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Public Health Preparedness Jeopardized by Budget Cuts

By HealthLeaders Media Staff  
   December 20, 2010

In the eighth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism report, 14 states scored 9 or higher (out of 10) on 10 key indicators of public health preparedness. Three states (Arkansas, North Dakota, and Washington) scored 10. Another 25 states and Washington, D.C., scored 7 or 8. The two lowest, Iowa and Montana, each scored a 5.

Since Sept. 11, 2001 and the anthrax attacks that followed it, the nation is better poised to prevent, identify and contain disease outbreak and bioterrorism threats; responses are also quicker to natural disasters and outbreaks, the report notes. However, these gains are jeopardized by severe budget cuts by federal, state, and local governments, according to the report released by two nonprofit organizations, the Trust for America's Health and the Robert Wood Johnson Foundation,

The recession–and the attendant dwindling coffers--has led to cuts in public health staffing and eroded the basic capabilities of state and local health departments, according to the report. For example, 33 states and Washington, D.C., cut public health funding from fiscal years 2008-09 to 2009-10, with 18 of those 33 cutting funding for the second year in a row.

In addition to state cuts, federal support for public health preparedness has been cut by 27 percent since FY 2005 (adjusted for inflation). Local public health departments report losing 23,000 jobs--totaling 15 percent of the local public health workforce--since January 2008. Funding from the American Recovery and Reinvestment Act and response efforts related to the H1N1 pandemic blunted the impact of public health cuts–until recently.

Ongoing gaps in preparedness include basic infrastructure and funding, biosurveillance, maintaining an adequate and expertly trained workforce, developing and manufacturing vaccines and medicines, surge capacity for providing care in major emergencies, and helping communities cope with and recover from emergencies.

Technology is another concern. Seven states currently cannot currently share data electronically with healthcare providers, and 10 lack an electronic syndromic surveillance system that can report and exchange information, the report finds.


Laura Segal, study coauthor and the Trust for America's Health's director of public affairs, expects to see state and federal leaders "trying to figure out how to continue to fund priorities with fewer resources," she said in an interview. "We are hopeful policymakers will see the importance of preparedness funding and protect support for these programs."

Congress may consider reauthorization of the Pandemic and All Hazards Preparedness Act, which, she explains, "would provide the opportunity to update the statute to address ongoing challenges for preparedness–including maintaining a sustained funding stream for preparedness, modernizing technologies so they match current state-of-the-art standards, and maintaining a trained workforce."

Public health preparedness is, she says, "an issue that crosses party lines–since everyone wants to do all he or she can to protect every member of society from suffering. The issue receives strong public support from every corner of the country." She points out that the last time the public health preparedness bill was reauthorized in 2006, Sen. Richard Burr (R-NC) chaired the subcommittee that authored the legislation and it was supported across the political spectrum.

But the recession looms large, and if anything can trump politics, it's economics.

"The economic situation has obviously changed dramatically since then–and while we continue to see strong bi-partisan support for preparedness issues–the challenges are about balancing cuts against funding for other issues and priorities. The funding for preparedness is discretionary, rather than mandatory which makes it a much more likely target for cuts–at the federal, state, and local levels. It is hard to prognosticate about the political … but we are hoping this report and our efforts with partners will help remind policymakers about what is at stake if they continue to make cuts."

A full list of all of the indicators and scores, and the full report, are available on TFAH's Web site at www.healthyamericans.org and RWJF's Web site at www.rwjf.org.

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