Anthrax pulls us back

Caught: The threat of bioterrorism proves the need to revive elements of our public health system.

October 21, 2001|By Elin Gursky | Elin Gursky,SPECIAL TO THE SUN

In the few short weeks since the attacks on the World Trade Center and the Pentagon, grief has turned to worry as the specter of biological terrorism that has invaded American lives. The public's fears of flying and ascending tall buildings have been replaced with the fear of opening mail.

The fact that biological weapons exist is no surprise. That they have been unleashed at the dawn of the 21st century has caused profound sadness and alarm. How could this happen? How can we be better prepared?

A bioterrorism attack does not announce itself with a loud bang or an explosion, but through the clinical and epidemiologic evidence of an outbreak demonstrated by clusters of patients at hospital emergency rooms and physicians' offices. The responders will not be the military, but public health and medical professionals. If they are adequately prepared, their rapid diagnostic and treatment skills will mean lives saved.

Public health experts have had grave concerns about the possibility of bioterrorism for many years and have been working to prepare the nation for it. But this has been no easy task. The public health infrastructure has been eroded for several decades. To defeat bioterrorism in the coming years, the nation's neglected public health system must be overhauled.

The age of antibiotics and vaccines that eliminated many childhood illnesses was thought to have made dinosaurs of the nation's "shoeleather" heroes - the physicians and epidemiologists who tracked infectious individuals and contained the spread of community diseases like tuberculosis and syphilis. The experts who monitored disease incidence and population health trends played second string to the burgeoning clinics that sought to provide fee-for-service health care to the marginalized, disenfranchised, and the uninsured. In the minds of many, public health was no longer about the public, but the poor. The past few weeks have reminded Americans that public health is for everybody.

The limited funds that the public health has received in the past few decades were targeted to the disease of the day: Money that went to HIV/AIDS one year shifted to multi-drug resistant tuberculosis the next, and hepatitis C after that. For lack of funding, public health got away from its nuts-and-bolts work: disease surveillance, tracking and prevention. The result has been unacceptable rates of cardiovascular disease, breast and prostate cancer in adults, and obesity, diabetes and violence in adolescents.

Our country's local health departments, those on the front lines of infectious disease outbreaks, environmental contamination and, yes, bioterrorism events, are depleted of the trained cadre of professionals who once saw the pinnacle of their careers as service to the health of populations and communities. Of the 3,000 local public health departments in the United States, the median staff size is 13. Few public health professionals are available to answer phone calls from a hospital emergency room at 2 a.m. Saturday when a patient appears with a strange rash.

Poor communication

Electronic information systems are fragmented or nonexistent, impeding the ability to connect the dots of surges of hospital admissions to discern trends in disease and disability. The technology that allows supermarkets to track sales of frozen broccoli should be employed by health departments to follow novel disease events. Communication is the foundation of a responsive public health system. But there are few communication platforms in place that link public health departments with hospitals, emergency responders and others essential to the safety of populations.

This fall's tragic events have awakened policy-makers to the critical needs of infusing public health with increased dollars. History may record this as one of the most pivotal decisions for the future of America. Rendered with thought and understanding, these resources can reap the levels of preparedness that the nation deserves and expects.

Guiding principles

The principles of funding public health that leaders should recognize are:

The capacity of the more than 3,000 local health departments across the nation must be strengthened. They are responsible for detection, and any local response.

Communication platforms must be improved not only to facilitate information sharing across public health agencies, but also among all essential community health and safety providers who will play a critical role in containing a bioterrorist attack.

Bioterrorism planning must be community-based. Public health departments, hospitals, physicians and emergency authorities must integrate and coordinate their training, including simulations and drills, to assure that roles and responsibilities are clear.

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