Wednesday, March 12, 2008

The State of State Public Health Preparedness

Over at In Case of Emergency, Jimmy Jazz - who knows his public health - examines the recent CDC report: Public Health Preparedness: Mobilizing State by State. His post is worth reading, but here are a few highlights.

Jimmy summarizes thusly:

So, what does the Public Health Preparedness: Mobilizing State by State report, released by the CDC, say? Basically that progress has been made, but we’ve still got work to do.
On the first main section of the report, Disease Detection and Investigation, Jimmy argues that improvements have been made:
[T]he CDC funding has, according to the report, paid for more than 500 epidemiologists in 2006. Yeah, but c’mon, they’re BT epi folks, all they do is sit around and wait for the big one, right? Nope, by and large, these folks increase the day to day capacity of public health surveillance and disease detection systems...
In the area of Laboratory Testing, things are not so good:
I think that what’s been going on in the labs front is the least impressive. ... Almost half of the state labs can’t effectively or securely transmit electronic data. What agents or conditions can be tested for is a patchwork quilt of state labs; with no one lab outside of CDC being able to do everything.
Response: Communication and Coordination, Jimmy argues there has been some progress:
The most telling statistic of the improvement in this area has to do with the Health Alert Network (HAN), as implemented by the CDC. In 2001, there was no coordinated way to distribute messages on health and medical issues to the health care community outside of panicked calls. Today, all 50 states, four cities, and a number of unsanctioned and paid for counties have established HANs to do just that. Messages can be delivered from the CDC to a huge portion of the healthcare community in literally minutes now.
Jimmy's argument reminds me that so many conversations about preparedness focus on assets and resources - money, people, technologies. From a certain perspective, focusing on these things is comforting. These are quantifiable goods, easy to compare.

But I'm more and more convinced that the key to preparedness is in developing the right system, including the people who are part of the system. And that's much tougher to analyze or compare.

As a system it needs to be able to respond to a variety of potential scenarios, scalable to a significant degree, and able to communicate clearly with those outside the system.

Anybody can buy and deploy a widget to solve a problem. What's needed is a superior system.

1 comment:

Jimmy Jazz said...


Thanks for the great post.

I couldn't agree with you more that the end result of all of this should be an integrated, robust system rather than a collection of new technologies and well-written plans.

Public health preparedness, unfortunately, is in the weird position of living in a "homeland security" world, while trying to learn what that actually means. We have the responsibility, the money and the drive to be an ESF, but no real history of how to do that. In lieu of the know-how, we're trying to just figure out where we stand, and that translates into an admittedly less than useful laundry list of technologies.

My post didn't really express that, in retrospect. It was written for a public health audience, one that is still very wary of public health preparedness. Many, many people in the field feel that it's a drain on "traditional" public health. In order to respond to that, I tried to show all of the cool, incremental progress we've accomplished. While intended to look impressive to public health folks, people who are in the "homeland security" world come off as less than impressed. As I said, it's a bit of a weird spot that we're in.

It's a process, right?

Thanks again, and keep up the great work,