Report: Bleak economy threatens state preparedness gains

Robert Roos  News Editor

Dec 14, 2010 (CIDRAP News) – A nonprofit group's annual report card on states' preparedness for public health emergencies shows that the states scored the highest ever this year, but recession-driven budget cuts are threatening to push preparedness measures downward.

"Overall, states have the highest scores ever for emergency preparedness," said Jeffrey Levi, PhD, executive director of the Trust for America's Health (TFAH), today in releasing the annual report at a press teleconference.

More than three fourths of the states met 7 or more of the 10 preparedness indicators TFAH assessed in the report, and 14 states met 9 or more of the criteria, Levi reported. Three states—Arkansas, North Dakota, and Washington—scored a perfect 10.

At the same time, 33 states and Washington, DC, budgeted less money for public health in 2009-10 than the year before, and 18 of those states cut funding for 2 years in a row, TFAH reported. Further, 53% of local health departments reported last January that their core funding had been reduced from the year before.

"The combined cuts constitute an emergency for emergency health preparedness in the United States," Levi said.

TFAH officials said state health departments benefited in 2009 from one-time funding provided under federal stimulus legislation (the American Recovery and Reinvestment Act) and to fight the H1N1 influenza pandemic, but those funds are now nearly gone.

The TFAH report, titled Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism, is the group's eighth annual assessment of state public health preparedness. Like its predecessors, the report says significant progress has been made since the terrorist attacks of 2001 revealed deficiencies in the nation's public health system.

But the spending on preparedness since then has not been enough "to backfill long-standing gaps in the public health infrastructure or update technologies to meet modern, state-of-the-art standards," the report asserts.

On the staffing front, TFAH says the nation has 50,000 fewer public health workers now than it did 20 years ago, and a third of the workforce is eligible to retire within 5 years. Quoting a recent survey by the National Association of County and City Health Officials (NACCHO), the report notes that about 23,000 jobs, about 15% of the total, have been lost since January 2008.

State scores
In releasing the state scores, TFAH officials and collaborators acknowledged that public health preparedness is difficult to measure.

The report "is not a comprehensive analysis, nor is it exhaustive, but it's a snapshot of key issues," said James S. Blumenstock, chief program officer for public health practice at the Association of State and Territorial Health Officials (ASTHO).

Of the 10 criteria TFAH used this year, only four match or are closely related to criteria used in last year's report. The 10 indicators are:

• Funding commitment (increased or maintained)
• Health information technology (electronic sharing of health information with healthcare providers)
• Electronic syndromic surveillance
• Incident response capacity (staff members who were notified of exercises or incidents acknowledged such notifications within 60 minutes)
• Emergency operations center (EOC) (activation of state's EOC for a drill or real incident at least twice in 2007-08)
• After-action reports (development of at least two after-actions reports following an exercise or incident in 2007-08)
• Foodborne disease detection and reporting (ability to recognize E coli O157:H7 and submit results to PulseNet within 4 working days)
• Laboratory surge capacity (sufficient staff to work 5 12-hour days for 6 to 8 weeks in response to a disease outbreak)
• Laboratory response capacity for chemical threats (increased or maintained)

Besides the three states that scored on all 10 indicators, the report says 11 states met nine indicators, 18 states met eight, 7 states and Washington, DC, met seven, nine states scored six, and two states (Iowa and Montana) scored five. No state scored lower than five.

Four of the indicators—pertaining to incident response capacity, EOCs, after-action reports, and food borne disease detection—were borrowed from a Centers for Disease Control and Prevention (CDC) report that was released in September, TFAH noted.

Some key findings that TFAH noted in a press release are:

• Seven states cannot share data electronically with healthcare providers.
• Ten states lack an electronic syndromic surveillance system.
• Half of states do not require child-care facilities to have a written evacuation and relocation plan.
• Only four states lack the lab staff to work 5 12-hour days for 6 to 8 weeks.
• Only one state reduced its lab response capacity for chemical threats between August 2009 and August 2010.

In response to a question from a Montana reporter, officials said a lower score doesn't necessarily translate into increased risk for the public.

"I wouldn't want any readers to draw the conclusion that they're at increased risk because they live in a state that didn't get a perfect score," said Blumenstock. "These are just 10 of what could be hundreds of indicators, given the depth and breadth of overall preparedness. If a state didn't get a point for an indicator or category . . . it doesn’t mean they're totally void of that capability or capacity. And this is an evolving and enduring process."

Concerning public health budget cuts, Robert M. Pestronk, MPH, executive director of NACCHO, said local health departments around the country have already felt the pressure. He said 13% of local departments have recently cut their immunization budgets, 9% have reduced "core capacity to detect and analyze threats," and 7% have made direct cuts in their emergency preparedness capabilities. The numbers mean departments have fewer people to handle those tasks, he said.

Pestronk and the other officials decried the fluctuating and inconsistent funding for public health preparedness. "The way in which we're funding local health departments would be equivalent to funding fire departments after the fires have already started," he said.

On a general level, the report also talks about the need to improve healthcare surge capacity across the country, to build an integrated nationwide biosurveillance system, to provide more support for community resilience, especially in relation to vulnerable populations, and to expand research and development of medical countermeasures to health threats.

See also:

Dec 14 TFAH press release
http://healthyamericans.org/newsroom/releases/?releaseid=225

Full text of TFAH report (52 pages)
http://healthyamericans.org/assets/files/TFAH2010ReadyorNot%20FINAL.pdf

Dec 15, 2009, CIDRAP News story on 2009 "Ready or Not?" report
http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/dec1509ready-jw.html

Sep 21 CIDRAP News story "CDC says state and local preparedness improving"
http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/sep2110prepared.html

Apr 6 CIDRAP News story "NACCHO: Local public health jobs down 15% in 2 years"
http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/apr0610localph.html

Jan 26 CIDRAP News story on report that US has poor ability to respond to a bioterrorist attack
http://www.cidrap.umn.edu/cidrap/content/bt/bioprep/news/jan2610bioweapon.html