WASHINGTON, D.C. -- After the anthrax attacks of fall 2001, Congress made the single largest investment in state and local public health capacities since World War II. But after spending almost $3 billion to date on public health preparedness, how much better prepared are we for a terrorist attack?
With the support of the Robert Wood Johnson Foundation, the Century Foundation Working Group on Bioterrorism Preparedness has studied how these funds have been used and assessed what has been done well, what gaps remain, and what should be done in the future.
In the project's final report, "Breathing Easier? The Report of The Century Foundation Working Group on Bioterrorism Preparedness" a group of leading public health policy experts and practitioners concluded that the new federal funding has resulted in considerable improvements to the U.S. public health system, but that substantial vulnerabilities remain. The group found that without clearer definitions of what constitutes preparedness and standards for achieving it, the infusion of funds may not succeed in enabling the public health system to respond effectively to a future bioterrorist attack.
"While increased federal funding has improved the capacity of the public health system to respond to bioterror threats, this report underscores the need for sustained investments in public health or we risk losing the gains we've made," said Georges C. Benjamin, MD, FACP, executive director of the American Public Health Association. "Investments in preparedness must also be made in concert with other public health goals. Strengthening the work force and rebuilding the infrastructure will enhance our ability to support an all hazards approach to public health."
The working group developed a set of recommendations for how bioterrorism funding can strengthen the fabric of public health, rather than stretch it too thin. The group's recommendations include the following:
The government should define public health preparedness more clearly and develop minimum national standards.
Federal and state public health officials, in cooperation with experts in public health, should define what local public health capabilities should be.
Laws governing how responses to public health emergencies and public health investigations are conducted must be modernized.
The public health workforce needs to be enlarged and its skills upgraded.
To sustain improvements in the public health system, the flow of federal and state funding must continue without interruption.
A balance must be struck between preparing for a biological attack and maintaining and expanding other vital functions of the public health system.
"There is concern among the working group that the influx of new money ought to be used productively," said Leif Wellington Haase, Century Foundation health care fellow and executive director of the foundation's Public Health Preparedness and Bioterrorism Project. "If it reinforces existing divisions between state, federal, and local health agencies or if it builds discrete capacities helpful only for bioterrorism-related tasks, to the detriment of broader public health goals, the United States will be less, not more, prepared for an attack," he added.
The Working Group on Bioterrorism Preparedness was aided in its deliberations by two reports prepared by working group members and released by The Century Foundation last year: "Progress and Peril: Bioterrorism Preparedness Dollars and Public Health," by Elin Gursky, and "Illinois: Preparedness at a Price," by Bernard Turnock. These reports and "Breathing Easier?" are part of a broader Century Foundation effort that explores ways to improve domestic security. They are available along with many related publications at www.homelandsec.org, the Web site for The Century Foundation's Homeland Security Project. They can also be found on the Century Foundation Web site at www.tcf.org.
The Century Foundation conducts public policy research and analyses of economic, social, and foreign policy issues, including inequality, retirement security, election reform, media studies, homeland security, and international affairs. The foundation produces books, reports, and other publications, convenes task forces and working groups, and operates eight informational Web sites. With offices in New York City and Washington, D.C., The Century Foundation is nonprofit and nonpartisan and was founded in 1919 by Edward A. Filene.
The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. It concentrates its grantmaking in four goal areas: to assure that all Americans have access to basic health care at a reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social, and economic harm caused by substance abuse-tobacco, alcohol, and illicit drugs.