Cuts in public health fund undermine preparedness

By Christopher G. Atchison


Recently, the Trust for America’s Health (TFAH) issued a report that warned of a dramatic decline in funding for emergency preparedness across the nation from fiscal year 2009-10 to fiscal year 2010-11. Iowa alone has seen a 16.2 percent decrease in funding during this time.

Jeffrey Levi, the group’s executive director, said this reduction means “a decade’s worth of progress [is] eroding in front of our eyes.” As someone who has spent 25 years in public health practice, I believe Levi is correct, and his warning is ominous.

Repeatedly, public funding for public health has tracked with the popular perception of risk. If there is a disease threat, support for public health goes up. If the threat appears low, funding goes down.

I was in Illinois in 1985 when the region experienced a large Salmonella outbreak. Immediately, funding was found to build a long-sought, new state laboratory so we could better identify such organisms. The TFAH report tells me this cycle of preparation and disregard is repeating itself once again.

When the current cycle began 10 years ago, I was in Georgia meeting with Centers for Disease Control officials, for discussions on how schools of public health could improve their training programs. When we sat down at 8 a.m. on Sept. 11, 2001, terrorism was still an abstract concept.

Unfortunately, by

10 a.m., the abstraction had ended and our focus had fundamentally shifted. The need to improve our nation’s ability to deal with terrorism brought funding to public health with a focus on conditions caused by human malicious intent.

The benefits of this effort went beyond preparedness for terrorism. Over the next five years, schools of public health moved to initiate new areas of training and education for students as well as engage at a profoundly higher level with state and local health agencies. We established entirely new working agreements with public safety and security programs, which included addressing how criminal investigations into biological threats could be conducted in parallel with public health disease investigations.

Health officials learned new skills focused on protocols of the Federal Emergency Management Administration. New approaches to communications with the public were developed and shared. Laboratory and disease investigation capacities were increased, and systems to take advantage of these improvements were put in place. The nation did become better prepared. It benefitted from these enhancements, not as the result of a response to another act of terror but in response to a decade’s worth of disasters and emergencies.

In Iowa, we used these approaches and partnerships to address floods, tornadoes and a pandemic of influenza. In our routine daily work, these new capabilities allowed us to better address health threats to newborns, food outbreaks and environmental contaminants. Disease investigators were trained and new laboratory equipment put on line. Today’s food safety is but one example of how we have advanced in the last 10 years.

Unfortunately, cuts in funding for public health preparedness diminish our ability to maintain levels of safety upon which our nation relies. We can absorb the cuts identified by the TFAH report for only so long. We must maintain capability through continued training and equipment replacement.

The TFAH report is a warning that we should not ignore the lessons of history and wait for another event to overwhelm our ability to respond.

Christopher G. Atchison is Director of the State Hygienic Laboratory at the University of Iowa and Associate Dean for Public Health Practice, UI College of Public Health. Comments:


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