Abstract:
This Article examines the significant governance challenges that
arise during responses to public health emergencies and proposes a
new multifaceted strategy—integrated pluralistic governance—to
address these challenges. Emergency preparedness is an inherently
complex problem that entails the integration of scientific and medical
expertise, good logistical planning, and clear laws and policies. The
governance function has particular import for public health
emergencies because pandemics, hurricanes, and other disasters can
have profoundly divisive social and political consequences.
Moreover, recent disasters like Hurricane Katrina and the BP
Deepwater Horizon oil spill revealed an emergency preparedness and
response infrastructure in the United States that was broken: starved
of necessary resources, beset by problems at all levels of government,
and undermined by poor decision making at each of these levels.Governance theories are particularly relevant to addressing the
challenges posed by public health emergencies because these theories
can help to explain and shape outcomes within complex systems. This
Article delineates and explores three categories of governance
models: traditional governance models, New Governance models,
and diffuse governance models. These models provide insight into
existing efforts to govern public health emergencies within and
outside of formal emergency response systems and highlight
unexplored avenues for strengthening these systems. Integrated
pluralistic governance adopts aspects of all three governance models
and encourages the development of concurrency, coordination, and
redundancy to create a more effective and resilient public health
emergency response system.