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HSPD21: Everything Else

November 27, 2007

End Sign This post is the last in a series examining the recently-released Homeland Security Presidential Directive 21: Public Health and Medical Preparedness. Previous posts can be found here: Initial Reactions, Biosurveillance, Countermeasure Distribution, Mass Casualty Care, Community Resilience.

After the four main goals covered in previous posts, five extra sections can be found in the Directive, covering Risk Awareness, Education and Training, a Disaster Health System, the National Health Security Strategy and the Implementation Plan for the Directive.  I’ll cover each in a fashion similar to earlier posts and, as before, do my best to focus on the content.

Risk Awareness

The Directive states that a non-classified briefing be conceived, developed and distributed to all State governors, and mayors and senior county officials from the 50 largest metropolitan statistical areas in the country.  The briefing should be written for the non-health professional and cover such topics as:

…[T]he scope of the risks to the public health posed by relevant threats and catastrophic public health events (including weapons of mass destruction)…

This briefing should be ongoing and kept up-to-date, with new information and threats being passed on appropriately.  The Secretary of DHS should head this effort up and work to obtain appropriate security clearance for State and local government leaders so that they might be able to receive classified threat intelligence.  (All in less than six months.)

Education and Training

There is talk about coordinating federal grant programs in public health and medical preparedness, as well as coordinating preparedness training across the federal government so as to present a common response framework.  Both of these are pursuant to previous regulations (Pandemic and All-Hazards Preparedness Act [PAHPA] and HSPD-8).  A quick to regular readers, that second one there, the due date is a full year after release – bravo!

The third section under E&T calls for the formation of an academic Joint Program for Disaster Medicine and Public Health, with the goal of being an academic center of excellence in the following fields:

…[D]omestic medicine preparedness and response, international health, international disaster and humanitarian medical assistance, and military medicine.

Sounds pretty cool, where can I sign up?

National Health Security Strategy

Pursuant to PAHPA, the HHS Secretary must submit a quadrennial National Health Security Strategy (NHSS) (if I understand it right, it’s similar to the also-quadrennial National Security Review) to Congress.  The only change is that the implementation plan developed in response to this Directive be incorporated into that initial NHSS.

Task Force and Implementation Plan

The newly-established Public Health and Medical Preparedness Task Force (comprised of lots of muckety-mucks) should develop the previously-mentioned Plan.  The Plan shall:

(i) provide additional detailed roles and responsibilities of heads of executive departments and agencies relating to and consistent with the Strategy and actions set forth in this directive;

(ii) provide additional guidance on public health and medical directives in Biodefense for the 21st Century; and

(iii) direct the full examination of resource requirements.

In sum, I think this is the kind of Directive I could get behind – I really wish I was an author on this, kudos to the authors and planners.  If only they had changed a sum total of 20 or 30 words – the deadlines.

The deadlines are ridiculous.  In a world where we talk every day about planning for all hazards natural, accidental and terroristic, saying that we can coordinate more than 2,000 separate and often antagonistic governments in a matter of months is simply foolhardy.  And worse, I worry that it could doom the whole thing.  In an effort to get it all done in time shortcuts will be taken, goals will be uncompleted, or even worse, completed in a scattershot and half-assed manner.

Please be aware that I’m not saying this will happen, but every day gets us that much closer to those ridiculous deadlines, and the pressure to deliver will only increase.  In the final year of President Bush’s term, people will be looking for legacies, and public health preparedness and disaster medicine is one heck of a legacy.

One good thing about the deadlines, though, is that we’ll know sooner rather than later if my fears are unfounded.

Photo credit: StandingTall

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