The Robert Wood Johnson Foundation (RWJF) recently released the National Health Security Preparedness Index (NHSPI) assessing both the nationwide, and state specific, levels of public health readiness. Of the areas assessed in the report, the highest preparedness ranking was in the index of Incident and Information Management (8.4 out of 10), an impressive benchmark and testament to the recognized value of emergency operations and responder safety. However, other areas surveyed by the report provide a more troubling view of the nation’s preparedness, specifically, the category of Healthcare Delivery (5.1 out of 10) which provided the lowest score of the index. The low score is based on an evaluation of the overall healthcare system’s ability to function both daily and under surge conditions with a strong service delivery foundation. The NHSPI highlights the state’s need to ensure proper support of healthcare preparedness. When compared to previous years, the NHSPI does show the nation as a whole is improving, however, next year’s index report may not be able to demonstrate an improvement as the loss of healthcare funding continues to be a struggle for several states.

In addition to the RWJF report, the Trust for America’s Health (TFAH) recently released Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts outlining the financial issues impacting state public health funding. The Trust’s report indicates stagnant federal funding for public health that is limiting prevention and preparedness activities. Additionally, six states, Alabama, Indiana, Kansas, North Carolina, Ohio and Oklahoma, are specifically mentioned as they have cut public health spending over the past three years demonstrating the instability in funding sources. As the nation anticipates the arrival of the Zika virus and the threat of biological weapons as a tool or terror continues, decreasing public health funding seems irrational.

In Oklahoma, falling oil prices have created a $1.3 billion budget shortfall for the upcoming 2016–2017 budget and all areas of healthcare are bracing for a major impact to services. As a result of this 20 percent reduction in spending, many Oklahoma healthcare and social support agencies are being forced to reduce staff or services. One of the most significant cuts was announced on March 29th when the Oklahoma Health Care Authority (OHCA) indicated that the Oklahoma Medicaid program would reduce provider spending by 25 percent with an anticipated reduction in health services for those living with chronic medical conditions to include reduced payments for physician, hospital, home health, and ambulance services. Along with Medicaid cuts, the Oklahoma Department of Mental health is losing $13 million and will reduce the mental health, substance abuse, and other programs that the agency provides to residents. Finally, the Oklahoma Department of Human Services (DHS) has been forced to buyout employee retirements and continues to struggle with funding services. All of these reductions not only limits the state’s ability to delivery of services on a daily basis, but also respond effectively to a public health emergency.

In Oklahoma, the frontline emergency responder can anticipate a change in their ability to deliver effective services as budget allocations are gutted. Many rural hospitals, skilled nursing facilities, and ambulance services rely on Medicaid funding for survival and a loss of revenue may result in hospital closures and loss of emergency care in some of the most underserved areas of the state. Persons in the community that receive mental health services may lose the access to counseling and the prescription medications needed to maintain their journey to recovery. The ability to refer vulnerable adults to DHS’s Adult Protective Services has been reduced to only the absolute worst cases due to a 60 percent staffing reduction. Law enforcement, fire service, and emergency medical providers will struggle to manage a population no longer receiving state supported services and will find it even more difficult to manage a large public health event without the appropriate resources.

It is evident from the data contained within the RWJF and TFAH reports that the service delivery and funding priorities for public health are inconsistent across the nation. As a whole, the nation may have a new public health emergency looming as daily services are suspended, delayed, or deferred within several states. The increase in the number of adults over 65 years of age in communities will see those living with chronic health conditions and a reduced income defer the purchase of medications or suspend regular physician visits resulting in the continued over utilization of the hospital emergency department. Finally, these system wide failures do not promote the overall improvement in the U.S. healthcare system which continued to consume 18 percent of the Gross Domestic Product and lack consistent quality. Our health security is at risk and we are rapidly becoming a vulnerable population.

NHSPI — http://nhspi.org/

TFAH — http://healthyamericans.org/assets/files/TFAH-2016-InvestInAmericaRpt-FINAL.pdf

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