Background
Public health emergencies have increased in recent years and have shown a trend of causing considerable damage [
1]. According to the emergency events database (EM-DAT), the most widely used and influential disaster database in the world, the average number of deaths per major public health event was more than 10,000 [
2]. Population growth, urban development, migration, and other issues brought about by globalization have sped up the incidence of public health events, such as epidemics [
3,
4]. Public health events also propelled the process of emergency management, giving top priority to changes in emergency operations. The outbreak of coronavirus disease 2019 (COVID-19) in China spread rapidly throughout the world in a short time, which illustrated the need to build a resilient health emergency system that can withstand epidemics [
5].
Public health emergency management (PHEM) is a relatively new field that draws on specific sets of knowledge, techniques, and organizing principles found in emergency management [
6]. Specifically, it includes public health emergency planning, organization, leadership, coordination, control, evaluation, prevention, preparation, and response [
7]. For COVID-19, China’s PHEM system quickly took the following measures: emergency mobilization measures within the government, lockdown of cities and communities, nationwide medical mobilization, provision of financial support, preferential policies for the medical community and pharmaceutical industry, and the categorical comprehensive publicity to spread prevention and treatment knowledge [
8]. These measures effectively reduced the spread of the disease. Thus, current recommendations are mostly derived from the reported Chinese experience [
9]. Given the weaknesses and deficiencies exposed by the COVID-19 outbreak, people have recognized the need to improve the national PHEM system [
10,
11].
A growing body of research has studied PHEM from different perspectives, mainly those of institutions, funds, technologies, and laws. The public health emergency was a severe challenge to health institutions such as hospitals, the Centers for Disease Control and Prevention (CDC), and governments [
7,
12]. The solutions to these challenges were characterized by sustainability, redundancy, and flexibility [
13]. Monetary and technology resources can merge the roles and responsibilities of public health preparedness and emergency management [
14]. Severe deficiencies in legal preparedness can undermine effective responses to public health emergencies [
15,
16]. These were the essential factors in dealing with public health emergencies. Additionally, many countries took corresponding measures to strengthen the emergency management of public health. For example, the USA established PHEM operations centers either independently in health departments or as a part of the overall command system in the government [
17]. China established the PHEM system from the national level to the local level to be responsible for emergency preparedness and response in 2004 [
17]. In March 2018, the Ministry of Emergency Management of the People’s Republic of China was established, which was an integral part of the State Council. Thus, we can see that PHEM is still a timely topic for scholars and governments [
18,
19].
However, there are still some problems that need to be solved. To the best of our knowledge, there is little evidence about the differences that occurred between international and Chinese PHEM. Moreover, what are the hotspots and trends of PHEM? What are the main research forces of PHEM? It is necessary to sort out the characteristics of the development of PHEM and explore the hotspots of PHEM research. Additionally, we compared international and Chinese research on PHEM. Based on this situation, we reviewed the articles on PHEM that were published over the past nearly 30 years in international and Chinese journals. Then, we used the knowledge map method to reveal the research strengths, frontiers, and development trends in this field. Study conclusions are helpful to draw people’s attention to public health emergencies, provide a reference for scholars to understand the current situation and trends of PHEM, and for government departments to formulate guidance strategies.
Discussion
International research on PHEM occurred earlier than the Chinese research, and it has been growing over time. This means that international scholars have paid increasing attention to PHEM. In 1991, the first article on PHEM was written by Richard L. Siegel and was titled
Code 9: a systematic approach for responding to medical emergencies occurring in and around a hospital [
56]. It mentioned the need for an organized system to respond to such emergencies involving patients, visitors, local community residents, and hospital employees, both inside the hospital and on the grounds surrounding the building. He recommended the establishment of a systematic emergency response system in all health care institutions. Since then, academia has begun to pay attention to emergency management of public health incidents. The number of international articles is increasing gradually, reaching the maximum in 2017, and it is expected to continue to grow in the next 3 years. The development of PHEM in China shows a fluctuating pattern. The occurrence of public health emergencies in the 10 years from 2006 to 2016 showed a general trend of first rising and then slowly declining. It is likely related to the number of significant events that occur in each year [
57]. The severe acute respiratory syndrome (SARS) epidemic in 2003 resulted in significant increases in both the amount of research and articles on emergency management [
7]. The number of articles reached a small climax in 2008. Events such as the Wenchuan earthquake and the southern snow disaster occurred in that year. The maximum was in 2013, with human infection from H7N9, the Ya’an earthquake, and death from a hepatitis B vaccine occurring that year. Moreover, 10 years after the SARS outbreak, some authors compared the development of PHEM in China over the 10-year period. The first Chinese article on PHEM was written by Tiewu Jia and was titled
Capacity-building for public health emergency response to disasters (2003) [
58]. This article was published during the epidemic of SARS. In 2003, China did not establish a network and echelon PHEM system. The author combined the development of emergency management, reform of health and epidemic prevention institutions, and discussed the capacity building of public health emergency response. It is helpful for the social function orientation of the disease control center and the improvement of disease prevention ability. Although the number of Chinese articles decreased in the following years, it remained above 48. In summary, the above analysis shows that PHEM is still a timely topic.
