Biology Reference
In-Depth Information
onto positions in these newly funded programs (Gebbie and Turnock 2006).
The CSTE survey found that in most states their support for epidemiology
programs did not increase between 2001 and 2006, suggesting that federal
funds may have supplanted funds that had previously been supported with
state and local funds. By 2006, federal funding for state epidemiology pro-
grams had increased 9% to 71%. Since 2001, state funding for epidemiology
had declined 13% to an average of 23% (Boulton et al. 2009). In 2008, during a
period of serious economic decline, at the beginning of what has been called
“The Great Recession,” a survey of local health departments (LHDs) found
that a majority of LHDs had frozen hiring or reduced staff, representing an
estimated 7,000 local public health workers nationwide (National Association
of County and City Health Officials [NACCHO], 2009).
Thus, in both upward and downward economic times, the federal govern-
ment has been gaining “market share” as financier of the last resort for public
health. However, this societal function—protecting the health and welfare of
the public—has traditionally and constitutionally been viewed as a domain of
the state and not the federal government. Despite this historical perspective
that all public health—and certainly all public health surveillance—is local,
public health advocacy groups typically promote an even larger role for the
federal government as the solution for the looming crisis facing the public
health workforce (Perlino 2006). Suggested solutions include federally funded
public health workforce scholarships, additional funding for Health Resources
and Services Administration (HRSA) programs, federally funded leadership
development programs, and internships and fellowships at agencies such as
CDC and NIH. This is not to say that such recommendations lack value; many
of them do strive to address important needs. Rather, the cautionary analogy
is from an economic market perspective; whenever there is an overreliance
within a multi-tiered sector upon one supplier of a critical commodity, that
sector can experience significant volatility during both up and down markets.
Since 2005, federal support to states for bioterrorism preparedness has begun
to decline (Trust for America's Health 2008). We do not yet know what the long-
term effects of this will be (perhaps influenza funding will serve as a bridge
loan, at least while the current pandemic smolders); but, thus far, state and
local governments do not seem to be stepping up to meet their fiscal responsi-
bilities to perform their role in protecting the public's health.
17.3 Maximizing Linkage between Detection and Response
The key to maximizing the linkage between detection and response is
dependent upon two critical factors. First, the public health surveillance (or
detection) system must have clear objectives, and these objectives must reign
paramount in shaping the design of the system. Second, emerging health
