US Public Health System

¶ … U.S. Public Health System to better assess and defend against threats from bio-terrorism and infectious disease. This report discusses public health agencies that are "exemplary" in providing public health services in some way or another. That only thirteen were chosen out of seventy-three initially studied indicates how difficult it is to find exemplary public health protection against infectious disease and bio-terrorism threats. Data collection and surveillance are two areas that need improvement, especially in the field, as this report clearly notes.

This report contains information about thirteen agencies that offer the best of public health services. It shows what other agencies need to do to come up to a level of exemplary services, and how far some have to go to catch up. For example, the authors cite the "Citywatch" computer monitoring system for the Illinois Department of Health. They write, it is "A sophisticated computer-assisted emergency notification system that alerts multiple organizations and individuals about public health emergencies at one time via telephones, pagers, email, fax, PDAs, TDD-TTY, and other devices" (Tanielian, T. et al., 2005, p. 13). This allows the agency to monitor all of its public health agencies and consistently see how quickly they respond to public health emergencies. This is an excellent system, and it is too bad that it is not available in every community. It helps coordinate communication between locations, it makes the communication quicker and more effective, and it keeps the agencies ready to respond to emergencies. What this indicates is that a majority of public health agencies do not have this kind of coordinated system that can be periodically tested, and that they suffer as a result. They have slower response times because it takes longer to notify all the agencies, and that could be deadly in a bio-terrorism attack or spread of infectious disease. As the authors note, the system "overcomes a serious gap in public health preparedness" (Tanielian, T. et al., 2005, p. 15). If there is a serious gap in most public health preparedness, this means the public in most areas faces a greater danger, and that must be addressed.

Another exemplary example is the University of Pittsburg, which uses a system called the Real-Time Outbreak and Disease Surveillance System (RODS), to monitor patient numbers and admissions in the emergency room and throughout the medical center to assess pending disease and condition emergencies. The authors note, "RODS allows health departments to monitor the number of patients with symptoms of flu, respiratory illnesses, diarrhea, skin rashes, and other conditions. This ability has been thought by some to enable possible early warning of medium- to large-scale disease outbreaks or bioterrorist attacks" (Tanielian, T. et al., 2005, p. 16). Because our country always faces the threat of another terrorist attack, it is important to be able to identify if an attack is occurring through bio-terrorism, and this system can help indicate the beginnings of a bioterrorist attack or serious health crisis in the making. Medical centers without this type of system have to rely on gathering information the traditional way, which takes much longer and leads to much slower results.

The good news is that RODS is in use in several states besides the University of Pittsburgh's Medical Center. It was originally developed for the 2002 Olympic Games in Salt Lake City, and has spread widely since then. The system also contains data about over-the-counter medicine sales from across the nation, to analyze trends in health outbreaks around the country. The system analyzes all the hospitals in many areas, another way it speeds up communication and analysis. Clearly, if there were a national system like this, connecting all the hospitals and medical centers, it would me much quicker and easier to see where outbreaks were occurring, or an attack was occurring. When you can identify this type of information quicker, you can devise solutions and anecdotes quicker, and keep the problem from spreading. The RODS program is easy to use and does not cost much for health departments to access it, so there is really no reason for health departments not to sign on and begin using this system.

In North Carolina, public health workers have set up teams to help local responders learn how to respond to outbreaks of disease. The authors continue, "The Public Health Regional Surveillance Teams (PHRSTs) collaborate with local health organizations and first responders to prepare for and respond to disease outbreaks. By doing so, they promote community preparedness and build shared expertise in readiness and response" (Tanielian, T. et al., 2005, p. 17). Often, it is the community responders that encounter an attack or outbreak at first, so it makes sense to train them how to effectively respond to an emergency. They educate and inform on a variety of subjects in each of the state's counties, and this information and training is ongoing. This would help areas that may be small or rural to react as effectively as larger agencies, and it could help keep diseases from spreading more quickly, because the responders are trained to recognize the symptoms and causes of diseases.

Each of the systems described in the RAND report has one thing in common. They all produce enhanced communication, either between responders or between healthcare organizations. They illustrate that communication and surveillance are the keys to managing any type of healthcare emergency. During the September 11 terrorist attacks, the emergency responders had trouble communicating with each other because their radios were on different frequencies (among other things). Many of these systems were developed after the terrorist attacks, because they recognized the need for coordinating communication and surveillance before another event occurred. They were also often developed with bioterrorism funding, which is exactly what that funding was meant to do. They show that emergency responders are aware of the flaws in the system, and they want to solve them effectively.

No matter what agency is responding to an outbreak or attack, they must be able to communicate effectively. Those areas that have not developed the right response systems are literally more dangerous to their community safety, and citizens face more concerns about their safety. In any type of emergency, public agencies must be able to communicate to the public, too, and this type of communication in most communities seems to be lacking. While all of these programs are success stories, these types of successes are not happening in most communities across the country, and that means most communities are still at risk.