Measuring and Enhancing Public Health Preparedness

1. Measuring and Enhancing Public Health Preparedness Nicole Lurie, M.D., M.S.P.H. August 15, 2006

2. Today’s Objectives Familiarize you with the public health infrastructure and the components that are most essential to public health preparedness Convince you of the importance and challenges of assessing public health system performance and of developing better tools to do so Share highlights of some of our work Discuss challenges in integrating public health’s efforts with those of traditional first responders, and with the rest of public health Discuss the quality challenge

3. Background (1) ‘The public health system is in disarray’ – IOM, 1988 ‘The public health system remains in disarray today’ – IOM, 2001 No reform of statutory framework Funding insufficient Limited support Gaps in workforce, laboratory capacity, IT, organizational capacity Mixed progress on environment, mental health, indigent care Rebuilding the public health system was on the back burner before 9/11 and the anthrax attacks Since then, Congress has allocated more than $5 billion to improve state and local public health Vision of dual-use investment to both ‘rebuild’ infrastructure and ‘enhance’ preparedness Evolving all-hazards emphasis

4. A Big Investment, but No Guiding Principles Should we rebuild, or redesign? How much, and in what, should we invest? How can we be accountable for results? How should the investment be structured and monitored? How should preparedness be measured? How does preparedness relate to other public health functions? Can investments really serve multiple purposes? How will we gauge success? Many unanswered questions remain if we’re going to pull this off, and be responsible stewards of society’s resources. We have no clear vision of what we are building—absent that, its tempting to tinker with fixing the past system—rebuilding rather than redesigning--, even though we know that route is likely to be expensive, inefficient and in the log run probably won’t get us where we need to go. Absent an understanding of the problem or the gap, how much money is needed? And what should we invest in? How can we be accountable for this investment—how should it be structured and monitored? How do key aspects of preparedness relate to other public health functions? Absent a system, its been hard to have ‘systems thinking’. How will we assure that investments can serve multiple purposes? Can a system that can detect an early outbreak of smallpox be used for WNV—or how about asthma? And…how will gauge success in this new area? Many unanswered questions remain if we’re going to pull this off, and be responsible stewards of society’s resources. We have no clear vision of what we are building—absent that, its tempting to tinker with fixing the past system—rebuilding rather than redesigning--, even though we know that route is likely to be expensive, inefficient and in the log run probably won’t get us where we need to go. Absent an understanding of the problem or the gap, how much money is needed? And what should we invest in? How can we be accountable for this investment—how should it be structured and monitored? How do key aspects of preparedness relate to other public health functions? Absent a system, its been hard to have ‘systems thinking’. How will we assure that investments can serve multiple purposes? Can a system that can detect an early outbreak of smallpox be used for WNV—or how about asthma? And…how will gauge success in this new area?