Preparing for Public Health Emergencies:

Meeting the Challenges in Rural America

Paul Campbell, MPA, ScD

Harvard School of Public HealthCenter For Public Health Preparedness

© HSPHCPHP 2005

Public Health Emergencies

Terrorism• Biological

• Chemical

• Nuclear

9/11/01 World Trade Center Attack

Bioterrorism Preparedness

Public Health Emergencies

Terrorism• Biological

• Chemical

• Nuclear

Emerging Diseases

2003 SARS Epidemic in Singapore

Public Health Emergencies

Terrorism• Biological• Chemical• Nuclear

Emerging Diseases

Accidents

Natural Disasters

Why Are We Researching and Advocating for

Rural Public Health Preparedness?

• Capacity

• Probability/Seriousness of Threats

• Policy/Resources

Why Are We Assessing and Advocating for

Rural Public Health Preparedness?

• Capacity

• ProbabilitySeriousness of Threats

• Policy/Resources

Ready or Not: Protecting the Public’s Health in the Age of Bioterrorism

2004

• RWJ Foundation Funded

• Trust for America’s Health

• 50 States included

• 10 Criteria developed by expert panel

• Results: Poor performance in heavily rural states

The Weakest Link? Bioterrorism Readiness in America’s Rural Hospitals

2004

• ANSER Institute for Homeland Security

• Elin Gursky, Senior Fellow

• Case research

• Results: Rural hospitals not equipped or staffed to address emergencies

Rural America

• Approximately 20% of US population

• Rural residents are:– More likely to be poor and elderly– More likely to die if injured– More (4X) likely to live in a medically

underserved area– Less likely to be served by well-staffed local

public health agency

Rural Preparedness Challenges

• Inadequate health care resources

• Inadequate public health resources

• Distances

• International borders

• Tribal relationships

• Complacency

Comparing Massachusetts & Maine

Massachusetts MainePopulation 6.4M 1.3M

Population density

Land Area: 8,000 sq. miles

810 persons per sq. mile

Land Area: 31,000 sq. miles

41 persons per sq. mile

Cities and towns

351 492

Per Capita Income

Rank, US

3 36

Massachusetts Maine

Health Dept.

Staff

3,000 365

Local Public

HealthMunicipal

Across State

Only 2

City

Acute Care Hospitals

74 44

EMS withMMRS

Fire with Mutual Aid State, Federal & Int’l Assets

LocalAcademicAssets with (A-CPHP)

Hospitals withDMAT and

NDMS and Promoted and Rejuvenated

Caregivers

Police withNat’l Guard

Local withRegionalGovernmentLocal

Public Health

Why Are We Assessing and Advocating for

Rural Public Health Preparedness?

• Capacity

• Probability/Seriousness of Threats

• Policy/Resources

Threats in Rural America

Bioterrorism– Food– Water– Defense installations– Seasonal population surges– Urban exodus

Threats in Rural America

Bioterrorism– Food– Water– Defense installations– Seasonal population surges– Urban exodus

All Hazards

New Sweden Arsenic Poisoning, 2003

Why Are We Assessing and Advocating for

Rural Public Health Preparedness?

• Capacity

• Probability/Seriousness of Threats

• Policy/Resources

Cities Readiness Initiative2004

• Redirection of CDC Funds

• $1 million removed from each state

• Funds redirected to 23 largest cities

Conference Sponsoring Organizations

• Harvard School of Public Health

• Maine Center for Public Health

• Maine Dept of Human Services

• Texas A&M Rural School of P.H.

• University of Minnesota S.P.H.

• University of North Carolina S.P.H.

• University of Pittsburgh SPH

Conference Conclusions

1. Rural America is vulnerable

2. Rural public health and health care systems need to be

strengthened

Conference Conclusions

3. Policymakers need to acknowledge resource requirements

4. Rural public health and health care leaders need to work together to optimize cost-effectiveness