States and localities were already struggling to pay for the rising costs of emergency public health preparedness when they were hit with the unavoidable costs associated with preparedness for the H1N1 influenza pandemic, as well as preparedness for large-scale public health emergencies.

But now, cash-strapped states have cut nearly $300 million from public health programs during the last year as federal funding for public health has been flat for the past five years, according to a new analysis by the Trust for America’s Health (TFAH).

These cuts, coupled with local budgetary cuts and decreased federal expenditures, have left many states and communities struggling to provide basic disease prevention and emergency health preparedness.

"Chronic under funding for public health means that millions of Americans are needlessly suffering from preventable diseases, health care costs have skyrocketed, and our workforce is not as healthy as it needs to be to compete with the rest of the world," said TFAH Executive Director Jeffrey Levi. "If we are going to improve the health of Americans, we need to fundamentally rethink our approach to funding and managing public health and disease prevention in the United States."

But as previous TFAH reports, studies by other NGOs, and surveys by the federal government in recent years have revealed, as Homeland Security Today and HSToday.us have reported, funding for emergency public health preparedness – especially for catastrophic mass casualty terrorist attacks or natural disasters – has continued to be woefully inadequate.

This problem has continued to grow at a time when authorities have validly warned about the threat of a highly virulent influenza pandemic or mass casualty terrorist attack, such as the growing threat of a terrorist attack using a nuclear bomb or radiological dispersal device.

In today’s devastated national economy, hospitals are accumulating a debilitating ledger of unpaid bills from having to provide care to the uninsured - who studies show increasingly are using emergency rooms to obtain the most basic of medical care – and from inadequate Medicare reimbursement for ER and trauma care services.

HSToday.us has repeatedly sounded the alarm about the swelling crisis in trauma and ER care across the nation.

Meanwhile, the Government Accountability Office (GAO) reported that the federal government needs to better prepare to respond to and recover from attacks using radiological or nuclear weapons.

Disturbing, GAO’s survey found that almost all 13 cities and most states that it studied believe they would need to rely heavily on the federal government to conduct and fund analysis and environmental cleanup activities. However, city and state officials were inconsistent in views on which federal agencies to turn to for help, which could hamper the recovery effort.

At least two-thirds of the city, state, and federal respondents expressed concern about federal capability to provide the necessary cleanup actions after these incidents.

Other recent studies have warned that national preparedness for an attack using nuclear bombs is lacking and that both funding and planning continues to get short shrift.

Elsewhere, GAO found that the Federal Emergency Management Administration (FEMA) faces challenges integrating community preparedness programs into its strategic approach.

“Although it is unrealistic to expect first responders to assist everyone in a disaster, 37 percent of those surveyed in 2007 said that the primary reason they were unprepared was because they believed emergency personnel would help them in the event of a disaster,” the new GAO report stated. “Also, the 2003 and 2007 Citizen Corps surveys reported that 62 and 57 percent of respondents, respectively, said that they expected to rely on emergency responders in the first 72 hours following a disaster.

Similarly, surveys have found that large percentages of the population nevertheless believe that in the event of a mass casualty event that affects them they will have adequate access to both trauma centers and ERs. But as the Trauma Center Association of America  has warned for more than five years, as HSToday.us has reported, that just isn’t the reality of the situation.

Despite current healthcare reform proposals in Congress, the TFAH report said the level of funding for preparedness programs just isn't enough. Furthermore, the report revealed, the magnitude of states’ cuts wasn't offset by the $1 billion in funds that public health received in the administration's economic stimulus package because the one-time funding doesn’t provide sustained funding to keep vital programs funded at the levels they need to be.

"Overall, the economic situation has drastically hurt public health departments across the country," the report stated.

And states are expected to cut budgets even deeper in the coming year, which will further limit the ability of public health departments to carry out a variety of crucial services, including bioterrorism and health emergency preparedness.

“As the earthquake in Haiti reminds us, large-scale disasters often occur without warning and, absent adequate planning, medical supplies and staffing, can tax global medical resources and logistics capabilities to the brink,” wrote Dr Peter Katona, Associate Professor of Clinical Medicine at the David Geffen School of Medicine at UCLA and a Physician Specialist at the LA County EMS Agency, in his op-ed,  Is Our Health Care System a Homeland Security Liability?

Editor of the books, Countering Terrorism and WMD: Creating a Global Counter-Terrorism Network, and Global Biosecurity: Threats and Responses, Katona wrote that “other potential disasters, like the recent slowly evolving swine flu pandemic, provide an unmistakable warning. The last six-months' labored and expensive efforts to deploy public health staff at all levels to deal with vaccine production and distribution should be a wake-up call for everyone.

“Unless we repair our capacity to cope with major medical crises on our own homeland, large populations will be vulnerable during the serious challenges that are sure to come.”

“Much remains to be done,” Katona warned, stressing that “we need to enhance our emergency responder surge and coordination capacity. Anticipating the worst, we must prepare for a brief breakdown of services such as water, food, electricity, oxygen, phone, electricity or fuel. We will need to be self-reliant until public authorities can quickly restore these goods and services. We need to better prepare for a shortage of the workforce as many essential workers are incapacitated, need to deal with their families, or merely leave the stricken area.”