Public Health

Funding Cuts Threaten Public Health Preparedness

As the funding decreases, who will take over the various public health initiatives and programs?

Since the terrorist attacks of 9/11, considerable funding has been provided to local, state and federal public health agencies and organizations to better prepare them to cope with the continually changing and increasingly dangerous realities of today’s world. These realities include the possibility of public health entities needing to plan for and respond to the full spectrum of weapons of mass destruction threats (i.e., chemical, biological, radiological and nuclear) as well as other threats such as pandemic influenza.  

But the various funding streams used by these programs are slowly being cut — specifically the Public Health Emergency Preparedness (PHEP) and Cities Readiness Initiative grants released by the federal government to support state and local health departments. As they decrease, health departments are coping as best they can. But according to the National Association of County and City Health Officials, some 55 percent of the nation’s local health departments reduced or eliminated at least one program between July 2010 and June 2011, and 20 percent of these programs focused on emergency preparedness. Also because of the budget cuts, 53 percent of all health departments experienced some sort of negative job impact (e.g., employee furloughs or reduced staff working hours) that cuts into their overall state of readiness.

So what happens next? The aforementioned funding allows for dedicated personnel, equipment, National Incident Management System (NIMS) and Incident Command System (ICS) classes, various training and even participation in exercises. As that funding decreases, who will take over the various initiatives implemented by these programs if and when they go away? Does the emergency management discipline have enough knowledge to seamlessly pick up the critical public health preparedness pieces? 

Understanding Public Health Preparedness

The list of public health's accomplishments includes:
-- development of all-hazards preparedness plans;
-- implementing NIMS;
-- administering workforce training in emergency response;
-- creating public education campaigns;
-- implementing new or improved communication systems;
-- completion of various public health emergency exercises;
-- collaboration with nonprofit and faith-based organizations on emergency response planning;
-- enhancement of disease surveillance systems;
-- hiring new staff to work on preparedness planning;
-- implementation or improvement of syndromic surveillance systems;
-- development of a medical surge capacity plan;
-- improved the physical security of their facilities;
-- implementing a Medical Reserve Corps volunteer program;
-- enhanced local public health laboratories;
-- implementing a Community Emergency Response Team program; and
-- stockpiling various vaccines or antivirals

Another element that must be understood is what types of emergency incidents the PHEP programs and their overarching health departments typically respond to. In a 2010 report by the National Association of County and City Health Officials detailing local health department capabilities, these entities reported responding to the following emergency incidents during the time period outlined: infectious disease (26 percent), natural disaster (23 percent), foodborne outbreak (21 percent), chemical spills or releases (9 percent), and exposure to a potential biological agent (5 percent). 

The responsibilities of public health entities in an emergency aren’t limited to those situations detailed above — they also must respond during weather-based emergencies like hurricanes and snowstorms. The duties involved in these incidents can include health system readiness, mass care responsibilities and assistance with shelters/sheltering. Additional areas of emergency preparedness and response typically include epidemiological investigations, foodborne emergency preparedness and response to various environmental hazards.

On a daily basis, the responsibilities of PHEP units or programs include:

  • training health department personnel how to respond to emergencies they will typically have to confront;
  • training in the ICS and NIMS to assure coordinated response (both within the health department and with other, more traditional emergency response partners);
  • outreach and collaboration with external partners such as public safety, private sector, nongovernmental organizations and community organizations;
  • constant modernization and revision of various emergency plans (e.g., emergency operations plan, medical countermeasures dispensing, non-pharmaceutical interventions, pandemic influenza, anthrax preparedness, etc.);
  • planning for drills and exercises that test emergency plans; and
  • implementing the corrective actions learned from the exercises. 

Critical Efforts

Perhaps one of the most important areas that PHEP programs cover is the development of realistic, operational and well researched pandemic influenza plans. These plans are seen as fundamental and necessary to federal, state and local public health entities. During recent events, including the severe acute respiratory syndrome outbreak in 2002-2003 and H1N1 pandemic seen in 2009-2010, these planning efforts and other public health measures — including the isolation of infected individuals, quarantine of exposed individuals, implementation of community control and social distancing measures, dissemination of information and issuing travel advisories — were widely seen as being successful in staunching the progression.

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