From the perspective of cooperative networks, we find that there is more cooperation among Chinese authors but less cooperation among authors from different institutions. The cooperation between different research institutions is believed to be highly effective in facilitating high-level and fruitful research, which can also help develop the research field into a more established area [
59]. Therefore, Chinese scholars should strengthen cooperation between different institutions. The research institution focus on PHEM mainly comes from universities and health institutions, while Chinese institutions have regional differences. Reasons include the following: the western region had poor fiscal capacity, a limited personnel size, and an inadequate stockpile in terms of working budget, timely reserves, and prompt delivery [
60]. As a leader in international PHEM, the CDC has begun to help other entities strengthen their capacity, recognition, and technical expertise to strengthen their PHEM capacity [
61]. Additionally, some other health institutions, such as the WHO, have promoted development in this field. In 2005, the 58th World Health Assembly (WHA) adopted the revised International Health Regulations, which instructed the WHO member states to collaboratively confront public health emergencies of global significance [
5,
17,
62]. Universities have undertaken the scientific task of PHEM, and they have conducted in-depth research on it in China. The Chinese CDC has carried out more disease prevention and control services, but its scientific research ability is weak. The country network analysis shows obvious differences in regional and economic development levels for PHEM. Those countries with more developed health emergency management systems are the most high-income ones. Geographically, most of these countries are concentrated in Europe, where the numbers of publications and citations are also significantly higher [
60]. The USA, the UK, Japan, and other countries have constantly built and improved their PHEM systems, which have become a comprehensive management network.
Co-word analysis of PHEM international research is more complex, extensive, and multidimensional. It reflects some of the major ideas of this research. Based on these ideas, scholars mainly focused on emergency preparedness and monitoring of public health events. From the perspective of Chinese PHEM development, it has gone through a process from theory to preparation, disposition, response, evaluation, organization, and discussion. That is, the main contents of China’s health emergency management include the prevention and preparation of health emergencies as well as the key links of disposition, evaluation, and management, system construction, personnel training, and so on. The development of the whole discipline is therefore systematic and clear. The keywords with the strongest citation burst for international research on PHEM started with terrorism and bioterrorism [
63], followed by disaster planning and emergency preparedness. In recent years, epidemics and infectious diseases have become the new research frontier. From the perspective of the whole development context, international research on PHEM has been related to current affairs hotspots, such as terrorism, which may have originated from the 911 incident, and epidemics, which may be related to the epidemic of infectious diseases caused by viruses and bacteria such as the Ebola virus. The study of PHEM in China is a process from theory formation to practice discussion, involving many links of management. During 2003–2008, Chinese scholars focused on health emergency response and disposition. After that, Chinese scholars began to learn more about foreign PHEM models. Some new methods have gradually been applied to Chinese PHEM in recent years.
The top-ranked articles by citation for the international knowledge domain of PHEM appeared in 2005, 2007, 2009, 2014, 2015, and 2016. In 2005, Lawrence M. Wein [
45] developed a mathematical model of a cow-to-consumer supply chain to reduce bioterrorism events. Once again, it shows that international emergency management research is based on terrorism and bioterrorism. In 2007, Nathalie Embriaco focused on the working condition of emergency management personnel [
46]. Kim Knowlton [
44] and Salim S. Abdool Karim [
47] mentioned the emergency department. The above three articles are all about the factors involved in health emergency management. The remaining articles analyze the specific events involving the mechanism, response, and recovery [
43,
48‐
50]. From the above analysis, it can be seen that terrorism, emergency response and health incident management, and the disposition of public health events are the hotspots of international attention.
Legislative situation and characteristics of China’s emergency law [
53],
Legal construction of public emergency response in China: legal construction task proposed by SARS crisis management practice [
54], and
The realistic subject of administrative rule of law in public emergency management [
55] were published in 2003. All three articles discussed the problems existing in the construction of the administrative legal system under the background of SARS. After that, three articles were published in 2004, mainly studying the mechanism and structure of PHEM in China. This research proposed the need to establish the emergency response mechanism for PHEM and establish emergency structure construction as soon as possible. In 2009, Kaibin Zhong wrote the article
Review and prospect: construction of emergency management system in China [
52]. He elaborated on the core contents of Chinese PHEM construction, including emergency plans, emergency structures, emergency mechanisms, and legal systems. China’s PHEM integrates emergency systems, emergency mechanisms, and legal systems in an all-round way, which is characterized by comprehensiveness, institutionalization, openness, and guarantees. In 2011,
The status quo of emergency management system for sudden public health events in America and Japan and its enlightenment [
64] was published, showing that China has been learning the theory and experience of PHEM from some advanced countries. From the above analysis, it can be seen that the legal system, mechanism, and structure, system, and learning from abroad are the theoretical guidance for Chinese PHEM in the past 30 years.
Admittedly, there are some limitations to this study. First, the conclusions drawn from this study were based on only two large literature retrieval libraries. Other databases, such as Embase and Springer Link, were not studied. Not being able to search all the literature in this field may lead to incomplete retrieval results. Second, CiteSpace has some shortcomings in processing the results of the Chinese database; it cannot translate the result from Chinese into English directly. Third, there is a 1-year or longer time lag between our paper submission and its publication. The database articles may change during this time. Fourth, we conducted a comparison between Chinese and international databases similar to that performed in many other studies. It should be acknowledged that the two databases had different acceptance ratios, and this difference in data sources might lead to bias in the study results. In addition, we categorized English articles focusing on China as being part of the international database and did not analyze them alone. Although only a small part of the total, this may have created some deficiencies. This limitation may constitute an object of future studies, namely, those analyzing the differences between English papers focusing on China vs. Chinese papers.
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