State, local public health get mixed grades on readiness

Dec 19, 2012 (CIDRAP News) – An annual report on state and local public health preparedness offered mixed grades today, saying much progress has been made in the past decade but that important gaps persist and an ominous budget-cutting trend continued in most states.

The Trust for America's Health (TFAH), a nonprofit, nonpartisan advocacy group in Washington, DC, said 35 states met no more than 6 of 10 key indicators that were used to gauge preparedness this year, ranging from funding to community resiliency and laboratory capacity.

The report is the 10th annual edition of TFAH's Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism. It was issued in partnership with the Robert Wood Johnson Foundation.

"The biggest threats to public health preparedness are budget cuts and complacency," TFAH Executive Director Jeffrey Levi, PhD, said in introducing the report at a press teleconference today.

TFAH found that 29 states reduced public health funding between fiscal years 2010-11 and 2011-12. Twenty-three of those cut their budgets 2 years in a row, and 14 did so 3 years running. And since 2008, budget cuts have forced 45,700 job losses in state and local public health, the report says, with 57% of local health departments reducing or dropping at least one program in 2011.

In addition, preparedness grants from the Centers for Disease Control and Prevention (CDC) have declined by 38%, adjusted for inflation, since 2005, TFAH said.

On the 10 preparedness indicators, five states led the pack by meeting 8 of 10: Maryland, Mississippi, North Carolina, Vermont, and Wisconsin. On the other end of the scale, Kansas and Montana met only 3 of the 10.

One finding TFAH emphasized was that only two states have met the national goal of vaccinating 90% of young children (10 to 35 months of age) against pertussis. This year Washington state had one of the biggest pertussis outbreaks in recent history, the group noted.

Levi said the set of indicators used this year is not identical to sets in previous years, as TFAH adjusts the indicators to reflect changing priorities and concerns. "New issues arise, and we need to pay attention to that," he said. "Climate change would be a good example of that."

Only 15 states have climate-change adaptation plans, which include planning for the health threats posed by extreme weather events, the report says.

Some of the indicators have been retired over the years because large majorities of states achieved them, the report says. For example, all states now have met the CDC standard for the capability to receive and distribute medical supplies from the Strategic National Stockpile.

Other findings about the preparedness indicators include these:

  • Forty-seven states and Washington, DC, were able to notify and gather public health staff to ensure a quick response to an incident in 2011, according to CDC findings.
  • Thirteen states and the nation's capital do not require Medicaid to cover flu shots without copayments for beneficiaries younger than 65.
  • Twenty states do not require licensed child-care facilities to have an evacuation and relocation plan for multiple hazards, a requirement listed as a barometer of community resilience.
  • Twenty-states have not been accredited by the Emergency Management Accreditation Program, a voluntary, peer-reviewed process.
  • Twenty-six states and Washington do not participate in a multi-state compact allowing nurses to practice in other states in emergencies.
  • Thirteen state public health labs say they don't have enough staff to work five 12-hour days for 6 to 8 weeks in response to an infectious disease outbreak.
  • Only one public health lab, in Washington, DC, reported a decrease in its capacity to deal with chemical threats between August 2011 and August 2012.

TFAH said the scores are not intended to reflect on the performance of specific state or local health departments, because they are influenced by factors that are often beyond the control of those agencies.

The report offers a number of recommendations to remedy the gaps in preparedness. One of them is for Congress to reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA)—a goal that moved closer today with House passage of the latest version of the reauthorization bill.

TFAH also called for modernizing biosurveillance to create a "real-time, interoperable system to better detect and respond to problems."

Officials at TFAH were asked if that means they endorse BioWatch, the Department of Homeland Security Program that monitors the air in major cities for pathogens that might signal a bioterrorist attack.

"We're not necessarily endorsing a specific approach, Levi replied. "What we're saying and what is consistent with what the administration is saying is we need to be harnessing new technologies. With the move to high-tech approaches to health information technologies we can learn so much more about public health and have situational awareness during a public health emergency."

In other comments at the press conference, Paul Kuehnert, MS, RN, of the Robert Wood Johnson Foundation said the past 18 months have brought many lessons about how to respond to public health threats. He recited a sizable list of state and local responses to Superstorm Sandy on the East Coast, such as a hotline that New Jersey's health department established to answer questions about mold hazards and drinking water.

"The response to Sandy was inspiring. It provided a clear set of examples of the important role public health plays in a time of need," Kuehnert said. He is senior program officer and director of the foundation's public health team.

See also:

Dec 19 TFAH press release

Full text of the TFAH report (80 pages)

Dec 20, 2011, CIDRAP News story on 2011 TFAH report

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