State Category: Louisiana

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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Hurricane Katrina: What we learned, Then and Now

By Karen DeSalvo, Former Acting Assistant Secretary for Health, U.S. Department of Health and Human Services

This story was published in Ready or Not? 2017.

There are a significant amount of vital lessons that need to and have been learned from the preparation for, response to, and recovery from Hurricane Katrina. One long-term lesson that I think is worth highlighting and has shown its importance during recent weather-related emergencies is the need for public health to take a significant leadership and coordinator role before, during and after an emergency.

In the immediate aftermath of Hurricane Katrina, it was evident that connections were missing—whether it be local public health to state officials, public health to first responders, or public health to the community.

Public health leaders simply weren’t the chief health strategists for their communities. The field was focused on an important set of discrete responsibilities or program but not on the need to build connections with community leaders, first responders and other critical infrastructure that could ensure people had safe places to go and access to medications and other critical supports.

With this realization, it was apparent public health had to connect more with the full gamut of organizations and people involved with an emergency response. And, since then, we have done so not only in New Orleans, but in communities across the country.

For example, during subsequent hurricanes in New Orleans, public health was able to work directly and quickly with hospitals and other care facilities to know if power was on and what beds and medications were available.

And, if you look at the response in Houston, you’ll note that public health was everywhere. They were in communities meeting people and alerting them to potential dangers and infectious diseases, what food and water was safe, etc. And, they were all over social media in a culturally competent way, reaching more and more people.

If you compare the Houston Harvey response to Katrina, it should be apparent that one of the benefits in Houston was the high level of connectedness between public health and the community they serve.

How we can better Prepare for the Next Emergency

In addition to public health continuing to be the coordinator for health for our communities in disaster and every day, to better respond to the next public health emergency, the nation needs to:

  • Expand funding;
  • Improve the foundational capabilities of public health;
  • Better leverage technology;
  • Increase training; and
  • Focus on the underlying health and resiliency of our communities—particularly those who are most vulnerable.

We need more funding for public health—we need public health departments at the local and state levels to have the foundational capabilities required to respond to public health emergencies but also to help build resilience between events.  These funds can’t be categorical, they have to provide core funding that can be nimble for a community to address their biggest health needs. For instance, parts of California might be more prone to wildfires while the Gulf Coast needs to focus on hurricanes. If we don’t have these capabilities in place, we’re forcing our public health workers to just react, rather than prepare to respond.

We also need more funding to go directly to local health departments. States have a huge responsibility during an emergency and often can’t funnel as many resources as you’d think to the local level. During Katrina, we saw this front and center.

While more funding is important, it must be paired with concrete expectations and accountability. Every single health department in the country should be accredited which will help ensure that they can stand up emergency operations when necessary.

When Katrina hit, we were using flip phones, Blackberries and an early version of Google maps. We’ve come a long way with technology in little over a decade, but our preparedness hasn’t quite kept up. We must do better with technology.

We have a great start with this by better leveraging the Department of Health and Human Services’ emPOWER, an online tool that houses and provides Medicare claims data to hospitals, first responders, and health officials to help map the electricity needs during an emergency. emPOWER enables responders to prioritize evacuations and can identify vulnerable populations who will need follow-up services. But it’s limited to the Medicare population.  This type of tool must be expanded to or created for Medicaid and, where appropriate, private payers. First responders and public health must have real-time population level data.

An additional reason more resources are needed is to increase drills and training that specifically focuses on local leadership and the U.S. Public Health Service Commissioned Corps. Annually, public health workers should drill in a vulnerable area alongside the Commissioned Corps—an invaluable resource. Currently, when the Commissioned Corps deploys to an emergency the connections with local responders aren’t there and often the Commissioned Corps can be underutilized.

Lastly, we simply must do more to improve the resiliency of our communities. The healthier a group of people are, the better they respond to an emergency.

In-between emergencies, public health must use data and find opportunities to engage more with vulnerable populations. For example, this could include creating pilot programs with Medicare providers, home health organizations and others involved with the care of older adults. We must improve the health of our older population and, at the same time, have the processes in place that can maintain their connection to care during an emergency that might result in evacuations and/or loss of power.

The nation’s preparedness has improved immensely since Hurricane Katrina—we must keep improving.

New Orleans’ Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In New Orleans, Louisiana, more than 90 percent of housing structures were built prior to 1978 – the year lead was decreased in residential paint – making city residents vulnerable to lead-based paint hazards. In addition to deteriorating paint and the lead contaminated dust it generates, the lead dust from the use of leaded gasoline contributed significantly to elevated soil lead levels.

While leaded gasoline was phased out in the 1970s through the 1990s, the lead dust remains in soil, particularly within transit-heavy areas of the city. Researchers estimate that vehicles deposited more than 10,000 metric tons of lead dust in New Orleans soil between 1950 and 1985. In 2004, more than 40 percent of New Orleans soils exceeded the EPA’s cleanup standard for play areas.

Lead in soil can disproportionally impact children because they are more like to inhale and ingest dust and dirt.

Hurricanes Katrina and Rita

In August, 2005, storm surges from the Hurricanes flooded 80 percent of the homes of New Orleans and deposited massive quantities of low lead sediments into the city. The sediments created a natural barrier on top of the pre-existing high-lead soil establishing a cleaner, less hazardous landscape. This, combined with citywide cleanup and remediation efforts, reduced lead dust in homes and surrounding soil. Lead assessments conducted in Katrina’s immediate aftermath found a 46 percent reduction in median soil lead levels. And the declines continued. Before the storm, 15 of the city’s 46 census tract neighborhoods exceeded the EPA’s regulatory soil lead standards; by 2010, only 6 neighborhoods exceeded standards.

At the same time, there was a decrease in children’s BLL. Prior to the Hurricanes, 50 percent of New Orleans’s children had BLL’s equal or greater that the federal reference value of 5 µg/dL. Ten years after the Hurricanes, about 5 percent of the children’s BLL exceed that exposure value.

Lead-Safe Soil Emplacement Interventions

Inspired by the city’s unique natural experiment, researchers used a similar approach to clean up soil at 10 childcare centers in New Orleans, covering lead-contaminated surface soils with a water-permeable barrier and 6-inch layer of low-lead soil. Since 2005, nine of the 10 federal public housing projects were rebuilt using this process—landscaped with low lead soil to raise the elevation of the housing. This intervention was expanded to all New Orleans’s childcare center play areas and public playgrounds that tested high for lead.

Challenges Remain

These efforts, combined with the potential reduction of lead from fresh topsoil deposited by the storm surge during Hurricane Katrina, led to a decrease in the percentage of children with elevated BLLs in high-lead communities (mainly inner city) from 64 percent in 2005 to 19 percent by 2015. In short, household restoration and cleaning reduced lead-based paint hazards and washed-in sediments reduced soil lead. The remaining challenge is to reduce exposure in high lead communities by conducting more “soil emplacement interventions and continuing lead paint hazard reduction strategies.”

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.