Preparing for Public Health Emergencies: Meeting the Challenges in Rural America Paul Campbell, MPA, ScD Harvard School of Public Health Center For Public Health Preparedness © HSPHCPHP 2005

Public Health Emergencies Terrorism Biological Chemical Nuclear

9/11/01 World Trade Center Attack

Bioterrorism Preparedness

Public Health Emergencies Terrorism Biological Chemical Nuclear Emerging Diseases

2003 SARS Epidemic in Singapore

Public Health Emergencies Terrorism Biological Chemical Nuclear Emerging Diseases Accidents Natural Disasters

Why Are We Researching and Advocating for Rural Public Health Preparedness? Capacity Probability/Seriousness of Threats Policy/Resources

Why Are We Assessing and Advocating for Rural Public Health Preparedness? Capacity ProbabilitySeriousness of Threats Policy/Resources

Ready or Not: Protecting the Publics Health in the Age of Bioterrorism 2004 RWJ Foundation Funded Trust for Americas Health 50 States included 10 Criteria developed by expert panel Results: Poor performance in heavily rural states

The Weakest Link? Bioterrorism Readiness in Americas Rural Hospitals 2004 ANSER Institute for Homeland Security Elin Gursky, Senior Fellow Case research Results: Rural hospitals not equipped or staffed to address emergencies

Rural America Approximately 20% of US population Rural residents are: –More likely to be poor and elderly –More likely to die if injured –More (4X) likely to live in a medically underserved area –Less likely to be served by well-staffed local public health agency

Rural Preparedness Challenges Inadequate health care resources Inadequate public health resources Distances International borders Tribal relationships Complacency

Comparing Massachusetts & Maine

MassachusettsMaine Population6.4M1.3M Population density Land Area: 8,000 sq. miles 810 persons per sq. mile Land Area: 31,000 sq. miles 41 persons per sq. mile Cities and towns Per Capita Income Rank, US 336

MassachusettsMaine Health Dept. Staff 3, Local Public Health Municipal Across State Only 2 City Acute Care Hospitals 7444

EMS with MMRS Fire with Mutual Aid State, Federal & Intl Assets Local Academic Assets with (A-CPHP) Hospitals with DMAT and NDMS and Promoted and Rejuvenated Caregivers Police with Natl Guard Local with Regional Government Local Public Health

Why Are We Assessing and Advocating for Rural Public Health Preparedness? Capacity Probability/Seriousness of Threats Policy/Resources

Threats in Rural America Bioterrorism –Food –Water –Defense installations –Seasonal population surges –Urban exodus

Threats in Rural America Bioterrorism –Food –Water –Defense installations –Seasonal population surges –Urban exodus All Hazards

New Sweden Arsenic Poisoning, 2003

Why Are We Assessing and Advocating for Rural Public Health Preparedness? Capacity Probability/Seriousness of Threats Policy/Resources

Cities Readiness Initiative 2004 Redirection of CDC Funds $1 million removed from each state Funds redirected to 23 largest cities

Conference Sponsoring Organizations Harvard School of Public Health Maine Center for Public Health Maine Dept of Human Services Texas A&M Rural School of P.H. University of Minnesota S.P.H. University of North Carolina S.P.H. University of Pittsburgh SPH

Conference Conclusions 1. Rural America is vulnerable 2. Rural public health and health care systems need to be strengthened

Conference Conclusions 3. Policymakers need to acknowledge resource requirements 4. Rural public health and health care leaders need to work together to optimize cost-effectiveness