Healthcare and Public Health Critical Infrastructure Sector

In an attempt to optimize the resilience and the security of the nation’s critical infrastructure, it is significant to apply a concerted approach to integrate all the critical stakeholders and partners.  One of the critical infrastructure sectors is healthcare and public health sector towards this integration. Due to this, it is quintessential to ensure healthcare operations are in continuity during an emergency. This is facilitated through disaster response making it an asset that upraises its significance to national security more than the partner’s status. It is crucial to apply a sector-specific plan that enhances its association with the stakeholders in healthcare and public health sector where it liaises with the Homeland Security department. 

The Profile of Healthcare and Public Health (HPH) Sector

The HPH sector can be termed as an open, diverse, and large sector that spans both in the private and public sector. It is inclusive of publicly accessible healthcare facilities, manufacturers, suppliers, research centers, as well as, other physical assets that are complex and large public-private information technology systems.  This system is essential in the delivery of quality care to residents, as well as, supporting the secure and fast transmission and storage of large healthcare sector data. One of the critical elements in HPH sector in the maintenance of national health security is the accessibility to health. According to Walker-Roberts, Hammoudeh, and Dehghantanha (2018), approximately 262 million Americans seek outpatient department or emergency units and at any time, approximately 50% of individuals seek at least one prescription to mitigate health problems. This is an indication of the great impact disruption of the HPH would have on society. 

Some of HPH reforms like the Affordable Care Act and Patient Protection Act initiate innovations in healthcare delivery, as well as, patient’s care. This benefits the HPH, as well as, introduce potential vulnerabilities in particular due to information security risks. The cost and efficiency of the healthcare sector have been enhanced by the overreliance of health situational awareness upon cost-effective real-time data transmission due to the vast enactment of health information technology (Health IT). Nonetheless, the system is at risk of cyber disruptions and communication failures (Homeland Security, 2016). 

In the present world, critical infrastructures continue to face threats, which have diversified to biological and digital platforms. Security and resilience have been promoted by Healthcare and Public Health (HPH) Sector-Specific Plan (SSP) to cover all hazards in critical infrastructures. For its success, there is a need to link the strategic guidance to the unique operating landscape and risk landscape of this critical infrastructure.  An integrated approach has been formulated by healthcare and public health sector, which is founded on the National Infrastructure Protection Plan 2013 (Homeland Security, 2016). This approach aims to manage the risks of HPH, as well as, its employees. The HPH SSP framework is as illustrated in figure 1

Figure 1: HPH SPP Framework (Homeland Security, 2016)

The SSP framework is an integration of Federal departments and agencies, SLTT governments, and the private sector, all with the objective of reducing the critical infrastructure risk. The SSP audience includes the community, which consists of private sector owners and operators, international partners, SLTT government organizations, Federal departments and agencies, as well as, other private and non-profit organizations that have a role to play in strengthening and securing security and resilience of HPH sector critical infrastructure. 

The integrated approach in HPH identifies and prepares both the potential threats and hazards. In national preparedness, it assumes that all potential risks and hazards are imminent. May and Koski (2013) explain that there is a need to leverage simulation technology that explores all dimensions such as after biological or chemical attack.  The sector-specific attack is seen as vital as it utilizes potential risks scenarios as cast in films. This is particularly significant following the last terrorist attack, which was characterized by a lapse of imaginings. 

Another form of national preparedness is mitigation of weaknesses established in the healthcare and public health sector critical infrastructure, its systems, and its networks. At this stage, there is a need to identify any vulnerability and ad hoc plans applied to resolve the issues. It is essential to note that the critical infrastructure within the purview stretches beyond the internals assets (May and Koski, 2013). The approach aims at reducing the potential impact of the eventualities, as well as, timely restoration of the optimal functioning of HPH. This calls for a need to optimize collaborative risk management and public-private partnership. For efficiency, it is essential that the health and the public health sector align its objectives and goals, as well as, ensuring the free flow of information in all processes.

Emerging Hazards and Threats in HPH

One group of hazard or threat is climate change, extreme weather, and natural disasters. Due to its vast spread, the HPH sector (including supply chains, information systems, employees and facilities) is at risk of natural disasters. Extreme weather and climate change can greatly affect HPH, for example, during the 2012 Superstorm Sandy and 2011 Joplin Tornado. This creates a challenge to any attempts to mitigate operational disruptions following its continual to meet the increasing demand. 

Another emerging risk and hazards are pandemics and health crisis. Achour and Price (2010) explain that emerging and re-emerging healthcare issues (diseases) places the HPH employees at risk and greatly influences their productivity.  Some of the re-emerging health issues facing the U.S. today include the severe influenza pandemic, Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS). Additionally, the sector is facing challenges and stresses from multidrug-resistant bacteria and supply shortages. In particular, the multidrug-resistant bacteria are directly challenging healthcare workers, HPH facilities, suppliers of diagnostic equipment, and poses hazards to patients.  According to Walker-Roberts, Hammoudeh, and Dehghantanha (2018), approximately 23,000 persons die every year while two million attain illnesses resulting from drug-resistant bacteria in the United States annually.

