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 PolicyNC DHHS

Major Investments in PreparednessNCPH 2002-2008

• State Capacity– Epidemiology– Laboratory– Informatics

• Regional Capacity– Epidemiology, Planning, Response– Laboratory

• Local Capacity– Preparedness Coordinators

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)

E. coli Outbreak* at E. coli Outbreak* at State Fair ResponseState Fair Response

October 2011October 2011North CarolinaNorth Carolina

Departments of Health and Human ServiceDepartments of Health and Human Serviceandand

Agriculture and Consumer ServicesAgriculture and Consumer Services

*25 ill, 6 hospitalized, 3 needing dialysis

Public Health Operations Organization

Public Health Operations Organization

Information Fusion for Outbreak Investigation

Joint Operations

Epidemiology with context

Successful Outcome

Eight days following initial reported cases

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

Irene: August 27, 2011

cbsnews.com, accessed Feb. 1, 2012

PHEP Funding Awards to North Carolina 2002-11

24.125.8

20.3

25.9

17.7

21.1

16.5 16.1 16.4

13.4

$0

$5

$10

$15

$20

$25

$30

2002 '03 '04 '05 '06 '07 '08 '09 '10 '11

Year of Award

(Mil

lion

s)

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)

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