State Category: Texas

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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Local Public Health Preparedness and Response to Hurricanes and Other Emergencies: High Tech and High Touch

By Umair Shah, MD, MPH, Executive Director and Local Health Authority for Harris County Public Health

This story was published in Ready or Not? 2017.

Harris County, Texas, is a large and rapidly growing community. We are the third largest county in the United States with 4.5 million residents spread over 1,700 square miles.

We are diverse in every sense of the word, making it vital to communicate in culturally competent ways. Additionally, since we are growing and people come from all over, they might not have experience with mosquito or hurricane seasons. We cannot assume our constituents, year after year, are the same. So we must continue to reach out to our community and educate.

That means we need adequate capacity within the department and a diverse team with a broad array of skills and experiences who continual drill and train.

To ensure we reach all our constituents, we are mobile—we take public health to the public. We’ve built health villages with large RV units—that focus on all aspects of health from mosquito abatement to dental services to immunizations.

We didn’t stop there – we knew to be a trusted source during an emergency we must foster a real intimate sense of community.

I mention this because, day-to-day, we rely both on high tech and high touch. We must remember the importance of both. As much as we talk about technology, social media and sophisticated surveillance systems, we cannot lose the high touch of knocking on a door or stopping to share a story, laugh or cry. At the end of the day, the high tech gets the visibility, but it’s the high touch that allows the high tech to succeed.

This is the backdrop that all our preparedness activities take.

Being Prepared

Even preceding Hurricane Katrina, we made sure that every single Harris County Public Health employee had up-to-date Incident Command Systems (ICS) training—and new staffers get this training as part of initiation.

And, every year, we practice—drills, exercises, call down lists, etc.—making sure we can perform all the tasks we’ll need to do during a response.

So, in reality, our response to Hurricane Harvey started more than a decade before the hurricane ever made landfall.

Hurricane Harvey

Before Harvey even hit, our preparedness director alerted staff and the executive team that a major response would be necessary. With this advanced warning, we put all assets in place before landfall.

We set up communications pathways and communicated to all staff, ensuring they were aware of what was coming and their roles and responsibilities.

Once we were in place, we turned to the community. Our communications team sent out messages before the storm about how to be prepared: get your kits ready; what will you do without power; what if you’re displaced; how will you care for the elderly, children and pets; and many more.

Aside from those messages, we needed to make sure people avoided flood water—there could be any number of dangers from power lines to insects to animals to sewage to toxins.

I highlight talking to the public because we’re all in this together. We can respond great from a systems perspective, but if, for instance, people lose access to medications or begin to eat unsafe foods, we could see infectious disease outbreaks or worsened chronic conditions.

In addition to communicating, building and leveraging partnerships is key to a good response.

For example, we worked with state public health and federal partners (the U.S. Air Force) to continue ground and aerial spraying for mosquitos to ensure there wouldn’t be increased levels of Zika or dengue or chikungunya. All levels of government coordinated to ensure we maintained adequate control over mosquitos and other infectious diseases.

Harris County also sheltered a number of people. Our epidemiologists relied on outside experts and volunteers to help them go cot-to-cot to make sure there wasn’t an infectious disease outbreak and that people maintained access to medicines—a high touch strategy.

This is just a small sample of all the activities we did to keep people safe. At the end of the day, a good response involves working across systems to ensure strong partnerships are in place.

Going Forward

I’m always struck by the fact that everyone talks about the importance of health during an emergency, but, when the emergency goes away, we often forget that we need to adequately resource public health agencies so they have the tools and resources to take on the next emergency.

It’s about capacity.

I worry, one day, there will be an emergency that we haven’t trained for enough and don’t have adequate resources in place. Public health can’t all of a sudden be ready to respond to a major emergency – we need to drill and train and have access to infrastructure and technology.

To better prepare for and respond to emergencies, we also must improve technology solutions, electronic surveillance activities, and infrastructure support. We need more epidemiologists and environmental toxicology experts. And, we need more social workers and community health workers to fan into the community and link folks with vital social services.

The best response features a combination of high tech and high touch. This is where our department shines day in and day out. We’ve never let one overtake the other.

Nationally, though, we can’t rest on our laurels—the next storm could be different and we need to be ready and prepared.

Dallas Information Exchange Portal

The Dallas Information Exchange Portal (IEP) is an electronic platform which enables health care providers, community based organizations, and social service agencies to share medical and social information via a secure network. Through patient-authorized, secure two-way exchange of information, IEP is improving care transitions and increasing coordination of care around both clinical and social issues like homelessness, hunger, and substance abuse. The ultimate goal of the program is not only to improve clinical outcomes and measures, but also generate significant cost savings to health systems. The initiative began in 2014 with a $12 million grant from the W.W. Caruth, Jr. Foundation at Communities Foundation of Texas. To read more about this innovative program, see this brief summary [link].

