Assessing and Addressing US Health Security Risks

T here are a range of worrisome threats to US health and national security—worrisome because they have the potential to cause widespread disruption and damage to the public's health and to the US and global economies. These threats include major natural hazards like large earthquakes and hurricanes and infectious disease pandemics ; accidental threats, including technological failures, such as nuclear power plant disasters like Three Mile Island and Fukushima; and intentional attacks by thinking adversaries , including terrorist use of biological, chemical, or nuclear/radiological weapons. Securing the United States against threats to health and security inherently involves tradeoffs. Not every health security–related threat carries the same level of risk to the country, and not every government program addressing those threats can have top priority. So, with many and varied health security threats and with limited resources to address them, it is important for the United States to have a clear process for determining risks and tradeoffs in a way that affords the public the most protection we can offer. Utilizing our best risk assessment methodologies is an important part of determining risk and setting national priorities. Risk assessment is useful both for understanding the range of possible health security challenges the country might face (eg, possible disaster/outbreak scenarios) and for gathering data and knowledge about threats, which may help security and public health experts prepare and respond if something does occur. It involves a systematic evaluation of the likelihood (probability) of an event occurring, as well as of the consequences that result when a disaster does happen (eg, illnesses, injuries, deaths, and economic disruption). A purposeful risk assessment process can help leaders compare the severity of different types of health security risk and can inform decisions about where funding and resources are most needed. Risk assessment allows decision makers to view a wider range of risk scenarios and examine them systematically. Without a formal process to assess risk, decision makers often rely on personal experience, which is inherently limited (we are only human after all). Conducting a risk assessment that systematically compares likelihood, vulnerability, and consequences for different scenarios helps reduce individual and group biases, which can prevent decision makers from seeing the full picture of risk before decisions are made. Risk assessment is currently carried out by a variety of federal, state, and local government agencies for important but varied and delimited purposes. For example, the Department of Homeland …