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Last Updated

28 Sep 2003

Source:  Albany Times Union (NY), September 28, 2003

Public health programs feared lost in new battle

Preventing bioterror attacks has become a top priority, but at what cost to other efforts?

By CLAIRE HUGHES, Staff writer

Nearly two years after doctors confirmed the first case of anthrax in Florida, preparation for a bioterrorist attack has moved near the top of local health officials' agendas.

The question is: Is that change in priorities for the better?

In Schenectady County, Health Commissioner Dr. Russell Fricke isn't convinced his staff is spending time confronting the health problems most threatening to residents. The likelihood that bioterrorists would choose the western edge of the Capital Region as a target is extremely low, he said. What's real is that too many teenagers are getting pregnant and too many mothers are smoking, putting themselves and their children at risk for cancer.

"I would always be inclined to place my emphasis on the thing that is either highly probable, or actually here," Fricke said.

The federally driven emphasis on preparing for a germ-toting terrorist has local public health officials split in their opinions:

The bioterror threat has raised public awareness of public health and directed dollars to local agencies whose funding had been eroding for years. Those dollars have bought more staff and equipment, and improved health officials' abilities to prepare for the outbreak of any infectious disease -- whether the illness is planted like a bomb or spread naturally.

Yet some worry the bioterrorism focus has decimated health-promotion and disease-prevention efforts that address persistent problems, such as teen pregnancy, high blood pressure and obesity.

"Public health is gaining more responsibility and not necessarily the staff that go along with it," said Denise Ayers, Rensselaer County public health director. "We have multiple programs in multiple areas that we have to address, and we don't have the resources to do it with."

Some county health officials see direct hits to services as a result of the shift in public health's agenda. In Rensselaer County, staffers have less time than they did two years ago to participate in health fairs and community outreach efforts to educate residents about chronic, potentially life-threatening conditions, Ayers said.

"There's never enough hours in the day, and there's never enough hours to do it," she said. "It's just a continuous uphill battle."

In Schenectady County, plans to collect and analyze data to address high rates of teen pregnancy and maternal smoking have been shelved since Sept. 11, 2001, Fricke said. County health workers still visit new mothers with children at risk for medical problems, but the department has not been able to expand those visits to pregnant women, as had been planned.

In other parts of the state, too, health officials pointed to initiatives that are getting less attention since fall 2001. In Dutchess County, the health department is running fewer injury prevention programs urging the use of bicycle helmets and seat belts, said Health Commissioner Dr. Michael Caldwell. In Onondaga County, cancer screenings have been reduced, said Health Commissioner Dr. Lloyd Novick.

But state Health Commissioner Dr. Antonia C. Novello said the current focus on bioterrorism is not a shift in priorities. Health officials still do the same work, she said -- promoting healthy lifestyles and an environment with clean water and air. Anticipation of a bioterror attack just provides one new way of approaching that work.

"Nothing has lowered the importance of the other health needs of the state," Novello said.

Indeed, some county health officials have softened their criticism of bioterrorism prevention efforts since the failure of the federal smallpox vaccination program earlier this year forced them to rethink their approach. Novick, an outspoken critic of the smallpox plan, which he said involved a massive investment of his staff's time, said bioterrorism prevention is now more appropriately focused on overall emergency preparedness rather than the threat of a single disease.

"The general priority is in line," Novick said. "I think we have seen too much of a skew in that priority towards smallpox preparedness, whereas the effort needs to be more evenly distributed against other possible biological threats."

Bioterrorism and emergency preparedness have also brought some benefits, health officials agree.

In the last two years, health departments in the four-county Capital Region have been awarded $1.6 million in federal funding to combat bioterrorism. Hospitals are to receive at least $60,000 each. Albany Medical Center has been allotted $725,000 -- money that comes with a designation as a regional resource center for bioterrorism prevention, responsible for coordinating hospital efforts to prepare for an attack in a 13-county area.

The funds, which accompany federal mandates to develop antiterrorism plans, have boosted health officials' ability to handle an emergency or an infectious disease outbreak, they said. Most public health departments have added staff, such as epidemiologists who track the spread of illness or health educators who provide training on disaster preparedness. In Saratoga County, for example, three new health workers have been hired, including a bioterrorism coordinator and an emergency preparedness educator.

Nonetheless, staff hired with bioterrorism preparedness grants legally cannot be used for other initiatives, noted Ayers.

Planning to respond to a potential bioterrorist attack also has brought together agencies that once operated independently -- a seemingly subtle change that experts say could make a huge difference in disaster response.

Dr. Timothy Brooks, chairman of Saratoga Hospital's Department of Emergency Medicine, recalled the incident two years ago that led him to spearhead the Countywide Emergency Preparedness Committee, which now includes dozens of health and safety officials, including police and fire departments. After several anthrax cases had been confirmed nationwide, a worker at Saratoga County Mental Health opened a letter from New Jersey that was not addressed to a particular individual and appeared to contain some powder -- all indications it could contain anthrax.

Someone casually notified an employee of the nearby hospital and word eventually got to the emergency room. People who touched the letter were contacted and told to come in to the hospital to be showered down. The letter, which turned out not to contain anthrax, was handed over to police.

"The way it was managed was, 'Well, OK, it's probably nothing,' " Brooks said. "But that was not the way to approach it."

Today, there is a protocol established among several county agencies for who to contact and what to do in case of exposure to a suspicious substance, he said. The clearer coordination and chain of command will speed a response in any emergency, county officials said.

The federal anti-bioterrorism agenda also has allowed local health agencies to stock their disease-fighting arsenals with new tools. Albany County has hired an epidemiologist to track the occurrence of infectious disease, with an eye toward spotting the sudden appearance of unusual symptoms that could indicate an attack.

The new staffer, Carol Killian, has designed a computer program that also allows the county to better track Lyme disease, a growing problem within the Capital Region, and led to the county's recognition of a pertussis outbreak in June. That allowed county officials to notify doctors and residents about the outbreak as it was happening, rather than weeks or months later.

"It helps us to monitor illness in the community to see if there is concern about a disease that might need to be addressed," said Albany County Health Commissioner Dr. James Crucetti.

Yet, looking back to mid-2001, Crucetti conceded he had plans that could not be realized after Sept. 11 and the subsequent anthrax scare. Among them was his desire to involve county health workers in the Healthy Capital District Initiative, a regional effort to promote health.

Still, he doesn't deem that loss to be crucial.

"We haven't lost sight of other public health priorities," he said.