Acknowledgements
A Multi-State Survey on Public
Health Emergency Preparedness
Paul Kuehnert, MS, RN
Acting Deputy Director
Bureau of Health
Maine Department of Health and Human Services
Why Maine?
Maine is:
• Large, poor rural state
• No county or regional health departments
• 2 municipal health departments
• 39 private hospitals
• Primary care shortage areas across state
• EMS services largely volunteer staffed
• No School of Public Health
Research
Who:
– Maine Center for Public Health
– Harvard Center for PHP
– Office of Public Health Emergency Preparedness
– Regional Resource Centers
– University of Southern Maine
Why:
– Increase our learning
– Inform our policy decisions/advocacy
– Share our successes and our challenges
– Threat of redirection of funding from rural states
Paul Campbell
Joshua Frances
Hugh Tilson
Harvard Ctr for Public Health Preparedness
The Maine PHEP Policy Research Group
RWJ Executive Nurse Fellows Program
Key Strategy: Collaboration
Multiple public and private partners in all
strategic areas:
–
–
–
–
Maine Center for Public Health
Harvard Center for PHP
University of Southern Maine
State agency and private partners
2004 Multi-State Survey
• Descriptive
• Largely qualitative
• Two questions:
– What are the current perceptions of state
capacity for response to public health
emergencies?
– What are the differences (if any) of perceptions
of capacity for public health emergencies
between rural and non-rural states?
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Sample
• TFAH score used to select sample of states
• All states that fell into either the highest
(scores of 6-7) or lowest (scores of 2-3)
scoring groups of states (N=26)
• “Rural state” defined as > 25% of its
population living outside of SMSAs as
defined by the US Census Bureau (N=18)
Methods
•
Phone and email-based semi-structured
interview of state PHEP Directors
•
17 questions in each of 3 sections:
1. Current capacity --- Y/N Comments
2. Barriers --- Ranking 1 - 5 Comments
3. Enabling factors --- Ranking 1 – 5
Comments
Methods (cont’d)
•
Questions grouped into 5 subject areas:
1. Public policy (4 questions)
Sample Questions
Do you have the following in your state:
•
“ Current state (vs. solely federal) financial
support for PHEP?” [Public policy]
•
“Well-equipped and staffed hospital emergency
rooms statewide? [Health care system]
•
“Electronic communication system linking state
and local public health departments 24/7
statewide? [Public health system]
2. Health care system (2 questions)
3. Public health system (4 questions)
4. Public health workforce (4 questions)
5. Connectivity (3 questions)
•
Comments and explanations encouraged
throughout the interview
Sample Questions (cont’d)
Does your state have:
4. “Strong training support in public health
emergency preparedness from academic
{preparedness} center?” [Public health
workforce]
5. “Effective connectivity with other (nonPH) state bodies involved in emergency
preparedness?” [Connectivity]
Results: Respondents
•
•
•
•
•
•
96% response rate (25/26 states)
17 Rural states, 8 Urban
3/17 (18%) of Rural states TFAH score > 6
5/8 (63%) of Urban states TFAH score > 6
6/8 (75%) Urban states received CRI funds
1/17 (6%) Rural states received CRI funds
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Results: Current Capacity Score
17
16
15
14
13
12
11
10
9
8
7
6
5
4
3
2
1
0
Results: Current Capacity
• Urban: more likely to describe health care
and public health systems as strong
11.4
11.1
13.1
Rural
Urban
Results: Barriers
• All:
– Lack of state general fund support
– Status of regional/statewide health care system
– Inadequately staffed/equipped ERs
• Urban:
– Lack of local elected official support
– Lack of support among legislators
• Rural:
– Lack of strong local health departments
– Lack of 24/7 electronic communications system linking
state and local health departments
Summary: Rural-Urban
Comparisons
• Political support:
Strong local and state
legislative support less likely in rural states
• Health care system: Adequate health care
systems less common in rural states
• Public health system: Urban states more likely
to have adequate public health infrastructure
• Public health workforce: Urban states more
likely to have adequately trained workforce
• Connectivity: Rural states more likely to have
strong working relationships with non-public
health state agencies
Results: Enabling Factors
• All:
– Training support from academic preparedness centers
– Electronic communications systems 24/7 linking state
and local health departments
• Urban:
–
–
–
–
Strong local health departments statewide
Planning/evaluation framework using logic models
Graduate PH degree program in state
Well equipped/staffed ERs
• Rural:
– Effective connectivity with other state agencies
– Support of the Governor
– Recent experience with a public health emergency
Implications
• PHEP capacity still lags in most states
• Rural states face common challenges in building
PHEP capacity
• Further research needed to better describe rural
states’ needs and identify successful strategies
• Financial and human resources need to be targeted
to rural states
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Paul Kuehnert
Maine Dept. of
Health & Human Services
207-287-5179
paul.kuehnert@maine.gov
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