Public health: no progress in four years

Four years of talking about repairing our public health infrastructure and this is where we are:

BATON ROUGE, La. — Authorities along the Gulf Coast faced the near-collapse of the public health system Tuesday, with water supplies sporadic, electricity shut off, hospitals closing and the threat of more injuries and infectious diseases in the aftermath of Hurricane Katrina. (Thomas Maugh and Ellen Barry, LA Times)

True, this is an extraordinary event. But isn't that what preparedness is supposed to be about, extraordinary events? Nor are we much better off in places that preparedness funds targeted. As reader NG brought to our attention a couple of days ago, an article in Health Affairs provides evidence these funds haven't helped much where it was supposed to make the most difference, response times to urgent infectious disease reports:

The survey of nineteen local public health agencies in eighteen states — representing all parts of the country, as well as urban and rural regions — showed response times ranging from less than a minute to more than 40 hours to six to ten test calls placed during daytime, nighttime and weekend hours, according to David Dausey, an associate policy researcher at RAND Corporation in Pittsburgh, and two colleagues.

The objective was to reach a responsible action officer directly. The action officer is one designated to receive urgent calls. In some cases, not only was there delayed or indirect transfer to an action officer, but no response at all.

So where has all the "bioterrorism" money gone in local public health? It's a good question. Much is unaccounted for, much has probably gone to the hucksters who came out of the woodwork to sell local health departments dubious technical fixes, much has certainly gone to wasted multiple "needs assessments" and plans for smallpox vaccination programs of health care workers that never succeeded.

One thing for sure. It was a vain hope that this money could be used to fix a dying and decaying public health infrastructure. The system is in worse shape now than four years ago and possibly the worst shape it has been in for forty years. Public health professionals told themselves they would use this money for their own purposes. Instead the money used them for its own purposes. And those purposes didn't have anything to do with public health.