State Category: Iowa

Half of States Scored 5 or Lower Out of 10 Indicators in Report on Health Emergency Preparedness

Report Finds Funding to Support Base Level of Preparedness Cut More than Half Since 2002

 

Washington, D.C., December 19, 2017 – In Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, 25 states scored a 5 or lower on 10 key indicators of public health preparedness. Alaska scored lowest at 2 out of 10, and Massachusetts and Rhode Island scored the highest at 9 out of 10.

The report, issued today by the Trust for America’s Health (TFAH), found the country does not invest enough to maintain strong, basic core capabilities for health security readiness and, instead, is in a continued state of inefficiently reacting with federal emergency supplemental funding packages each time a disaster strikes.

According to Ready or Not?, federal funding to support the base level of preparedness has been cut by more than half since 2002, which has eroded advancements and reduced the country’s capabilities.

“While we’ve seen great public health preparedness advances, often at the state and community level, progress is continually stilted, halted and uneven,” said John Auerbach, president and CEO of TFAH.  “As a nation, we—year after year—fail to fully support public health and preparedness. If we don’t improve our baseline funding and capabilities, we’ll continue to be caught completely off-guard when hurricanes, wildfires and infectious disease outbreaks hit.”

Ready or Not? features six expert commentaries from public health officials who share perspectives on and experiences from the historic hurricanes, wildfires and other events of 2017, including from California, Florida, Louisiana and Texas.

The report also examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Some key findings include:

  • Just 19 states and Washington, D.C. increased or maintained funding for public health from Fiscal Year (FY) 2015-2016 to FY 2016-2017.
  • The primary source for state and local preparedness for health emergencies has been cut by about one-third (from $940 million in FY 2002 to $667 million in FY 2017) and hospital emergency preparedness funds have been cut in half ($514 million in FY 2003 to $254 million in FY 2017).
  • In 20 states and Washington, D.C. 70 percent or more of hospitals reported meeting Antibiotic Stewardship Program core elements in 2016.
  • Just 20 states vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2016 to Spring 2017—and no state was above 56 percent.
  • 47 state labs and Washington, D.C. provided biosafety training and/or provided information about biosafety training courses (July 1, 2016 to June 30, 2017).

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

  • Communities should maintain a key set of foundational capabilities and focus on performance outcomes in exchange for increased flexibility and reduced bureaucracy.
  • Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of core capabilities so they are ready when needed. In addition, a complementary Public Health Emergency Fund is needed to provide immediate surge funding for specific action for major emerging threats.
  • Strengthening and maintaining consistent support for global health security as an effective strategy for preventing and controlling health crises. Germs know no borders.
  • Innovating and modernizing infrastructure needs – including a more focused investment strategy to support science and technology upgrades that leverage recent breakthroughs and hold the promise of transforming the nation’s ability to promptly detect and contain disease outbreaks and respond to other health emergencies.
  • Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as Chief Health Strategist for a community.
  • Reconsidering health system preparedness for new threats and mass outbreaks.  Develop stronger coalitions and partnerships among providers, hospitals and healthcare facilities, insurance providers, pharmaceutical and health equipment businesses, emergency management and public health agencies.
  • Preventing the negative health consequences of climate change and weather-related threats. It is essential to build the capacity to anticipate, plan for and respond to climate-related events.
  • Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop superbugs and antibiotic resistance. 
  • Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.
  • Supporting a culture of resilience so all communities are better prepared to cope with and recover from emergencies, particularly focusing on those who are most vulnerable.   Sometimes the aftermath of an emergency situation may be more harmful than the initial event.  This must also include support for local organizations and small businesses to prepare for and to respond to emergencies.

The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Score Summary: 

A full list of all of the indicators and scores and the full report are available on TFAH’s website.  For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator.  Zero is the lowest possible overall score, 10 is the highest.  The data for the indicators are from publicly available sources or were provided from public officials.

9 out of 10: Massachusetts and Rhode Island

8 out of 10: Delaware, North Carolina and Virginia

7 out of 10: Arizona, Colorado, Connecticut, Hawaii, Minnesota, New York, Oregon and Washington

6 out of 10: California, District of Columbia, Florida, Illinois, Maryland, Nebraska, New Jersey, North Dakota, South Carolina, South Dakota, Utah, Vermont and West Virginia

5 out of 10: Georgia, Idaho, Maine, Mississippi, Montana and Tennessee

4 out of 10: Alabama, Arkansas, Iowa, Louisiana, Missouri, New Hampshire, Oklahoma and Pennsylvania

3 out of 10: Indiana, Kansas, Kentucky, Michigan, Nevada, New Mexico, Ohio, Texas, Wisconsin and Wyoming

2 out of 10: Alaska

 Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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Increasing Access to Breastfeeding Friendly Hospitals: The Iowa Experience

By Jane Stockton, Community Health Consultant, Bureau of Nutrition and Health Promotion, Iowa Department of Public Health & Catherine Lillehoj, Ph.D. Research Analyst, Iowa Department of Public Health

The Iowa Department of Public Health (IDPH) has a long tradition of striving to improve the health and wellness of all residents. Because breastfeeding is a key strategy to preventing obesity among children and youth, IDPH has worked for the past several years to increase rates of breastfeeding initiation and duration.

