The nation’s ability to respond to a wide range of deadly emergencies, from salmonella-tainted melons to weather events like Superstorm Sandy to bioterrorism, is losing ground after years of progress, says a report out Wednesday.
In a study of the 50 states and the District of Columbia, researchers found only five states met eight of 10 measures used to evaluate public health preparedness. Among the measures they examined: Do states have plans to evacuate children from schools during emergencies? Have they met vaccination requirements? Can they staff labs for prolonged disease outbreaks? How has funding changed?
Thirty-five states and Washington, D.C., scored six or lower in the 10th annual report by the Trust for America’s Health, with the Robert Wood Johnson Foundation. The measures come from publicly available sources including the Centers for Disease Control and Prevention, the Center for Climate Control and Energy Solutions and Save the Children.
The main cause for the gaps among states, the authors say, are deep budget cuts: 29 states cut public health budgets from 2010 to 2012. Twenty-three states cut their budgets for the second year in a row. But 21 states and D.C. increased or maintained funding levels.
One of every five state public health jobs has been cut, the report says; federal funds for state and local preparedness have dropped 38% from 2005 to 2012.
The groups impacted: public health teams that join first responders and provide care during emergencies, and those that help communities, such as agencies helping residents recover from Superstorm Sandy in New Jersey and New York.
“Investments made after Sept. 11, the anthrax attacks and Hurricane Katrina led to dramatic improvements, but now budget cuts and complacency are our biggest threats,” says Jeffrey Levi, executive director of the Trust for America’s Health. “Since then, there have been a series of significant health emergencies, but we haven’t learned that we need to bolster and maintain a consistent level of health emergency preparedness.”
The country has not paid “sufficent” attention, the authors say, to “the everyday threats public health departments and health care providers face repeatedly.” In addition to extreme weather and foodborne illnesses, “we have suffered a deadly rise of West Nile virus, a fungal meningitis outbreak and a resurgence of old diseases we thought were largely conquered — whooping cough and tuberculosis — all in a growing era of antibiotic resistance.”
The findings show the nation’s unwillingness to address an expanding list of hazards, says Jim Blumenstock, chief program officer for Public Health Practice at the Association of State and Territorial Health Officials.
“It would be nice if we could say we’re no longer concerned about bioterrorism, it’s Mother Nature we have to face,” says Blumenstock. “But no, we have to be ready to address bioterrorism, severe storm events, and even random occurrences of violence, like we’re experiencing in Connecticut at Sandy Hook.”
Not everyone is likely to agree with the report’s findings.
Florida trimmed its budget by 15.5%, but Florida’s director of public health, John Armstrong, noted in his review of budget materials, “the Florida Department of Health has had and continues to have the resources necessary to accomplish our public health functions in Florida.”
Five states (Maryland, Mississippi, North Carolina, Vermont and Wisconsin) tied for best score, 8. Two states (Kansas, Montana) had lowest score, 3.
In addition to funding levels, the researchers examined each state for:
— Ability to deal with chemical terrorism – (49 states increased or maintained their capability; Washington, D.C., declined to answer the question and Massachusetts decreased its capability); extreme weather events (15 states have plans).
— Staffing for a prolonged infectious disease outbreak – (37 states and the Washington, D.C. have the capacity to supply a workforce in public health labs that would handle a prolonged infectious disease outbreak).
— Accreditation by the Emergency Management Accreditation Program (29 states and Washington, D.C., have been accredited.)
— Having multihazard written evacuation plans for relocating children in all K-12 schools, including how to deal with gun-related violence (30 states and Washington, D.C., have plans).
— Medicaid coverage of flu shots (13 states and Washington, D.C., require a co-pay).
— Meeting the federal goal of vaccinating 90% of children ages 19 months to 35 months old against whooping cough. Two states met the Health and Human Services department’s goal (Hawaii, Nebraska).
— Nurses’ ability to work in other states (26 states and Washington, D.C., do not permit it.) They are the front line for children in many instances, the report says.
— How quickly it can notify public health workers to ensure a quick response. The report says 47 states demonstrated the ability to do so in less than an hour. Three states took longer than 59 minutes: Hawaii (221 minutes), Connecticut (70 minutes), New York (72 minutes).
“This study doesn’t paint a pretty picture,” says Kathleen Tierney, director of the Naturall Hazards Center at the University of Colorado in Boulder. Her program is not associated with the report.
“You have to be able to invest in sustaining problems, keep up with emerging problems, keep up with state of the art equipment, and learn what best practices are out there,” Tierney says. “Even for states that are maintaining their budget that really means their budget is going down because costs are increasing.”