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Ready Or Not 2008, Part Three

January 13, 2009

tfahThis is part three 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, and part two can be found here.

This post covers the Recommendations section of the report, and is probably my favorite part. The opening statement is really good:

Overall, this report finds that significant progress has been made in the nation’s preparedness to respond to public health emergencies based on state-by-state measures and available data. Yet much work remains on critical issues of preparedness, including: surge capacity, legal protections for health care volunteers, and eliminating geographic disparities in preparedness planning. Above all, preparedness requires a sustained effort and ongoing investment of funds. The progress we have seen is threatened by diminishing federal support to states and localities for their preparedness activities, and it is unlikely that these states and localities can make up the funding shortfalls, given the current nationwide financial crisis.

The report stresses that progress should be made in the following eleven areas:

1. Funding;
2. Restructuring of federal health agencies;
3. Transparency, accountability, and oversight;
4. Surge capacity;
5. Preparedness and health reform;
6. Public health workforce;
7. Research and development;
8. Legal preparedness;
9. Health and sick leave benefits;
10. Food safety reforms; and
11. Community resiliency.

That funding got put at the top of the list is impressive. TFAH understands that properly funding public health preparedness activities is a key component of ensuring the public’s safety. It specifically notes that funding should be sustained at a rate tied to inflation, as preparedness isn’t a one-time purchase–“We finally bought that preparedness, so we should be good now!”–but an ongoing investment in the public health infrastructure (for my new readers, are you sensing a theme here?). Specifically mentioned are the Cooperative Agreement, panflu funding and SNS.

The next point is on reorganizing the federal health agencies that deal with preparedness issues. As public health preparedness has grown from basically nothing to  a full-fledged field, bits and pieces have been added on as needed. An OHA here, an NBIS there, an ASPR here, and voila! There needs to be some rhyme or reason to it all–if only to eliminate duplicating work. While I know how the interplay of DHS and HHS should work in an emergency, there is little guidance on how the two should work together before an emergency. This is something I’d love to see cleared up.

The third recommendation has to do with transparency. For an incoming administration that’s boasting of increase governmental transparency, this should be a no-brainer. As a public health preparedness blogger, I’m all for more information on the status of public health preparedness. That said, the report focuses on reporting for PAHPA and PHEP through HHS and CDC. Public health programs that live in other departments like DHS and VA aren’t mentioned, but should be included.

The fourth is about increasing surge capacity. Not much more to say about that.

The fifth is the shortest, but I would argue probably the most important. It’s titled “Preparedness and Health Reform,” but I would argue that it should be, “Public Health.” A strong public health infrastructure and field keeps us prepared and helps decrease morbidity and mortality in the population. Simply put, take care of public health and save lives.

The sixth recommendation has to do with the public health workforce. As I’ve noted before, the public health workforce is graying and not being replaced as they retire. I’m a big supporter of the Public Health Preparedness Workforce Development Act that’s been introduced in 2007 and 2008. I hope that it makes it to the floor again this year and actually does something when it gets sent to committee, instead of dying–again.

The next recommendation is Research and Development. While it seems to have been written for BARDA and Project BioShield, I was taken that they included upgrades to local and state surveillance systems. I would argue that improving these systems so they can talk in real-time across borders and up to the feds is the critical next step, and should be given priority over BARDA investments.

The next two recommendations are legal in nature and are a bear to deal with–but, they’re super important. Liability protection, MOUs, clear bench guidelines and affordances made for sick and emergency leave are all things that should be worked out before the emergency. To do it afterwards is a second round disaster.

The tenth recommendation has to do with food safety. Salmonella typhirium, anyone? It’s a damn shame that three people had to die because a food-borne outbreak went on for months. Now, listen, I know how hard this is–so much food, so many vendors, so many people, so many sicknesses–but seriously, something needs to be done about this.

The final recommendation is on community resilience. I’ve written about this topic before, and am still conflicted about it. In this report, it’s treated as a sort of best practice catch-all bin. There are ten very concrete recommendations exquisitely presented, then one to remind us that children are not small adults, and that we should communicate with at-risk populations, and we should guard against complacency. Um, thanks for the tip? The introduction to the recommendations says this:

Taking this into account, preparedness plans need to consider the diverse needs of the U.S. population, in particular, “at-risk,” “special needs,” and “vulnerable” populations.

Now, see? That’s something I can get behind–except I would call it Special Populations Planning, not Community Resilience.

That last little bit notwithstanding, I think this is my favorite of the TFAH reports that I’ve read. Whether that’s because public health preparedness has reached a level where goading the field to please do better is kind of pointless, or for some other reason is something I can’t tell; though I hope it’s for that reason.

As I mentioned last year, I look forward to CDC’s report on the state of public health preparedness coming in a few months. I said I hoped it would supplement the TFAH report and not try to provide some sort of “balance.” This generally positive report should facilitate that, but we’ll see.

Image credit: TFAH

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