Ever since the terrorist outbreak that occurred on 11th September 2001, the emergency preparedness is now one of the top priorities in the metropolitan areas. In fact, few of these areas have gotten substantial federal funding to aid and support improvements. Even though, a lot of growth and progress has been made, the preparedness level still varies across various societies. The larger societies have stronger response capabilities, while there is a few faintness seen specifically in the areas of workforce education and communication. The experience in regards to various strong leadership, public health emergencies, fruitful collaboration and passable funding have contributed to high states of willingness. Vital challenges are inclusive of postponement in receipt of federal funding, staffing scarcities and lack of funding. In this paper, I will be discussing the Public Health Preparedness Capabilities of America.
Public Health Threats
The public health threats are always going to be around. They can be due to an accident, natural disaster or any kind of intentional mean. These various threats can direct towards the start of public health incidents. The ability to respond, prevent and vigorously recover from the public health threats is crucial for the protection and security of our Nations public health. The terrorist attack of 9/11 was the start of a much needed awareness (Horney et al., 2017). The following anthrax attack made visible the weaknesses in the public healthcare infrastructure and attracted the attention of the US policy makers to the importance for a strong public health emergency preparedness at the local level. The localities have been given more than two years to progress the emergency preparedness capabilities. Many of these localities have gotten new federal funding to aid these labors. Current studies have projected that the local emergency preparedness has progressed ever since 9/11, but there is still a huge gap. These studies have helped identify the weaknesses and strengths of organizations like local health departments and hospitals. Having said that, a few of current national evaluations have been taken under consideration by the use of the community as a unit of analysis. The importance of community level analysis is evident, due to the fact that terrorist attacks involve a lot of organizations and community. Additionally, the use of a more qualitative approach permits capturing the market and policy factors that can have an impact on the preparedness.
Further, will be discussing the states of preparedness for the public health crises. Ever since the public health has received a jump in funding and support after the 9/11 attacks, this is a crucial point in the time for the societies and policy makers to have a better look on emergency preparedness. Will also be discussing the progress and objectives in six centers for Disease Control and Prevention (CDC) focused localities designed to advance local public health authorities preparedness for public health emergencies. Shedding light on three communities that project high levels preparedness, having a focus on the factors that support readiness. Also will be discussing the analysis of some of the challenges that societies face in the preparedness labors and the exploring of the policy insinuations of our findings.
Methods
The findings made are based on the data collected via Community Tracking Study (CTS) site visitations that were held in 12 metropolitan statistical areas (MSAs) in-between 2002 September and May 2003. In every society a reporter was interviewed, two executives from the largest hospitals, first responder, an academic researcher or professor and a public healthcare agency representor. Plenty of interviews were conducted on a state level, inclusive of representors from the primary care connotation, states association of health plans, state hospital association, governors office and state department of health. In total, 132 interviews were conducted in person and via telephone across the twelve sites. Questions that were open-ended were constructed in regards to the objectives and progress of the six CDC focus areas. There was one limitation in the finding, that they were on the basis of the correspondents self-evaluation of the preparedness. Even though a comparison of the response within the sites can be checked for consistency. It cannot be confirmed that the replies are unbiased evaluation. Additionally, the eight-month period of time of the site visits, progression across the sites cannot be associated at a separate point in the time.
Preparedness Activities Since 9/11
The Change in Funds
Looking at the broad concern that public health has been sadly unfunded for ages, but the investment in public health started increasing ever since the tragedy of 9/11. In fact, the federal funding increased from a few hundred dollars to billions on this day. After the 9/11 incident the US Department of Health and Human services via CDC, services administration, and health resources contributed more than a billion in grants for the states to progress the antibioterrorism plan. Amongst the twelve CTS societies, funding to the states ranged from around twelve million for Arkansas to around seventy million for California (Watson, Watson Sell, 2017). These funds were used by the States for infrastructure development and infrastructure development and the allocation of portions to local jurisdictions for the same activities.
