Money Well Spent: Public Health Dollars Save Lives

By Jean O’Connor, JD, DrPH, Deputy State Public Health Director, Oregon

About a week and a half ago, the Oregon Public Health Division learned about a child with hemolytic-uremic syndrome (HUS), this sounds complicated but it’s essentially kidney failure brought on by an infection of the digestive system. In an otherwise healthy child, E. coli O157:H7 is often the cause of HUS, and more often than not, it’s acquired by consuming infected food. Every year E. coli causes an estimated 70,000 cases of human illness and about 2,100 hospitalizations. When public health practitioners see a case of HUS alarm bells go off because there may be something in the environment that could harm others.

As soon as the child was diagnosed, Oregon disease detectives started their investigation. They learned that a group of families, likely unaware of the danger, drank raw milk from a cow infected with E. coli. Raw, or unpasteurized milk, is risky to consume and is illegal to sell it because it’s so dangerous. Without pasteurization, which is a heating process that kills most germs, people who drink the milk may be exposed to all the dangerous bacteria found in cow feces. Some of the people who drank the milk became sick with bloody diarrhea, and four of the children who drank it have been hospitalized. This week, Oregon Public Health Division’s epidemiologists and laboratorians—some of whom are paid with preparedness dollars–worked to identify those who sought medical treatment and confirmed that the milk was the likely source of the outbreak. By identifying the cause and working with the farmer producing the milk, lives have been saved.

This recent outbreak demonstrates how the funding CDC provides to states for public health preparedness and response is being used to protect the public’s health every day. These dollars are an incredibly important way to connect the health care delivery system (e.g., hospitals and doctors offices) with public health and save on healthcare costs for everyone. In Oregon, we use these funds to literally get down in the dirt to find the cause of an illness and to fund sophisticated communications tools that will help us connect across the state even when an event such as an earthquake takes out daily telecommunication systems.

I don’t want you to get the idea that Oregon is any more dangerous than other states—public health professionals all over the country work to prevent and control disease outbreaks all the time—but there are a few more recent examples I want to share with you about how public health preparedness dollars save lives every day.

Return on Investment: Vaccination Campaign

One of those examples comes from a small town in the central part of our state, located in Oregon’s fantastic high desert and a great place to visit. In this town, they had three cases of a rare, but vaccine preventable bacterial illness, meningococcal disease (meningitis is one of these diseases). Meningococcal disease can cause an infection in the brain and spine that causes swelling, and many people who get it either die or suffer some permanent disability, such as loss of a limb or hearing. As the cases were reported and confirmed by our state public health laboratory, state and Crook County public health staff worked together to identify the contacts of those who were infected and provide them with antibiotics to prevent them from becoming ill.

When the third meningococcal case was identified(constituting an outbreak), state and county staff convened on a conference call and quickly realized that the number of potential contacts was so large that the best protection for the community would be to vaccinate people at risk. To tackle such a large undertaking, we brought together our leadership team, risk communications expert, vaccine program staff who could order the vaccine the county needed from CDC, and our epidemiologists who understood the outbreak. During the subsequent days, state staff worked to support Crook County Health Department, which did amazing on-the-ground work to vaccinate more than 1,000 people in the community.  Public health preparedness dollars went in to funding many of the staff who worked on this response.

Return on Investment: Preventing Injuries

During the floods in Oregon this past winter, we used our preparedness resources to stand up an Incident Management Team in our public health Agency Operations Center to ensure our response was coordinated with other state agencies and to provide surveillance of flood and storm clean-up related injuries. We also activated the public health emergency communication system, which is paid for with preparedness dollars, to coordinate emergency risk communication messages with county health departments. The emergency messages focused on the dangers of entering flood water, safety tips on using chainsaws during flood clean-up, and warnings about carbon monoxide poisoning from using generators incorrectly. The local media was a great partner in alerting the public; our messages went out to radio and newspapers across the state. Injuries are one of the leading causes of death for children and young adults and preventing them is an important priority for public health.

I worked for many years at CDC, and was directly involved with the H1N1 and Haiti cholera responses, a good chunk of that time was spent answering questions from Congress and the Office of Management and Budget about the value of public health preparedness dollars. When the chance to work in a public health leadership role in my home state came up, despite the tenuous budget situation for public health nation-wide, I couldn’t turn it down. And now that I’m here, I often find myself wishing I could show people just how important this federal investment in preparedness and response is to protecting the public’s health every day. There is a common misperception that the dollars and systems sit around waiting for a big event or a bioterrorist attack. The reality is that we use preparedness dollars to fund tools and systems that are used every day to protect the public’s health. And as much as I like to think my home state and the people I work with are special, I just paid a visit to our neighbor to the north, Washington State, where I heard similar stories to the ones I shared with you today and they include cows, vaccines, and I think someone even mentioned zombies, too!

Public health preparedness is one of the 10 great public health achievements of the past decade. If I had a crystal ball that predicted the future, I know it would tell us that public health preparedness and community resilience will turn out to be one of the greatest achievements of this century. The critical issue is finding a way to sustain this investment.