Jack Thompson, MSW Paul Wiesner, MD

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Putting Public Health Preparedness into Context
Health Challenges in the 21st Century

• Jack Thompson, MSW Paul Wiesner, MD

Northwest Center for Public Health
Practice School of Public Health Community
Medicine University of Washington
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Current Public Health Issues (Alphabetical)

• Accountability
• Constituency development
• Disparities/health determinants
• Environmental health priorities
• Financial challenges
• Preparedness
• Public health/medical care tensions
• Public health system issues
• Service delivery/program issues
• Workforce

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Class Ranking

• Class Ranking
• Program issues
• Determinants
• Env. health
• Workforce
• Finance
• PH systems
• Accountability
• PH/medical care
• Preparedness
• Constituency

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Wyoming Ranking

• Class Ranking Wyoming
• Program issues PH/medical care
• Determinants Workforce
• Env. health Finance
• Workforce Program issues
• Finance PH systems
• PH systems Constituency
• Accountability Env. health
• PH/medical care Preparedness
• Preparedness Accountability
• Constituency Determinants

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HTIP Participants Ranking

• Class Ranking Wyoming HTIP
• Program issues PH/medical care Program issues
• Determinants Workforce Finance
• Env. health Finance PH/medical care
• Workforce Program issues Constituency
• Finance PH systems Determinants
• PH systems Constituency Workforce
• Accountability Env. health Preparedness
• PH/medical care Preparedness Env. health
• Preparedness Accountability PH systems
• Constituency Determinants Accountability

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Common Issues

• Program issues
• Financial challenges
• Public health/medical care tensions
• Workforce

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Service Delivery/Program Issues

• increasing number of positive Hepatitis C
  patients.
• prevention/reduction of chronic disease.
• obesity, poor diet and lack of exercise.
• emerging infectious diseases.
• drug resistance MDRO, Tuberculosis, prevention
  of spread, treatment failure.

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Financing Challenges

• Federal funds are decreasing but expectations
  are increasing.
• adequate funding for preventive care.
• Service delivery constraintsmany public health
  departments are having to cut services due to
  costs.
• Budget cuts are carving into the muscle of core
  public health prevention work threatening public
  healths capacity and ability to respond to
  unanticipated emergencies.

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Public Health/Medical Care Tensions

• insurance coverage for public health services.
• access to care, affordable health care.
• disintegrating health care system.
• lack of insurance to encourage early or
  preventive care.
• If enough people go without care, it becomes a
  population health issue.
• We are seeing more focus on individuals rather
  than the concept of the common good or the good
  of the community.

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Workforce

• There is a nursing shortage.
• need for leadership development.
• workforce turnover and issue of cost of
  training.
• lack of qualified, experienced workforce and
  the retention of workers.
• There is a workforce crisisleadership and
  management needs are primary challenges.
• the graying of the workforce, with the
  continuing lack of coherent response to pipeline
  issues.

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Common Issues

• Program issues
• Financial challenges
• Public health/medical care tensions
• Workforce

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Poll Question

• In your opinion, is the list of common issues
  consistent with the priorities you are facing in
  your public health practice?
• A. Yes
• B. No

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HTIP Participants Ranking

• Class Ranking Wyoming HTIP
• Program issues PH/medical care Program issues
• Determinants Workforce Finance
• Env. health Finance PH/medical care
• Workforce Program issues Constituency
• Finance PH systems Determinants
• PH systems Constituency Workforce
• Accountability Env. health Preparedness
• PH/medical care Preparedness Env. health
• Preparedness Accountability PH systems
• Constituency Determinants Accountability

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A Surprise

• These two issues were near the bottom of each
  list
• Preparedness
• Accountability

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Poll Question

• Why are these two near the bottom of the lists?
• A. Accountability is a buzzword used by
  bureaucrats not public health people.
• B. Preparedness has already overwhelmed more
  important issues.
• C. Accountability and preparedness have little to
  do with real world public health.
• D. Some other reason.

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Framing the Issue
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The Local Public Health System (LPHS)
All the organizations, entities, and individuals
that contribute to the publics health
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Public Health Programs
Community
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Public Health Science
Community
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Public Health Infrastructure
Information Systems
Organizational Capacity
Workforce
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Local Public Health Agency
Information Systems
Organizational Capacity
Workforce
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Local Public Health System
Community
Information Systems
Organizational Capacity
Workforce
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Public health preparedness is not something you
purchase and place on a shelf for use when needed.
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Public health infrastructure
Public health preparedness

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Public Health Preparedness Is ...
Infrastructure, plans, and resources that enable
the local public health system to address
significant community health issues and handle
community health emergencies.
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Results in more than immediate health protection.
Public Health Preparedness (Infrastructure)

• Increased accountability
• Stronger partnerships
• Sustained advocacy
• Responsive systems

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Why Is Preparedness Important?

• Unpredicted, rare but catastrophic events
• Predictable but novel events
• Immediate, everyday public health threats

• World Trade Center
• Anthrax
• Y2K
• WNV in Atlanta (2001)
• Pandemic influenza
• TB and HIV
• Tobacco
• Injuries
• Cancer and heart disease

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Public health preparedness is about building and
maintaining infrastructure.
Timeline
1996
2001
2000
1999
West Nile Virus
Bioterrorism
Y2K
Olympics
Center for Public Health Preparedness
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DeKalb County Board of Health

• Center for Public Health Preparedness
• One of three local public health departments
• Formed in 1999 with CDC support
• Three focus areas
• Building local public health capacity
• Enhancing surveillance and communications
• Training

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Expect the Unexpected and Be Prepared to Respond
1999
2001
2002
WNV
New York
WTC Terrorism
Anthrax Scare
DeKalb County
WNV
Center for Public Health Preparedness
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Poll Question
How frequently does my local public health
jurisdiction engage our neighboring jurisdictions
in program planning, public health preparedness,
or other collaborative efforts?
A. Rarely B. Often C. Never D. Dont know
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Preparedness Lessons from WNV
A critical ingredient in public health
preparedness is the collaboration of multiple
local public health systems.
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Atlanta Metro-Area
3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton 3-4
Gwinnett/Rockdale/ Newton 3-5 DeKalb
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West Nile Virus
Issue Fragmented detection capabilities were
unlikely to detect disease
Preparedness response Metro-Atlanta Surveillance
Task-Force (MASTF) formed
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West Nile Virus Response
MASTF membership

• Metro-area health districts
• DeKalb
• Cobb-Douglas
• Fulton
• Gwinnett/Rockdale/Newton
• Clayton
• Division of public health

• Dept. of Agriculture
• Environmental Protection Division
• Environmental Protection Agency - Region 4
• Public Health Lab
• USDA
• CDC

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If we are not all prepared, then none of us is
prepared.
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Some Final Thoughts

• Preparedness is a continuous and never ending
  effort.
• Most important first step is building
  relationships.
• Collaboration between internal and external
  disciplines is crucial.
• Well trained people are the essential ingredient
  in public health preparedness.

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Common Issues

• Program issues
• Financial challenges
• Public health/medical care tensions
• Workforce