Is America prepared for more Ebola cases? Hospitals and local health departments are certainly more alert to the threat than they were three weeks ago, when Thomas Duncan first turned up at a Dallas emergency room with fever and abdominal pain. But it’s likely the country is less prepared today than it was six years ago.
State and local health departments employ 19 percent fewer people today than they did in 2008, according to estimates by the Association of State & Territorial Health Officials. That’s a decline of 51,000 jobs.
The threat of Ebola makes the problem of a more thinly staffed public health system feel more urgent. But the consequences affect Americans’ health every day outside of the spotlight. Besides prepping for rare infectious diseases, health departments routinely combat the spread of more common illnesses, from seasonal flu, to HIV, to lifestyle-influenced conditions such as diabetes or obesity.
When prevention works, it’s invisible. Running a quit line for smokers or offering a vaccination clinic doesn’t make headlines the way lugging out the hazmat suits for an Ebola drill does. But that routine work of health authorities saves lives, and there are a lot fewer people to do it now than there were a few years ago. The missing capacity can’t be cured with a surge of cash, says Jeff Levi, executive director of the Trust for America’s Health. ”You may be able to buy equipment quickly, but you can’t buy trained personnel quickly.”
Tom Frieden, director of the Centers for Disease Control, says the agency plans to do more to prepare health-care workers for treating Ebola patients after a nurse who cared for Duncan in Dallas became infected, despite protocols intended to keep clinicians safe. “We will double down on training, outreach, education, and assistance throughout the health-care system,” Frieden told reporters on Monday.
There’s no federal standard for what a public health officer should do, according to an April report by the Trust for America’s Health. “Federal public health programs as currently structured, do not actively promote a set of baseline, consistent capabilities that every community across the country should meet,” the report said, and there’s little reason behind the way funds are distributed. That means some places may be doing a lot to prepare and others may be doing little. “It looks different from community to community,” says Jack Herrmann, chief of public health programs at the National Association of County & City Health Officials. “You’re not going to find uniformity across the country about this.”
