Keeping public health in the spot light is critical and what better place to do it than the front page of DailyKos, one of the most visited blogs in the world (average daily visits over 800,000). For six weeks DKos frontpager DemFromCT, one of the founders of FluWiki and himself a pulmonary specialist, has been running a series called Flu and You, interviewing public health types (including one of the reveres). This week he interviews Jeff Levi of Trust for America's Health (TFAH), and the entire thing is worth a read. I want to single out only one aspect that is especially timely, the missed opportunity to include pandemic preparedness in the stimulus. The four "centrists" (really not at all centrist but quite right of center) removed the pandemic money in the compromise. Republican Senator Susan Collins of Maine was particularly proud of this "accomplishment," so she gets special mention. Thanks for nothing, Senator Collins.
How does pandemic flu money stimulate the economy, anyway? Dem put that question, in the context of public health in general, directly to Dr.Levi:
Jeff Levi: There are two levels of argument in favor of including pandemic preparedness in particular and public health programs in general as part of the stimulus bill. First, these do meet the test of stimulating the economy. Much of the nearly $900 million in pandemic money would go toward research and development - biomedical research that is very similar to the work that NIH funds. Ironically, as the pandemic money was being cut as inappropriate to a stimulus bill, the Senate was simultaneously increasing funding for the NIH. In fact, the bioscience sector is a source of high-wage jobs. The average bioscience job paid $71,000 in 2006, $29,000 more than the average private sector job. It has been estimated that each bioscience job generates an additional 5.8 jobs in the national economy.The public health sector in general is also hurting. TFAH has conservatively estimated that the $5.8 billion in public health spending that was withdrawn from the Senate bill would have created 40,000 jobs - that’s without calculating a multiplier effect in the local economy. State and local health departments are hurting. Recent surveys by the trade associations for state and local health officials have shown that 11,000 jobs have already been lost; another 10,000 have remained unfilled as they became vacant. This gets at the core capacity of health departments to respond to emergencies such as a pandemic as well as to serve a core safety net function during a recession - providing preventive services and direct care for the growing number of uninsured.
As originally proposed by the Administration, the stimulus bill was meant to accomplish two related goals: first, provide direct stimulus to the economy and second, to start building the nation’s core capacities for health reform. Indeed, the funding for creating electronic health records remains in both the House and Senate bills, as well as funding for comparative effectiveness research. The prevention and wellness funds were also designed to increase the capacity of our public health programs to improve the health of communities - so that uninsured Americans (and all Americans) would enter the reformed health care system healthier. That is still a worthwhile goal of any legislation called the Economic Recovery and Reinvestment Act. But as I mentioned above, these investments can also have a stimulative effect. (Flu and You, VI)
We've said it often here but it can't be said too often: if you want to prepare for an influenza pandemic -- or any other sharp shock to the system -- the best thing you can do is strengthen the public health and social service infrastructure. Buying and stockpiling vaccine and antiviral might -- or might not -- work for flu, but a strong public health and social service system works for everything, including deep recessions. They also prevent jobs from being lost and create new jobs. Public health and social services are labor intensive. Every dollar goes directly into the economy, back to the people who provided it. But the dollar isn't just recycled. It creates value first, value that benefits the community.
Every dollar for public health cut out of the stimulus bill means less jobs and a waker and less healthy community. Susan Collins was just re-elected in Maine, so she probably feels she can do whatever she wants. Too bad she didn't do what was right, instead.
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In personality and character, Susan Collins reminds me of Indonesian Health Minister Siti Fadilah Supari. Two charismatic and articulate individuals possessing a manipulating ego-driven desire-addiction for power at any and all public health costs... So similar, yet acting from opposite sides of the equation:
Supari utilized the "biological weapon" plotline from Maine's first and most famous son of the horror literature genre, Stephen King, in her book "It's Time for the World to Change - the Divine Hand Behind Avian Influenza." For background research info refer to Australia's ABC media @ http://www.abc.net.au/am/content/2008/s2167325.htm .
