Programs implemented by public health preparedness programs since 2001 include: the development of various emergency preparedness plans; implementation of National Incident Management System and Incident Command System classes; administration of workforce training in emergency response; administration of public education campaigns; implementation of communication systems; and completion of various public health emergency exercises.
Perhaps not as widely known as general emergency management programs, public health preparedness programs have distinct responsibilities and can be found in health departments, large and small, across the United States. The programs traditionally derive their funding from the federal government through the Public Health Emergency Preparedness (PHEP) cooperative agreements. An additional component of these agreements is funding for the Cities Readiness Initiative, which helps states and local jurisdictions draw emergency medical supplies from the Centers for Disease Control and Prevention’s (CDC) Strategic National Stockpile.
Background
Following the anthrax attacks in 2001, and with the recognition that all responses to public health emergencies begin at the local level, Congress appropriated the funding needed by the CDC to improve the disaster preparedness capabilities of public health departments nationwide. This dedicated funding — distributed in the form of the aforementioned grants — was and is specifically intended for use by states, territories and major U.S. cities throughout the nation. In most cases, the funding is provided to states and then distributed to local jurisdictions.
Since the initial allocations, there has been a steady decline in the funding available from the CDC’s PHEP cooperative-agreement allocation to support public health preparedness activities in state and local health departments. Meanwhile, the demands on public health emergency preparedness planning, preparedness and response capabilities, and workloads continued to increase and have expanded to included areas such as pandemic preparedness, mass fatality planning and volunteer management.
While LHD preparedness programs have received some additional but limited support from other sources of funding — those funds also have been declining. In 2007, 46 percent of the nation’s LHDs reported receiving at least some financial support from local, city or county funds. However, that percentage dropped to 29 percent in 2009 and continues to decrease. Further complicating the picture is that several media reports indicate that state and local budgets for public health also have diminished significantly in recent years — primarily, it seems, because of the nation’s overall economic decline.
According to a December 2011 report issued by Trust for America’s Health (a private-sector health policy organization), the cutbacks in this vital element of public health systems are occurring on three levels — state, local and federal.
This same report identified a number of key programs considered to be “at risk” because of the continued cuts in federal public health emergency preparedness funds. More specifically:
• Of the 72 cities participating in the Cities Readiness Initiative, 51 are now at risk of being cut from a program that supports the ability of cities to rapidly distribute and administer vaccines and medications to a large number of people during unforeseen emergencies.
• All 10 of the state laboratories currently possessing Level 1 chemical testing capabilities are at risk of losing their top-level status, a downgrade that would leave the CDC itself with the only public health laboratory in the country possessing the full ability to test for chemical terrorism and accidents.
• Twenty-four states are also at risk of losing the support provided by career epidemiology field officers (i.e., CDC experts assigned to various state health departments to supplement state and local efforts to prepare for and respond to various disease outbreaks and other medical disasters).
Clearly public health agencies and facilities across the country play a critical role in the nation’s overall emergency preparedness and response capabilities. That role has grown even more important since the 2001 anthrax attacks as well as, in the decade since, numerous natural disasters, foodborne outbreaks and other major public health emergencies (e.g., SARS and H1N1) that have been in the headlines in recent years. Local and state health departments are, in fact, better prepared for emergencies now than ever before in the nation’s history. This is primarily due to the increased funding provide through the PHEP and Cities Readiness Initiative grants and the combination of already experienced funding cuts coupled with the expectant additional cuts, is a cause for major concern for emergency planners.
Impending Issues
The end is coming and it’s coming soon — already 55 percent of the nation’s LHDs reduced or eliminated at least one program between July 2010 and June 2011, and 20 percent of these programs were in, or related to, emergency preparedness. In addition, 53 percent of all health departments have experienced some type of negative job impact (e.g., furloughing of employees and/or an overall reduction of hours); this also reduces overall readiness. In addition, many state and local health departments are having difficulty managing their budgets, hiring and training staff, and conducting long-term strategic planning under the conditions of unpredictable fluctuations in funding.
A continuation of this state of decline will have major implications for public health emergency preparedness efforts and may well result in a decrease in training efforts, an inability to drill or exercise, and/or simply a lack of the resources needed to support the real-world public health emergency responses looming just over the horizon.
The federal partners of state and local jurisdictions also are not immune to these long-running fiscal constraints. Since 2005, the CDC has seen its budgets for preparedness and response slashed by more than $350 million (to the current, fiscal year 2011, levels of about $832 million). This significant cutback in funding directly and adversely challenges the CDC’s ability to respond to pandemics and other public health emergencies.
What all of this equates to are fewer dedicated public health emergency preparedness personnel, fewer resources such as laboratories, few exercises to test a health department’s preparedness, fewer drills, etc. More succinctly, these cuts will impact public health readiness on a grand level. In times of crisis, any reduction in capabilities caused by underfunding public health opens the nation to overburdened health-care systems, overwhelmed response systems and overloaded communication systems.
Raphael M. Barishansky is the chief of public health emergency preparedness and response for the Prince George’s County, Md., Department of Health. Prior to this position, he served as executive director of the Hudson Valley Regional EMS Council based in Newburgh, N.Y.
