Penny-wise, pound-foolish? State gaps threaten disaster readiness
While states and local governments have made significant progress in critical areas of the nation's emergency health preparedness effort, critical areas still require attention and sustained funding, according to the fifth annual report from Trust for America's Health (TFAH). In addition, TFAH says the continuing trend of annual cuts in federal funding for state and local preparedness activities threaten the nation's safety.
The report, "Ready or Not? Protecting the Public's Health from Disease, Disaster, and Bioterrorism," contains state-by-state health preparedness scores based on 10 key indicators to assess health emergency preparedness capabilities. TFAH evaluated all 50 U.S. states and the District of Columbia and reports that 35 states and D.C. scored eight or higher on the 10 indicators. Illinois, Kentucky, Nebraska, New Jersey, Pennsylvania, Tennessee, and Virginia scored the highest with 10 out of 10, while Arkansas, Iowa, Mississippi, Nevada, Wisconsin, and Wyoming scored the lowest with six out of 10 (see chart, below).
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How does your state rank on disaster readiness? A recently issued report by Trust for America's Health includes the following state-by-state health preparedness scores based on 10 key indicators of readiness:
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"The improvements in state preparedness are encouraging, but the job of preparing the United States for major health emergencies is not nearly done," says TFAH executive director Jeff Levi. "And just when we are beginning to see a return on the federal investment in preparedness programs, the president and Congress have continued to cut these funds. These efforts may seem penny-wise now, but could prove pound-foolish later."
TFAH director of government affairs Rich Hamburg tells State Health Watch the group has seen some return on investment on the federal funds that have been appropriated and now is not the time for the federal government to cut those funds.
Preparedness plans should include the diverse needs of the U.S. population, particularly at-risk, special-needs, and vulnerable populations. "Only by effectively reaching out to all segments of the U.S. population can the country appropriately be prepared to survive and overcome crises," the TFAH report says. Mr. Hamburg notes data still are not being collected on many of the indicators TFAH uses to develop its ratings, making it difficult to be sure what is happening.
All of TFAH's work in this area, Mr. Hamburg says, is intended to ensure that the level of emergency preparedness for individual Americans doesn't vary depending on where they live. "When you plan for a pandemic flu," he says, "it's something that will affect all states almost at once." But state-by-state differences have been seen. Thus, 14 states have purchased less than half their allocation of antiviral medications to stockpile locally. Mr. Hamburg says the purchases often are affected by individual state fiscal issues and it's necessary that states prioritize their interventions.
Similarly, there are variations in state recruiting for the Medical Reserve Corps. Mr. Hamburg says North Dakota has 450 volunteers per 100,000 population, while Pennsylvania has 14 volunteers per 100,000 and Maine has three volunteers per 100,000.
"The public deserves to know how prepared states and communities are for public health emergencies," he says, "especially since our public opinion poll shows people do not feel safer."
Still, the TFAH reports significant progress has been made among the states in those areas where data are available. And overall scores have risen from prior years, reflecting a combination of factors including a major infusion of funding from the federal government to states and localities and a higher priority on pandemic influenza preparedness among state and local health departments.
Top 10 preparedness indicators
The report uses these 10 preparedness indicators:
1. Mass DistributionStrategic National Stockpile. Does the state have an adequate plan to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile? Thirteen states don't have adequate plans to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile.
2. Mass DistributionAntiviral Stockpiling. Did the state buy a portion of its share of federally subsidized antiviral drugs to stockpile for use during a flu pandemic? Seven states have not purchased any portion of their federally subsidized or unsubsidized antivirals.
3. Public Health LaboratoriesBio-Threat Testing. Does the state lab director report having sufficient laboratory capabilities to test for biological threats? Seven states and D.C. lack sufficient capabilities to test for biological threats.
4. Public Health LaboratoriesWorkforce Surge Preparedness. If needed in an emergency, does the state public health laboratory have the capability to provide 24/7 coverage to analyze samples? Two states and D.C. report their public health laboratories do not have the capability to provide 24/7 coverage to analyze samples.
5. Biosurveillance. Does the state use a disease surveillance system that is compatible with the Center for Disease Control and Prevention's national system, including integrating data from multiple sources, using electronic lab reporting, and using an Internet browser? Twelve states do not have a disease surveillance system that is compatible with the CDC's National Electronic Disease Surveillance System.
6. Healthcare Volunteer Liability Protection. Does the state have laws that reduce or limit the liability exposure for health care volunteers who serve in a public health emergency? Some 21 states don't have statutes that address one or both of two critical legal elements to extend liability protection to health care volunteers during emergencies.
7. Emergency Preparedness Drills. Does the state health department engage the state National Guard in public health emergency preparedness drills or training exercises? All 50 states and D.C. held an emergency preparedness drill or exercise in 2007 with health department officials and the state National Guard.
8. Community Resiliency. Does the state meet a minimum threshold of Medical Reserve Corps volunteers per 100,000 persons? Some 13 states don't meet a minimum threshold for Medical Reserve Corps volunteers for every 100,000 citizens.
9. Public Health ProgressSeniors' Seasonal Flu Vaccination. Did the state increase its rates for immunizing adults aged 65 and older for the seasonal flu? Flu vaccination rates for seniors decreased in 11 states.
10. Funding Commitment. Did the state maintain or increase funding for public health programs for FY 2005-06 to FY 2006-07? Six states cut their public health budgets between FY 2005-06 and FY 2006-07.
Feds must provide funding
In December 2006, Congress updated and reauthorized the Public Health Security and Bioterrorism Act, renaming it the Pandemic and All-Hazards Preparedness Act (PAHPA). Also, TFAH says, the White House issued a number of presidential directives with components intended to improve public health emergency preparedness. The next challenge is to ensure that the measures in the legislation and directives are carried out and result in improved public health preparedness. TFAH says this will require sufficient funding from the president and Congress to carry out federal preparedness activities. Another challenge is to address funding levels for upgrading state and local public health preparedness, which have been decreasing yearly since 2004, severely affecting progress.
"The passage of this legislation...does not mean that the changes called for have been achieved," the report says. "In fact, this report shows delays in the implementation of many of the specified measures, and a continued lack of accountability for ensuring the measures are being carried out. In addition, without increased investment and political prioritization, even basic improvements needed are unlikely to be achieved."
To further strengthen emergency preparedness, TFAH recommends action in these areas: transparency, accountability, and oversight; funding; surge capacity; public health work force; research and development; legal reforms; health and sick leave benefits; food safety reforms; and community resiliency.
The group says to ensure HHS fully complies with the new legislation and does so in an open and transparent manner, Congress should use its oversight powers to guarantee full implementation and execution of PAHPA.
The federal government, the group says, should provide consistent, predictable, and sustained funding for preparedness activities to state and local health departments, including funding for activities in the event of a pandemic flu. Funding for public health emergency preparedness activities should be restored to FY 2005 levels of $919 million, pandemic preparedness should be funded at $1.2 billion, and there should be a transparent accounting of pandemic influenza funding since there are indications that $1.8 billion in appropriated funds for pandemic influenza have not been spent.
Download the report and state-by-state assessments at www.healthyamericans.org. Contact Mr. Hamburg at (202) 223-9876.
While states and local governments have made significant progress in critical areas of the nation's emergency health preparedness effort, critical areas still require attention and sustained funding, according to the fifth annual report from Trust for America's Health (TFAH).You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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