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."

Donald 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 trained."

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 executive director.

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."




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