Biology Reference
In-Depth Information
an FDA-approved (under its Emergency Use Authorization) within a mat-
ter of days. The rapidity with which this test for this emerging infectious
disease arrived in the hands of state public health laboratories (Dawood
2009) was unprecedented.
17.2.4 Workforce Capacity
Public health workers are a diverse group, comprising nurses, physicians,
health educators, sanitarians, epidemiologists, and those with other skill
sets. In many ways the public health workforce believes in and reflects an
enduring faith in the transformative power of social capital. A trained and
competent public health workforce is a foundational requirement for ensur-
ing an adequate response to public health threats, regardless of their cause.
Recent interest, and concern, about the viability of the public health infra-
structure was first prompted by a 2002 Institute of Medicine report that
highlighted the fragility of the public health professional workforce (IOM
2002). Others have claimed that workforce shortages in public health are just
over the horizon, as an aging population approaches retirement eligibility or
seeks opportunity elsewhere. During the past decade, we have seen the size
of the public health workforce subjected to larger market forces, with parallel
gains realized with rising anxiety about dread diseases and the intentional
use of microbes as terrorist weapons, as well as losses accrued in the face of
mounting state and local government budget shortfalls.
Prompted, in part, by President Clinton's interest in bioterrorism, which
was allegedly sparked by his reading of Richard Preston's
The Cobra Event
(Preston 1997), the Department of Health and Human Services submitted a
Fiscal Year 1999 budget initiative to Congress, and Congress allocated $120.8
million to create CDC's Bioterrorism Preparedness and Response Program
(U.S. GAO 2001; Nash 2002). In fiscal year 2000, Congress allocated $56.9 mil-
lion to award to the states and major metropolitan areas. State and local public
health agencies used this unexpected but welcome largesse to hire additional
personnel, particularly those staff with desirable skills in disciplines such as
epidemiology and emergency preparedness. Following 9/11 and the anthrax
outbreak, federal outlays to state and large metropolitan health departments
grew rapidly and peaked in 2005 (Trust for America's Health 2008). As a result,
between 2001 and 2006, the number of epidemiologists employed in state and
local public health grew by 40%, according to a series of surveys conducted
by the Council of State and Territorial Epidemiologists (CSTE) (Boulton et al.
2009). At the same time, various other measures of preparedness, such as the
number of states participating in LRN, showed similar positive gains.
These advances, although quite laudable, may be obscuring some develop-
ments that will have serious long-term impact upon the capacity and resil-
iency of the public health system. While federal dollars were pouring into state
coffers to support bioterrorism preparedness, many observers with firsthand
k nowledge believed that state and local governments were shifting their staff
