We Can Prevent a Health Crisis

In this commentary, the Honorable Thomas H. Kean, M.A., chairman of the board of trustees of the Robert Wood Johnson Foundation, and Risa Lavizzo-Mourey, M.D., M.B.A., Foundation president and CEO, propose a three-pronged strategy to prepare for public health emergencies. This commentary appeared on the opinion page of the Philadelphia Inquirer.

The nation's public health leaders who gathered in Philadelphia this week confronted a reality so harsh that it frightened even them: Our cities and states are unprepared to handle public-health catastrophes caused by disease, natural disaster or bioterrorism, despite the terrible lessons of 9/11 and the Katrina calamity.

This isn't just because the American Public Health Association's annual meeting, originally scheduled in New Orleans, was one of Katrina's many casualties. These disasters and new reports, such as the one issued by the nonpartisan Trust for America's Health (TFAH) last week, deliver a chilling conclusion: Even now, we fear that no one is watching our backs.

For all the furor over pandemic flu, state and local preparations remain inadequate. In the event of a major bioterrorism attack or crippling natural disaster, Chicago and New York are the only cities ready to distribute vaccines, antidotes, and medical equipment to large numbers of their populations.

Hospitals in one-third of the states have yet to plan effectively for the sudden and massive surge of people who would be injured in a disaster or infected in a bioterror attack.

Only 10 states have public-health labs with adequate facilities, technology, and training to respond to a chemical attack. Half the states don't use the recommended national reporting system to track outbreaks of communicable disease and share information between jurisdictions. And hospitals in only two states, Rhode Island and South Dakota, have extensive plans to keep health care workers on the job during a major outbreak of infectious disease.

We should be somewhat reassured that the federal government is amassing a national stockpile of medicine and medical supplies to be shipped within 12 hours of a terrorist attack, major natural disaster or accident. But 43 states are not ready to distribute these critical supplies locally.

And in words that eerily evoke FEMA's Katrina dysfunction, state and local public-health officials warn, in the TFAH report, that the stockpile is "shrouded in mystery and the worst kind of bureaucracy" and guidance to the states is "anything but helpful."

A post-9/11 preparedness assessment earlier this year found that 80 percent of local public health departments cannot communicate instantly with state health departments, hospitals or local medical practices. Just as on 9/11, when first responders radio for help, no one can hear because the networks are not compatible.

The bottom line is that more than four years after 9/11, our government is not living up to its obligation to protect the security and health of our people.

There is an answer, a three-pronged strategy that America can begin carrying out right now.

  • First, properly fund public health and disease prevention. Right now, 95 percent of all health spending goes for medical care and biomedical research. No more than 2 percent is for the protection of the public's health and the prevention of disease. That makes no sense.
  • Second, let state and local health and preparedness officials do their jobs without undue hassle, delay or second-guessing and with consistent and measurable standards, good coordination, enough resources and savvy leadership.
  • Third, engage business, the faith community and civic organizations more fully into public health and emergency preparedness.

When the different sectors of a community team up to protect the safety of their families and each other, it's called "connectedness" and it's time it became the rallying cry of emergency preparedness so no one, ever again, is left behind in these days of terror and threat.

The public has every right to expect that the strongest and most powerful country in the world would be ready for the very worst, but it is not.

We don't have much time left to make this right. Until we are able to put moral purpose ahead of expedient politics, history will judge us a democracy unwilling or unable to take care of its own.

Thomas H. Kean is former governor of New Jersey and chairman of the board of the Robert Wood Johnson Foundation.

Risa Lavizzo-Mourey, M.D., M.B.A., is the foundation's president and CEO

Contact Risa Lavizzo-Mourey at op-ed@rwjf.org.