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Ready Or Not 2007 Review

January 2, 2008

Ready or Not 2007 Advertisement This was the first year that I read this report in my current job.  If I knew then blah blah blah.  Basically, I thought it was a good report.  I think that Trust for America’s Health (TFAH) raised some good points, though I still worry about the “be scared” message it can send.

If there is one thing I’ve learned in this job, it is that a large part of public health preparedness is toning down fears.  There are literally a million things that will kill us all; and the evening news just LOVES to tell everyone about them all, in breathless fashion.  So, when reports like this come out, and W-NEWS in Cedar Rapids, Iowa leads the night’s stories with how unprepared Iowa is and how Iowans are the shame of the United States and the state public health department has wasted millions of dollars – well, it can be a bit unproductive.

And I know I’m not absolved of this myself.  I bitch and moan about the dreadful state of affairs on this blog more than most, so I gladly accept some of the blame.  It’s a tight rope to walk, vacillating between trying to get things done and scaring the living daylights out of my readers, and one that I now appreciate much more.  So, with that in mind, I think this is a good report.  I think that the introduction, pages 1 – 14, is a very nice, quick overview of public health preparedness efforts in the US, and I encourage you all of at least read that part.

The Ready or Not 2007 report focused on ten indicators, from Strategic National Stockpile (SNS) distribution planning to funding commitments.  Each state (and the District of Columbia [DC]) either passed (and received a point) or failed each indicator, so the best a state could do was 10 points.  As noted before, seven states scored a perfect 10, while six states only received six points.

First, the bad stuff.

There were, as noted in the report, limitations to these rankings, as most of this information is simply not available, and if it is, there is no way for TFAH to independently confirm or rate the information they collect.  For example, 38 out of 51 jurisdictions received credit for having an SNS distribution plan.  There is no, and there can be no, comprehensive review of  how effective these plans are, or if they’re even do-able.  TFAH merely accepted that any state that received above a 60 from the CDC’s SNS assessment tool did an adequate job.  Now, as someone who has seen this tool, 60 points is pretty poor.  Some states, though, scored more than 90 and 95 points, yet in TFAH’s report, no difference exists.

I also was a bit unhappy with the inclusion of DC as part of this report.  So much of DC’s response effort would be managed by the federal government that there is no need to duplicate federal efforts, which unfairly lowers the DC score.  For example, the two indicators that DC did not receive credit for were both lab-based.  I’m sure that if a sample is taken in DC for some potential bio-threat or a rush of samples comes in, due to their being considered part of the National Capital Region, these samples would be handled directly by the FBI and/or CDC.  Penalizing DC for depending on the federal government seems unnecessary.

Some of the indicators were a bit crude.  For example, community resiliency was ranked solely on the number of Medical Reserve Corps members per 100,000 persons.  Also, TFAH measured “public health progress” by the reported increase or decrease in seniors seasonal flu vaccination rates.  And, of course, the “do you have a plan – any plan” SNS plan question.

Now, the good stuff.

I really liked the consistent references to all-hazards preparedness, and the constant linking of day-to-day public health to preparedness measures.  While I complained earlier about using vaccination rates for public health progress, that’s a key part of seasonal public health work, and one that helps health officials understand how that type of work can be used in response to a large event.  I know that some locales (and I believe Colorado did a huge one of these early this year) do seasonal flu vaccination clinics to test their SNS distribution plans.

TFAH did it right when they made sure that each state had a biosurveillance system that linked with the CDC’s.  This is a huge part of detecting unusual disease incidence rates and clusters and helps every single day.

I appreciate the specific focus on health care worker liability coverage.  This is something that I’ve had some experience with, so I know how ornery it can be – and what a backlash it can cause from the health care community.  While I personally feel that the courts and legislatures would step in after a disaster to absolve health care workers, there is absolutely no reason health care liability in a disaster situation shouldn’t be addressed right now.  The fact that this was the indicator that the states did worst on (only 29 states’ regulations dealt with at least one of two liability measures) is shameful, considering this should be the easiest thing to fix, as it requires no new massive outlays of funding, capital project improvements or other large scale projects.

My overall positive view is that while seeing that some states might not be doing as well as we’d like, reports like this keep these issues on the front burner and keep folks aware of things like the fact that public health preparedness funding is being cut and we’re still not ready.

Some final notes on two of the remaining chapters, Additional Issues and Concerns, and Recommendations, before we close.

The Additional Issues and Concerns functioned as sort of a catch-all for public health related topics that adversely affect preparedness and response efforts, yet are scarcely addressed, or only very recently, by governments and funding agencies.  That said, as a public health first person, I think these are key to response and can impart valuable lessons that will help inform public health response.

First up is the public health workforce shortage.  As you may, or may not know, positions in traditional public health are increasingly being staffed by older folks, and when they retire, they simply aren’t being replaced.  A professor of mine once noted that my local health agency, the Philadelphia Department of Public Health, has, at any given time, up to half of the positions in the Commissioner’s Office unfilled.  The TFAH report highlights legislation intended to address this shortage, and the fact that nothing is being done about it.  The 2006 Pandemic and All-Hazards Preparedness Act calls for two programs to address the shortage, but neither program received any funding in 2007.  In addition to those unfunded programs, Senators Hagel and Durbin have re-introduced – for the third time – their Public Health Workforce Development Act.  Expect to see it re-introduced after the next Senate is sworn in.

Also addressed are issues of mental health, children, and vulnerable populations.  They finally note the continued spread of drug-resistant conditions such as MRSA and MDR-TB, which we’ve addressed as well, once or twice.

The final section I’ll cover is Recommendations.  Their recommendations cover a lot of ground and could completely re-jigger public health as we know it – that’s a good thing.  The bad thing?  It’ll cost a lot of money and require a ton of effort.  As we’ve seen from the budget battles, the money and effort just aren’t there.  Expect to see the same nine recommendations next year.

Image credit: TFAH promo

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