The Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism report, published by Trust for America’s Health and the Robert Wood Johnson Foundation, said cuts in public health staff may cause local health departments to become less efficient and leave the country at risk for disease outbreaks and bioterrorism threats.
Since January 2008, local public health departments reported losing 23,000 jobs — totaling 15 percent of the local public health work force, according to the report. Thirty-three states and Washington, D.C., cut public health funding in the last two years, and federal funding was cut by 27 percent since 2005.
The findings are part of the annual report, which for the past eight years has graded states on a one-to-10 scale on 10 key indicators of public health preparedness. The indicators are swapped from year-to-year as more states reach an optimal grade for a particular indicator.
Indicators this year include state funding commitment; electronic health IT electronic syndronomic surveillance; incident response capacity; emergency operations center; after action reports; community resilience; foodborne disease detection and reporting; and public health laboratories — surge work force and response to chemical threat, which are counted as two separate categories.
Although states have made progress — this year 14 states scored nine or higher on the indicators — that progress is being slowed as government supplemental funds to support H1N1 pandemic flu response and funds from the American Recovery and Reinvestment Act begin to dry up, said Richard Hamburg, deputy director of Trust for America’s Health.
“We’ve seen a lot of one-time money flowing in from the federal government,” he said. “It’s hard to hire staff with one-time money. … We would be in a lot better shape if more resources were allocated on a year-to-year basis.”
Public health is heavily reliant on its work force, and when fewer employees are being asked to handle the same weight in tasks, progress will slip, Hamburg said.
Washington state, one of three states that scored a perfect 10 for all indicators, has begun to feel the stress of the public health work force cuts at the state and local levels, said Washington state Secretary of Health Mary Selecky.
“One of the most important things we have to do is protect what we’ve done well, and make sure we have the quick response systems that we’ve put into place, but we’re going to have them with many less people,” she said. “That concerns me.”
Selecky said over the past decade the state has made substantial strides in preparedness, but she foresees challenges following more budget cuts. “We’ve got to focus the efforts on where we need to be prepared, but there are some efforts that will really have to be set aside,” she said.
Arkansas and North Dakota were the other two states to get a perfect score on the report. Another 25 states and Washington, D.C., scored in the seven-to-eight range and no state scored lower than a five.
The report provided recommendations to address the major gaps in emergency preparedness, including funding and infrastructure; work force; vaccine and pharmaceutical research development and manufacturing; and community resiliency support.
Some key findings include:
- seven states cannot currently share data electronically with health-care providers;
- 10 states do not have an electronic syndromic surveillance system that can report and exchange information to rapidly detect disease outbreaks;
- half of states do not mandate that all licensed child-care facilities have a multihazard written evacuation and relocation plan;
- only four states report not having enough staffing capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak; and
- only one state decreased its Laboratory Response Network for Chemical Threats chemical capacity in the last year.
