| BACKGROUNDWith promotion of industrialization, development of urbanization andglobalization, we have stepped into high risk society from traditional society. In current social life, emergent incident has increasingly became normality to whether a country or a region. American 9·11 in 2001 and subsequent white anthrax terrorism had brought international society into emergent status of public incidents response. SARS, which broke out in 32 countries and regions, knolled warning alarm for preparing the global unexpected public crisis.Social justice, good governance and effective emergency management are three cornerstones of constructing harmonious society. Social stability and public security must be the prerequisite and guarantee for implementing Concept for Sustainable Development and constructing harmonious society. Continuous incidents could seriously damage social stability and economy, and even destroy achievements of social development.Centers for Disease Control and Prevention (CDC) are a crucial institution comprising public health system in China. The competence of emergency preparedness is directly rested with the emergency response capability of CDC. Public health emergency to a large extent is inevitable, even can not be accurately predicted. However, it can be prevented; at least its affection and damage can be alleviated and decelerated. Consequently, it is more important to strengthen the emergency management of public health incidents. And the key point of strengthening the construction for emergency response capability is to evaluate it, and inspect the emergency response factors' completeness, coordination and comprehensive capability which can to a large extent of alleviate affection and damage of, such as manpower, organization, institution, technology and resources which are required in face of emergency for CDC at all levels.By three years constructions for public health system after SARS, CDC at all levels had gotten considerable developments in emergency response capability, and constant withstood a serious of challenges of public health emergency. CDC at county level are always the first responders of the public health emergency, are direct main battlefield of disaster rescue and disease prevention. The level and capability of its emergency response, and whether it can estimate character and trend of the emergency correctly and take timely and effective control measures, has important significance for preparing and preventing public health emergency successfully.Based on this, the rationale of the research included three aspects as follows:First, practical requirements of public health emergency operation: a) it was implementing laws and regulations requirements; b) it was practical evidence requirement of emergency operation.Second, lack of theory research of public health emergency: not unified in definition, confusion of incidents classification and grade scales, and lack of basic research of evaluation indicator, evaluation standard and evaluation method.Third, evaluation practice challenges of emergency response capability: for the time being, evaluation research subject of response capability was more focusing on the research of city and government response capability or response capability to some disasters; the researches of CDC response capability were also focusing on the provincial and municipal levels. Finite researches on emergency response capability of CDC institutions at county level are insufficient in terms of research dimensions and depth, and indicators system and evaluation methods were unpractical. The evaluation of emergency response capability could neither reflect the guidance and orientation function of capability evaluation, nor promoted the emergency response capability construction for CDC at county level.Developing evaluation research of emergency response capability for CDC at county level was either the basic of response capability construction, or an important work for inspecting completeness and coordination of the emergency response factors, including manpower, organization, institution, technology and resources which were required in face of emergency. And it was an important work of strengthening the construction of emergency response capability by searching out the advantage and shortage of emergency management. Furthermore, the top-down policymaking was more seeking truth from facts and combining with practical, then meeting the requirement of modern management.OBJECTIVEBased on current situation and problem-oriented research of public health emergency, and utilizing related basic theories of emergency response and management, the research studied the characteristics, occurrence mechanism, hierarchical classification and response mechanism of public health incidents, and studied component elements and evaluation system of emergency response capability; by using field investigation and theory research, and drawing lessons from literatures of research results and best practices at home and abroad, this research explored to establish evaluation indicators, standard and method of emergency response capability for CDC at county level in order to provide a guidance and orientation in capacity building practice; based on quantitative evaluation of emergency response capability, the research diagnosed the defects of emergency response capability for CDC at county level, and identified advantages and disadvantages of the emergency management, then providing suggestions of planning and reforming policy in emergency preparedness.METHODOLOGYAccording to methodological principle of combining common with specialty, theory with practice, system with part, internal aspects with external, and utilizing theoretical method and demonstrating methods, the research studied and evaluated the emergency response capability for public health incidents, then providing policy suggestions for further improvement of public health emergency response capability.Through knowing present situation, evaluation system, advantages and disadvantages, and so on by literature review, the research constructed essential thoughts by utilizing system analysis method to study emergency response system and capability, and core elements of capability evaluation. In accordance with the data, experiences and facts acquired, and utilizing logic argument and deductive inductive analogical methods, this research analyzed the action of emergency response capability for public health incidents from both theory and practice. Using Delphi method, establishing basic framework and indicator screening of emergency response capability evaluation indicator system, this research determined evaluation indicator weight by Analytic Hierarchy Process, and chose Qingdao as a sample city.RESULTSa. This research discussed occurrence and response mechanism of public health incident theoretically. It clarified the hierarchical classification standard, and proposed three elements and four elements occurrence mechanism of public health emergency, generalizing influencing factors of public health emergency to people, matters, environment and management, which comprised four basic factors. And it classified mechanism system of public health emergency into three systems and eight types from three processes of occurrence, development and evolution.b. Established emergency management system from conception, including three dimensions of time dimension, knowledge dimension and logic dimension. Clarified core emergency response capability of prevention stage, operation stage and Post-Emergency Response Rehabilitation and Reconstruction stage in the whole process and established evaluation indicator sets of emergency response capability for technology element indicator set and management indicator set.c. Clarified component elements and evaluation indicator system of emergency response capability for CDC. Proposed and established STORM framework (Surveillance & Warning Capacity, Technical implementation Capacity, Resources Store Capacity, Operation Management Capacity, Mobilization & Coordination Capacity), including 5 first grade indicators and 24 second grade indicators. The study also proposed emergency response capability evaluation