By Jennifer Hudman
As illnesses and deaths from anthrax attacks increased through
the fall, Americans turned to the public health infrastructure.
They found the nation's disease tracking surveillance systems, its
workforce, and the policies and leadership the backbone of
our ability to monitor and respond to disease outbreaks weakened
by decades of neglect.
"National health experts have long agreed that America needs
to strengthen its public health defenses," says Shelley Hearne,
DrPH, visiting scholar in Health Policy and Management. "Our
public health and medical professionals are in critical need of
the resources, communications networks, and training that will allow
them to quickly detect and respond to chemical and biological threats
to public health."
Claude Earl Fox, director of the Johns Hopkins Urban Health Institute,
says funds need to be immediately targeted to infrastructure, preventive
medicine residency programs, and schools of public health. Our public
health responses have been traditionally categorical, such as the
immunization program at the CDC or the Ryan White AIDS program at
HRSA, says Fox, MD, MPH. "While these programs are important,
there is no flexibility of how the money is spent and this has subsequently
limited the building of the public health infrastructure."
Steinwachs, professor and chair of Health Policy and Management,
agrees with Fox and worries that laws and programs will be created
only to meet bioterrorism threats. "However, these won't assure
that we have an overarching structure to protect against all health
threats," Steinwachs says. For example, a recent congressional
bill allocated $1.5 billion for "rebuilding the public health
response system." However, most of the money is earmarked for
antibiotic and vaccine development.
Steinwachs, PhD, identifies a key area in which the public health
system can be strengthened improved coordination and communication
between all public health agencies. "A challenge we face is
that the federal agencies have all the money, the state has all
the authority, and all the action happens at the local level. We
need to find a way for the three to work together," he says.
The flow of communication and information among the medical and
public health professionals at the different levels needs to become
a matter of routine, rather than an ad hoc interaction occurring
only in a crisis, adds Hearne.
A major challenge is strained resources. "The public health
infrastructure's capacity to respond to the needs around bioterrorism
while maintaining the basic public health services that are normally
provided on a day-to-day basis is the challenge," Fox explains.
Important public health functions, such as disease monitoring and
intervention and food safety efforts, could cease if the nation
experiences a large bioterrorist attack. "Local health departments
and state laboratories are understaffed, under-resourced, and under
a tremendous amount of pressure," he says. "The bottom
line is that the nation needs to appropriate extra money to meet
basic needs of staffing and training in public health four
of five persons in the public health workforce are not professionally
The good news is that the public supports strengthening public health
and its infrastructure, according to findings from a March 2000
report by the Pew Environmental Health Commission, which was written
here at the School. The report found that the public strongly supported
the U.S. spending more to protect public health. "The levels
of support for public health we saw then were incredibly strong,
and now, after the tragic events of Sept. 11 and the ongoing threats
of bioterrorism, we might now be able to translate that support
into targeted action," says Hearne, the Commission's former
Elin Gursky, ScD '85, visiting scholar at the School and senior
fellow, Center for Civilian Biodefense Strategies, sees the current
situation as an opportunity to build the infrastructure. "This
fall's tragic events have awakened policy makers to the critical
needs of infusing public health with increased dollars," Gursky
says. "History may record this as one of the most pivotal decisions
for the future of our country. Rendered with thought and understanding,
these resources can reap the levels of preparedness that our country
deserves and expects."