The third emerging hazard is supply chain corruption and disruptions. An efficient supply chain ensures that supplies are on time ensuring the HPH sector has the capacity to handle an emergency, diagnostic capabilities, or inventories to enable the majority of health professionals sensitive to cascade the implications of system-level corruptions and disruptions. According to Achour and Price (2010), the majority of HPH operators are in the private sector and any disruptions in this sector may result in delays and disruptions of care delivery to patients. Additionally, unprecedented speed in rapid global transportation networks can unintentionally deliver contaminated food, tainted blood products, adulterated pharmaceutical supplies, or disseminate diseases. 

The fourth threat is malicious human acts where for examples domestic extremist groups, malicious actors, or international terrorists may disseminate chemical or biological agents, use explosive, nuclear, or radiological devices or even attack the HPH critical infrastructure sector (O’Sullivan et al, 2013). These acts can cause national, regional, or local disruption to the delivery of vital services. Another form of threats is cyber-attacks. This is particularly in the IT department in the health sector, which stores and transmits personally identifiable health information to control financial operations, maintain patient records, and ensure delivery of care.

The Subsectors of HPH

One of the subsectors is public health, which integrates with the healthcare sector to improve the health of the residents through community services, policy, and education. Some of the public health services financed by the government include health information communication and outreach, laboratory testing and coordination, emergency response, preparedness planning, epidemiological surveillance, and programs, which boost community resilience (O’Sullivan et al 2013). Homeland Security (2016) explains that the role of public health programs includes conducting response and recovery solutions, facilitating joint public-private sector plans and exercise, developing mitigation strategies and plans, and guiding local hazard and risk assessments. 

Another subsector for HPH is the Federal government. Walker-Roberts, Hammoudeh, and Dehghantanha (2018) explain that HPH critical infrastructure requires funds, development of policies, and coordination of Federal Government activities.  Some of the coordinated activities are provided in the Emergency Support Function (ESF). In addition, the sector contains GCC (Government Coordinating Council), which is inclusive of dynamic federal and government partners. The partners originate from varying departments including the DoD (Department of Defense), HHS and any other sector willing to assist the system’s resilience, as well as, supporting the healthcare and public health sector operations. 

Preparedness

One of the roles of the HPH is joining the critical infrastructure to national preparedness communities. The HPH members attain this through the identification of capability gaps where they focus on the risk management activities of the sector. Based on the capability gaps, it is possible for the members to evaluate and formulate corrective measures. From these measures, the HPH should collaborate with other critical infrastructure and emergency management communities to identify the best practices. Correspondingly, facing disasters and other hazards gives the sector the reason for improving their information system, achieve shared situational awareness, complications of infrastructure systems, and its interdependencies and dependencies to support restoration activities (Dudenhoeffer, Permann, and Manic, 2006). 

Conclusion

The critical infrastructure of the healthcare and public health sector operate in a dynamic and complex environment. The environment for HPH is characterized by a complicated and diverse mix of both natural and man-made hazards and threats. Some of the identified threats and hazards in the HPH sector include corruption in the supply chain; climate change, extreme weather, and natural disasters; pandemics and health crisis; cybersecurity and malicious human acts. However, the HPH cannot be effective without integration with Federal departments and agencies, SLTT governments, and the private sector.  

The diverse and dynamic risks facing the healthcare and public health sector requires a dynamic approach to risk management. Due to this, there is a need for the SSP to be flexible to attain the HPH sector goals including partnership and information sharing mechanisms, performance metrics, and priority activities. Therefore, every step in disaster management is essential in managing risks and hazards in the healthcare and public health sector critical infrastructure.

Reference

Achour, N., & Price, A. D. (2010). Resilience strategies of healthcare facilities: present and future. International Journal of Disaster Resilience in the Built Environment, 1(3), 264-276.

Dudenhoeffer, D. D., Permann, M. R., & Manic, M. (2006, December). CIMS: A framework for infrastructure interdependency modeling and analysis. In Proceedings of the 38th conference on Winter simulation (pp. 478-485). Winter Simulation Conference.

Homeland Security (2016). Healthcare and Public Health Sector-Specific Plan. Homeland Security. [online] Available at: https://www.phe.gov/Preparedness/planning/cip/Documents/2016-hph-ssp.pdf [Accessed 26 Apr. 2019].

May, P. J., & Koski, C. (2013). Addressing public risks: Extreme events and critical infrastructures. Review of Policy Research, 30(2), 139-159.

O’Sullivan, T. L., Kuziemsky, C. E., Toal-Sullivan, D., & Corneil, W. (2013). Unraveling the complexities of disaster management: A framework for critical social infrastructure to promote population health and resilience. Social Science & Medicine, 93, 238-246.

Walker-Roberts, S., Hammoudeh, M., & Dehghantanha, A. (2018). A systematic review of the availability and efficacy of countermeasures to internal threats in healthcare critical infrastructure. IEEE Access, 6, 25167-25177.