standards, 4 level states as well as planning measures and priority of emergency capability building.d. Made demonstration study by utilizing evaluation model of emergency response capability for public health incidents. Evaluating the present situation of emergency response capability in 12 sample cities, the level state of whole emergency response capability was weak; simulating result showed that improving the weight of operation management capability and Surveillance and Warning capability could improve comprehensive scores of CDC emergency response capability respectively; meanwhile averagely decreasing indicator weight of other one grade could improve comprehensive scores of 12 samples emergency response capabilityCONCLUSIONS & SUGGESTIONSa. The emergency response capability evaluation for CDC at county level should emphasize on the specialty as main content of public health emergency, and it should be combined with generality of public health emergency. According to common characteristics reflected by the perspective which was combined object with subject, macrocosm with microcosm, it clarified 5 levels contents which reflected the response capability based on the center of emergency response capability evaluation for CDC at county level.b. The evaluation comprehensive indicators of emergency response capability for CDC at county level must reflect the influence for indicator system of 5 respective weights, including Surveillance & Warning, Technical implementation, Resources Store, Operation Management and Mobilization & Coordination. These were main indicators to evaluate emergency response capability for CDC.c. In the process of preparing and operating public health emergency, the improvement of emergency response capability for CDC at county level was the realization process of dynamic mutual coordination and perfect states. It included 5 respects: Surveillance & Warning capacity, Technical implementation capacity, Resources Store capacity, Operation Management capacity and Mobilization & Coordination capacity.d. In the process of improving emergency response capability for CDC, well coordination of the 5 dimensions must be based on the scientific indicator system and evaluation method. Consequently, according to either the connotation of emergency response capability or its evaluation practice, we should regard evaluation indicator system as a carrier of emergency response capability evaluation. Improving the indicator system was the theoretical foundation of emergency response capability evaluation.e. According to The Emergency Response Law of the People's Republic of China, government and involved department at county level was the responsibility subject of ordinary (four levels: especially serious, serious, large and ordinary) emergency response. From practical results of 12 samples, government should further improve the construction and promotion of operation management capability, and surveillance and warning capability on the premise of guaranteeing economic investment, to prepare and operate public health emergency timely, properly and effectively.INNOVATIONS & LIMITATIONSThe innovations of this research were as follows:First, research oriented on field with important practice value but lack of theory.The current research was mainly focused on the indicator system of establishing regional emergency response capability, while the research subject was focused on the indicator system of emergency response capability and exploration of its support theory. The research started with occurrence mechanism and characteristics of public health emergency, with investigated the response mechanism, then analyzing contradictive disciplinarian between occurrence and response of public health emergency, which could strengthen the conception of response management, supplement and improve related theory system of emergency response capability.Second, research object was oriented on the CDC at county level, which had the significant responsibility of prevention in the frontline of response and operation.Because of in the frontline of emergency response for public health incidents, CDC at county level took the most responsibility of prevention and operation, but the emphasized aspects and depth of current research were both inadequate. By analyzing component elements of emergency response capability for public health emergency, and mainly analyzing emergency response capability and constructing comprehensive evaluation system, this study focused on CDC at county level, had important significance for implementing emergency response strategy, evaluating emergency response capability and strengthening capability construction for CDC in face of serious disasters and emergencies.Third, integration of research method and indicator screening could efficiently realize longitudinal and horizontal evaluation between institutions.Indicator evaluation system of emergency response capability constructing by Delphi and AHP, was beneficial to evaluate comprehensive emergency response capability clearly, and could provide a feasible standard and operational instrument for evaluation among different institutions or even third party evaluation, which had important practical significance for searching advantage and shortage of emergency response capability and improving management and response capability for public health crisis.Limitations:The evaluation of emergency response capability was a complicated system project which had abundant contents, various methods and multi-disciplinary theory. In specific practice of public health, governments at all levels and involved institutions highly emphasized the construction and evaluation of emergency response capability for public health incidents. Although the research had done lots of studies, and constructed capability evaluation indicator and model framework, it still left many detail problems to be investigated and studied because of complex research object and limited research capability.First, study samples. The study samples were 12 regional CDC institutions of Qingdao. Although all the samples were investigated and met the research requirement according to research purpose, there still existed some problems on it. If sample data from different economic status at provincial level or from other regions were acquired, it would greatly modified and improved the conclusion of the research.Second, screening and selecting evaluation indicators. Owing to lack of further research and experience of emergency response capability for CDC at county level, some evaluation indicators may be overlooked or selected improperly. So we need further study to keep the indicator system improved and reasonable.Third, research on classification and level of public health incidents. The research theoretically constructed a model of level and classification which was based on infectious disease of public health emergency. It was difficult to get a nice model by Delphi method because of limited time and finance. Consequently, it couldn't provide every indicator weight, which made grading method unsuccessful in aspect of quantitative analysis.RESEARCH PROSPECTSFirst, improving practice research of evaluation indicator system of CDC emergency response capability for public health incidents. The regional practice research provided evidence for evaluating emergency response capability for CDC at county level. It will provide perfect evidence on evaluating emergency response capability for county CDC properly and comprehensively if the survey carried out in nationwide and provincial level or continuous data collection in a region.Second, improving research on theory and practice by combining quantitative and qualitative method at all levels and classifications of public health emergency. The research didn't do grading practical research according to different types of infectious disease and other kinds of public health emergencies. The study result could be regarded as the starting point for further studying public health emergency and probation on realizing the target of comprehensive and scientific classification and grading for public health emergencies.
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