Public health group gives nation mixed grades for preparedness efforts

Sep 18, 2002 (CIDRAP News) – The United States deserves good marks for its efforts to improve core aspects of public health preparedness in the past year, but the nation performed generally poorly in international aid and cooperation to reduce threats to public health, according to the American Public Health Association (APHA).

In a report card on US efforts, the APHA gave the nation "B" grades in improving the public health infrastructure, providing for medical care for the victims of terrorist attacks, and training healthcare personnel and the public in preparedness. But the nation got a "D" in international aid to relieve poverty and related conditions that contribute to terrorism and in efforts to ban unconventional weapons through international treaties.

The United States also failed to do much to prevent racial and religious discrimination and protect human rights and civil liberties on the home front, the APHA said. On the other hand, the association praised the country for its efforts to stabilize Afghanistan.

The APHA developed a set of principles for the public health response to terrorism soon after the Sep 11 attacks. "This report card assesses whether U.S. policy has been consistent with those principles," the group said in releasing the report last week. The report is titled "One Year After the Terrorist Attacks: Is Public Health Prepared?" Some key findings, with the grades awarded, are summarized below.

Improving public health infrastructure: B
Accomplishments cited include the preparation of state public health preparedness plans with the help of $1.1 billion in federal funds; enactment of the wide-ranging Public Health Security and Bioterrorism Preparedness and Response Act of 2002 in June; expansion of the Laboratory Response Network so that each state has at least one laboratory capable of identifying pathogens and chemicals that could be used by bioterrorists; and the consideration of public health emergency powers bills in 17 states. However, the nation lacks a set of performance goals and measures for judging preparedness, and regional coordination is not yet up to par, the report says.

Ensuring the availability of medical care for victims of terrorists attacks: B+
The report says the nation has "stockpiled enough smallpox vaccine to vaccinate the entire US population"; increased from 8 to 12 the number of "push packs" of emergency medical supplies that can be shipped quickly anywhere in the country; and expanded the National Disaster Medical System's volunteer force to 10,000 healthcare workers. On the other hand, most of the money approved for hospital preparedness has not yet reached the hospitals that need it.

Educating health professionals and the public in terrorism preparedness: B
Many medical schools and teaching hospitals have added programs and course content dealing with bioterrorism preparedness, and the CDC provides detailed information through its Web site, the APHA says. However, qualified laboratory personnel are in short supply.

Protecting the environment, food and water, and rescue and recovery workers: B
All public water systems have begun vulnerability assessments in the past year, and most have tightened their security, the report says. This year Congress provided funds to hire up to 750 new food inspectors to supplement the existing force of 125, though experts remain concerned about the risk of pathogens entering the country via imported food.

Addressing global conditions that can contribute to the rise of terrorism: D
This year, the proportion of the US budget devoted to foreign humanitarian and economic aid is at its lowest level since the end of World War II, the APHA says. Of the "G8" countries, the United States contributes one of the lowest amounts, as a proportion of total wealth, to the Global Fund for AIDS, TB, and Malaria.

Advocating the control and ultimate elimination of biological, chemical, and nuclear weapons: D
Last November the United States rejected a protocol designed to strengthen the 1975 Biological Weapons Convention and tried to dissolve the ad hoc committee that developed the protocol, the report says. In June the Bush administration abrogated the Anti-Ballistic Missile Treaty with Russia. In addition, both the United States and Russia have told the group that administers the Chemical Weapons Convention that they will not meet a June 2007 deadline for destroying their chemical weapons stockpiles.

Other areas
In other areas, the APHA awarded the United States:

  • A "C" for progress in clarifying the roles of public health, law enforcement, and emergency response agencies in terrorism preparedness (Among other problems, rigid state licensing rules for physicians would limit coordination in an emergency.)
  • A "B+" for efforts to effect "a speedy end of the armed conflict in Afghanistan and promote non-violent means of conflict resolution" there.
  • An "F" for efforts to prevent hate crimes and discrimination, promote dialogue among groups, and protect human rights and civil liberties during the campaign against terrorism.
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