States’ Public Health Preparedness has Improved, but Better Tracking Measures are Needed

Public health preparedness at the state and local levels has increased in the last few years, according to a Centers for Disease Control and Prevention (CDC) report — but challenges remain, including developing better measures to track preparedness improvements and capabilities. The CDC report Public Health Preparedness: Strengthening the Nation’s Emergency Response State by State was released Sept. 21 and lists fact sheets for each state, four cities and eight U.S. insular territories.

The CDC will use the report’s findings to identify where states had difficulties and provide better guidance, resources and expertise in those areas. “It’s got to be data for action, and we have to act on what we’re learning to improve what’s going on with the state and local health departments,” said Dr. Ali Khan, director of the CDC’s Office of Public Health Preparedness and Response.

This was the CDC’s third report on the topic, and Khan identified two categories that saw significant improvement: laboratory capacity and readiness. He said there was more rapid identification of disease-causing bacteria by PulseNet laboratories, which comprise a national network of state, local and federal public health and food regulatory labs. Khan also identified multiple ways readiness has improved including:

•  the number of states and localities that activated public health operations centers as parts of drills or exercises increased;
• the ability to bring workers and officials together for an emergency within one hour increased; and
• the number of states that can utilize the Strategic National Stockpile increased. In 2006, 37 states were able to receive and dispense the stockpile’s medical countermeasures, but now all 50 states have the capability, according to Khan.

To obtain a well rounded view of the information, data was collected from the CDC, states, National Association of County and City Health Officers, and Council of State and Territorial Epidemiologists. The CDC’s initial report in 2008 looked at 26 measures of public health preparedness and this year’s report examined 52 measures, Khan said. Some of the measures identified in the fact sheets include that the public health department: has a 24/7 reporting capacity system that could receive urgent disease reports any time of the day; conducted at least one unannounced notification to emergency operations staff outside of normal business hours; and participated in a Public Health Information Network forum (community of practice) to leverage best practices for the exchange of information.

Khan said for the most part the report used data from 2008 so it doesn’t reflect the fiscal challenges of the last year and a half. “I released this report at the [Directors of] Public Health Preparedness meeting in Newport, R.I., and they were all talking about furlough Fridays, where the state and local health officials aren’t available potentially on a Friday because of furloughs,” he said. “Unfortunately you can’t send a memo to a terrorist or to a hurricane saying, ‘Don’t show up on a Friday because we’ll be on furlough.’”

This challenge will be magnified as resources continue to decrease at state and local public health departments. “We’ve had a 29 percent decrease in resources since the peak of 2003 to now,” Khan said. “Even though we do have a significant amount of resources available to us — over $600 million — that’s got to be distributed across all 50 states and over 72 cities as part of the Cities Readiness Initiative.”

Although most of the information was from 2008, the CDC was able to include data from the 2009 H1N1 pandemic because the report was being written while that response was ongoing. Khan credited investments in public health preparedness with helping governments at all levels respond to H1N1, and said California’s response to the pandemic was a good example. According to the CDC’s report, the state established an Emergency Operations Center and activated the state warehouse, which deployed about 2 million courses of antiviral drugs to local health departments in the first month of the pandemic. The majority of shipments were received by local health departments within 24 hours of request.

Khan said although there have been increases in public health preparedness, many challenges remain, like developing a composite way to identify how well a locality or state is prepared. He would like to have a system that integrates information on performance and accomplishments in a community to provide an overall view of its preparedness. Other work that must continue includes developing resilient communities, but that starts with understanding what a resilient community is, how it’s accomplished and measured, and what activities are needed to engage communities.