State Category: Nebraska

Half of States Scored 5 or Lower Out of 10 Indicators in Report on Health Emergency Preparedness

Report Finds Funding to Support Base Level of Preparedness Cut More than Half Since 2002

 

Washington, D.C., December 19, 2017 – In Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, 25 states scored a 5 or lower on 10 key indicators of public health preparedness. Alaska scored lowest at 2 out of 10, and Massachusetts and Rhode Island scored the highest at 9 out of 10.

The report, issued today by the Trust for America’s Health (TFAH), found the country does not invest enough to maintain strong, basic core capabilities for health security readiness and, instead, is in a continued state of inefficiently reacting with federal emergency supplemental funding packages each time a disaster strikes.

According to Ready or Not?, federal funding to support the base level of preparedness has been cut by more than half since 2002, which has eroded advancements and reduced the country’s capabilities.

“While we’ve seen great public health preparedness advances, often at the state and community level, progress is continually stilted, halted and uneven,” said John Auerbach, president and CEO of TFAH.  “As a nation, we—year after year—fail to fully support public health and preparedness. If we don’t improve our baseline funding and capabilities, we’ll continue to be caught completely off-guard when hurricanes, wildfires and infectious disease outbreaks hit.”

Ready or Not? features six expert commentaries from public health officials who share perspectives on and experiences from the historic hurricanes, wildfires and other events of 2017, including from California, Florida, Louisiana and Texas.

The report also examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Some key findings include:

  • Just 19 states and Washington, D.C. increased or maintained funding for public health from Fiscal Year (FY) 2015-2016 to FY 2016-2017.
  • The primary source for state and local preparedness for health emergencies has been cut by about one-third (from $940 million in FY 2002 to $667 million in FY 2017) and hospital emergency preparedness funds have been cut in half ($514 million in FY 2003 to $254 million in FY 2017).
  • In 20 states and Washington, D.C. 70 percent or more of hospitals reported meeting Antibiotic Stewardship Program core elements in 2016.
  • Just 20 states vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2016 to Spring 2017—and no state was above 56 percent.
  • 47 state labs and Washington, D.C. provided biosafety training and/or provided information about biosafety training courses (July 1, 2016 to June 30, 2017).

The Ready or Not? report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

  • Communities should maintain a key set of foundational capabilities and focus on performance outcomes in exchange for increased flexibility and reduced bureaucracy.
  • Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of core capabilities so they are ready when needed. In addition, a complementary Public Health Emergency Fund is needed to provide immediate surge funding for specific action for major emerging threats.
  • Strengthening and maintaining consistent support for global health security as an effective strategy for preventing and controlling health crises. Germs know no borders.
  • Innovating and modernizing infrastructure needs – including a more focused investment strategy to support science and technology upgrades that leverage recent breakthroughs and hold the promise of transforming the nation’s ability to promptly detect and contain disease outbreaks and respond to other health emergencies.
  • Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as Chief Health Strategist for a community.
  • Reconsidering health system preparedness for new threats and mass outbreaks.  Develop stronger coalitions and partnerships among providers, hospitals and healthcare facilities, insurance providers, pharmaceutical and health equipment businesses, emergency management and public health agencies.
  • Preventing the negative health consequences of climate change and weather-related threats. It is essential to build the capacity to anticipate, plan for and respond to climate-related events.
  • Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop superbugs and antibiotic resistance. 
  • Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.
  • Supporting a culture of resilience so all communities are better prepared to cope with and recover from emergencies, particularly focusing on those who are most vulnerable.   Sometimes the aftermath of an emergency situation may be more harmful than the initial event.  This must also include support for local organizations and small businesses to prepare for and to respond to emergencies.

The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Score Summary: 

A full list of all of the indicators and scores and the full report are available on TFAH’s website.  For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator.  Zero is the lowest possible overall score, 10 is the highest.  The data for the indicators are from publicly available sources or were provided from public officials.

9 out of 10: Massachusetts and Rhode Island

8 out of 10: Delaware, North Carolina and Virginia

7 out of 10: Arizona, Colorado, Connecticut, Hawaii, Minnesota, New York, Oregon and Washington

6 out of 10: California, District of Columbia, Florida, Illinois, Maryland, Nebraska, New Jersey, North Dakota, South Carolina, South Dakota, Utah, Vermont and West Virginia

5 out of 10: Georgia, Idaho, Maine, Mississippi, Montana and Tennessee

4 out of 10: Alabama, Arkansas, Iowa, Louisiana, Missouri, New Hampshire, Oklahoma and Pennsylvania

3 out of 10: Indiana, Kansas, Kentucky, Michigan, Nevada, New Mexico, Ohio, Texas, Wisconsin and Wyoming

2 out of 10: Alaska

 Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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Omaha’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

Lead is a significant environmental health hazard to children in Omaha, home to the nation’s largest residential U.S. Environmental Protection Agency (EPA) Superfund site– a program that provides resources to address lead contamination in soil caused by an old refinery. In 1998, after it was revealed that nearly 10 percent of the children tested in Douglas County had blood lead levels higher than 10 µg/dL, the Omaha City Council requested assistance from the EPA. In 2003, Omaha was added to the Superfund National Priorities List, with approximately 14 square miles of residential property in East Omaha considered at high risk.

