The Coming Public Health Collapse

Co-posted on Genesee Valley Nurse

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The Anthrax attacks that followed in the days after 9/11/01 reminded us of the need for public health emergency preparedness.

Public health efforts have vaccinated millions, crushed Polio, and eradicated Smallpox, and they've done so while operating in the background of emergency management in relative obscurity...until September, 2001. The Anthrax attacks provided a wake up call to the Nation that our public health system was vital to the effectiveness of domestic preparedness efforts. Public Health was thrust into the public safety arena. With emerging biologic threats that jumped off the pages of a novel and into reality, it looked as if public health was destined to remain a part of the new traditional responder group.

Not so fast.

In Ready or Not? 2011, Protecting the Public from Diseases, Disasters, and Bioterrorism, the Trust for Americas Health reports that "key programs that detect and respond to bioterrorism, new disease outbreaks and natural or accidental disasters are at risk due to federal and state budget cuts."

We're still searching for preparedness in America. Rather than continuing to support efforts to maintain a durable healthcare/public health preparedness system, we're going to go backwards.

"We're seeing a decade's worth of progress eroding in front of our eyes," said Jeff Levi, PhD, Executive Director of TFAH. "Preparedness had been on an upward trajectory, but now some of the most elementary capabilities - including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies, and treat people during mass traumas - are experiencing cuts in every state across the country."

Here are a few examples of the capabilities that will be lost:

• 51 cities at risk for elimination from the Cities Readiness Initiative
• 10 state labs at risk for losing "Level 1" chemical testing abilities
• 24 states at risk to lose Career Epidemiology Field Officers
• 14 universities at risk to lose Preparedness and Emergency Response Learning Center funds

Why? Because when nothing happens, nothing happens. And nobody wants to pay when nothing happens. We've seen concern and hype over SARS, Avian Flu, Swine Flu - and nothing not much happened. Our impression of preparedness is high visibility people with uniforms, badges, guns under the failed approach of Homeland Security. Healthcare and public health operate in the background of preparedness and lack that high visibility until some biologic threat is exposed. Then, and only then, is the value of a durable healthcare/public health system realized...temporally. Katrina reminded healthcare systems to be ready. How can they be if they're not assisted with the same level of resources afforded to other Homeland Security measures?

Preparedness for biologic events, natural or intentional, requires funding to remain constant for healthcare and public health. That funding needs to be on par with other traditional response groups. Without healthcare/public health we will face what it  means to live or die in disaster.

Failure to maintain healthcare/public health durability will worsen the ripple effect from biologic events by increasing strain on traditional responders and healthcare systems and by worsening the impact on special needs and at-risk populations. These things add up to poor outcomes from natural or intentional biologic events. Poor outcomes that can be predicted, and prevented if we'd change the way we think.