Hot Topics:

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Hot Topics Public Health Preparedness and
Response
Mark D. Fussell Senior Management Official -
Texas Centers for Disease Control and
Prevention 2008 Public Health Preparedness
Symposium Tyler, Texas - June 12, 2008
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Overview

• Lifting Public Health through Preparedness
• Specific Challenges/Hot Topics
• Keys to Success

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What is Good Public Health?

• A culture of prevention
• Fluoridated, clean, safe drinking water
• Germ-free food
• Smokeless, clean air (Tyler!)
• Safe, navigable environments
• Educated, informed and motivated populations
• High levels of immunization coverage
• Transparency, networks and partnerships
• Action guided by science and evidence
• Capacity to rapidly detect and respond
• Focus on health impact

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Health Impact Moving the Needle on Health

• Improve health status of large and diverse
  populations (tipping points)
• Reduce or eliminate health disparities
• Accelerate adoption of healthy behaviors
• Achieve greater efficiency of public health
  services functions (e.g., laboratory,
  surveillance, reporting)
• Prevent the decline of population health status
  in the wake of a biological, occupational,
  terrorist, or environmental disasters or events
• Increase prevention effectiveness (health impact
  per dollar invested)

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Public Health Preparedness

• The continuous process of improving the health
  systems capacity to detect, respond to, recover
  from, and mitigate the consequences of terrorism
  and other health emergencies.

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To Lift Public HealthWe Need to Be Better
Prepared
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• New Operating Environments
• But CDCs Roles Remain the Same

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The Difference Today Public Health has Better
Tools!
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Resources for State Local Preparedness

• Public Health Emergency Preparedness
• Cooperative Agreement (CDC)
• 5.7 billion awarded since FY 99
• 897 million in FY 2007
• 62 grantees
• Funding source for over 3,500 individuals
• Usually one of top three non CMS funding
  source for State Health Departments
• Companion to Hospital Preparedness Grants

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Laboratory Response Network

• National network of hospitals, state and local
  public health, federal, military, veterinary,
  agriculture, food and environmental testing
  laboratories
• Provides laboratory diagnostic capacity to
  respond to biological and chemical terrorism and
  other public health emergencies

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Bio-Sense

• Enable early event detection and health
  situational awareness using
• real-time clinical data from hospitals
• Lab requests / results
• DoD and VA clinical data
• Over-the-counter drug sales
• Allow local, state, and federal public health
  simultaneous access to health data to
• Analyze syndromes
• Visualize as geospatial maps, time series,
  patient line listings
• Query as needed

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Strategic National Stockpile

• National repository of critical medical assets
  including antibiotics, antiviral drugs,
  antitoxins, other life-support medications and
  supplies
• Procurement and storage of medical material in
  multiple strategic locations across the country
• Building a cache of vaccines and antiviral drugs
  to prepare for pandemic influenza

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Multimedia Information / Education

• Epi-X / Health Alert Network Messages
• MMWR
• Newly designed Website
• Satellite Broadcasts
• Hotlines clinicians
• and public
• Podcasts/ Webcasts

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The Difference Today Public Health has Better
Peripheral Vision!
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We See and Play in Better Ways

• Local - tribal - state - federal
• Domestic - international
• Public private-non profit
• Across sectors
• Animal human - agro
• Health protection - homeland security -economic
  protection

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The ESF View at Federal Level
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Some Specific Challenges/Hot Topicsfor Public
Health
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ChallengeEffectively Operating in Todays
Environment
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Operational Requirements

• Fast detection
• Fast science
• Fast effective communication
• Fast effective integration
• Fast effective action

• Translation to Audiences
• Flexible Systems
• New Networks
• Expanded Partnerships
• Balancing Global/Domestic
• Stand the Heat
• Thicker Skin
• Negotiation Skills

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ChallengeDynamic Planning Environment

• Appreciation for strategic and operational
  planning
• Plans being developed for all-hazards response
  and critical scenarios
• Cascade from the National Response Plan

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ChallengeManaging Up Achieving Results

• 100 have response plans for at least one
  priority agent
• 94 have exercised response plans in the last 12
  months
• 98 have established Incident Command System
  structures
• 100 evaluate urgent disease reports 24/7/365

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ChallengeBalancingUrgent Threats Urgent
Realities
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On Achieving Harmony

• Balancing the Categorical and Crosscutting
• What will occur with what may occur
• Appreciation of both contexts
• Preparedness as a Driver to Lift the System

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All-Hazards ApproachesShould Help Us Greatly

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Urgent Threats Infectious Diseases
SARS
Pandemic Influenza
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Urgent Threats Terrorism
9/11
Anthrax
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Urgent Threats Natural Disasters
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Urgent Realities
Tobacco Control
West Nile Virus
Environmental Health
Infectious Diseases
Chronic Diseases
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Some Realities in Texas

• How to best address MRSA (Pilot)
• How to best measure and prevent Healthcare
  Associated Infections (?)
• The Uninsured/Underinsured
• Unintended Pregnancies
• Border Health
• Tuberculosis
• Obesity/Diabetes
• Health Disparities

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ChallengeResource Limitations Constraints
Ongoing Expectations to Deliver
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Public Health Investment

• What is the appropriate mix of federal, state,
  local investments into public health?
• How can states and localities accurately
  demonstrate match of federal funds in the absence
  of dedicated funding?

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Risks of Categorical Approaches and Fragmented
Initiatives

• Strategic National Stockpile planning
• Smallpox vaccination
• Cities Readiness Initiative
• Early Warning Infectious Disease Surveillance
• Level 1 Chemical Laboratory Surge Capacity
• Pandemic Influenza preparedness
• Real Time Disease Detection
• Demonstration pandemic influenza projects

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Challenge The WorkforcePeople are the
Backbone of Public Health
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Growing Demands Declining Workforce

• Public Health is labor intensive
• Shrinking, aging workforce
• 50 retirement eligibility within next 5 years
• Nurses, Epidemiologists, Laboratorians,
  Environmental Health Specialists
• 250,000 needed by 2020 just to replenish losses

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Growing Demands Systems Challenges

• Recruitment and retention challenges
• Training and leadership challenges
• Our reactive systems need to be proactive

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Some Keys to Success

• Systems Thinking
• Accountability
• 360 Degree Vision
• Innovation and Improvement

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Think Systems First

• Many systems at play
• Each system and moving part is required
• Know your purpose/stay in your lane
• Reach for collaboration and partnership

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Accountability

• Wise investments/good stewars
• Clear benchmarks and metrics
• Willingness to change/consider new approaches
• Comfortable to report /-

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360 Degree Vision

• Work up, down and across
• Success through networks
• Seek new platforms for progress

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Innovation and Improvement
Move the Field Forward

• Identify exemplary practices
• Promote operations research
• Conduct after-action reviews
• Undertake corrective action plans
• Meta-lead

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• Thank You!

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