Federal funding cuts could threaten public health progress

Washington -- The nation's public health system is much better positioned to respond to emergencies than it was five years ago, say local administrators. But they fear recent federal funding cuts will undermine their gains.

Officials point to funding increases that arrived in the post-9/11 era as a big reason for the improvements. Events in the fall of 2001 served to highlight the role public health plays in defending the United States, but departments nationwide struggled to meet the challenge and resorted to such tactics as shifting personnel from disease control to contend with anthrax-tainted letters.

Congress responded by providing money that many regarded as long-overdue. Public health officials say they have used those funds to strengthen and modernize what had been a shaky and archaic infrastructure. Now the flow of dollars is slowing, and officials fear it could lead to the dismantling of their progress.

In fiscal 2002, the Centers for Disease Control and Prevention distributed $918 million in emergency preparedness funds to states, territories and four large cities. Over the next five years, funding declined, according to a report released last month by the National Assn. of County and City Health Officials.

Because of those funding cuts, 28% of the local health departments surveyed by NACCHO reduced staff time on emergency preparedness, 27% delayed completion of preparedness plans, and 17% delayed or canceled work-force training.

The report was based on findings from two Web-based surveys. One survey was directed to local health departments in each state and the other to a representative sample of the nation's 2,800 local health departments.

It's the uncertainty of future funding that is hitting hard at local departments, several officials said. Public health is a service that relies on people, said Karen Smith, MD, MPH, Napa County, Calif., public health officer and chair of the NACCHO committee that drafted the report.

"We aren't machine-dependent," she said. "We need humans trained in specific areas."

Without stable funding, hiring becomes difficult, she said. "You can't train people and hire them and the next year say, 'Oops, so sorry, the funding is gone.' "

"It's not just a matter of buying the equipment and then saying, 'That's done,' " said Julie Willems Van Dijk, RN, health officer in Marathon County, Wis. "It's maintaining equipment and having staff who know how to use the equipment."

Gains cited

The improvements over the past five years have been dramatic, local officials say. Their perception of the public health role in emergency preparedness in general and national security in particular has shifted, Van Dijk said.

"Prior to the events of 2001, emergency preparedness wouldn't be anywhere near the top of the radar screen," she said. "Now we are an integral part of the emergency preparedness, emergency response system in our community."

Even though preparedness began as a way to improve responses to an attack by terrorists, the focus has broadened, Van Dijk said. "Today I'm less concerned about responding to an intentional terrorist event than I am about responding to a natural disaster like a flood or emerging infection."

Most officials believe that their preparations are beneficial across the spectrum of possible disasters. Van Dijk attributes the rapid identification of spinach as the cause of last year's E. coli outbreak to public health improvements in laboratories and DNA typing.

"I think we see ourselves in a much more proactive, real-time response to all emergencies," she said.

Public health also has developed solid partnerships with law enforcement, fire and emergency medical services, say officials, and it has strengthened ties with local hospitals and medical communities.

"What we have built is helping us day to day," said Michael Caldwell, MD, MPH, health commissioner for Dutchess County, N.Y., which is located north of New York City in the Hudson River Valley. "We have added epidemiologists, health educators and a coordinator of emergency services."

The county's emergency plan has been tested with blackouts, heat waves and floods in recent years, Dr. Caldwell said. In early September, an oil tank fire on the Hudson River caused the closing of a two-mile stretch of the river and close monitoring of air and water quality. "We are now thought of whenever there is an emergency," Dr. Caldwell said. "They ask, what is the health component?"

When Wisconsin police make an arrest in a home where methamphetamines are found, the health department is at the top of their call list, Van Dijk said. Knowing people in other systems personally affords more protection, not only in a terrorist event, but also for communicable diseases or environmental threats, she said.

"We are proud of what we've done," Dr. Caldwell said. "We see money going to other priorities, but [public health] is clearly one of the major priorities for our country, for protection as well as homeland security."