Trust for America’s Health has released its 2007 edition of “Ready Or Not?”, a yearly treasure trove of information on the state of public health preparedness in the US. The report provides a thorough assessment of the wide array of activities, issues and trends that intersect to help form this constantly changing field. It is a gem and should be required reading for anyone with a professional interest in the field.

TFAH’s modus operandi for assessing preparedness has remained largely the same for the last several years: In light of its related observations that (a) the government does not provide routine assessments of preparedness to the public, and (b) the extent of objective, universally agreed upon measures of public health preparedness is questionable, the study authors present 10 indicators which are proposed as proxies for what they consider to be its most salient (and valid) dimensions. Although the authors concede that the measures are not always ideal, I believe that in at least one instance the selected indicator is positively puzzling. The dimension is community resilience; the indicator is whether a state has 14 or more Medical Reserve Corps volunteers per 100,000 population. If you are asking: “What does the MRC have to do with community resilience?” – then you are asking a valid question… and that presupposes that you know the answer to the valid prior question “What actually is the MRC?” The quick and dirty answer to the latter question, found here, is that the MRC is a service organization sponsored by the federal government (specifically, the Office of the Surgeon General) to bring together community volunteers who can provide organized medical and health-related services and expertise routinely and in times of crisis to meet local community needs. The MRC fits within the rubric of the Citizen Corps and other national volunteer/service institutions.

The answer to the former is a bit trickier. As a service organization recruiting local practitioners and experts, the MRC arguably reflects local communities’ abilities to harness latent, residual, or reserve “talent” which can be mobilized to deploy as and where needed within that community, say during a sudden crisis. Yet to my mind a tenuous inference exists in equating the existence of a certain number of practitioners who have registered or volunteered to be available in a disaster with a community’s resilience. There are, for example, numerous methodological pitfalls, which likely outweigh the benefit of this measure. I will highlight three of them.

First, there is the issue of selection bias – that is, the notion that certain states, and indeed certain communities within those states, are more (or less) likely to have medical practitioners and other experts volunteer for the MRC owing to a number of factors, ranging from community civic/civil orientations or involvement to economic opportunities and allowances, and more. In other words, some states have populations that are more likely to know about and volunteer with the MRC than others.

Second and third, I am unaware of any literature vetting or in fact proposing that one measure of a community’s resilience should revolve around some proportion of its formally organized medical volunteers, not to mention the fact that the population from which to construct this rate is to be found in a relatively obscure federally-sponsored program. Related to all this is the threshold number itself: 14. By TFAH’s own indication, the number reflects the 25th percentile of states’ proportion of MRC volunteers per 100,000. This means, in essence, that what constitutes acceptable community resilience is itself unhinged from any normative metric; there is no prescriptive claim as to what an acceptable number should be (based in science or philosophy or religion or palm-reading, etc.) other than the descriptive claim that what is acceptable hinges on what is currently in evidence.

So where does that leave us? Maybe a clue to this can be found in the concept of resilience, which in recent years has come to be described, give or take, as a community’s (or some other unit’s) ability to absorb loss, maintain its “structural” or social organizational integrity, and continue to function. It is particularly salient as a concept for VSS insofar as an emphasis has been placed in relatively recent years on critical infrastructures as key nodes which can facilitate resilience. For example, as things like redundancy and durability and sustainability are built into critical systems, the argument goes, they will be able to absorb the shock of an extreme or otherwise overwhelming event (of whatever duration) and permit effective response and recovery, if not in a seemless manner then at least with nominal acceptable effectiveness.

So, with all this said, the question arises yet again. What does the MRC have to do with community resilience? Until I see some stronger proofs, my sense is: not much.