Terrorism preparedness and the local health department – Ready for what?

Local health departments have been preparing to respond to terrorism and public health emergencies for much of the last decade. These efforts have been driven by an infusion of federal funding and reinforced by terrorist attacks and natural disasters with tragic public health consequences that riveted national attention. The benefits of these efforts have been substantial: enhanced disease surveillance systems, improved communication capacity, well-developed and exercised plans for mass prophylaxis, and recognition of the contribution that health departments make to public safety. But major challenges remain. Federal grants require cities to plan for specific events like an anthrax release, using Points of Dispensing to dispense antibiotics to their entire population within a 48 hour period. Preparing for this Herculean task diverts efforts from preparing for hazards that may be more likely to occur, and from innovative approaches to response activities that are critical in any emergency, like sustaining health department operations when resources are scarce, or supporting vulnerable populations. The organization of preparedness programs into self-contained units within departments of health, with staff and planning activities that are rarely integrated into daily public health operations, also undermines their contributions. Enhancements to the daily, cross-cutting work of public health practice are needed to build public health infrastructure and foster real emergency readiness. Promoting community resilience to face disasters is the critical next step, one for which local health departments are uniquely positioned, but one that requires a broad vision for public health preparedness.