The Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP) budgets have consistently been cut for the past decade. However, our known and unknown public health threats seem to be increasing.
According to the latest Trust for America’s Health Report, the PHEP budget that provides support for states and localities to prepare for and respond to all types of disasters has dropped from $940 million in FY 2002 to $651 million in FY 2016. The HPP budget provides funding for healthcare systems to respond to and recover from health emergencies and has seen a 50% cut over the years from $515 million in FY 2004 to $255 million in FY 2016.
In 2009, at the start of all of the budget cuts, we saw our first large scale pandemic in the 21st century. Lucky for us, the U.S. government had been spending money on pandemic flu planning for years. The problem was, the 2009 H1N1 flu pandemic didn’t happen according to the plan. It was supposed to be severe and start in Asia, and instead the pesky flu pandemic had mild severity and started in Mexico. Post H1N1, our government took it upon themselves to cut PHEP and HPP funds and give additional funds for H1N1 planning. I was working for the Wyoming Department of Health as their Emergency Preparedness Epidemiologist at this time and I can promise you that we had already revised our plan and responded accordingly. We didn’t need funds to do it after the fact. What we needed was our general PHEP and HPP funds to remain steady (or in a dream world – increase) so that we could look at what our actual needs in preparedness were (i.e., training and increased surveillance efforts).
Fast forward to 2014, additional cuts have been made to PHEP and HPP. One of them I deem to be so crucial it may (again this is my opinion) have led to our hospital systems not being prepared enough to handle an Ebola patient. This was more than $100 million cut to the HPP fund that led to the cut in training programs that included how to ‘don and doff’ personal protective equipment (if you are unfamiliar with the Ebola situation in Texas, the unfamiliarity with donning and doffing procedures is what ultimately led to the spread of Ebola to the healthcare personnel). From late 2014-2015, epidemiology and preparedness programs across the country worked tirelessly on active surveillance, training internal and external partners, and planning. Then in mid 2015, we were blessed with money to plan for our response to Ebola. We hired people to plan for something that we had just spent 9 months planning for. (Can anyone say waste of funds?) These funds were to be used from May 2015-September 2016.
Does anyone know what happened in February 2016? The World Health Organization declared a public health emergency for Zika.
Could we use that wonderful Ebola planning money to support preparedness and/or response activities for Zika? Nope.
Does anyone know what was passed last week? The Zika Response and Safety Act of 2016.
So here we have 9 months of planning and response efforts already underway and the government finally decides what public health officials have been telling them all along. We need money to plan in order to prevent local transmission. Maybe if we had received those funds, along with not being cut again this year in PHEP and HPP, we wouldn’t have the situation that we do in Miami.
In order to protect the public’s health, public health practitioners need to be able to plan for health threats appropriately. If budgets continue to get cut then we will continue to plan for things that have already happened. This can, and in my opinion has, left us with improperly trained staff and strained resources which makes us vulnerable to emerging and re-emerging public health threats. This can easily be fixed by using the situational awareness information that comes from local, state, federal, and global public health agencies to strategically plan for what our country’s public health needs are instead of planning budgets based on what just happened.
References
- http://healthyamericans.org/assets/files/TFAH-2016-InvestInAmericaRpt-FINAL.pdf
- http://www.flu.gov/planning-preparedness/federal/pandemic-influenza-implementation.pdf
- http://www.who.int/dg/speeches/2009/influenza_h1n1_lessons_20090702/en/
- http://www.slate.com/articles/health_and_science/medical_examiner/2014/10/dallas_ebola_timeline_the_many_medical_missteps_at_texas_health_presbyterian.html
- http://healthyamericans.org/health-issues/wp-content/uploads/2015/03/FY16-PHEP-HPP.pdf
- http://www.who.int/emergencies/zika-virus/en/
- https://www.congress.gov/bill/114th-congress/house-bill/4446
- http://www.cdc.gov/zika/intheus/florida-update.html
Amber Erickson, MPH 
When Zika first burst onto the seen of late, especially with regard to the risk to the U.S. I remembered watching news clips of reporters asking congressmen whether they would approve additional funding to combat the spread of the virus. I was also astonished by their reaction, which seemed very nonchalant and bored on either ignorance of how much of a threat viruses can be or disillusioned hope that the virus would not impact Americans on a large scale. Then we got report after report of more people being diagnosed with Zika on American soil. When the health of people is at risk, you cannot hope things work out for the best, you do actually have to prepare to avert the worst.
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Sadly no one ever thinks there is a health risk until it is at their front door. Until our politicians start actually listening to data from public health we won’t see any changes.
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Your post always shine light on issues that need to be addressed. With all the different public health emergencies that are emerging, you would think that this is one of the last areas that would experience a budget cut. In recent years, the world’s public health emergencies continue to occur and seriously affect people’s health physically and mentally (Zhiheg et al., 2012). I believe that the main issue is having proper funding but this area of public health also needs proper staff and training. I understand that public health professionals will not be ready for each emerging issue but we should have the proper resources to be able to handle most situations that come about.
References
Zhiheng, Z., Caixia, W., Jiaji, W., Huajie, Y., Chao, W., & Wannian, L. (2012). The knowledge, attitude and behavior about public health emergencies and the response capacity of primary care medical staffs of Guangdong Province, China. BMC Health Services Research, 12, 338. http://doi.org/10.1186/1472-6963-12-338
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Amber, you had hit on the right spot that aching me enough to volunteer for the Emergency and Preparedness Program at Georgia East Central District Health Department. The work behinds the emergency and disaster preparedness had never been truly appreciated. After the 911 event in 2001, government increased the funding to assist the community respond and recover after man-made/natural disasters. But, this funding has fallen considerably since the economic crisis in 2008. Furthermore, disaster funding distribution is deeply inefficient: huge cash infusions are disbursed right after a disaster, only to fall abruptly after interest wanes. These issues have exposed significant problems with our nation’s preparedness for public health emergencies. The decline in funding was blamed for the deficiencies in public health infrastructure, workforce, and planning that compromise all-hazards readiness. The important of public health as well as hospital emergency preparedness had been evident by the failure of Katrina in 2005. Hopefully, the officials would recognize this crucial issue before another disaster strikes.
Click to access Final%20white%20paper%20Preparedness%20FinancingJan14.pdf
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