State Category: South Carolina

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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Connecting Diabetes Care from the Clinic to the Community

BY JOHNNA REED, vice president, business development, Bon Secours Health System

In 2011, the Bon Secours St. Francis Health System in Greenville, South Carolina created a Diabetes Integrated Practice Unit (IPU) to foster a new environment that improves the health of patients with, or at risk of developing, type 2 diabetes.

Since most of the factors that influence health exist outside of the doctor’s office, we’ve learned the importance of connecting our patients to resources in their communities. This helps them in their daily lives and better supports their ongoing medical care.

The goal of the Diabetes IPU is to connect patients with community resources that can help benefit their health through improved nutrition, increased physical activity and support to manage their condition. The program also ensures that physicians and other caregivers have sufficient time to focus on their patient’s needed care. This added time also allows providers and patients to work together to understand how obesity, prediabetes and diabetes can affect health and daily life and to set goals that work for each patient’s unique circumstances. 

The program also emphasizes the importance of prevention, to avoid developing additional health risks or problems in the future. We help prediabetics avoid the progression to diabetes and help diabetics avoid developing additional conditions.

The program is designed around a network of community and clinical resources, providers and technology. While the program hub is at St. Francis Millennium, the programs themselves are delivered where patients are—at work, home, and throughout the community.

The Diabetes IPU includes an extensive coordinated team of care givers, including a primary care physician, ophthalmology, cardiology, nephrology and podiatry services, and an endocrinologist who consults with the primary care physicians regarding innovations in diabetes care and assists with the care of patients facing particular medical challenges.

The medical care is managed by a registered nurse care coordinator. It’s also important to note that our care team includes a psychologist, social worker, registered dietician, diabetes educator, pharmacist, and an exercise physiologist to help patients get to a healthy weight. It is not just a clinicalcentered approach — it’s a total community health approach.

HOW THE IPU WORKS:

A patient’s initial visit with the diabetes team begins with a fasting blood draw to determine blood glucose, HbA1c, cholesterol, and other relevant lab values. Following the blood draw, patients are provided a diabetes-appropriate breakfast. Next, the patient is asked to participate in a small group discussion about issues they have in dealing with diabetes, led by a diabetes educator and nurse. Facilitators are continually surprised at the level of engagement in these groups — patients tend to share readily and openly.

The group discussion not only introduces patients to others who share similar health and lifestyle challenges—including being overweight or obese and struggling to engage in physical activity and eat healthy—but also enables the nurse facilitator to determine the best match for the patient with individual caregivers. After the discussion, the entire group receives an introduction to exercise with an exercise physiologist who provides an easy, low stress overview of exercise options.

In the course of this first morning, the patient sees the primary physician, psychologist, diabetes educator, and registered dietitian. Each patient also receives a retinal scan and foot exam. Finally, patients are served a diabetes friendly lunch with the clinical team present to answer questions about the food or anything else related to diabetes.

However, our work doesn’t stop when the patient leaves the clinic. Because the needs of patients with type 2 diabetes require support and resources in the community, our diabetes program provides worksite and home services. After their visit, a team member meets with patients in their home to assess the support network available and to identify areas where patients will face particular challenges. Our teams then work with family and employers to inform and facilitate improvements in the home and work environments and sometimes in the local grocery stores and pharmacies.

Often, the care team conducts a thorough workplace assessment to determine how each patient’s work setting impacts his or her health. For example, if there is no access to healthy foods, we work with the employer to improve the food options at a worksite. It might be surprising that employers have been incredibly supportive, however they fully understand the importance of having a healthy, happy, and productive workforce.

From the patient perspective, the most important measure is improvement in the ability to live (i.e., to work, participate in family life, attend important events, and enjoy daily activities). With each patient, the care team identifies capabilities that are motivating and meaningful and track their improvement. While these measures require greater effort to quantify, they are often the drivers of people’s long-term commitment to lifestyle change and health.

Patients have responded incredibly well. A recent patient entered the program hoping to improve his health, get off regular insulin and lose about 60 lbs. With the diabetes team’s help, he understood the need to deny barriers and stressors, such as fast food and sugary drinks, and was very successful.

Through the program, he increased glucose monitoring from to three to four times daily; went from not exercising at all to exercising four times a week at the facility we recommended to him; attended all prescribed education opportunities and shared medical group appointments; and engaged often with our dietician. While he hasn’t yet reached all his top-level goals, he lost more than 45 lbs., reduced his BMI from 33.7 to 27.5 and his waist size from 44 to 36, and no longer needs mealtime insulin coverage.

The most successful patients are the ones who receive a continuum of care from the clinic to their community. Our model improves a physician’s capability by bringing all of the necessary community resources together. Research shows that what happens outside the doctor’s office can have a major impact—either positive or negative—on our health. That’s why we began the Diabetes IPU model and why we’ll continue using it to fight obesity and improve the care of individuals with prediabetes or diabetes.