Smallpox. Anthrax. Pandemics. Food poisonings. All of the aforementioned are the bailiwick of public health preparedness programs across the United States.
Programs implemented by public health preparedness programs since 2001 include: the development of various emergency preparedness plans; implementation of National Incident Management System and Incident Command System classes; administration of workforce training in emergency response; administration of public education campaigns; implementation of communication systems; and completion of various public health emergency exercises.
Perhaps not as widely known as general emergency management programs, public health preparedness programs have distinct responsibilities and can be found in health departments, large and small, across the United States. The programs traditionally derive their funding from the federal government through the Public Health Emergency Preparedness (PHEP) cooperative agreements. An additional component of these agreements is funding for the Cities Readiness Initiative, which helps states and local jurisdictions draw emergency medical supplies from the Centers for Disease Control and Prevention’s (CDC) Strategic National Stockpile.
Background
Following the anthrax attacks in 2001, and with the recognition that all responses to public health emergencies begin at the local level, Congress appropriated the funding needed by the CDC to improve the disaster preparedness capabilities of public health departments nationwide. This dedicated funding — distributed in the form of the aforementioned grants — was and is specifically intended for use by states, territories and major U.S. cities throughout the nation. In most cases, the funding is provided to states and then distributed to local jurisdictions.
Since the initial allocations, there has been a steady decline in the funding available from the CDC’s PHEP cooperative-agreement allocation to support public health preparedness activities in state and local health departments. Meanwhile, the demands on public health emergency preparedness planning, preparedness and response capabilities, and workloads continued to increase and have expanded to included areas such as pandemic preparedness, mass fatality planning and volunteer management.
Nonetheless, federal funding is still the core source of financial support for the public heath preparedness programs of many local health departments (LHD). In 2007, the National Association of County and City Health Officials (NACCHO) reported that 41 percent of all state and local health departments that received funding from the CDC’s PHEP grants advised that those funds comprised 100 percent of their budgets for preparedness activities — this included the cost of dedicated emergency preparedness staffing. A 2009 NACCHO follow-up survey indicated that, in approximately 68 percent of LHDs, the PHEP cooperative agreement funds constituted 90 percent or more of their preparedness budgets. “PHEP funds are critically important to local health departments,” said Jack Herrmann, senior adviser and chief of public health preparedness of NACCHO, a nonprofit organization that represents the nation’s 2,800 local governmental public health agencies. “In many cases the CDC’s PHEP funding is the only funding that local health departments receive in order to conduct their preparedness activities. Because of the gradual decline in these funds, we are now seeing that critical preparedness activities at the local level are being eliminated or significantly curtailed, which will ultimately impact the health and safety of the nation.”
While LHD preparedness programs have received some additional but limited support from other sources of funding — those funds also have been declining. In 2007, 46 percent of the nation’s LHDs reported receiving at least some financial support from local, city or county funds. However, that percentage dropped to 29 percent in 2009 and continues to decrease. Further complicating the picture is that several media reports indicate that state and local budgets for public health also have diminished significantly in recent years — primarily, it seems, because of the nation’s overall economic decline.
According to a December 2011 report issued by Trust for America’s Health (a private-sector health policy organization), the cutbacks in this vital element of public health systems are occurring on three levels — state, local and federal.
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