Education Access & Quality

Social determinants of health (SDOH) are non-medical factors that influence health outcomes. They are the conditions in which people are born, live, learn, work, play, worship, and age, and the wider set of forces and systems shaping the conditions of daily life.

SDOH are grouped by Healthy People 2030 into five key areas. This discussion guide focuses on the area of education access and quality. This area refers to the connection of education and training to health and well-being.

Before the Discussion

If you have not already done so, please take the following steps:

• Review the introduction and discussion guide instructions for information on how to use the guide.
• Learn more about SDOH (e.g., education access and quality), key issues, and the lived experiences of people with limited access to quality education and training (i.e., understanding of your audience).
• Familiarize yourself with local voluntary organizations active in disaster (VOAD) and the services they provide.
• Create a list of partner government and community-based agencies to invite to your discussion. Use the prework questions to help you decide who to invite. Invitees should include VOAD whose services support people with limited access to quality education and training.
• Decide if you will distribute the prework questions to participants in advance of the activity or answer the questions as a group before the activity. If you opt for the former, ask participants to record their answers and bring them to the activity.

Education Access & Quality

Education access and quality includes key issues such as educational attainment in general and language and literacy. These factors can influence how people prepare for and respond to an emergency. For example,

• People with limited English proficiency may find it difficult to receive, understand, and take protective actions, such as evacuating during an emergency.
• People who aren’t taught media and online-search literacy skills can have difficulty identifying reputable sources of crisis and emergency risk information.
• People who live in rural and lower-income communities may have fewer training opportunities to learn practical skills they can use during an emergency. Examples include cardiopulmonary resuscitation (CPR) and how to “Stop the Bleed.”

The objectives of this discussion-based activity are to help emergency planners

• better understand how conditions associated with access to quality education and training can affect people’s preparedness for and response to emergencies.
• identify gaps in emergency planning and partnerships associated with access to quality education and training and their impacts on people’s preparedness for and response to emergencies.
• ideate ways to build new and leverage existing partnerships in the whole community to reduce or remove barriers to personal health preparedness for and response to emergencies.

Just promoting healthy choices and protective actions won’t eliminate the impacts of SDOH. Public health departments and their partners must act to understand and address conditions of access to quality education and training in their planning and processes.

Scenario Overview

The discussion guides in this series use the scenario of a mass evacuation. Mass evacuations are possible in response to many different types of emergencies, including hurricanes, chemical spills, and wildfires.

An evacuation order may raise questions in the minds of many people in the community.

• “Why is there an evacuation order?”
• “What am I being asked to do?”
• “Why am I being asked to evacuate? What’s the danger if I don’t?”

Often, it’s not just a matter of following an evacuation order. There’s also the matter of being able to find, understand, and use messages to take protective action for themselves and others.

Please note that neither this scenario nor the discussion questions address all key issues associated with access to quality education and training. Examples and evidence of SDOH impacts and interventions are likely to evolve with additional research and experience.

Lessons from the Field

Review the below key issues and barriers that a mass evacuation might cause members of your community.

Think of past events that caused perceptible preparedness and response challenges in/to your community. Incorporate identified gaps and lessons learned from those events into your discussion. Lived experiences can add depth to your discussion.

Key Issues & Barriers

An evacuation order has been issued in your community.

Some people with limited literacy or education, including people with limited English proficiency (LEP), have either not received or do not understand the evacuation order.

Some people decide not to evacuate because they do not understand the notification.

Some people who live in rural areas are less connected to other people and community organizations. As a result, they rely on word of mouth for emergency notifications and are not aware of the evacuation order.