Superfund

In 1998, when the Omaha City Council requested EPA assistance to address the high frequency of children in eastern Omaha found by the Douglas County Health Department to have elevated blood lead levels, the EPA began investigating the lead contamination in the Omaha areas under the authority of the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), also known as the Superfund law.

After blood tests revealed elevated lead levels in nearly 600 children, the EPA formed the Omaha Lead Superfund Site in 1999, which has become the largest residential lead remediation in the country. Cleanup of residential properties included testing a wide array of soil in places like child care facilities, schools, playgrounds, parks, and homes; removal and replacement of contaminated soil; and planting new sod and grass seed.

The Douglas County Health Department Childhood Lead Poisoning Prevention Program offers free inspections to families in Douglas County living in pre-1978 housing where children under seven-years-old live and play. Families with children who have been found to have elevated blood lead levels are given top priority. They also administer an EPA-funded interior dust program where residents who have had their soil remediated can receive education and a free HEPA vacuum.

EPA’s work is ending after it completed testing soil samples from 40,000 properties and cleaned up more than 12,000 properties that were contaminated with lead; however, the work of lead remediation will continue in partnership with the city. In May 2015, the EPA awarded $40 million to the City of Omaha through a cooperative agreement to address the final phases of the work, including ongoing attempts to collect soil samples and clean up the remaining properties. The rationale is that the owners of remaining properties will feel more at ease working with the city than with the federal government.

Updated Nuisance Ordinance

In December 2010, the Omaha City Council amended the “nuisance” chapter of the Omaha Municipal Code, adding lead-based paint to the list of specific examples of situations declared to be nuisances. Under the revised law, lead-based paint or other lead-based coating materials (such as liquid coatings on furniture) is a hazard and a “nuisance” on the interior or exterior of a home when it is accessible, or may become accessible, to ingestion or inhalation.

Once notified of a lead-based paint “nuisance,” a designated city officer and/or health director of the health department gives written “notice to abate” to the property owner and/or occupant or to the person causing the nuisance. If the person ordered to remove the hazard neither requests a hearing nor abates it within the specified time, the city will take care of it and bill the responsible party. In addition, that person may be fined up to $500 and/or imprisoned for up to six months for each day the nuisance remains.

Lead Hazard Control Program

A HUD-funded initiative, the City of Omaha Lead Hazard Control program, repairs interior lead-based paint hazards, including window and door replacement and paint stabilization, in homes occupied by children under age 7 within the boundaries of the Superfund site. The Omaha Healthy Kids Alliance (OHKA) works in tandem with this program to address additional environmental hazards and structural concerns, to provide education and referrals, and to monitor the program’s impact on health and track data.

OHKA is a nonprofit children’s environmental health organization working to improve children’s health through their Healthy Homes initiative. OHKA evaluates residences for health, safety, and environmental risks, works with families to create individual plans for a healthy home environment, and advocates for policies and best practices that promote health and protect children. It assists clients by delivering supplies, repairing houses, and referring them to community partners.

Grassroots Latino Environmental Education Program

OHKA partnered with the University of Nebraska Medical Center’s College of Public Health, Omaha community-based organizations, and the EPA in 2014 to launch the Grassroots Latino Environmental Education (GLEE) program. GLEE’s goal is to make information about environmental hazards more easily available in Spanish. Understanding that promotoras – community health workers – are effective at disseminating information to the Latino population, it was important to teach them about the connections between a person’s personal health and the environment in which they live. Through GLEE, OHKA trained more than 40 promotoras who educated over 1,000 Spanish-speaking Omaha residents in two years.

Lead Education Action Program

In 2016, OHKA received 6 years of funding from the EPA and the City of Omaha for the Lead Education Action Program (LEAP). The goal of the $5.4 million LEAP program is to support the City’s efforts to take over the Superfund cleanup activities, to educate the community about lead and healthy homes, and to direct residents to use the Omaha Lead Registry website, which is kept up-to-date with new information provided by government agencies, community groups, and private citizens.

One LEAP’s key initiatives is the Lead Free in Five campaign. Launched in October of 2016, with a convening of over 100 community leaders, the campaign aims to address childhood lead poisoning in Omaha through a community-wide strategy of policies, education, and infrastructure.
Results

In 2012, the Douglas County Health Department reported 119 children had tested positive for elevated blood lead levels, compared to 451 children in 1998. Not only were more children tested (17,294) in 2012 than had been previously  but only 0.5 percent of the children showed blood lead levels higher than 9.5 µg/dL, a marked decrease from 13 percent in 1998. As of June 2013, fewer than two percent of eastern Omaha children tested showed elevated lead levels, compared to 33 percent before the Superfund cleanup.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.

Live Well Omaha

Initiated in 1995, Live Well Omaha (LWO) is a community-led collaborative created out of a shared concern that no one organization in the community has the capacity to solve health disparity issues alone. With a focus on healthy eating and active living, and an interest in obesity prevention, LWO has more than 40 active partners from a variety of sectors—public/private organizations, nonprofit, businesses, educators, health systems, and insurance companies. As a result of LWO’s work, childhood obesity rates have been held constant in the Omaha community (from 2008 to 2012); 30 municipal bike-sharing stations have been created; the employer community has embraced healthy vending; and more than $7 million of investment funding has been brought into the Omaha metro area. LWO is funded by the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention Communities Putting Prevention to Work and Community Transformation Grants. To read more about this innovative program, see this brief summary [link].