Public Health and Healthcare Emergency Preparedness

The 10th annual public health report by Trust for America’s Health was just released, prompting headlines about widespread state failures to adequately prepare for emergency public health needs. Although not surprising, it prompted me to revisit my own thoughts about public health.

Public Health Logo By US Army Institute Of Heraldry (Own work) [Public domain], via Wikimedia Commons

Before my involvement in emergency preparedness, I barely thought of public health. They seemed responsible for infectious disease monitoring and convincing the public about healthy lifestyles – pretty boring! As a practicing physician, I read a monthly newsletter, kept a list of diseases to tell public health about (which rarely occurred), and otherwise didn’t really consider them part of the medical world. I suspect many in medicine (and government) feel the same!

Fast forward to 2012. I’ve had some training in chemical, biological, and nuclear terrorism. I’ve read about pandemics, epidemics, new diseases, and problems with increasing antibiotic resistance. I’ve discovered giant holes in healthcare emergency preparedness, like poorly defined planning for physicians and outpatient medicine. In other words, I’ve learned we have massive potential emergency healthcare problems, and guess what?  Public health is the governmental area responsible for figuring them out!

Public Health Departments – Who Does What

States are “legally responsible” for citizen health, but often hand much of this down to local governments and health departments (similar to the mantra that “every disaster is a local disaster”). Local control equals wide variation. Some local public health departments prioritize preparedness, including public education and sponsoring medical reserve corps. Others pass off parts of preparedness to county emergency management, and focus on other public health problems.  I don’t mean to downplay state level public health. Although also incredibly variable from state to state, state public health might help set state health policy, track epidemiology of infectious disease, perform health inspections, or coordinate public health threat response on a state-wide level. Despite all these responsibilities, for some reason public health activities at all levels often seem fairly invisible to the public they serve.

The most important state government role is MONEY! State budgets determine public health funding, both at state and local levels. Unfortunately, public health was hit hard in the past few years. 29 states decreased funding, including “loser” states like Oregon, with decreases of over 15%, sometimes three years in a row. If state budgets act as a gauge of state commitment to healthcare emergency planning, we’re in big trouble!

What about the federal government? What do they do? After 9/11, healthcare preparedness became a huge priority. In truth, federal government took up the slack for the states. Almost 15 billion in funding allowed every state to develop emergency and pandemic plans, including how to get medications from the National Strategic Stockpile. Most states can now rapidly test for biologic and chemical threats, and have plans for rapid communication with the Centers for Disease Control (CDC). Speaking of the CDC, this huge federally funded public health and research institution is responsible for national response to everything from food borne illness (E. Coli for example) to epidemics.  Unfortunately, after a great few years, federal budgets since 2005 have cut 38% of support for local health departments and healthcare planners.

Centers For Disease Contro

Centers For Disease Control, Atlanta.
Photo by Brett Weinstein

Why You Should Care About Public Health

Why should you care? What might happen without strong public health? Let me give you just two imaginary public health disaster scenarios:

1) A new disease arises and quickly spreads around the world via global travel. Although it kills only a “measly” 2% of its victims, it sickens 20 % of the population for up to two weeks, 5 % of whom require hospitalization. (Doing the math on America’s 2011 population equals 62,318,383 total patients, 3,115,959 hospitalized, and 1,246,368 deaths if the disease spread everywhere without control – truly a health catastrophe, but not out of the realm of possibility.)

Emerging Zoonotic diseases

Emerging zoonotic diseases (disease spread from animals to humans). Picture by International Livestock Research Institute.

  • Public health and the CDC are the only ones able to identify the disease and decide the best treatment. They figure out how to slow spread of the disease, including quarantine if needed. Vaccine development requires their research and public health determines how to get vaccine to the entire population. Can hospitals and health systems treat 20% of the population? Not without previous funding for healthcare preparedness!

2) After a massive Pacific Northwest earthquake, water mains are destroyed and wells won’t work because of lack of electricity. Clean water supplies are running out and desperate people start drinking from unclean sources. Water borne illness is increasing, including giardia, hepatitis, and even a few cases of cholera, possibly brought into America by international aid workers.

Unclean water

Child with unclean water from well. Photo by Living Water International,

  • Public health departments watch for disease in disasters, catching them early, identifying the source, and intervening before too many people sicken. They might help develop other sources of clean water and assist with sanitation plans to prevent spread. They plan the best treatments to prevent death and disability, and educate the public on how to avoid becoming sick

Trust For America’s Health 2012 Annual Report

As mentioned above, The Trust For America’s Health 10th annual report, Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorismreviews public health emergency preparedness. Besides state funding, they looked at an eclectic collection of health preparedness measures including childhood vaccination rates, coverage of flu shots, childcare evacuation plans, climate change planning, and others. They chose areas to measure largely based on availability of reliable data from all 50 states.  Many public health activities were not assessed at all – a major fault of the report.

For most people, I suggest just reading the summary, including data for your state. If involved in healthcare preparedness, or if you like details, slog through the 80 page full report, as it contains valuable facts, recommendations, and expert commentaries on many areas of public health preparedness including terrorism, infectious disease, surge capacity, and even weather threats.

It is now clear to me that strong, active, and visible public health departments are a key factor in healthcare emergency preparedness, although it has taken me 25 years in medicine to reach this realization. Just when I finally recognize their value, unfortunately financial support, and thus public health effectiveness, is being steadily eroded away. I suspect most people are as clueless as I was about the role public health plays, but I guarantee, when a healthcare emergency arises, no matter who you are, you will be impacted by both their strengths and their weaknesses.  Take the time to learn about public health now, and become their advocate, or we will all be sorry in the long run!

Stay safe,

Sheila Sund, M.D.

  1. Richard Newton says:

    Very good article. One thing that isn’t touched upon in the article, since its focus is Public Health and its role in Preparedness, is how Public Health is also routinely providing intervention to those of society overlooked or ignored by the mainstream. Those people without insurance or personal wealth do not received the same access to health care as an employee for Microsoft or a hospital organization. We are also providing them with a health care point of contact and information concerning disaster preparedness. Many of the activities of PH are focused around monitoring our communities but also providing citizens a means of access to the systems in place. You often hear of how our mental health system is broken, and it is as I recently discovered on a family personal basis, but their staff levels, at least in some regions, are much beyond PH staffing. The potential capability of response for specific roles when there are 50 mental health counselors and aides as compared with 9 Nurses and aides is obvious. Both roles are extremely important. Both need funding and support. Both greatly assist their communities in good times and bad. Just as we are trained concerning response not being a one organization capability, PH and MH must work side by side and I defer to decide which is most important over a long-term period. (Short term of course it is Public Health and its actions toward life and limb).

    • disasterdoc says:

      I agree completely. Although not part of my current preparedness focus, it is impossible to practice medicine for 25 years without daily reminders of the huge holes in our system for those without access to both physical and mental health services (pretty crazy considering how much we spend overall on health care in this country!). Ironically, the one time you always can get care is when you become eligible for hospice – a shame you have to be dying to be eligible! I am curious to see how this plays out over the next few years with the change in health insurance requirements under ObamaCare.

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