Emergency preparedness losing ground due to budget cuts

States have made significant strides in public health preparedness in the last 10 years, but budget cuts and work-force reductions are eroding that success and casting a cloud over future progress, says a December 2012 report.

The majority of states scored slightly lower on emergency health preparedness than in 2010, according to the report, “Ready or Not? Protecting the Public's Health from Diseases, Disasters and Bioterrorism.” The annual analysis, released Dec. 19, 2012, was conducted by the Trust for America's Health and the Robert Wood Johnson Foundation.

“In the past decade, there have been a series of significant health emergencies, including extreme weather events, a flu pandemic and foodborne outbreaks,” said Jeffrey Levi, executive director of TFAH, an advocacy organization focused on disease prevention. “But, for some reason, as a country we haven't learned that we need to bolster and maintain a consistent level of health emergency preparedness. Investments made after Sept. 11, the anthrax attacks and Hurricane Katrina led to dramatic improvements, but now budget cuts and complacency are the biggest threats we face.”

States were ranked based on 10 indicators, including response readiness, infectious disease control, emergency management and health system preparedness. A new indicator in 2012 was extreme weather event preparedness, which measured whether states have climate change adaptation plans in place.

Given climate-change research and the recent prevalence of extreme weather events such as droughts and hurricanes, “we thought it was important to highlight what” climate change preparedness requires, Levi said. “I don't think there's a health department that hasn't thought about these issues, but our role is to make sure that health departments are integrating into the larger state efforts around climate change” issues.

States got one point for meeting one of the 10 indicators and zero if they didn't meet it. Overall, 35 states and the District of Columbia scored a six or lower out of 10. Kansas and Montana scored lowest, each receiving a three out of 10. Maryland, Mississippi, North Carolina, Vermont and Wisconsin scored highest, all receiving an eight out of 10. In 2010, most states scored a seven or higher on the report, with 14 states scoring a nine or better.

The 2012 survey showed only two states met the national goal of vaccinating 90% of young children against pertussis. Experts said the finding is especially troubling after significant outbreaks this year led to 18,000 cases and nine infant deaths.

The analysis found that 35 states and the District of Columbia do not have complete climate change adaptation plans, which include planning for health threats posed by extreme weather events.

Still, health officials have learned from past weather disasters, which was evident this year in addressing Hurricane Sandy, Levi said.

There were “a lot of challenges with response to Sandy, but Hurricane Sandy was not Hurricane Katrina, and that had a lot to do with what we've learned about preparedness in the last 10 years,” he said.

What states are doing better

Amid the areas that need improvement, the report illustrates the success states have made in protecting the public, said Jim Blumenstock, chief program officer for public health practice at the Assn. of State and Territorial Health Officials.

This includes better disease surveillance, improved efforts to store and provide emergency vaccinations and better information sharing among local, state and federal agencies, he said.

The report “really shows the depth and breadth of public health [departments] across the country and what their responsibilities are to protect the public from all hazards,” he said. “These hazards don't stop coming. While much has been accomplished, I think everyone can agree that more [work] remains, and we can't allow any deterioration in the progress that has been made over time.”

But growing budget cuts at health departments across the country are, in fact, slowing emergency preparedness efforts, the report said.

Twenty-nine states cut public health funding between 2010 and 2012, with 23 of these states cutting funds for the second year in a row. In addition, federal funds for state and local preparedness have decreased 38% from fiscal years 2005 to 2012. States also are reporting that gains in public health preparedness achieved in the past decade are eroding. Since 2008, budget cuts have resulted in more than 45,700 job losses at state and local health departments. Such financial hits are ending core preparedness programs nationwide, the report said.

“The future is bleak for public health preparedness if we don't see a re-prioritization of funding toward health preparedness,” said Jack Herrmann, senior adviser and chief of public health preparedness for the National Assn. of County and City Health Officials.

“Many people have this illusion that the billions of dollars provided to public health preparedness means we're now prepared when, in fact, we have to sustain that funding. It's not a one-time deposit.”

Herrmann notes that while the analysis provides a picture of how states are performing, it is not a complete measure of emergency preparedness. Local health departments, which have significant roles in preparing and addressing public health emergencies, are not measured in the report, he said.

“The take-away message is that while this report may provide a snapshot of state preparedness, it's not easily translatable and should not be easily interpreted as 'this is how preparedness is at the local level.' ”