figure out a way to bring the crisis to an end before more people were exposed to the highly virulent disease. Case number KS1161.
In September 2014, as several West African countries continued to battle a deadly outbreak of the Ebola virus, Dallas, Texas emerged as ground zero for the disease in the U.S. This case recounts how, over the course of three days, Thomas Eric Duncan, who had recently arrived in the city from Liberia, reported twice to Dallas Presbyterian Hospital exhibiting signs of illness. Having sent him home after his first visit, the hospital admitted him after his second; and with his symptoms worsening rapidly, tests soon revealed everyone's worst fear: he had Ebola. "Fears and Realities" describes how local, state, and federal public health authorities, along with elected officials and hospital administrators, responded to the alarming news - a hugely difficult task made all the more challenging by confusion over Duncan's background and travel history, and, eventually, by the intense focus and considerable concern on the part of the media and public at large. Efforts to curtail the spread of the disease were further complicated when two nurses who had cared for Duncan also tested positive for Ebola, even though they apparently had followed CDC protocols when interacting with him. With three confirmed cases of the disease in Dallas - each patient with their own network of contacts - authorities scrambled to understand what was happening and to figure out a way to bring the crisis to an end before more people were exposed to the highly virulent disease.
From 2010 through 2013, the Oregon Health Authority's Public Health Division conducted its first health impact assessment (HIA), a process in which a public health organization draws on an array of analytical techniques to gauge the likely health effects of a policy or proposal in another sector (in this instance, the HIA examined the potential effects of wind farms - which constituted a large and growing element of the state's alternative energy strategy - on residents' health). After situating the HIA in the context of the state's "health in all policies" approach (which calls for public health to deepen its connection to other sectors), the case captures the genesis of the HIA, the implementation process, and the response following its publication. The case focuses on how the public health division's relatively small staff managed the HIA's surprisingly large workload and how the public health team worked to incorporate the perspectives of a diverse-and sometimes opposed-set of stakeholders, most notably grassroots opposition groups and representatives of the renewable energy sector. Case number 2038.0
In July 2012, a gunman entered a movie theater in Aurora, Colorado and opened fire, killing 12 people, injuring 58 others, and traumatizing a community. This case briefly describes the shooting and emergency response but focuses primarily on the recovery process in the year that followed. In particular, it highlights the work of the Aurora Public Schools, which under the leadership of Superintendent John L. Barry, drew on years of emergency management training to play a substantial role in the response and then unveiled an expansive recovery plan. This included hiring a full-time disaster recovery coordinator, partnering with an array of community organizations, and holding mental health workshops and other events to support APS community members. The case also details the range of reactions that staff and community members had to APS' efforts, broader community-wide recovery efforts, and stakeholders' perspectives on the effectiveness of the recovery. HKS Case Number 2024.0.
Like many other states at the time, Minnesota found itself facing several serious long-term public health challenges in the mid- and late-2000s, including rapidly rising health care costs and residents' increasing vulnerability to chronic diseases arising from unhealthy behaviors like smoking as well as higher obesity rates. Compounding these challenges, in 2008 a major economic recession took hold across the country, prompting states to target health and human services programs for extensive budget cuts. In Minnesota, even as the recession started to subside, analyses of the state budget indicated that it needed new strategies for slowing the growth rate of health care spending; and in response the state legislature passed a major health reform law that, among other things, aimed to reduce costs. A key component of this law was the establishment of the Statewide Health Improvement Program (SHIP), which sought to reduce smoking and obesity rates - two of the main drivers of a number of chronic diseases and, hence, of higher long-term health costs for the state. In designing and launching SHIP, state health officials decided to focus on developing a close partnership with the private sector. This, they believed, would enable them to combine government's wide ranging authorities and subject matter expertise in public health with the private sector's broad reach and its advanced marketing and communication practices and resources. This case tells the story of how leaders of the SHIP initiative worked with businesses and corporate executives in an effort to have as far-reaching an impact as possible. It highlights the mutual advantages of a public-private partnership while also illustrating challenges the two sides encountered as they worked to develop and implement the program. HKS Case Number 2004.0.