Rural urban differences in public health emergency preparedness: Results from the 2005 NACCHO survey

BACKGROUND: In the years following the terrorist attacks of 2001, government agencies and private organizations have endeavored to increase the ability of the US to prevent, detect, and respond to public health emergencies. The nation's local public health infrastructure is a vital component of emergency preparedness (EP). Among other variables, the NACCHO 2005 National Profile of Local Health Departments (LHDs) included questions on the following EP activities: Developing an EP plan; Legal review of the plan; Participating in drills; Participating in actual emergencies; Assessing competencies; Providing training; or having no EP activities. The study seeks to describe the EP activities of LHDs as a function of their geographic designation (Rural, Suburban, and Urban).

DATA CHARACTERISTICS: Relevant responses were delineated by 2,294 LHDs. 912 (39.8%) of the LHDs were Rural; 458 (20.0%) were Suburban; and 924 (40.3%) were Urban. 55 LHDs (2.4%) did not conduct any of the five discretionary EP activities. 75.2% participated in 4+ discretionary EP activities. These LHDs provide public health services to 92.1% of the population.

RESULTS: While the vast majority of LHDs had “Developed or updated a written emergency plan,” Rural LHDs were less likely then their Suburban and Urban Counterparts (87.7%, 91.3%, 92.3%) [X2, p<0.01]. Similarly, while approximately 65% of LHDs had a legal review of the plan, Rural LHDs were less likely then their Suburban and Urban Counterparts (58.7%, 65.1%, 72.2%) [X2, p<0.01]. 91.8% of all respondents had “Participated in emergency preparedness drills or exercises.” However, Rural LHDs were less likely to have “Participated in an actual public health emergency” (26.9%, 38.7%, 46.8%) [X2, p<0.01]. Geographic classification showed no significant differences in the LHDs who "Assessed EP competencies" or "Provided training." On average Rural LHDs received significantly less CDC funding ($40,752; $86,207; $342,425). Logistic regression models confirmed the bivariate results. Other significant variables included: CDC funding, % black, FTE employees per capita.

CONCLUSIONS: While preparedness activities and preparedness training were reported by 98% of LHDs, rural LHDs still lag behind their urban counterparts. From a policy perspective, funding was more likely to go to urban areas that were more likely to have participated in an actual disaster. Also, the significantly lower rural LHD funding could help to account for their being less likely to develop or legally review EP plans. Overall, if federal funding were to be decreased or discontinued the recent gains made in revitalizing the public health infrastructure would be wasted.