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Ready or Not 2008, Part Two

January 5, 2009

trust1This is part two of my Trust for America’s Health 2008 “Ready or Not: Protecting the Public’s Health from Disease, Disasters, and Bioterrorism” review. Part one can be found here.

Today, I’ll be touching on parts of section two of the report. As I noted in yesterday’s post, I’m going to skip sections three and four because I’m not very confident in apprising them. If anyone does have any strong feelings about those sections, please feel free to leave a comment below, or email me, and I’ll be happily to go over some of feelings on the subject.

I noted in yesterday’s post that the federal government’s preparedness activities shouldn’t be exempt from review by the Trust, or by any of us. And the report does just that, right off the bat, saying:

While much progress has been made in meeting these deliverables, TFAH finds that the federal government continues to lag in several key areas:

  • Congress has failed to deliver a sustained financial commitment towards preparedness — especially at the state and local level — where many of the essential preparedness and response activities occur.
  • The federal government has failed to align its own policies with the recommendations and guidance it set forth for individual and household preparedness.
  • The current federal emergency preparedness structure is complex and overlapping; the Obama administration will need to untangle this.

That first point is the scariest. Yes, I work in the field, so it’s in my best interest to ensure that public health funding is sustained, but that doesn’t mean that I’m wrong when I say that public health funding, including for preparedness, should be sustained and increased. And anyone who tells you that we just can’t afford that type of investment is confusing their millions with their billions. Take the following passage from a recent New York Times editorial that discussed, among many other things, the amount of money being lavished on Wall Street firms:

Weeks after receiving its first $25 billion taxpayer investment, Citigroup returned to the Treasury to confess that — lo! — the markets still didn’t trust Citigroup to survive. In response, on Nov. 24, the Treasury handed Citigroup another $20 billion from the Troubled Assets Relief Program, and then simply guaranteed $306 billion of Citigroup’s assets. The Treasury didn’t ask for its fair share of the action, or management changes, or for that matter anything much at all beyond a teaspoon of warrants and a sliver of preferred stock. The $306 billion guarantee was an undisguised gift. The Treasury didn’t even bother to explain what the crisis was, just that the action was taken in response to Citigroup’s “declining stock price.”

Three hundred billion dollars is still a lot of money. It’s almost 2 percent of gross domestic product, and about what we spend annually on the departments of Agriculture, Education, Energy, Homeland Security, Housing and Urban Development and Transportation combined.

Now, don’t take my criticism as an assault on the attempt to fix the mess made by Wall Street, I think something needs to be done about it, and done yesterday. But when we can’t find half a billion dollars (.14% of the funds given or guaranteed to Citigroup alone) to make sure that our hospitals and local health, fire, police and EMAs can respond to a disaster we’re assured of happening, one has to question the feds priorities.

A colleague once told me that I’m no expert on public health funding, so take what I’m saying with a grain of salt, but when I’m saying it, the Trust is saying it, the Campaign for Public Health is saying it, well, maybe there’s something to it.

The report also notes the mishmash of agencies and offices at the federal level with some role in public health preparedness. In the mad scramble to create a public health preparedness infrastructure after 2001, every agency started working toward that goal, and now everyone is duplicating work already done, or done better by someone else. The report rightly states that a top-to-bottom review of public health preparedness roles and responsibilities, sooner rather than later.

A big part of that review should focus on biosurveillance. We’ve talked about it before, and we’ll talk about again, as at least two reports are scheduled to come out this spring/summer on federal biosurveillance efforts–biosurveillance isn’t there yet, and that’s a damn shame.

The report looks at the key deliverables of PAHPA, which I found really impressive. I’m glad someone’s keeping an eye on that. I wish they would have done the same for the deliverables for HSPD-21. I spent a lot of time deciphering the Declaration, and felt that the proscribed timelines were much too rushed, and would lead to poorly completed outcomes, or the view that the implementation of the Declaration had unnecessarily fallen behind schedule. I’d love to see how things are going. If any of my readers have any insight into that… well, please drop me a line.

Section five of the report, Recommendations, is my favorite, and as such, I really don’t want to cram it into the bottom of this already long post. Expect my review sometime tomorrow.

Image credit: TFAH

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