disaster,75 in part because the federal government is reluctant to assume
national authority in the context of emergencies.76 Within states, there are
often conflicting agency responsibilities—triggered in part by varying levels
of emergency, disaster, and public health emergency declarations—that may
create complications among regulatory agencies (and with non-agency
actors) during emergency response efforts.77 Given this confusion
engendered by redundant institutions, the federal government has sought to
unify emergency preparedness authorities through incentives for coordinated
response protocols, financial support, and voluminous guidance.78 During the
Hurricane Katrina response, for example, better coordination among systems
and the availability of alternative mechanisms of governance to effectuate
rapid response could have circumvented the gridlocked bureaucracy and
operational failures that occurred.79 Yet even in emergency response
situations, where efficient responses are paramount, complementary systems
can play a positive role in effectuating good public health outcomes—
provided these overlapping authorities have coordinated, or at least well-aligned features.80 Under complementary emergency preparedness systems,
there is a mechanism for effective governance even upon the failure of one
or more concurrent systems and an opportunity to enhance the capacity and
effectiveness of response efforts.81
IV. SHIFTING THE BASELINE: MOVING FROM REDUNDANCY TO
Overlapping or duplicative public health systems have both negative and
positive attributes of redundancy that impact their ability to influence public
health governance. Whereas the negative attributes of redundancy produce
primarily negative public health outcomes or negative externalities that
overshadow potential benefits, positive overlap in the form of
complementarity produces a beneficial outcome or meets a desired policy
goal without undermining those benefits through negative consequences.
75. Corey P. Hanrahan & Bryan A. Liang, Promoting Public Health and Provider
Response to Emergencies and Disasters, 11 U. PA. J.L. & SOC. CHANGE 29 (2008).
76. David L. Feinberg, Hurricane Katrina and the Public Health-Based Argument for
Greater Federal Involvement in Disaster Preparedness and Response, 13 VA. J. SOC. POL’Y
& L. 596 (2006).
77. James G. Hodge, Jr. et al., The Legal Framework for Meeting Surge Capacity Through
the Use of Volunteer Health Professionals During Public Health Emergencies and Other
Disasters, 22 J. CONTEMP. HEALTH L. & POL’Y 5 (2005).
78. Benjamin E. Berkman, Susan C. Kim & Lindsay F. Wiley, Assessing the Impact of
Federal Law on Public Health Preparedness, 4 ST. LOUIS U.J. HEALTH L. & POL’Y 155 (2010).
79. Id. at 401–09.