Fighting Chronic Absence with a Flu Shot

The full version of this story, published by Healthy Schools Campaign, is available at https://healthyschoolscampaign.org/policy/fighting-chronic-absence-with-a-flu-shot/. Below is just an introduction.

Schools in Central Texas had a problem. Students in that region were missing more days than the state average at every single grade level.

This absence problem hits Texas schools on two fronts: student achievement and funding. Data shows high school students who miss 10 or more days of school are three times more likely to drop out than students who miss five days or fewer. In some states, Texas included, school funding is based on a figure called “average daily attendance” rather than total enrollment. That means that schools receive funding only for students that are in school. That also means that the more students are absent—for whatever reason—the less funding the school gets.

Improving the Health of Communities by Increasing Access to Affordable, Locally Grown Foods

BY MICHEL NISCHAN, CEO and Founder, Wholesome Wave

When my son was diagnosed with type 1 diabetes, I became painfully aware of the direct connection between food and health. As a chef, this realization caused me to transform the way I fed my family and customers. Fresh, nutrient-dense, locally grown foods became the foundation for the type of diet that would give my son and restaurant guests the best long-term health.

Quickly, though, I recognized that not every family can afford to purchase healthy foods. As a result, I founded Wholesome Wave in 2007.

Wholesome Wave is a 501(c)(3) nonprofit dedicated to making healthy, locally and regionally grown food affordable to everyone, regardless of income. We work collaboratively with underserved communities, nonprofits, farmers, farmers’ markets, healthcare providers, and government entities to form networks that improve health, increase fruit and vegetable consumption and generate revenue for small and mid-sized farms.

Double Value Coupon Program

In 2008, we launched the Double Value Coupon Program (DVCP), a network of more than 50 nutrition incentive programs operated at 305 farmers markets in 24 states and DC. The program provides customers with a monetary incentive when they spend their federal nutrition benefits at participating farmers markets. The incentive matches the amount spent and can be used to purchase healthy, fresh, locally grown fruits and vegetables.

Farmers and farmers’ markets benefit from this approach, and have been key allies as we work towards federal and local policy change.  In 2013, federal nutrition benefits and DVCP incentives accounted for $2.45 million in sales at farmers’ markets.

Communities also see an increase in economic activity.  The $2.45 million spent at local farmers’ markets creates a significant ripple effect. In addition to the dollars spent at markets, almost one-third of DVCP consumers said they planned to spend an average of nearly $30 at nearby businesses on market day, resulting in more than $1 million spent at local businesses. We also see that the demographics of market participants are more diverse – our approach breaks down social barriers and allows consumers who receive federal benefits to be seen as critical participants in local economies.

Equally as important, people are eating healthier. Our 2011 Diet and Behavior Shopping Study indicated 90 percent of DVCP consumers increased or greatly increased their consumption of fresh fruit and vegetables – a behavior change that continues well after market season ends.

Today, the program reaches more than 35,800 participants and their families and impacts more than 3,500 farmers. Combined with the new Food Insecurity Nutrition Incentives Program in the latest Farm Bill, this approach is now being scaled up with $100 million allocated for nutrition incentives over five years.

Fruit and Vegetable Prescription Program

We developed the Fruit and Vegetable Prescription Program (FVRx) to measure health outcomes linked to fruit and vegetable consumption. The four to six month program is designed to provide assistance to overweight and obese children who are affected by diet-related diseases such as type 2 diabetes. In 2013, the program impacted 1,288 children and adults in 5 states and DC. Nearly two-thirds of the participants are enrolled in SNAP and roughly a quarter receive WIC benefits.

The model works within the normal doctor-patient relationship.  During the visit, the doctor writes a prescription for produce that the patient’s family can redeem at participating farmers’ markets. The prescription includes at least one serving of produce per day for each patient and each family member – i.e., a family of four would receive $28 per week to spend on produce. In addition to the prescription, there are follow-up monthly meetings with the practitioner and a nutritionist to provide guidance and support for healthy eating, and to measure fruit and vegetable consumption.  Other medical follow-ups are performed, including tracking body mass index (BMI).

FVRx improves the health of participants. Forty-two percent of child participants saw a decrease in their BMI and 55 percent of participants increased their fruit and vegetable consumption by an average of two cups. In addition, families reported a significant increase in household food security.

Each dollar invested in the program provides healthier foods for participants, boosts income for small and mid-sized farms and supports the overall health of the community. As with the DVCP, there are benefits for producers and communities.  In 2012 alone, FVRx brought in $120,000 in additional revenue for the 26 participating markets.

In less than seven years, Wholesome Wave has extended its reach to 25 states and DC and is working with more than 60 community-based organizations, community healthcare centers in six states, two hospital systems, and many others. Our work proves that increasing access to affordable healthy food is a powerful social equalizer, health improver, economic driver and community builder.

Wholesome Wave is working to change the world we eat in. As the number of on-the-ground partners increases, we get closer to a more equitable food system for everyone.  This means healthier citizens and communities, and a more vibrant economy nationwide.