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Health

Thanks To Budget Cuts, U.S. Remains Unprepared To Combat Future Public Health Emergencies

Despite numerous public health threats over the past decade — including bioterrorism threats like anthrax attacks, the spread of airborne diseases like the swine flu epidemic, and extreme weather disasters like Hurricanes Katrina and Sandy — a new report finds that states across the country still have serious gaps in their emergency preparedness plans.

The Trust for America’s Health report used 10 measures to evaluate states’ public health emergency preparedness, examining indicators such as whether states have met vaccination requirements or whether they have emergency evacuation plans for schoolchildren, and found that just five states currently meet at least eight of those markers. Thirty five states and the District of Columbia fell far short, meeting six or fewer of the 10 key public health indicators.

Only two states have met the CDC’s recommending goal of vaccinating 90 percent of young children for whooping cough. Thirty five states and the District of Columbia don’t have adequate climate change adaptation plans, which would help plan for the health threats that result from extreme weather events like Superstorm Sandy. Thirteen states don’t have enough public health staffers available to work around the clock to respond to an emergency outbreak like swine flu. And, as USA Today reports, the authors of the report cite state budget cuts as the biggest reason that states are falling short on these public health initiatives:

One of every five state public health jobs has been cut, the report says; federal funds for state and local preparedness have dropped 38% from 2005 to 2012. [...]

“Investments made after Sept. 11, the anthrax attacks and Hurricane Katrina led to dramatic improvements, but now budget cuts and complacency are our biggest threats,” says Jeffrey Levi, executive director of the Trust for America’s Health. “Since then, there have been a series of significant health emergencies, but we haven’t learned that we need to bolster and maintain a consistent level of health emergency preparedness.”

The country has not paid “sufficient” attention, the authors say, to “the everyday threats public health departments and health care providers face repeatedly.” In addition to extreme weather and foodborne illnesses, “we have suffered a deadly rise of West Nile virus, a fungal meningitis outbreak and a resurgence of old diseases we thought were largely conquered — whooping cough and tuberculosis — all in a growing era of antibiotic resistance.”

According to the report, 29 states cut their public health budgets from 2010 to 2012. But it’s not just the disaster preparedness funds that hang in the balance — House Republicans have also threatened to slash funding for disaster relief efforts, and have dragged their feet on authorizing federal funds to help clean up the significant damage that resulted from the recent Superstorm Sandy, despite the serious public health threats that linger in the storm’s wake.

And Kathleen Tierney, the director of the National Hazards Center at the University of Colorado in Boulder, warns that the funding situation may be even more dire than it appears on the surface. “This study doesn’t paint a pretty picture,” she told USA Today. “You have to be able to invest in sustaining problems, keep up with emerging problems, keep up with state of the art equipment, and learn what best practices are out there. Even for states that are maintaining their budget, that really means their budget is going down because costs are increasing.”

NEWS FLASH

Majority Of U.S. Schools Unprepared For Pandemic | Less than half of U.S. schools have plans in place to prevent or address a widespread pandemic, according to a study published in the new issue of the American Journal of Infection Control. Just 40 percent of schools have updated their plans since the widespread outbreak of H1N1, or swine flu, in 2009. Despite the fact that the H1N1 pandemic disproportionately affected school-age children, the lead author of the study explained that “findings from this study suggest that most schools are even less prepared for an infectious disease disaster, such as a pandemic, compared to a natural disaster or other type of event.” Over the past few months, the country has seen an uptick in the spread of whooping cough, but state budget cuts have hampered public officials’ response to outbreaks.

Yglesias

In Defense of Flu Vigilance

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Now that the “swine flu” epidemic is maybe looking not-so-bad, there are signs in the air of a backlash against the speed with which the US government, the World Health Organization, and other government agencies worked to ring the alarm bell. I think that would be a big mistake. Part of the essence of the emergence of a new flu strain is that you can’t get a solid, statistically valid sense of how deadly it is until it’s already infected tons and tons of people. But by then it’s way too late to ring the alarm. You need to act, in the first instance, on the fact that a new flu strain could be extremely dangerous so it’s highly desirable to stop it from spreading widely.

Second, the way you stop a flu virus from spreading widely is that you’ve got to raise the level of public concern. There are several billion people living on the planet earth. If each of them becomes a bit more vigilant about washing their hands, a bit more vigilant about staying home from school or work from feeling ill, a bit more hesitant to travel to infection hotspots, a bit more careful about where they sneeze, etc., that all can ad up to a big reduction in the transmission rate. And if it works, you sit back and say “oh, well, I got all panicked over nothing.” But while it’s never good to panic, people haven’t been concerned over nothing—they’ve been concerned over the fact that unless people start acting more concerned, something bad could happen. But a prudent level of concern can solve the problem. That’s the system working, not a pointless gesture.