Allocating Amongst Communities
When it was the time of site visits it was seen that more than half of CTS societies had gotten at least some part of the state allocation selected for their community. Additionally, some societies were given funds directly from Metropolitan Medical Response System, a federal program which was initiated prior 9/11 to make a positive impact on local emergency preparedness systems. Even though, via HSRA the allocation was around a hundred million to the states for the sake of hospital preparedness, but not any hospitals had received the amount at the time of site visitation. Even the hospitals that received funds via federal sources, the amount was not considered substantial. Bigger hospital systems claimed to have used their own funds as oppose to waiting for federal reimbursing. On a good note, a hospital in Miami claimed to have used around three million for preparedness activities since the event of 9/11.
The Rules that Govern the Federal Fund.
The federal funds which were for public health preparedness were dispersed though strict rules that contain using federal funds for other activities such as nutrition activities and restaurant check. There was no evidence of this found, however, a few preparedness activities had a positive impact on the traditional healthcare activities. For instance, the federal funds given were utilized for the improvement of labs and to hire epidemiologists, which means that the public health will be increased in general as well not just for bioterrorism (Savoia et al., 2017). However, there are a few respondents who claim that it can be difficult to maintain the funding streams.
The uses of Federal Funds
Even though a large portion of the federal funds was consumed for capital investments, such as communication systems, lab equipment, and the equipment which was used for decontamination. These funds were also consumed for personal training, planning activities and maintenance for the sake of capital projects.
The Leadership and its Involvement
Even though a person would expect variations in perceived risk of public health emergency happening across the societies, majority believe that their risk was very high, either a terrorist attack or any accident that was inclusive of a nearby nuclear plant. This notion of priority has developed a sense of collaboration amongst groups that had no prior involvement. In majority of the communities, the county health department has the become the main firm for local preparedness planning, various activities and the receiving of massive chunk of CDC funding that is allotted to the community. The local healthcare departments have worked really hard on creating bioterrorism response. The emergency preparedness leaders mainly reported to the high-level collaborations and cooperation.
The Hospital Activities
If a hospital had or had not received the outside funds they still claimed and responded to being involved community planning meetings. Most of the planning was around the reduction and elimination of bioterrorism. They conducted drills to gain funds. Most of these investments were all about decontamination facilities and various activities. A few respondents considered them to be an improvement but not really major impact. In a few cases, the preparedness activities were actually considered to be distractions for the employees but had next to no impact on the hospitals financial capacity or liability. Even then, there are hospitals that report that they are not adequately prepared for an emergency.
Healthcare Activities and Physician
It was heard the physician activities were mostly less involved than other firms in public health preparedness. Even though, a few respondents from various societies claimed that they witnessed improved and communication and the reporting of disease with the physicians office. Majority of them claimed this area to be lacking. The health plans were usually sidelined. Yet it was heard that efforts are being put to have improvement in the communication systems with the physicians and hospitals monitoring any unusual clinical trends and further communicate the public health information to the members.
The Emergency Preparedness in the 6 Focused Areas
When it came to the distribution of funds, CDC required guarantees to addresses to various crucial areas that were on different stages of application. The larger areas such as Boston, Miami and Orange County, portrayed robust systems in place and were more ambitious and determined with there plan and expectations of the emergency preparedness than the smaller sites. Having said that, the twelve sites have made mention worthy growth in some focus areas.
Readiness Valuation and Emergency Planning
There were respondents who made reports that they were further in these areas than along any other. In fact, all the 12 CTS societies could familiarize some examples of the activities undertaken over the period of time. The communities had a common goal, they wanted to progress well-articulated plan where occurrences are recognized promptly, and everyone is familiar with the response roles that they have. In progressing work plans for CDC, a lot of states used a bottom-up or regional approach, where the locals carried out needs valuation and developed work plans, some societies structured them on already existing protocols.
Illness Investigation and Epidemiology
A similar objective of having real investigation capacity to catch unusual groups of disease was followed by all 12 communities. Only Seattle and Boston had well-developed investigation and surveillance systems. The societies relied on various methods when disease investigation when the electronic reporting was not present. Additionally, to the upgrade of the systems the amount of epidemiologists on staff were being increased.
