Integrated Pluralistic Governance and Public Health Emergency Response

Lance Gable, Wayne State University

Abstract

This Article examines the significant governance challenges inherent in 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, as well as 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, Hurricane Katrina and its aftermath 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.