Epidemiology resources spread thin in state health departments

Budget cuts and reductions in federal funding for public health preparedness are partly to blame, report says.

By — Posted Jan. 6, 2010

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The number of state health department epidemiologists and the tasks they can perform have decreased since 2006, according to a study published in the Centers for Disease Control and Prevention's Dec. 18, 2009, Morbidity and Mortality Weekly Report (link).

The report and public health experts indicate that the reduction in health departments' epidemiology capacity is due in part to diminished federal public health preparedness funding, and states' overall budget cuts.

Annual grants to states through federal preparedness funding decreased from a high of $1 billion in 2002 to approximately $698 million in 2008. The reduction coincided with a decrease in bioterrorism/emergency epidemiology and surveillance capacity, the report states.

For physicians, this means possibly less guidance on how to treat public health emergencies, and more patients with illnesses that potentially could have been prevented had data been available, the report's authors said.

"Given the national mandate for enhanced preparedness, the continued erosion of epidemiology capacity [in public health] ... is surprising and concerning," said author Matthew Boulton, MD, MPH, associate dean for Public Health Practice at the University of Michigan School of Public Health.

Between April 2009 and June 2009, the Council of State and Territorial Epidemiologists conducted a standardized national assessment of state health departments' epidemiology capacity. The CSTE has conducted similar reviews periodically since 2001.

Researchers found that in 2009, 2,193 epidemiologists worked in state health departments; down 10% from the 2,436 reported in 2006. Respondents estimated that at least 1,490 additional epidemiologists are needed nationwide for optimal epidemiology in all program areas.

The report also indicated that surveillance and epidemiology capacity in bioterrorism/emergency response has dropped over the past five years. In 2004, 80% of states reported having substantial or higher capacity in this area, compared to the 73% having that level of capacity in 2009.

The report was the third time in a month that questions were raised about America's emergency preparedness. On Dec. 1, 2009, Dept. of Health and Human Services Secretary Kathleen Sebelius requested a review of the government's system for handling public health emergencies. On Dec. 15, 2009, Trust for America's Health and the Robert Wood Johnson Foundation issued a report detailing the nation's problems with public health emergency response. In both cases, problems related to the production and distribution of the influenza A(H1N1) vaccine were held up as an example.

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