Health Affairs

Posting date: June 2, 2004

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Health Affairs, 10.1377/hlthaff.w4.341
Copyright © 2004 by Project HOPE

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Local Variation In Public Health Preparedness: Lessons From California

Nicole Lurie ^1*, Jeffrey Wasserman ², Michael Stoto ³, Sarah Myers ⁴, Poki Namkung ⁵, Jonathan Fielding ⁶, Robert Burciaga Valdez ⁷

¹ Nicole Lurie is a senior natural scientist and the Paul O’Neill Alcoa Professor at RAND in Arlington, Virginia.
² Jeffrey Wasserman is a senior policy researcher at RAND in Santa Monica, California.
³ Michael Stoto is a senior statistical scientist at RAND in Arlington.
⁴ Sarah Myers is an associate social research scientist at RAND in Arlington.
⁵ Poki Namkung is health officer for the City of Berkeley (California).
⁶ Jonathan Fielding is director of public health and the health officer for the Los Angeles (California) County Department of Health Services.
⁷ Robert Valdez is a senior health scientist at RAND (Arlington).

^*Corresponding author.

Abstract

Since September 2001 Congress has allocated approximately $3 billion to strengthen the public health infrastructure. To achieve this goal, the U.S. Centers for Disease Control and Prevention (CDC) allocates funding to states, which distribute funds to local jurisdictions. Evidence-based measures to assess public health preparedness are lacking. We used an expert-panel process to develop performance measures, based on the ten essential public health services. We developed and conducted tabletop exercises in California to evalute preparedness to detect and respond to a hypothetical smallpox outbreak based on those measures. There was wide variation of readiness in California. While the sources of variation are often different, common infrastructure gaps need to be addressed.

Key Words: Health Promotion/Disease Prevention, Public Health, State/Local Issues, Bioterrorism

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