(Preface from Keim M. Emergency Health APHA Press, Washington, DC 2023)


I believe in public health.

  • Because of people like John Snow, I believe that disease does not occur randomly.
  • Because of Edward Jenner, I believe that disease can be prevented, 
  • And because of Edwin Chadwick, I believe that people must be protected.

I believe…

  • that social and environmental determinants of health influence modifiable risk factors for disease;
  • that public health’s role is to engage multiple sectors and community partners;
  • in the 10 essential public health services and;
  • in public health’s purpose that includes prevention, protection, promotion, response, and equity of access and quality;
  • that the highest degree of public health impact results from dealing with health determinants and risk factors

Why do I believe these things? I do so because they are proven.

And yet, to this day, public health has still not applied even these most basic principles and practices to address morbidity and mortality caused by disaster-related hazards.

Our current reactionary approach is expensive and ineffective.


There are no validated models for predicting disaster-related health risks. Most disaster-related epidemiological investigations assess victim demographics without correlation with other critical risk factors, such as geographical location and dose of hazardous exposure.

Considered in John Snow’s terms, every year (for many decades now), we count the number of cholera cases without bothering to find the contaminated well, let alone remove the pump handle. More recently (after Hurricane Maria hit Puerto Rico, and the lack of COVID testing during the pandemic) some have noted that public health no longer even counts all the cases!

Over the past 50 years the focus of the US approach to managing environmental health emergencies (as compared with managing infectious disease emergencies) has been mostly reactionary and curative, rather than precautionary and preventive.

For this reason, we have very few measures of effectiveness for either public health preparedness or response after literally hundreds of millions of dollars in public and private investment.

For this same reason, we should return to the basics of public health to address this health problem. And it is also for this reason that I write this book. Here I propose emergency health as a new paradigm that is better aligned with public health principles and as a more equitable and effective application of public health practice as applied to disasters.

Learn more at APHA Press

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