Collins, on the other hand (pardon the pun), is seemingly operating from an unconscious or hyper-conscious psychological denialist agenda. The Stephen King novel in question is one of his most famous -- "The Stand" (1978). Later, in 1994, this post-apocalyptic horror-sci-fi novel was adapted into a TV miniseries. It would appear Senator Collins from Maine has a "debunking" political agenda to enact midst antiviral resistant H1N1 and in the face of currently evolving antiviral resistant H2H-H5N1. The probability of evolutionary interplay between these two viruses is epidemiological reality -- a reality which ultimately may see fiction play out as fact...
I think that there are two issues here (or should be). The first issue is investment in panflu preparedness and the second is investment in traditional public health (ID, Chronic, Environmental, Injury, etc.). I have been monitoring the whole panflu / preparedness field for the past six or so years (and working in it for a few) and I have to say, we need to "re-invest" in traditional public health. It is a shame that the second largest budget item at the CDC (after vaccines for children) is preparedness.
You and the readers of this post are obvious to the fact that the pressing public health problems of our time (in terms of morbidity, mortality, quality of life, costs, ability to be minimized) are related to chronic diseases and exposures to toxins (particularly cigerette smoke). I remember when the bioterrorism funds came out in 2002, States were running around buying the most insane stuff, most of it un-needed, un-used, un-usable, and un-related to preparedness (new cell phones anyone?). And, according to TFAH, most states left many millions of dollars on the table unspent.
Now we have plans and biosurveillance systems. Anyone feel safer? Especially since, for hundreds of millions of dollars less, we have Google predicting influenza better, faster. What bioterrorism and panflu preparedness funds have done is create a "preparedness industrial complex" built on panic, leaving no one safer, us all a little poorer, and making it a little more difficult for real public healh to be funded and accomplished.
Wow, I feel better now.
Anon: I agree with what you say except for taking us to task for being oblivious (I assume that's what you meant, not "obvious"). Readers of this blog know that has been the mantra since our start in late 2004 and we have written countless posts warning of the distortion caused by concentrating on "biodefense" (an example here), to the importance of shoring up public health infrastructure (a random but typical example here). Glad to have you aboard.
Anon, your comments are well appreciated. Chronic disease management is a key component of health reform, as is public health inclusion (and as a pediatric pulmonologist, I'm with you on smoking issues.) It isn't "only preparedness", it's "rebuild public health to deal with preparedness and everything else".
Please note as well that the focus of my series has been seasonal flu and the importance of public health infrastructure (panflu prep is only part of the bigger picture.)
The other side of the coin, of course, is that PH folks have wanted to be invisible, work on only what they consider to be important, and then reserve the right to get ticked off when no one notices them at budget time. ;-)
Getting into the dialogue with the public is part of the new job description. Get used to it. It's the only way to build a constituency to support public health.
No, I meant "obvious." It was a complement. Lots of good public health folks on this blog - Reveres and readers!
Anon: Sorry I misunderstood you. Apologies.
Letter to Republican Senator Susan Collins of Maine,
Miss Collins, Maine History has been witness by French-Canadians that went out of Canada for multiple reasons and emigrate to New-England, its a reality in New England.
Their Catholic Churches habit to write down what they witness, describe a terrible tragedy happening in Maine when the Spanish Influenza swept it in 1918 and the lasting grip it had on all families of Maine.
There is a testimony of a Priest who a morning , after blessing the Consciousness of dying ones 4 times, was almost running to his church to cry and pray, .and he was grabbed by someone begging him to Granth the last sacramentsâ for the dying person.
I do not want to get into suffering details Governor, but in 2009 we have some efficient ways to reduce so much mortality and such a lasting morbidity .
I am convinced, knowing them, that most of Maine People are ready to participate in Preparedness Imperatives to face crisis.
In Portland, we can still hear from the elderly and from their youth writings, that;
All must be done to avoid this helplessness of us in face of such a crisis, the cost for Maine had lasting effects.
Regina Benjamin is about to become our new Surgeon General. So far, this is what I'm finding (from Daily Kos):
www.dailykos.com/storyonly/2009/7/13/11456/78
-relatively good news from a source I tend to relatively trust.-Hope for best, keep eyes open...