Yglesias

Mexico’s Quality Flu Response

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Tyler Cowen observes that the Mexican government, which doesn’t always have the best performance, seems to have handled the swine flu episode quite well:

I hesitate to speak too soon but I’m actually somewhat impressed by how the Mexican government, at least at the national level, has responded. There have been many failures of Mexican health care systems at local levels but keep a few things in mind: a) some of the problems lie with citizens who won’t go see doctors, or who won’t go see non-shaman doctors, b) too many Mexicans self-administer antibiotics, and c) when there is so much air pollution it is harder to discover flu cases, especially in the midst of flu season there. Nonetheless Mexican reporting systems seem to have discovered an unusual flu fairly promptly.

Once the national government discovered what is going on, they acted decisively and without undue panic. There has been very little denial, a common feature in the early stages of health crises (how long was it until the U.S. government acknowledged AIDS?). No one is treating the Mexican federal government like a banana republic or a basket case or thinking that the Canadian government would have done so much better.

I think this is about right. Certainly in comparison with how the Chinese government handled SARS and the avian flu outbreak, the Mexicans seem to be acting responsibly and effectively.

Yglesias

Swine Flu and Industrial Agriculture

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There’s been a great uptick in interest over the past couple of years in the environmental and ethical problems with the ways animals are conventionally raised in modern industrial agriculture settings. That, combined with the rise of swine flu, has naturally led to interest in the issue of whether or not the emergence and spread of the H1N1 virus is linked to pig Concentrated Animal Feeding Operations (CAFOs) in some damning way. Grist is hosting an interesting debate on the subject, with Tom Philpott making the case for links and Merritt Clifton pushing back and saying the evidence really isn’t in.

I’m not an expert, but my understanding of the general issue of animal-to-human flu strain “jumps” is that it is related to agriculture, but not necessarily to the CAFO question. The reason these transmission cases typical involve chickens (“avian flu”) or pigs (“swine flu”) is that these are the animals most commonly raised by man. And chicken and pig viruses are subject to animal-to-human transmission in part because it’s common for people and their animals to be living in extremely close quarters in the developed world. It’s true that strict adherence to humane treatment of free range animals would mitigate that risk. But the locus of the problem is less the state-of-the-art developed world CAFOs than it is developing world agricultural practices.

That’s in general. Of course in general these things also usually happen in Asia, where those practices are widespread. Since this particular flu arose in Mexico, where conditions are different, it’s not unreasonable to think that the circumstances of origin are different.

Health

How Health Care Reform Would Help Contain The Swine Flu

swineflu_maskUnder the ‘what should I do if I get sick‘ section of the CDC’s ‘Swine Flu and You’ page, the agency writes that “if you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms…you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.”

But for the millions of Americans who can’t afford to purchase health insurance, a visit to a “health care provider” is an expensive proposition. We know that the 45.7 million Americans without insurance are less likely to visit a doctor and receive needed care, but the the economic crisis, the erosion of employer-based benefits and the skyrocketing costs of health insurance are now causing an increasing number of insured Americans to avoid their “health care provider.” According to the latest Kaiser Poll, 60 percent of Americans say that “they or a member of their household have delayed or skipped health care in the past year” and many are “substituting home remedies or over the counter drugs for doctors visits.”

Unsustainable health care prices are already threatening the nation’s economic prosperity, but in the midst of a possible flu epidemic, the consequences of a large number of Americans forgoing care because it’s too costly become all the more frighting.

This isn’t to say that health care reform will end epidemics. Providing everyone with affordable access to basic medical benefits can only contain health emergencies, but it’s now difficult to argue that extending coverage to all Americans is a wasteful entitlement, or that the insured have little to gain from bringing everyone into the system.

Update

Over at Health Beat, Priscilla Wald — author of Contagiouspoints out, “we should not lose focus on the fact that nothing will go farther to contain the spread of disease than a healthy population with access to health care. “


Update

,Matt Yglesias on what the epidemic tells us about so-called consumer-driven health care:

More broadly, the epidemic serves a reminder that the health care system is in many ways a public function. Free markets work very well for ordinary consumption goods, but Tamiflu is not an ordinary consumption good. It’s important to be able to direct the health care delivery system’s resources toward public purposes and not have the resources allocated purely by market demand.


[upd

Yglesias

Biden and Airplanes

I guess I’ll just say that I’m a bit surprised it’s taken Joe Biden this long to say something dumb. The Vice President has a lot of virtues, but I would suggest not using him as a surrogate in circumstances where you need to walk a very fine line between expressing concern and not sparking panic.

Yglesias

America’s Employer-Friendly Labor Market Conditions Imperil Public Health

The Centers for Disease Control sensibly suggests that in these times of swine flu, if you get sick you should stay home rather than spread the disease to your coworkers:

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Which is nice for those people whose employers provide them with paid sick days. But as Pat Garofalo points out not that many people have employers who provide them with paid sick days:

Currently, nearly 50 percent of private-sector workers have no paid sick days. For low-income workers, the number jumps to 76 percent, and climbs to 86 percent for food service workers. These workers have to decide between the health of themselves and their co-workers, and the wages that they lose by staying home.

In other words, on any given day a large proportion of sick food service workers are going to find themselves unable to afford to take the day off, endangering the health of everyone else. This bill from Ted Kennedy and Rosa DeLauro would “guarantee workers up to seven paid sick days a year to recover from an illness or care for a sick family member.”

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