Impact of terrorism preparedness on public health

During the past 7 years, local health departments have assumed stronger roles in emergency preparedness. Substantial increases in directed funding have been coupled with greater responsibilities and accountabilities to funding agencies and elected official at all levels of government. In Los Angeles, we see positive effects on public health infrastructure, emergency communications, education of staff and the public about potential terrorist threats and related responses. Surveillance systems for infectious, chemical and radiologically induced illnesses have been expanded and enhanced. Closer alliances around emergency preparedness issues have been forged with other local health departments, and with uniformed protection agencies, investigative agencies and other sectors. Public health laws have been reviewed and in some cases altered to facilitate appropriate responses to emergency situations. We are paying more attention to the psychological needs of employees during crises. The many preparedness exercises have helped to improve planning, integrated implementation and evaluation of critical activities.

However, during this same period, core Federal funding for some traditional public health activities have been reduced. Other high priority opportunities, including addressing the toll of chronic diseases overall and related health disparities, have received insufficient attention and funding. Some Federal programs have required significant resource expenditure without obvious commensurate benefits. Funding reductions for core emergency preparedness require difficult choices about priorities for investment to sustain infrastructure improvements. In some instances differing mandates and priorities of the Federal agencies involved in preparedness have led to confusion in Federal guidance to local health departments, reducing efficiency and slowing responsiveness.