Federal spending on public health emergency preparedness, response, and recovery has been falling since 2005, and Congress is now considering how much to spend in the 2016 fiscal year. The final spending figure will play a key role in determining how well the American people are protected from disease, injury, and death in times of emergency.
Public health emergencies occur all too frequently across the United States. Hurricanes, tornadoes, earthquakes, fires, floods, infectious disease outbreaks, terrorist attacks, airline crashes, train wrecks, industrial explosions, chemical and radiological emergencies, and other calamities have all hit the United States in the past – and unfortunately are certain to hit again. When they do, the nation’s 2,800 local health departments will spring into action to protect their communities, save as many lives as possible, and help communities recover.
Ready to Respond & Recover Local health departments are in the business of expecting the unexpected, because they must be prepared 24/7 to respond to the next public health emergency. Public health emergency responders require frequent training exercises, education, medical supplies, and other equipment to do their jobs. Those who are full-time employees require salaries and benefits. All this makes public health preparedness, response, and recovery activities an expensive task. Although many state and local governments help pay for this, more than 55 percent of the nation’s local health departments rely solely on federal funds for their emergency preparedness activities.
One area where the role of public health agencies often gets overlooked is in community recovery. Recovery after an emergency requires collaboration, planning, and advocacy for the rebuilding of critical health systems to at least a level of functioning comparable to pre-incident levels. Local health departments serve a vital role in the visioning and developing of community strategic and disaster recovery planning efforts so that plans are based on communities’ needs and assets, to ensure that communities are able to build back stronger.
A recent report from the Institute of Medicine highlighted the need to leverage resources to achieve healthy, resilient, and sustainable communities after disasters. Communities become more resilient by addressing the fundamental social determinants of health. As public health agencies are tasked with addressing these determinants – such as housing, transportation, education, access to healthcare, nutrition, and others prior to a disaster – reduction in funding to support preparedness puts communities at risk of not becoming more resilient after disasters.
Key Public Health Programs The three key federal public health emergency preparedness, response, and recovery programs that Congress funds to aid state and local health departments are: Public Health Emergency Preparedness grants through the Centers for Disease Control and Prevention; the Hospital Preparedness Program through the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services; and the Medical Reserve Corps through the Office of the Surgeon General.
Public Health Emergency Preparedness grants go to all 50 state health departments, eight health departments in territories, and four metropolitan health departments. In addition, some local health departments receive funding through subcontracts with their state health departments. Health departments use the funds to pay the salaries of staff who work with hospitals, law enforcement, fire departments, and local government to develop emergency preparedness, response, and recovery plans and conduct training. Some health departments use the grants to establish and maintain systems that make possible early detection of disease outbreaks, rapid information sharing, and public notification. The funding has been vital – for example, for programs to prepare for and respond to Ebola.
Public Health Emergency Preparedness grants provided $919 million to local health departments in 2005, but the amount fell to $644 million in the 2015 fiscal year – a 30-percent cut. The National Association of County and City Health Officials (NACCHO) is seeking an increase to $675 million for the grants in the 2016 fiscal year – still $244 million below the 2005 funding level. President Barack Obama’s 2016 budget request seeks to maintain funding at $644 million. The House Appropriations Committee proposes spending $675 million, while the Senate Appropriations Committee proposes spending $644 million. Neither the full House nor Senate has voted on the spending.
The Hospital Emergency Preparedness Program provides funding for local health departments to partner with hospitals and other healthcare providers to ensure that the healthcare system at the community level can conduct activities to prepare for, respond to, and recover from emergencies. This program received $487 million in federal funds in 2005 but only $255 million in 2015. NACCHO is seeking an increase to $300 million in 2016. The president’s 2016 budget seeks to hold funding steady at $255 million, and the House and Senate Appropriations Committees have both proposed spending that amount. Neither house has voted on the appropriation.
The Medical Reserve Corps costs far less than the other programs, but still has great impact. The emergency medical response program is staffed by more than 200,000 volunteers organized into a network to protect the health and safety of their communities. Sixty-seven percent of Medical Reserve Corps units are housed within local health departments. The units deploy doctors, nurses, emergency medical technicians, paramedics, mental health professionals, and nonmedical volunteers with specialized skills who assist healthcare professionals to care for people in emergencies. For example, following Hurricanes Katrina and Rita in 2005, more than 6,000 Medical Reserve Corps volunteers from 150 units supported the emergency response and recovery efforts.
The Medical Reserve Corps received $10 million in federal funding in 2005 and $9 million in 2015. NACCHO is seeking $11 million for 2016, whereas the president’s budget requests $6 million. The House Appropriations Committee has proposed $6 million for the program, whereas the Senate Appropriations Committee has proposed $4 million – a 55-percent cut from current funding. The funding has not come up for a vote by the full House or Senate.
Dire Consequences of Funding Cuts Previous spending cuts by federal, state, and local governments for public health programs have already taken a toll on public health emergency preparedness, response, and recovery activities. A survey of local health departments by NACCHO that was published in June 2015 found that funding cuts have forced the gradual elimination of the jobs of nearly 52,000 health professionals in county, city, metropolitan, district, and tribal health departments across the United States since 2008. Remaining employees are working hard to protect their communities, but it is impossible for them to take on all the duties performed by colleagues who held the 52,000 jobs that were eliminated.
Work to prepare for, respond to, and recover from public health emergencies is vital and deserves bipartisan support in Congress. When emergencies strike, all people are impacted, regardless of political party affiliation. The modest funding increases that NACCHO is asking Congress to approve for Public Health Emergency Preparedness grants, the Hospital Preparedness Program, and the Medical Reserve Corps would be money well spent – helping Americans live safer, healthier, longer, and more productive lives.
LaMar Hasbrouck, MD, MPH, is executive director of the National Association of County and City Health Officials (NACCHO). He has public health experience at the local, state, national, and international levels, including serving as the director of the Illinois Department of Public Health; public health director in Ulster County, New York; a member of the Epidemic Intelligence Service at the U.S. Centers for Disease Control and Prevention; and a faculty member at three medical schools.