Five years ago, Iowa ranked 31 out of 53 states and territories on a national survey, the Maternity Practices in Infant Nutrition and Care (mPINC). When we looked a little deeper, we realized that the rural nature of our state made maternal nutrition and care somewhat difficult.

For instance, 89 percent of Iowa counties are considered rural, with hospitals in rural counties having a higher proportion of Medicaid births (40 to 60 percent of births). Sadly, these hospitals often don’t have the necessary resources to truly improve breastfeeding education and provide the appropriate technical assistance. In general, rural hospitals experience unique barriers due to distance between hospitals, patients and other facilities, plus staff are often not dedicated to working in maternity care units.

To get over these hurdles, IDPH targeted hospitals in rural counties with significant numbers of Medicaid births. One of the preliminary activities to improve breastfeeding was to meet with key hospital partners (e.g., OB managers, Chief Nursing Officers, Directors of Nursing, Educators). Along with key partners, hospital policies related to breastfeeding were reviewed and results of the mPINC survey were discussed. Following these initial meetings, 53 hospitals voluntarily completed a pre-assessment using a self-appraisal tool. Subsequently, the IDPH hosted a training, called 6 Steps 4 Success, which we developed specifically to address the Ten Steps to Successful Breastfeeding, a set of evidence-based practices that have been shown to increase breastfeeding initiation and duration.

After receiving technical assistance, resources and staff education, 37 of the 53 hospitals completed a post-assessment. The majority of the hospitals implemented at least three of the Ten Steps and the most widely adopted policy, encouraging breastfeeding on demand, was implemented by 83 percent of the hospitals. After attending the 6 Steps 4 Success training, one nurse stated, “This gave me a lot to think about. I have changed my position and going to change my ideas, way I promote breastfeeding.” Hospitals frequently express their gratitude for the technical assistance and education being brought to them in their rural setting, rather than having to go to the larger cities for these services.

To further enhance statewide breastfeeding initiatives, efforts for the past two years have focused on improving maternity practice in four or five hospitals each year that meet three criteria: rural location, Medicaid birth rate higher than statewide average and an mPINC score of less than the statewide composite score. Using their mPINC survey data, hospitals are given assistance in reviewing the results, determining where the greatest opportunities for improvement are, and developing an improvement plan to address at least two of the dimensions of care. Over the course of one year, hospitals are offered:

  1. Technical assistance related to breastfeeding policy – telephone, face-to-face, electronic messaging;
  2. Resources – desk references such as Hale’s Medications and Mother’s Milk, Continuity of care in Breastfeeding: Best Practices in the Maternity setting; model breastfeeding policy, and a Self Attachment video;
  3. Educational opportunities – funding to send one staff nurse to Certified Lactation Counselor (or comparable) training, Breastfeeding Education for Iowa Communities, a four hour training developed by the Iowa Breastfeeding Coalition, and/or 6 Steps 4 Success training; and
  4. Networking opportunities – Iowa’s Annual Breastfeeding Conference and networking call for all participating hospitals.

The most recent data indicate all participating hospitals demonstrated improvement in several areas including: Labor and delivery practice (an improvement ranging from 3 to 230 percent), Staff Training (63 percent improvement), Breastfeeding Assistance (18 percent improvement), and Structural and Organizational Aspects of Care (94 percent improvement). In addition, staff who became Certified Lactation Counselors are now educating other nurses in their hospital.

To truly make these activities pervasive and sustainable, the IDPH knew it was important to collaborate with key partners with valuable expertise, including:

  • University of Iowa Statewide Perinatal Team – Breastfeeding Guidelines were written and incorporated into the Guidelines for Perinatal Services published by IDPH and distributed by the University of Iowa’s Perinatal Care Program. The Guidelines for Perinatal Services provides the framework to be used in defining and evaluating the level of perinatal services being offered by hospitals.
  • Iowa Breastfeeding Coalition – Breastfeeding Education for Iowa Communities, a four hour training curriculum, is being presented to healthcare communities throughout the state. The training curriculum, based on WIC’s Grow and Glow curriculum, was written as a collaborative effort by IDPH staff and ICBLC members of the coalition.

Over the past five years Iowa hospitals have gone from understanding what the term “Baby Friendly” meant and about the significance of the Ten Steps to Successful Breastfeeding, to having one hospital designated as Baby Friendly and many other hospitals in the process of achieving that designation

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References

Lillehoj, C. & Dobson, B. (2012). Implementation of the Baby-Friendly Hospital Initiative Steps in Iowa Hospitals. http://authorservices.wiley.com/bauthor/onlineLibraryTPS.asp?DOI=10.1111/j.1552-6909.2012.01411.x&ArticleID=1043603.