Ready or Not: Public Health Preparedness Q&A With Paul Jarris

Dec 20, 2011, 2:01 PM, Posted by

Ready or Not?

Combined federal, state and local budget cuts mean basic elements of public health preparedness are at serious risk, according to a new report from Trust for America’s Health and the Robert Wood Johnson Foundation. The ninth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism report found that federal funds for state and local preparedness declined by 38 percent from fiscal year (FY) 2005 to 2012 (adjusted for inflation) - and additional cuts are expected under budget sequestration.

“We’re seeing a decade’s worth of progress eroding in front of our eyes,” said Jeff Levi, PhD, Executive Director of TFAH. “Preparedness had been on an upward trajectory, but now some of the most elementary capabilities—including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies, and treat people during mass traumas—are experiencing cuts in every state across the country.”

NewPublicHealth caught up with Paul Jarris, MD, Executive Director of the Association of State and Territorial Health Officials, to talk about what these cuts in public health preparedness funding mean for state and local health departments and for the health and safety of Americans.

NewPublicHealth: What is the one big take away from the 2011 Ready or Not report?

Paul Jarris: The takeaway is that public health has dramatically transformed itself and is now very capable of protecting the American public in numerous different incidents, both manmade and natural. But it’s not something to be taken for granted. The budget cuts are dramatic. Since 2005 we’ve seen 38 percent cuts in federal budgets for state and local preparedness.. These continued cuts are threatening the ability of public health to protect the American people.

NPH: Why is this latest round of cuts particularly concerning?

Paul Jarris: Our concern is that the federal cuts are occurring at the same time that state and local economies are in really difficult situations. We are not only seeing the cuts in the federal preparedness dollars and other areas, but we’re also seeing layoffs, furloughs and program cutbacks at state and local levels. Between state and local governments, we’ve seen over 50,000 public health workers lose their jobs. We have seen about 17 percent of the state workforce and 22 percent of the local workforce lost in the last two years. Nurses, epidemiologists, laboratorians, preparedness people—all the people there to protect the American public—are losing jobs. That is going to dramatically affect our ability to respond at the same level and quality that we’ve been responding.

We’re also finding that with these budget cuts, states are put in a position of not being able to plan and drill and maintain all the areas necessary for preparedness. For example, states are having to prioritize between areas like mass care and fatality management response and detection and other responses, which may leave the American people unprotected in the event that there is a mass casualty.

NPH: What at-risk funding cuts in the 2011 Ready or Not report pose the greatest threats to health and life if there is an emergency?

Paul Jarris: Again the thing we’re concerned about is the cumulative effects of these cuts over time. It’s important to keep in mind that we don’t have a preparedness capacity that we keep on the shelf. We have a public health workforce that otherwise has day jobs—they may be nurses in clinics, they may be laboratorians, they may be public health educators—and when there is an emergency they transform in what they do and respond to that emergency. Preparedness is about the entire public health workforce working with their communities, working with Homeland Security, law enforcement, fire and others. Not only are the budget cuts affecting our ability to prepare for and drill and respond among the public health preparedness workforce, but the other cuts to the workforce mean we don’t have the capacity to surge and respond to an event. Particularly with a serious, long-term even, we won’t have the bench strength to respond on a continual basis to protect the American people.

NPH: What are some recommendations for ensuring the country remains prepared for emerging threats?

Paul Jarris: First and most important, we can’t become complacent. We need to understand that there are emergencies occurring every day in this country—whether it’s the Gulf oil spill, the radiation from a nuclear power plant in Japan, the tornados in Alabama or Joplin, Mo., earthquakes even here in D.C., hurricanes all up the Northeast where we’re not used to having hurricane damage, wildfires in Texas. We’re responding continuously. That means the public health workforce needs to continually drill and refine our plans and become more and more expert. We have to continually work with the public to make sure they’re prepared and they have the resources they need in their homes and in their communities to respond to and recover from emergencies. We need to understand this takes continued investment.

Another area that’s important is medical countermeasures. It is important that we have new and better vaccines and antibiotics and antivirals, but a vaccine in a bottle does not protect the American public. We need to recognize that we need a robust capacity with public health workers who can go out and provide that vaccine to real people so people are immune or to provide that medicine so people are cured or protected in the event of an emergency.

The last thing I’d say is that we need strong communities that are resilient. That means working with them, educating them so they are prepared to respond and recover. But it also means providing good public health throughout this nation so that our communities are as healthy as possible because when they’re healthy then they’re better able to withstand an emergency or a threat to their health.

This commentary originally appeared on the RWJF New Public Health blog.