An unknown but deadly stomach virus wreaks havoc in your town. A train accident releases deadly chlorine gas, resulting in the death or injury of scores of residents. Does your local health department have what it takes to handle these crises?
In many cases the answer is no, but the reason might surprise you. While public health labs and offices might have sophisticated computer systems and state-of-the-art lab equipment, what they are missing are workers.
According to a 2004 report by the American Association for State and Territorial Health Officials (ASTHO), more than half the states say they are not fully prepared for a disaster because they lack public health workers. And the current ranks are not encouraging. The average age of a public health care worker is almost 47 years old. Over the next five years, some public health departments will have retirement rates of 45 percent.
“Remember what we learned about the tsunami, that there were scientists in Hawaii who saw what was coming and couldn’t reach anybody at the other end? If something were to happen in an American city, you need trained professionals to answer the phones, interpret the data and sound the alert,” said Leif Wellington Haase, a healthcare fellow at the Century Foundation and author of Breathing Easier? a report on bio-terrorism preparedness.
And the problem is not just numbers. Technology has made it easier for terrorists to acquire biological, chemical or nuclear agents, but how prepared are the workers to handle a sudden or unfamiliar epidemic? The ASTHO report stated that about 42 percent of the epidemiologists in public health departments lack formal training in this important field; in fact, less than half of those in the public health workforce have formal public health education.
Why is the situation so bad? For one thing, most men and women who obtain masters degrees in public health do not go to work for public health departments.
“Even though we are in a fairly large metropolitan area that includes Fort Worth, with half a million people and the state’s third busiest airport, we are a 'lean and mean' staff,” said Lou Brewer, the Health Director of Tarrant County, Texas. The department recently lost a biostatistician to the private sector. “We just could not compete with the offer; they doubled the salary,” she said.
Finding workers?
But it’s not always about money. After 9/11, municipalities have received increased funding from the Centers for Disease Control to hire additional public health employees. But finding these workers has not been easy.
“For many years, schools of public health were not encouraging students to go into public health departments, and the faculty was following the money and the research," said Robert Pestronk, the Health Officer for Gennessee County in Michigan, which includes the city of Flint. "It has been a real challenge.”
However, a 2003 report by the Association of Schools of Public Health indicated an almost seven percent increase in the number of applicants that fall. In an attempt to swell the ranks of future public health care workers, Senators Chuck Hagel (R-Neb.) and Dick Durbin, (D-Ill.) recently introduced a bill to provide scholarships and loan repayments to students pursuing degrees and careers in public health.
In the meantime, those in the “trenches” of bio-defense and homeland security are pushing for far more than an increase in public health workers.
Dr. Elin Gursky, Principal Deputy for Biodefense, National Strategy Support, at Analytic Services/ANSER, warns that current threats dictate a sweeping change in public health.
“What does a 21st century public health department look like? Right now public health departments are a major safety net for 44 million uninsured Americans, focusing on important issues like obesity and diabetes," said the author of the 2004 report Drafted to Fight Terror: US Public Health on the Front Lines of Biodefense. "But if there is a biological attack, we need different kinds of workers… Right now, the health promotion component is stronger than health protection.”
Health officials such as Gennessee County's Robert Pestronk agree that attention to public health should not waver just because 9/11 is fading from the headlines.
“Government public health departments at all levels are successful when they’re invisible — when they prevent things from happening.”
That is why, experts such as Haase warn, there have to be enough qualified people to “answer those phones.”