Dec 12, 2003 (CIDRAP News) – Despite a flood of new federal aid, the states are only modestly better prepared to cope with major health emergencies now than they were before the terrorist attacks of 2001, according to a report by a nonprofit public health advocacy group.
The Trust for America's Health (TFAH), based in Washington, DC, concluded that "states have achieved piecemeal progress, but that a full-scale effort to comprehensively fix the nation's public health system is falling short."
The group assessed 10 indicators of state public health preparedness, such as state public health appropriations, laboratory capacity, communication systems, and planning for pandemic influenza. No state met more than seven of the criteria, and only California, Florida, Maryland, and Tennessee satisfied seven. Five states—Arkansas, Kentucky, Mississippi, New Mexico, and Wisconsin—passed only two of the ten tests. Thirty-seven states satisfied three, four, or five standards.
The TFAH did find some progress in preparedness. "Major improvements have been made in emergency communications," with 89% of the US population now within reach of the Centers for Disease Control and Prevention's (CDC's) emergency communication network (the Health Alert Network), the report says.
In addition, all 50 states and the nation's capital now have CDC-approved bioterrorism preparedness plans. But many of the plans are only general frameworks, not specific blueprints for emergency response, the report says.
The document cites "major concerns" relating to six of the ten preparedness criteria:
- State budget cuts threaten to undermine readiness for bioterrorism and other health crises. Nearly two thirds of states reduced public health funds from fiscal year 2002 to 2003.
- Because of bureaucratic snags, only half the states have spent 90% or more of their federal bioterrorism preparedness funds for fiscal year 2002, which ended in September 2002.
- Only 17 states and Washington, DC, have passed along at least 50% of their federal funds to local health departments. State and local health departments often disagree on how to distribute resources.
- Public health agencies are facing a major shortage of workers. One sign of this is that only Florida and Illinois have assembled adequate teams of nurses, physicians, and pharmacists to receive and distribute emergency "push packages" of drugs and supplies from the National Pharmaceutical Stockpile.
- Only 13 states have a plan for responding to pandemic influenza.
In other findings, the report says that 43 states have at least one biosafety level 3 laboratory capable of handling important biological agents. On the other hand, only 11 states are adequately prepared to communicate with healthcare providers and the public about emerging health threats. Most states do not have information about SARS (severe acute respiratory syndrome) designed for their own populations, the group says.
The report offers several recommendations, starting with the proposition that public health agencies should be prepared for all threats, not just bioterrorism. In line with this, states should be allowed to use their federal funds to prepare for biological, chemical, radiological, and natural disease hazards. In addition, the CDC should set "measurable standards for comprehensive preparedness" for state and local health departments.
The group also recommends that:
- The CDC monitor state and local funding for critical public health functions and require maintenance of core public health funding as a prerequisite for continued federal aid
- The president organize a "summit" meeting to produce a blueprint for the future of the public health system and the resources needed to support it.
Executive summary of the report, "Ready or Not? Protecting the Public' Health in the Age of Bioterrorism"
Full text of the report