Discussion Questions

• What plans and procedures do you have for helping people find, understand, and use crisis and emergency risk communications and services?
  • Do plans include strategies that promote equitable access to information?
  • Do you design content for translation?
  • What plans and procedures do you follow for translating communications?
  • What are the most commonly spoken languages in your community? Do you have predeveloped communication in these languages?
• What plans and procedures do you have for reviewing crisis and emergency risk communications?
  • How do you ensure the cultural and linguistic appropriateness of content?
  • Do your communications follow National Standards for Culturally and Linguistically Appropriate Services standards?
  • What plans and procedures do you have for testing crisis and emergency risk communications? How can you recruit people from your intended audience to help test predeveloped materials and messages?
  • What plans and procedures do you have for adapting messages/materials to the diverse communication needs of different communities? (Example: The Puerto Rico Department of Health learned during Hurricane Maria that the best way to reach some geographically isolated communities in rural areas was with informative pamphlets. Pamphlets on topics such as food and water safety, vector control, mold, and mental health were distributed by military partners and delivered door-to-door by faith- and community-based organizations [Access and Functional Needs Toolkit, Integrating Community Partner Network to Inform Risk Communication Strategies, CDC]).
• What plans and procedures do you have for communicating with people who can/do not access and use the Internet?
  • What communication strategies (e.g., radio, door-to-door notifications, sirens) are available in your community?
  • How can your community be a part of a Community Outreach Information Network (COIN) or similar initiative if not already? A COIN is a group of trusted messengers, including faith- and community-based organizations, who can help with response planning, messaging testing, and disseminating information during emergencies.
  • How often does your community exercise the partner dissemination pathways it would use during an emergency?
• What plans and procedures do you have for communicating with people who have low online-search literacy?
  • How do you detect misinformation in your community?
  • What traditional and new media do you use to address misinformation in your community?
  • How can your community partner with other organizations to address misinformation?
• What training opportunities are available to people who want to learn preparedness and response skills?
  • Are these training opportunities accessible to people who live in rural or low-income communities?
  • Does your community support a Medical Reserve Corp Unit or Community Emergency Response Team? How can you encourage rural or low-income community members to engage with these teams?
  • How can your community partner with other organizations to create new training opportunities?
  • Have your community’s health communicators and officials taken Crisis and Emergency Risk Communication training?

After Your Discussion

A lot of useful information should come out of your discussion. Use this information to take actions that better prepare your community. Next steps may include the following:

1. Collect written or typed notes and any additional feedback from the note taker and participants. If the meeting is virtual, consider reviewing the transcript for additional insights, if you chose to record the meeting.
2. Summarize the discussion and detail any after actions in a written report (optional). A simple follow-up e-mail with highlights of the discussion and action items can ensure these ideas are implemented in future planning and response efforts.
3. Stay informed of contributions to the preparedness and response knowledge base and evidence-based resources related to education access and quality. Evidence of SDOH impacts in emergency response is likely to evolve with additional research and experience.
4. Seek out promising practices (i.e., interventions that include measurable results and report successful outcomes) that have removed or reduced the impacts of access to quality education and training on people’s preparedness for and response to emergencies. Examples of SDOH interventions are likely to evolve with additional research and experience.

Promising Practice

The San Diego County Emergency Operations Center (EOC) partners with more than 300 trusted community partners to translate critical information to non-English speaking communities through the Partner Relay Network.

The Partner Relay Network is an online, collaborative platform that receives emergency updates from the EOC, and community partners translate and disseminate this information to their communities via social media, texts, phones, and gatherings.

Resources

The below list of resources is not exhaustive. Neither the inclusion nor the mention of a resource in this discussion guide suggests an endorsement of a group, product, or service by CDC.

1. About Social Determinants of Health, CDC
2. Access and Functional Needs Toolkit Integrating a Community Partner Network to Inform Risk Communication Strategies, CDC
3. Public Health Emergency Preparedness and Response Capabilities: National Standards for State, Local, Tribal, and Territorial Public Health, CDC
4. Public Health Workbook: To Define, Locate, and Reach Special, Vulnerable, and At-risk Populations in an Emergency, CDC
5. Topic Collection for People with Access and Functional Needs, ASPR TRACIE