The Capacity of the Lab
There was a variation in the local efforts to develop lab capacity. For example, the use of funds from the DOJ and the estate health. Before 9/11 Miami set its renown lab. In many of the sites the public health agencies heavily relied on the on the state labs. This arrangement was well suited for Boston. Even after the upgrades the respondents claimed that there were several sites that claimed that their labs felt overwhelmed by the anthrax scare. It is also seen that there are many CTS societies that are working on partnering with private labs.
Communication Issues and Distributing Information
A common objective was projected by the respondents was to get information to the public and main companies as soon as possible in order to facilitate emergency counter. There were also respondents who claimed that it was difficult for them to maintain the publics demand for communication and information during the anthrax scare. Call centers were always busy because of this issue. Then the hospitals were forced to improve their system.
IT and Communication
It was claimed by the respondents that the communication amongst the key organizations and IT was the absolute weakest. This area was neglected before, but a fare share of improvement has been seen lately. Smaller companies have also procured this technology.
The Training of Workforce and Education
There are many communities who have faced hurdles when trying to educate and aware their work force for certain emergencies. They objectives were different when it came to various sites. Some were more focused on how many people should be responsible to handle terrorist threats on call or how the respondents should react to a threat. The training strategies were different for every community or site.
Factors Facilitating Preparedness
While the federal funds carry great importance lately to make a change, however, there were some communities that progressed before receiving chunks of new funds.
Syracuse
High marks were given to Syracuse for its level of preparedness, specially when it was compared to smaller cities. The Syracuse have expanded ever since the events of 9/11. After the tragic events Syracuse attained a huge chunk of funds via MMRS. These funds combined by New Yorks allocation of the CDC funds were primarily used for many activities like the improvement of staff, equipment and lab capacity.
Indianapolis
Preparedness has been very impressive due to the receiving of federal funds for the efforts that they made. The city had been working on the preparedness even before the event of 9/11 ever since 1998. There was also a strong sense of society that was a major factor in the improvement of the of the collaboration.
Orange County, California
The fact that the areas goes through the never-ending threat of earthquakes had prepared them well for events like the 9/11. The fact that there is a nuclear power plant on the south of the county has also helped them become great planners of disaster. Other than that, there strong leadership was given great credit for their role and contribution to the preparedness. Orange county also made maximum use of the federal funding.
Challenges in Preparedness
There are various challenges that can be faced but the most obvious is the lack of funding. There is improvement lately, nevertheless, there are still funding issues faced. Budget deficits have also been an issue. All the 12 CTS states were faced by budget issues. Lastly, the public health staffing seems to be huge issue and has proven to be a challenge (Qari et al., 2018).
Conclusion and Implications
The societies have shown massive improvement ever since the disaster of 9/11, some improvements have proved themselves by time. Further, primary deficiencies should be taken into consideration by the policy makers, mainly in the areas of communication and IT. Role of the local health leaders should be put into consideration. Leaders play a huge role here the communities can certainly benefit form them. Lastly, the states can also benefit from the guidance on the distribution of the public funding. The CDC should also work on encouraging states to distribute the funding on local levels as promptly as they can.
References
Horney, J. A., Carbone, E. G., Lynch, M., Wang, Z. J., Jones, T., Rose, D. A. (2017). How Health Department Contextual Factors Affect Public Health Preparedness (PHP) and Perceptions of the 15 PHP Capabilities.American journal of public health,107(S2), S153-S160.
Savoia, E., Lin, L., Bernard, D., Klein, N., James, L. P., Guicciardi, S. (2017). Public health system research in public health emergency preparedness in the United States (20092015) actionable knowledge base.American journal of public health,107(S2), e1-e6.
Watson, C. R., Watson, M., Sell, T. K. (2017). Public health preparedness funding key programs and trends from 2001 to 2017.American journal of public health,107(S2), S165-S167.
Qari, S. H., Yusuf, H. R., Groseclose, S. L., Leinhos, M. R., Carbone, E. G. (2018). Public health emergency preparedness system evaluation criteria and performance metrics a review of contributions of the CDC-funded preparedness and emergency response research centers.Disaster medicine and public health preparedness, 1-13.
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PUBLIC HEALTH ORGANIZATION AND MANAGEMENT
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Running head PUBLIC HEALTH ORGANIZATION AND MANAGEMENT
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