When you plan your weekly, monthly, and yearly budget, you set aside money to ensure you can pay for things like car insurance, groceries, doctor visits, fire insurance, etc. It is what you do as an adult to ensure your family has all the resources needed to weather the year.

The American people expect their local, state, and federal governments to do the same thing, especially when it comes to being prepared for health emergencies. However, that’s not really the case.

In our ninth annual study, Ready or Not? (http://healthyamericans.org/report/92), we analyzed current budgets and proposed upcoming budgets and likely funding scenarios and found that a number of programs that help detect and respond to bioterrorism and other health emergencies are at risk for major cuts or elimination. These cuts are expected to impact every state in the nation in one way or another.  Notably:

• 51 of the 72 cities that are currently part of the Cities Readiness Initiative are at risk for elimination from the program. This initiative supports the ability to rapidly distribute and administer vaccines and medications during emergencies;
• All 10 state labs with “Level 1” chemical testing status are at risk for losing top level capabilities, which could leave the U.S. Centers for Disease Control and Prevention (CDC) with the only public health lab in the country with full ability to test for chemical terrorism and accidents;
• 24 states are at risk for losing the support of career epidemiology field officers – CDC experts who supplement state and local gaps to rapidly prevent and respond to outbreaks and disasters, such as during the H1N1 flu pandemic and responding to the health impact of the Gulf Oil Spill in 2010; and
• The ability for CDC to mount a comprehensive response to nuclear, radiologic and chemical threats as well as natural disasters is at risk due to potential cuts to the National Center for Environmental Health. All 50 states and Washington, D.C. would lose the support CDC provides during these emergencies.

While bioterrorism grabs all the attention, Mother Nature can be just as vicious. We saw last year a number of climate-related public health emergencies: floods, hurricanes, snowfall, etc.  Local and state governments relied on federal funds and special one-time H1N1 dollars to handle the surge of patients, distribute medicines and keep people alive. If we continue on the current budgetary path, every community in the country will be less prepared and have fewer resources to handle these types of emergencies in the future.

In the past year, 40 states and Washington, D.C. cut state public health funds – with 29 of those states and D.C. cutting their budgets for a second year in a row and 15 for three years in a row.  In addition, federal funds for state and local preparedness declined by 38 percent from fiscal year 2005 to 2012 (adjusted for inflation). The Great Recession is clearly taking its toll on emergency health preparedness. 

In the report, Mel Kohn, M.D., M.P.H., state health officer and public health director, Oregon Health Authority, summed up how the country turns a blind eye to preparedness perfectly:

“It’s difficult to predict how or where the funding-induced deficiencies in our preparedness system will manifest themselves. New Orleans survived for many years, despite design defects and insufficient maintenance of its levee system. Funds that would have been spent on the levees were used for other priorities that probably seemed more urgent at the time. Those funding decisions either went unnoticed, or perhaps were even applauded as good stewardship of public funds. And each individual decision about funding may have appeared at the time as if it could be absorbed with little impact. But in the hindsight of Hurricane Katrina, it’s clear that over time the net effect of all those decisions was disastrous and tragic”

Ten years ago, during the anthrax attacks, we saw firsthand what happens when we don’t invest in public health preparedness.  We were graphically reminded of this again during Hurricane Katrina.  The country has made major strides toward being better prepared – many of the fruits of this investment were evident during the H1N1 flu pandemic response. 

While we were still far from our goals, we were leaps and bounds beyond where we were in 2001.  Sadly, the track we’re on now may mean history could tragically repeat itself.

As Kohn closed his piece:

“We should think of our public health preparedness system as a levee system that protects us at times of critical need and cannot be fixed on the spur of the moment. Can we really afford to let that erode?”

I’ll close with this: when the next disaster strikes, won’t it be better to be safe than sorry?

All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions, or policy positions.