As Western counterterrorism and intelligence officials worry about the increasing potential for an Islamist jihadist group or inspired individual to carry out a chemical, biological or radiological mass casualty attack in the United States, combined federal, state and local public health spending has fallen below pre-recession levels at $75.4 billion in 2013 — or $239 per person ($218 adjusted for inflation) compared to $241 per person in 2009, according the new Trust for America’s Health (TFAH) report, Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts.
Adjusting for inflation, TFAH said, “public health spending was 10 percent lower in 2013 than in 2009.
According to the new TFAH report, “federal funding for public health has remained at a relatively flat level for years,” noting that, “The budget for the Centers for Disease Control and Prevention (CDC) has decreased from a high of $7.07 billion in Fiscal Year 2005 to $6.93 billion in FY 2015. Spending through CDC averaged to only $20.01 per person in FY 2015. And the amount of federal funding spent to prevent disease and improve health in communities ranged significantly from state to state, with a per capita low of $15.14 in Indiana to a high of $50.09 in Alaska.
In addition, the report said, “public health emergency preparedness cuts in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Funding program — which provides support for states and localities to prepare for and respond to all types of disasters — has dropped from a high of $919 million in FY 2005 to $643 million in FY 2015.
Finally, the report said, “The Hospital Preparedness Program (HPP) — which seeks to improve medical surge capacity and enhance community and hospital preparedness for health emergencies — has been cut from a high of $515 million in fiscal year 2004 to just $255 million in FY 2015, a cut of more than 50 percent, including a more than $100 million cut in FY 2014.
At the state and local levels, the problem is even worse, the report found.
“Public health budgets have been cut at drastic rates,” the report bluntly stated. “According to a TFAH analysis, 22 states and Washington, DC decreased their public health budgets from FY 2012-13 to FY 2013-14. Budgets in 17 states decreased for two or more years in a row, and budgets in nine states decreased for three or more years in a row. In FY 2013-14, the median state funding for public health was $31.06 per person, ranging from a high of $156.01 in Hawaii to a low of $3.59 in Nevada. From FY 2008 to FY 2014, the median per capita state spending decreased from $33.71 to $31.06. This represents a cut of more than $1.3 billion adjusted for inflation.
“Thirteen years ago, the nation had a big wake-up call — the September 11th and anthrax tragedies, which pointed out major weaknesses in the country’s ability to respond to health emergencies. These events helped inspire a series of smart and strategic investments to bolster basic capabilities in our system. And, we’ve made considerable progress in the past decade to more effectively prepare for and respond to public health emergencies of all kinds,” TFAH Deputy Director Rich Hamburg told Homeland Security Today.
Continuing, Hamburg said,“Since 2001, investments have led to significant accomplishments in preparedness planning and coordination; public health laboratories; vaccine manufacturing; the Strategic National Stockpile; pharmaceutical and medical equipment distribution and administration; surveillance; communications; legal and liability protections; increasing and upgrading public health staffing trained to prevent and respond to emergencies; and limited improvements in medical surge capacity.”
However, he noted, “While many improvements have been achieved, resources have been insufficient to support all of the goals. And, over the past decade, preparedness funding has been repeatedly cut.”
“Unfortunately,” Hamburg said, “the country has a history of responding after a new high-profile threat has emerged and expects emergency supplemental funds to be able backfill basic infrastructure needs that have long deteriorated. The country fails to regularly designate resources to ensure that these systems are kept in place to fight new threats or prepare for mass casualty events.”
Hamburg said, “Emergency requests acknowledge ongoing gaps and vulnerabilities in the system. However, while emergency funds are important, they cannot backfill all problems, such as supporting ongoing expert, trained staff or capacities, or address problems quickly enough to keep pace with a new threat as it unfolds. It is essential to provide sufficient and sustained funding on a continued basis to make sure that capabilities are in place, established and well-tested when threats arise.”
Finally, Hamburg said, “Federal, state and local health departments must receive a sufficient level of funding, and some existing funding lines may need to be realigned to be able to ensure all states are able to meet and maintain a core set of foundational capabilities so they can adequately respond to emerging and ongoing threats and prepare for potential mass causality events. The use of all federal public health funds and the outcomes achieved from the use of funds must be transparent and clearly communicated with the public.
TFAH recommended that:
- Core funding for public health – at the federal, state and local levels – be increased;
- The first dollars of core funding should be used to assure that all Americans are protected by a set of foundational public health capabilities and services no matter where they live;
- Funding be considered strategically – so funds are used efficiently to maximize effectiveness in lowering disease rates and improving health;
- The Prevention Fund should be fully allocated to support evidence-based and innovative approaches to improve the public health system and reduce disease rates;
- Stable, sufficient, dedicated funding is needed to support public health emergencies and major disease outbreaks – so the country is not caught unprepared for threats ranging from Ebola to an act of bioterror – and is better equipped to reduce ongoing threats such as the flu, foodborne illnesses and measles; and
- Accountability must be at the cornerstone of public health funding. Americans deserve to know how effectively their tax dollars are used, and the government’s use of funds should be transparent and clearly communicated with the public.
“We cannot afford to let our guard down. We must remain vigilant in preparing for any potential mass casualty event. Yet, year after year, we see less and less funds going to the people who and departments that are responsible for preparing for a public health emergency,” Hamburg warned.
In December, TFAH said in the report, The Outbreaks: Protecting Americans from Infectious Diseases, that the Ebola outbreak exposed serious underlying gaps in the nation’s ability to manage severe infectious disease threats. TFAH found that, “Half of states and Washington, DC scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks.”
The problem of decreased funding also has been exacerbated by the disconnect between health care and public health preparedness, as was detailed in Homeland Security Today Senior Contributing Editor Peter Marghella’s report, When the Crossroads of Health Care and Public Health Never Meet.
Dr. Jim Blair also wrote in hisHomeland Security Today report, Forcing Emergency Preparedness on Health Care, that, “In an attempt to ready the public health care sector in a post-9/11 world, the newly formed Department of Homeland Security (DHS) in 2002 decided to treat the public and private health care sectors as similar in terms of emergency management requirements. In retrospect, it might not have been the best approach. The private sector has a long history of avoiding and delaying regulation, i.e., maintaining inventory of personal protective equipment, seismic upgrading in earthquake zones, installing redundant utility systems in flood zones, securing radiological materials vulnerable to theft and in-place detonation, among other things.”
“While federal resources could be (and were) mandated to achieve a higher level of readiness, the remaining 90 percent of the nation’s public health care sector could not be enticed or coaxed into following suit,” Blair said. “Public health sector emergency readiness became a hot potato issue, passed back and forth among DHS, Department of Health and Human Services and Centers for Medicare & Medicaid Services – with no ultimate authority to enforce a standard of preparation. The private sector dragged its feet, and even DHS could not entice hospitals to adopt suggested guidance, despite the private sector’s receipt of federal grant programs and resources.”
For more than 10 years, Homeland Security Today has reported on the nation’s inadequate capabilities to manage, respond to and mitigate a catastrophic mass casualty public health crisis.