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Public HealthInfrastructure and Workforce Preparedness

The Centers for Disease Control and Prevention’s (CDC) Bioterrorism Preparedness and Response Program is funded at a FY 2002 level of $2.3 billion.

We support a FY 2003 appropriations of $1.6 billion.  The FY 2003 budget request represents CDC’s commitment to further define, develop, and implement a nationwide set of public health capacities required at all levels—local, state, and federal—to prepare for, respond to, and recover from deliberate attacks on the health of American citizens.

Basic Facts About Public Health Infrastructure and Workforce Preparedness

• The health of America’s communities hinges on the Nation’s public health workforce—500,000 physicians, nurses, environmental health scientists, health educators, laboratorians, managers, and other professionals who practice on the front lines of public health.
• A trained public health workforce is key to achievement of the public health goals articulated in Healthy People 2010: Understanding and Improving Health and other major public health documents.
• The Nation’s public health infrastructure currently is not adequate to detect and respond to a large-scale bioterrorist event.
• Response to a bioterrorism event requires rapid deployment of limited public health resources in order to save lives and prevent others from becoming ill.
• Extensive partnership is required among federal, state, and local agencies, educational institutions and professional organizations to assure a systematic approach to training which will achieve an effective response.
• Without preparation in core competencies of bioterrorism and emergency preparedness, the capacity of agencies and communities to respond to public health crises is unpredictable.

Upgrading CDC, State and Local Capacity

At the heart of all successful public health activities—in government agencies as well as in the private and voluntary sectors—are public health workers.  They focus on populations and communities, and, in their efforts to ensure quality and accessibility of health services, they apply their knowledge of epidemiology and biostatistics and their ability to build coalitions and support systemic change.  Their work transcends the individual professional and technical skills brought to public health by environmentalists, health educators, managers, microbiologists, nurses, physicians, and others. There is good reason to be concerned, however, that the current public health workforce may not be fully prepared for the work that is required today and will continue to be necessary in the new century.

Brought into sharp focus by the 9-11 terrorist attacks on America, the best public health strategy to protect civilians against any health threat is the development, organization, and enhancement of public health prevention systems and tools. 

Notwithstanding the 9-11 terrorist attacks, major changes, including the emergence of managed approaches to care, unexpected environmental disasters and hazards, and age-related population shifts, are affecting public health systems.  Public health agencies are providing more population-focused services to entire communities and fewer personal health services to individuals, and there is an increased interest in measuring and evaluating performance. Hospital systems and managed care organizations are reaching out to develop community health coalitions; care for vulnerable populations is being reorganized under mandated contracts. These forces and events challenge the skills and abilities of public health workers, who need up-to-date knowledge and skills to deliver essential public health services effectively.

Of specific note, the FY 2003 budget proposes $940 million for use in upgrading state and local capacity to support a fully trained and properly protected public health workforce, strengthened public health laboratory capacity, increased surveillance and epidemiological capacity, and secure up-to-date communication and information systems—all supported by preparedness plans that are coordinated with other state and local emergency management operations.

Also included in the FY 2003 budget is the request to upgrade CDC capacity at $159 million to support CDC’s internal emergency response and preparedness efforts including increasing biological and chemical laboratory capacity; establishing multiple rapid response teams; and increasing the numbers of Epidemic Intelligence Service Officers to meet the demand from states in need of specially trained epidemiologists.  It would also support a full-time emergency operations center at CDC to coordinate response functions should another attack occur.

Actions to be Taken

• Support CDC’s request for $1.6 billion in funding for CDC’s Bioterrorism Preparedness and Response Program;
• Continue to enhance public health infrastructure for bioterrorism response;
• Expand the Centers for Public Health Preparedness (CPHP) program to assure national coverage;
• Focus CPHPs efforts on implementing a nationwide collaborative bioterrorism training plan to reach public health workers, and emergency room, infectious disease and health care personnel; and,
• Continue to develop response capacity.

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