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U.S. still faces public health preparedness gaps 10 years after 9/11

The nation has 50,000 fewer public health workers than it did 20 years ago, mainly because of government budget cuts.

By Christine S. Moyer — Posted Sept. 9, 2011

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A decade after the Sept. 11, 2001, attacks and the anthrax scare that same year, the United States still is not adequately prepared to respond to public health threats, experts say.

A report issued Sept. 1 by Trust for America's Health and the Robert Wood Johnson Foundation shows that significant public health improvements were made following the 2001 events (link).

Such improvements include developing clear emergency response plans, bolstering laboratory staffing and bio-testing capabilities, and implementing more effective disease surveillance systems in state health departments.

But during the past 10 years, the report says these efforts have been losing effectiveness, due largely to public health budget cuts. The cuts are leaving many departments across the country with too few staff members to adequately implement the measures. For example, some local and state health departments might no longer be able to properly staff their laboratories should there be an infectious disease outbreak, said Jeffrey Levi, PhD, executive director of Trust for America's Health.

Public health workers are "the eyes and ears that notice something unusual has happened. They identify the pathogen in the case of a bioterrorism attack and then mount the response needed to protect people," he said. "These issues are so scary that the public assumes the functions [needed to respond to them] are being maintained. It's almost hard to contemplate that they're not. But the reality is, we've been falling down on the job in terms of" investing in our public health system.

Among the most critical gaps in the nation's public health preparedness is the work-force shortage, Dr. Levi said. The U.S. has 50,000 fewer public health workers than it did 20 years ago, and one in three employees will be eligible to retire within five years, according to the report. Exacerbating the problem are recent budget cuts that have led to a 15% reduction of the local public health work force in the past two years.

Dr. Levi said another concern is the inability of the nation's medical system, particularly in primary care settings, to treat a massive influx of patients in an emergency. He said this problem was demonstrated during the influenza A (H1N1) pandemic in 2009-10, when many primary care offices were overwhelmed with ill patients and individuals who wanted the H1N1 flu vaccine. In some cases, patients waited for their appointments in their cars due to a lack of space in physicians' offices.

The federal government has taken some steps to help address the preparedness issue. In August 2010, the Food and Drug Administration launched the Medical Countermeasures Initiative, which is expected to help the nation respond faster and more effectively to infectious diseases threats.

Experts say lawmakers at all levels of government need to understand the importance of public health departments in responding to emergencies and allocate sufficient funding to these agencies.

"The biggest threat to bioterrorism preparedness today is complacency," said Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. "The worst thing we can do is make something a priority after [an emergency] happens. After it happens is too late."

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