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What I Aim For

September 2, 2008

As they say, the “silly season” is over, and it’s back to the grind.

Not to make a huge deal of it, but my tiny little blog got a visitor last week that I’m sure I don’t deserve. Jerry Hauer, you know Jerry Hauer, right?, commented on my post about the bioterrorism threat being overblown–here’s what he said:


Gaggioli doesn’t understand PODs, when we developed the concept in 1998 there was never an intent to have ongoing costs. Most PODs can be accomplished with little but available daily use material. As for Clark’s assertions, it appears he has neither read the intelligence nor has he looked at history.

Finally our goal when we started the grant program was to build a better public health infrastructure that could help with all aspects of public health. Bioterrorism was the rationale and funding stream.

The biggest waste of funds has been all these so called Centers of Excellence that are funded to please a congressperson or senator.


Strong words, I agree, but he’s been doing this since I was in diapers and has probably fought this battle a hundred times. Thanks, Mr. Hauer, for stopping by.

I wanted to tout Mr. Hauer’s comment on this post because it brings up something that I kind of hint at around here, but have never really focused on. I view public health preparedness as part and parcel of the entire field of public health. I’ve touched on the intersection of these two functionally separate fields a number of times, but always in the context of that particular post. Mr. Hauer’s comment, however, brought my interest in the two into sharp relief.

Public health preparedness is thought of as a focus of public health in the same way that maternal health is, or global health is, or water treatment is. It is focused on providing the greatest good to the greatest number of people. It is different, though, because it impacts all of these parts of public health in ways that none of my examples do.

Preparedness planning is for all of public health. In college, I was interested in public health policy, because it impacted all of these life-saving fields. Preparedness does the same thing. It is public health on it’s worst day, no matter what the cause is.  Planners are charged with taking the worst case scenario and coming up with a workable solution that utilizes the best thinking in a field and a way to apply that thinking in a less than optimal situation. Communicable disease outbreaks, food borne illnesses, bioterrorism; these are just some of the worst case scenarios that will ultimately constrain an already overloaded public health and health care system, yet require an even more tremendous response, leading to an overwhelmed system.

Obviously, early thinkers in public health preparedness realized that these types of situations occur, and, in today’s media culture, will garner a huge audience. Simply, and classically, put, nobody cares about public health until it stops working. And public health, when it does fail, fails big. Because we deal with the health of thousands of people at a time, a mistake, a delayed diagnosis, time spent looking at tomatoes when you should be looking at peppers, means lots of people get sick. Public health preparedness grew up as a field to deal with those situations, and somehow, it had to get paid for.

Now, I’m not expert on public health funding, but I know that a lot of public health folks, including my fellow bloggers, think that money spent on preparedness is money taken from traditional public health. I’ve disagreed a number of times with that statement because preparedness spending (read: bioterrorism, pandemic) is the vehicle for increasing the ability of public health organizations to respond to situations before they grow out of hand, and after they grow out of hand. Point being: A BT epidemiologist is still an epidemiologist on staff. Upgraded lab facilities mean more rapid and higher volume sample testing for chlamydia and for salmonella and for brucella. A POD plan works for a hepatitis A outbreak just as well as it does for seasonal influenza just as well as it does for an aerosolized anthrax attack.

That’s the intention, of course. The operationalization, admittedly, may not have been perfect. Fortunately, this isn’t a bell that can’t be unrung. That BT epidemiologist? She still works in the public health department-invite her to disease surveillance meetings! That geeky interoperable communications guy-ask him if he can help with data collection and transfer!

I know that in today’s world, dollars coming in means job and program security, and traditional public health programs are almost always the first thing on the chopping block. Bioterrorism funding is sexy, and recurring, and should be spent to reinforce and expand public health activities. As Mr. Hauer said above:

Finally our goal when we started the grant program was to build a better public health infrastructure that could help with all aspects of public health. Bioterrorism was the rationale and funding stream.

Image credit: NACCHO

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