field will also have to be able to systematically evaluate their response with better tools, asserted Goldstein.

Communication was a central theme during the workshop, and ranged from communication capacity at the local level to the need for more research communication. During the workshop, communication at the national level was emphasized; however, Goldstein noted that the majority of people in the country obtain most of their information from local sources. People do not turn to CNN or the CDC, but rather to the local health commissioner and the local TV and radio stations for information.

Local health departments are traditionally very small in the United States. Often, during a time of crisis, a local health department is busy attending to the health needs of affected people and does not have the time to develop an effective communication strategy. Goldstein suggested that there is a great need for a communication surge capacity and to have knowledgeable people to answer the phone, as well as to ensure that messages are consistent for the media and the public.

Additionally, there is a need for more work on the science of communication, observed Goldstein. There is a pervasive belief that if one has the right information, then everyone will understand the risk and take the right action. CDC is therefore emphasizing the necessity for more research in risk communication that would provide a better understanding of how various groups process messages from the scientific community.

The second theme during the workshop was the call for building capacity, which will have to occur through partnerships between NGOs and the government, public and private sector organizations, and federal and local entities. Goldstein emphasized the critical partnership between federal and local governments because in the United States people rely heavily on local government. In contrast to some European countries such as France, the United States takes a decentralized approach to emergency management, with local management in charge during times of disaster. This is not likely to change, so it is important to find ways to strengthen the local/federal partnership and increase intergovernmental cooperation.

Goldstein concluded that, despite all the challenges we face, it is obvious that we have come a long way toward preparing for disasters since September 11. Yet we have so much further to go. Additional progress will not be easy; but it is reassuring that we know so much more today than we did before.

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