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
Public’s Health in the Age of Bioterrorism
2004
•
•
•
•
RWJ Foundation Funded
Trust for America’s Health
50 States included
10 Criteria developed by expert panel
• Results: Poor performance in heavily
rural states
The Weakest Link? Bioterrorism
Readiness in America’s 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
Population
Massachusetts
Maine
6.4M
1.3M
Population Land Area: 8,000 sq. Land Area: 31,000 sq.
density
miles
miles
810 persons per sq.
41 persons per sq.
mile
mile
Cities and
towns
351
492
Per Capita
Income
Rank, US
3
36
Health
Dept.
Staff
Local Public
Health
Acute
Care
Hospitals
Massachusetts
Maine
3,000
365
Municipal
Across State
Only 2
City
74
44
Police with
Nat’l Guard
Fire with Mutual Aid
EMS with
MMRS
Local
Public
Health
Hospitals with
DMAT and
NDMS and Promoted
and Rejuvenated
Caregivers
Local with
Regional
Government
State, Federal &
Int’l Assets
Local
Academic
Assets with
(A-CPHP)
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