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View from a State North Carolina Public Health

View from a State North Carolina Public Health. Population 9.5M 54,000 square miles 5 th in growth rate in US 100 counties Decentralized Public Health system 85 local health departments (county or district). Jeffrey Engel, M.D. Former State Health Director

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View from a State North Carolina Public Health

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  1. View from a StateNorth Carolina Public Health • Population 9.5M • 54,000 square miles • 5th in growth rate in US • 100 counties • Decentralized Public Health system • 85 local health departments (county or district) Jeffrey Engel, M.D. Former State Health Director Senior Advisor for Health Policy NC DHHS

  2. Major Investments in PreparednessNCPH 2002-2008 • State Capacity • Epidemiology • Laboratory • Informatics • Regional Capacity • Epidemiology, Planning, Response • Laboratory • Local Capacity • Preparedness Coordinators

  3. New Capacity in Public HealthStrategic Building of an Integrated System • State (Division of Public Health) • Office of Public Health Preparedness and Response • State Laboratory: Bioterrorism and Emerging Pathogens Program • Biosurveillance and Informatics • Syndromic surveillance system with NC Hospital Association • National Electronic Diseases Surveillance System • Regional • Regional epidemiology offices • Hospital-based epidemiologists • Regional labs (Charlotte, Asheville, Greenville)

  4. E. coli Outbreak* at State Fair ResponseOctober 2011 North Carolina Departments of Health and Human Service and Agriculture and Consumer Services *25 ill, 6 hospitalized, 3 needing dialysis

  5. Public Health Operations Organization

  6. Public Health Operations Organization

  7. Information Fusion for Outbreak Investigation

  8. Joint Operations

  9. Epidemiology with context

  10. Successful Outcome Eight days following initial reported cases

  11. State Reductions2011 Budget • Elimination of Public Health Pest Management Program • NC no longer has any entomologists, so…. • Hurricane Irene August 2011 • Post-hurricane marsh mosquito nuisance • No state capacity to respond • Every county “on their own” • Aerial spraying costly ($100,000 per application) • FEMA reimburses 75% • Dare County sprays, Pamlico County does not

  12. Irene: August 27, 2011 cbsnews.com, accessed Feb. 1, 2012

  13. Recent ReductionsPHEP Grant 2008-2011 • State Position Eliminations • Two lab positions • Two epidemiologist positions • One vet position (Dept. of Agriculture) • Regional • 7 teams of 4 people down to 4 teams of 5 people (8 positions) • 13 hospital epidemiologists down to 8 (5 positions) • Local • 70% down to 25% of local health departments who can support a full-time preparedness coordinator (38 positions)

  14. North Carolina Summary • Public Health Preparedness and Response • PH major critical infrastructure is a trained and adequate workforce • Technical resources: lab, informatics • Communication: common language (National Incident Management System), protocols and plans • Since 2008, Federal and State Reductions Resulted in Loss of 60 Positions

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