Transcript Slide 1

Trust for America’s Health
Congressional Briefing
Ready or Not? Protecting the Public’s Health from Disease, Disasters, and Bioterrorism
February 3, 2012
Still Vulnerable:
Persistent Challenges for an Unprepared
Nation
Irwin Redlener, MD
Director, National Center for Disaster Preparedness
Professor of Clinical Population & Family Health
Columbia University Mailman School of Public Health
[email protected]
Five Major Concerns
1. Haven’t defined/
benchmarked basic terms
What is “prepared”?
Who is “prepared”?
Goal:
A disaster-prepared, less
vulnerable population via
reduced risk, increased
resiliency and improved
response and recovery
Vulnerable populations
= Achilles’ heel(s)
of disaster
response
How Many?
• Children: 75 million
• > 65: 40 million
• Significant chronic illness: >120 m
• People with disabilities, 21 – 64: 22 m
• Living in poverty: 44 million
• Undocumented: > 11 million
• Prison population: > 2 million
• Nursing homes: 1.5 million
…VI/Ps ? Probably > 50% of U.S.
2. Challenges of
implementing national
preparedness agenda in a
federalist society
2001-Present
Random Acts of Preparedness
3. Growing deficiencies in
public health emergency
response workforce
The Workforce Gap
A Mandate to Prepare As Resources Decline
• 23,000 jobs at state and local public health
agencies from 2008-09
• 50,000 fewer workers over the last 20
years
• 50% of workforce able to retire in 2012
• 80% of public workers have not had formal
training for their jobs
4. Failure of imagination/
inability to think “at scale”
Concern is not about large
emergencies or “small”
disasters…
These generally manageable
by local or regional resources
…issue is about prevention of
and response to
megadisasters
“Megadisaster”
A catastrophic, high-consequence event, irrespective
of etiology, that overwhelms or threatens to
overwhelm local and regional response capacity.
Indicators may include:
• Inability to manage immediate rescue of endangered
survivors
• Significant backlog of victims unable to get
appropriate medical care or other essential support
• Inability to protect vital infrastructure or prevent
significant property destruction
• Uncontrolled societal breakdown
10 KT Nuclear detonation in NYC
Living casualties
•
•
•
•
Delayed
Immediate
Minimal
Expectant
20%
20%
40%
20%
=
=
=
=
74,000
64,000
148,000
74,000
Total hospital beds in
NY State?
< 40,000
17
Pandemic Flu in NYC: Assumptions
•
•
•
•
Population of 8.2 million
H5N1 attack rate: 30%
Hospitalization rate: 10%
Mortality rate: 2.5% of those
infected
• Six month flu season
Potential Realities
• 2.4 million people sick (including 600,000 children)
with avian flu
• 60,000 deaths (includes 15,000 children); 200,000
hospital admissions
• More than 300 deaths/ day
• Not enough: Vaccine, antiviral meds (tamiflu),
hospital beds, ventilators, etc.
…plus schools closed, many parents ill, potential
quarantines, economy in trouble, little assistance
from “the outside”, etc.
5. Growing – and
dangerous – disparity
between needs and
resources
(honey, I shrunk the
preparedness budget…)
Preparedness Funding Crisis
Preparedness and Response Funding at HHS and DHS fell 17% from
FY10 to FY11, a drop of $900M from $5.3B to $4.4B
•
-13% Public Health Emergency Preparedness Grants to State and
Local Health Departments (HHS)
•
-40% Academic Public Health Preparedness Centers (HHS)
•
-11% Hospital Preparedness Programs –a 35% decrease over the
last 5 years (HHS)
•
-58% Regional Catastrophic Grant Preparedness Program (DHS)
•
-75% Emergency Operations Center Grant Program (DHS)
•
-28% Homeland Security Grant Program –the centerpiece of state
and local homeland security funding (DHS)
Why?
• Recession  Austerity
• Deferring insurance/ “won’t
happen on my watch…I hope”
• Extreme “silo-ization”
• Small, non-empowered
constituency (who actually
cares?)
What’s needed:
Political Leadership and Investments
Federal Budgets must reinvest and sustain funding at DHS and HHS
• Pass and fund PAHPA, HS Reauthorization
• Restore and expand funding to key regional programs like RCGP
• Restore and expand funding to key hospital and public health
programs
• Adopt recommendations of National Commission on Children and
Disasters
• Assume direct leadership for expanding medical counter-measure
innovations
Academic Partnerships
Academia must provide training, research, and a new workforce
• Restore funding to Academic Public Health Preparedness Centers
• Invest in new Centers of Excellence
Public Preparedness
Individuals and families must be ready for disasters
• Make into law the recommendations of the NCCD
• Rethink public messaging
…or, roll the dice