PHE 500 Module 5 Milestone Two Example

Everyone Has a Stake, Few Have a Seat: Stakeholders and the Public Health Response to Rabies in a Pennsylvania County

[Student Name]

Southern New Hampshire University

PHE 500: Principles of Public Health

Final Project Milestone Two

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Everyone Has a Stake, Few Have a Seat: Stakeholders and the Public Health Response to Rabies in a Pennsylvania County

Milestone One established that rabies deaths are rare in the county while exposures and vaccine courses are rising, and that cost makes protection uneven. This milestone asks who is affected, who acts and how the public health system currently responds. It identifies stakeholders, analyzes their interests and influence, describes the response through the three core functions and points out the gaps that later recommendations will need to close.

Stakeholder Map

Stakeholders were identified from the health department's contact logs, the spring partner meeting roster and interviews with the two rabies nurses. Table 1 summarizes them.

Table 1. Stakeholders in county rabies prevention

Note. Influence reflects ability to change the county's response.

What Stakeholders Said

Short conversations with six stakeholders added detail the table cannot show. A camp director said she reported the bat exposure immediately but worried for weeks that parents would pull their children. An emergency physician said the hospital sometimes has to order immune globulin from a regional distributor on weekends, which can delay the first dose by a day. A farm worker outreach nurse said several workers had been scratched by barn cats and never reported it, fearing cost and questions about status. A veterinarian said owners of barn cats rarely vaccinate them because the cats are not seen as pets. A wildlife rehabilitator said she takes in bats every summer and has never been asked to the partner meeting. And an animal control officer said he covers four townships alone.

Interests That Align and Collide

Most stakeholders share the goal of no human cases. Their interests diverge on cost and attention. Hospitals need to be paid for immune globulin, while uninsured residents need to afford it. Camps want bat exposures handled quietly to protect enrollment, while the health department needs prompt reports and sometimes public notice. Wildlife rehabilitators want to treat injured raccoons and bats, while animal control prefers to remove them. Farmers want quick answers so they can return to work, while investigations take time. Recognizing these tensions explains why some steps in the response stall even when everyone agrees on the goal.

The Current Response: Assessment

Assessment means gathering and analyzing information on the community's health in a systematic way (Institute of Medicine, 1988). In the county, assessment rests on bite reports from clinicians and residents, laboratory results from the state and a spreadsheet of vaccine authorizations. Its weakness is completeness. Christian et al. (2009) found that the nation has no reporting system for post-exposure prophylaxis, and the county's own count depends on the hospital pharmacy calling the department. Urgent care clinics outside the county seat report late.

The Current Response: Policy Development

Policy in rabies is set mainly by the state, which requires vaccination of dogs and cats and defines quarantine periods after exposure. The county's role is to apply these rules and to keep a response plan. That plan predates the most recent federal vaccine guidance and does not address cost, camps or language access. No county policy guides when the public should be notified of a rabid animal in a neighborhood.

The Current Response: Assurance

Assurance is strongest in the clinical chain. Every exposed resident who calls is assessed, and vaccine is available at the county's two hospitals. Pet vaccination is assured through low-cost clinics held six times a year with local veterinarians, which vaccinated 1,840 animals last year. Across the wider countryside, the federal and state oral vaccine program places baits in parts of the state to slow raccoon rabies (Slate et al., 2009), though the county lies outside its current zone. Assurance is weakest in affordability and outreach to residents who do not speak English or who avoid government contact.

Partnerships

The spring partner meeting brings together the health department, animal control, veterinarians, both hospitals and the camps. It is the system's best asset, because it means people know whom to call. Missing from the table are wildlife rehabilitators, urgent care clinics, the farm workers' outreach program run by a regional clinic and Amish community leaders. Castrucci (2021) argued that the essential services framework helps public health explain its role to partners; using it at the meeting could show each group where it fits.

An Equity View of the Response

Looking at the response by who it serves well reveals a clear pattern. Insured, English-speaking residents who live near the county seat and call promptly receive a fast, complete response. Uninsured farm workers, Amish families and residents far from the hospitals face more steps, more cost and more delay. The response is not designed to exclude anyone, but its default path fits some residents far better than others.

Implications for the Analysis

Three findings will shape the interventions milestone. The response depends on a few highly influential stakeholders, especially hospitals and the state, so recommendations need their support. Residents with the most exposure and the least access have the least influence, so equity requires deliberately bringing them in. And many problems are seams between partners, not failures of any single one, which points toward coordination as much as new programs.

Conclusion

The county's rabies response works because a small set of partners trust one another. It strains where costs fall on residents, where reports arrive late and where key groups have no seat at the table. Milestone Three will test interventions against these gaps.

Those tests will start with the residents the current path serves least.

References

Castrucci, B. C. (2021). The "10 Essential Public Health Services" is the common framework needed to communicate about public health. American Journal of Public Health, 111(4), 598-599. https://doi.org/10.2105/AJPH.2021.306189

Christian, K. A., Blanton, J. D., Auslander, M., & Rupprecht, C. E. (2009). Epidemiology of rabies post-exposure prophylaxis, United States of America, 2006-2008. Vaccine, 27(51), 7156-7161. https://doi.org/10.1016/j.vaccine.2009.09.028

Institute of Medicine. (1988). The future of public health. National Academy Press. https://doi.org/10.17226/1091

Slate, D., Algeo, T. P., Nelson, K. M., Chipman, R. B., Donovan, D., Blanton, J. D., Niezgoda, M., & Rupprecht, C. E. (2009). Oral rabies vaccination in North America: Opportunities, complexities, and challenges. PLoS Neglected Tropical Diseases, 3(12), Article e549. https://doi.org/10.1371/journal.pntd.0000549