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DisasterPreparednessandResponse.pdf

AJPH EDITORIALS

Disaster Preparedness and Response: Who Will Fund?

There is insufficient evidence available about the translation, dissemination, and implementa- tion of public health preparedness and response (PHPR) inter- ventions. This AJPH supple- ment, a Centers for Disease Control and Prevention (CDC)– funded initiative, begins reme- dying this lack of evidence through studies from the Pre- paredness and Emergency Re- sponse Research Centers and the Preparedness and Emergency Response Learning Centers. Al- though this collection of articles, reviewed by Qari et al. (p. S355), aims to provide an antidote to the lack of evidence-based PHPR interventions, the larger, over- riding concern the articles point to is the 1000-pound gorilla in the room: the decline in federal funding for PHPR.

PUBLIC HEALTH PREPAREDNESS AND RESPONSE FUNDING

Watson et al.1 described the trends in federal funding for state and local preparedness through the CDC from 2001 to 2017, showing that, although initial outlays after 9/11 were signifi- cant—$940 million in fiscal year (FY)2002—and had resulted in significant preparedness gains, funding decreased by 31% by 2017.1 A large portion of this decrease occurred while gov- ernmental health agencies were

in the throes of the Great Re- cession beginning in 2008, cre- ating a one–two punch that knocked many state and local health departments to the mat. Other targets for PHPR funding, such as the Hospital Preparedness Program in the Office of the Assistant Secretary for Pre- paredness and Response, were also reduced, with this specific initiative going from a high of $515 million in FY2003 to $255 million by FY2017, a 50% reduction.

The National Association of County and City Health Offi- cials’ 2016 National Profile of Local Health Departments noted that one fifth of local health de- partments reported reductions in funding for emergency pre- paredness compared with the previous year.2 Time and time again we have witnessed the impact of such drastic cuts in public health funding, with re- ductions in funding for tuber- culosis prevention, treatment, and control in the 1980s and the subsequent increase in tubercu- losis rates through the 1990s as just one relatively recent example.3

RESPONSE CAPACITY The impetus for PHPR

funding was, of course, the at- tacks of 9/11 and the anthrax attacks that followed shortly after. But what finally became apparent was that public health’s role in

emergency preparedness and re- sponse went far beyond the tra- ditional realms of disease outbreak investigation and control— public health has a seat at the table in emergency oper- ations centers as they respond to a wide variety of events that have real public health consequences, including train derailments, flooding, and wildfires. Thus, PHPR funding has supported governmental health agencies in responding not only to disease outbreaks that include severe acute respiratory syndrome, the 2009 H1N1 influenza pandemic, the Ebola epidemic in Africa and cases in the United States, and the Zika virus pandemic but also to Hurricanes Katrina and Sandy; the 2011 Joplin, Missouri, tor- nado; the 2013 Boston Marathon bombing; and the 2014 West Virginia Elk River chemical spill.3

In this era of increased global travel, infectious disease out- breaks will only increase, and in this era of climate change, cata- strophic weather-related events will place enormous demands on governmental health agencies at all levels to have the capacity to prepare for and mitigate such

disasters. Infectious diseases and climate change know no boundaries, and even if some state and large metropolitan governments can replace loses in federal funding, most cannot— and where one is vulnerable, we are all vulnerable.

FUNDING MOVING FORWARD

The president’s FY2019 budget for the Federal Emer- gency Management Agency was a reduction over the actual FY2017 budget, and the presi- dent’s FY2019 request of $800 000 000 for PHPR was more than $0.5 billion below the FY2017 actual spending of $1.4 billion. Furthermore, the President’s FY2019 budget eliminated funding of the Aca- demic Centers for Public Health Preparedness, resulting in a re- duction of $3.6 billion for the CDC’s state and local pre- paredness and response capabil- ities.4 In late September 2018, the US House of Representatives approved a budget that provides level funding in FY2019 for PHPR, including restoring the funding for the Academic Centers for Public Health Pre- paredness. As this editorial was in its final stages of production, President Trump indicated he

ABOUT THE AUTHOR Paul Campbell Erwin is with the School of Public Health, The University of Alabama at Birmingham.

Correspondence should be sent to Paul Campbell Erwin, MD, DrPH, Dean, School of Public Health, The University of Alabama at Birmingham, 1665 University Blvd RPHB 140B, Birmingham, AL 35294 (e-mail: [email protected]). Reprints can be ordered at http://www. ajph.org by clicking the “Reprints” link.

This editorial was accepted August 12, 2018. doi: 10.2105/AJPH.2018.304712

Supplement 5, 2018, Vol 108, No. S5 AJPH Erwin Editorial S351

would sign the budget version worked out through the House of Representatives. Thus, it ap- pears that the immediate funding crisis may be averted. But the President’s original budget speaks to this administration’s lack of value for PHPR, and therefore, its long-term funding outlook remains in jeopardy.

The work described in this AJPH supplement holds poten- tial for evolving to new recom- mendations on PHPR from the Community Guide, and that is a public good to be celebrated. The value, though, of any such future evidence-based recom- mendations will depend directly on sustained funding for pre- vention, emergency response, and mitigation. Considering that natural disasters are becoming the new normal in public health,5

funding the new recommenda- tions has tremendous implications for the public’s health.

Paul Campbell Erwin, MD, DrPH

ACKNOWLEDGMENTS This work was supported under a co- operative agreement with the Centers for DiseaseControlandPrevention’s (CDC’s) Collaboration With Academia to Strengthen Public Health Workforce Capacity (grant 3 U36 OE000002-04 S05), funded by the CDC and the Office of Public Health and Preparedness and Response through the Association of Schools and Programs of Public Health (ASPPH).

The author wishes to acknowledge the review and comments made on an earlier draft by Alfredo Morabia, MD, PhD, editor-in-chief at AJPH.

Note. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the CDC, the Department of Health and Human Services, or the ASPPH.

REFERENCES 1. Watson CR, Watson M, Sell TK. Public health preparedness funding: key programs and trends from 2001 to 2017. Am J Public Health. 2017;107(S2): S165–S167.

2. National Association of County and City Health Officials. National profile of local health departments. 2016. Available at: http://nacchoprofilestudy.org/ chapter-3. Accessed March 4, 2017.

3. Comstock GW. Variability of tuber- culosis trends in a time of resurgence. Clin Infect Dis. 1994;19(6):1015–1022.

4. Department of Health and Human Services. Centers for Disease Control and Prevention: justification of estimates for appropriation Committees. Available at: https://www.cdc.gov/budget/ documents/fy2019/fy-2019-cdc- congressional-justification.pdf. Accessed August 4, 2018.

5. Morabia A, Benjamin GC. Preparing and rebuilding after natural disasters: a new public health normal! Am J Public Health. 2018;108(1):9–10.

AJPH EDITORIALS

S352 Editorial Erwin AJPH Supplement 5, 2018, Vol 108, No. S5

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