MORGANTOWN, W.Va. – Trust for America’s Health released its annual Ready Or Not: Protecting the Public’s Health From Diseases, Disasters, and Bioterrorism report this month. The report analyses each state’s public health preparedness based on ten “top-priority” indicators. This year, the report includes some lessons learned through the pandemic as well.
In this Q&A, we talked to John Aurenbach, President and CEO of Trust for America’s Health, to put context behind the study and see what TFAH recommends for West Virginia to strengthen emergency preparedness.
Q: What do you think are some of the key takeaways from the study?
A: We’ve done the study now for 18 years, and over that time period, we’ve definitely seen improvements in emergency preparedness efforts around the country. But we’re still seeing very significant areas that are in need of improvement, and COVID-19 has just reinforced those.
Q: What do you think stands out in terms of West Virginia’s preparedness?
A: What we did, in terms of our looking state by state, is identify ten indicators that we think are good measures of whether states are fully prepared for all types of hazards, and we then divided the states into high, medium, and low based upon how they did with those indicators. West Virginia came out in the low area, and what we found there is not that there aren’t good things in West Virginia. The health department there at the state level is doing a very strong job, and there are a number of very positive things that have been done, but there are some clear areas where attention would be called for and would make a difference.
Q: What are some of the things you would recommend for West Virginia?
A: One example is paid sick leave. What we found in looking at emergencies, including COVID, is that when workers have paid sick leave, they’re much more likely not to come to work if they have an infectious disease, and unfortunately, if they have no paid sick leave, they’re more likely to come [in to work], and that can lead to transmitting illnesses and significant problems for the workers themselves. So, about 55% of people in West Virginia have paid sick leave. Almost half do not.
Another example is seasonal flu vaccination. That is a measure for how well a state is willing to undertake vaccination in a widespread manner, and only about half the people that are recommended to receive the seasonal flu vaccine in West Virginia actually do. So, those are two areas where strengthening those policies would be good preparations for future emergencies.
Q: There’s a lot of states that connect to West Virginia that are in the lower tier. Why do you think that might be?
A: I think one indicator that is extremely important in terms of measuring the level of preparedness in the state is how much support, how much investment there is in the public health system at both the local and state level. There have been a number of studies showing very clearly that the more that there is an investment in public health, the better the health of the population in general, but also the better prepared the population is in the event of an emergency. So, some of the states that surround West Virginia and West Virginia itself are at a rather low end of the investment in their own public health systems.
Public Health Funding, by state FY 2019-2020
So, we think recognizing how important those systems are and making sure they have the resources to do the day-in, day-out work–epidemiology, laboratory capacity, communicating with the public–if those resources increase, then the public’s health is likely to increase as well.
Q: I know that one thing that was discussed in the study was the differences between the federal role and the state role, and what each one brings to the table. Can you talk a little about that?
A: In emergencies, there is a role for both state and federal, and in addition to that, for local as well. The historical way that a major emergency like COVID has been handled within the country is to have clear, consistent direction from the federal government that then is adopted at the state level with adaptation to the local conditions. We didn’t have that with COVID, and so as a result, we’ve got fifty different approaches with different policies, and we’re seeing that now with who is being prioritized with vaccination. I think that the evidence from past emergencies is that consistency is good. Having the states and federal government work in partnership is absolutely important, but if there is unevenness in the response, it makes it difficult to have the most effective policies in place.
The evidence from past emergencies is that consistency is good. Having the states and federal government work in partnership is absolutely important. But, if there is unevenness in the response, it makes it difficult to have the most effective policies in place.John Aurenbach, President and CEO of Trust for America’s Health
Q: Do you think the stats this year were surprising at all? Or were they more on target with what you expected?
A: I think that we have seen these trends over the last several years that would lead us to believe that the survey this year was not that surprising. What we do hope is that COVID really changes things because it’s been a wakeup call to a lot of people that what we have done so far, our underinvestment in emergency preparedness and public health, has placed us in a vulnerable position. So we’re hoping that this year comes a turning point, and that next year we see quite significant change in these measures.
Just one example of that is around paid sick leave, where congress actually passed a law early in the pandemic response saying paid sick leave has to be covered for people who have COVID or who have been exposed to COVID, and I think that was a recognition that there is a strong relationship between socio-economics and combatting an emergency.
Q: Is there anything I didn’t ask that you wanted to touch on?
A: One lesson that we’ve also been reminded of this year is that while emergencies like COVID can affect everyone, there really is a disproportionate impact, a heavier burden that affects certain populations, and we have seen that with populations of color, we’ve seen that with lower-income families, and we’ve seen that with older adults. So, we have to recognize, I think, that with both of those examples, there are underlying reasons that make people more vulnerable that are really beyond their control. Having to do with whether they have to go into work when everyone else is teleworking and whether they have paid sick leave; whether or not they have easy access to healthcare, or they feel like there are barriers to health care.
So, we also feel like focusing on equity, focusing on fairness is a lesson that we’ve learned again in COVID, and we’re hoping that will result in policy paying more attention to guaranteeing that everybody has access to the public health system and the healthcare system regardless of the color of their skin, regardless of their income.