Public Health: Are We Too Slow?

One of the many roles of public health is to protect consumers from threats like foodborne outbreaks. Much of this hinges on quickly getting out clear messages to the public that provide simple steps to help stem the spread of disease. This is something public health professionals have been doing for over a hundred years, but a recent outbreak of Salmonella Heidelberg got us wondering, “Are we doing enough to keep the public safe? Are we too slow? And, How can we improve?”

That’s not to say there weren’t triumphs in this outbreak, but like most responses we had a moment of self-reflection when the crisis was over and we were able to take a step back and consider our methods. What we found was a need for stronger policies and faster messaging to the public.

The Outbreak

Between June 2012 and January 2013 epidemiologists with Oregon Public Health, along with the Washington State Department of Health, CDC, and the US Department of Agriculture independent of each other, began noting increases in the number of Salmonella infections. Thanks to surveillance systems like CDC’s Pulsenet and National Retail Monitoring System (NARMS), epidemiologists were able to narrow down the specific genetic make-up of the Salmonella in question (Salmonella Heidelberg) and link it to raw or undercooked Foster Farms brand chicken.

The Pros and Cons

For decision-making and public information, we did several things right. Including:

1. Communicating with the company responsible for the tainted chicken, which helped provide critical information needed to confirm the source.
2. Developing simple messages that explained the outbreak and how individuals could prevent Salmonella were developed. These messages followed the Crisis & Emergency Risk Communication  framework, which encourages the use of transparent messaging that provides the public with meaningful actions to protect themselves from harm.
3. Growing a strong partnership between our epidemiologists, leadership, and risk communication officer over the course of the investigation provided a basis for mutual trust and respect. This rapport led to faster message development.
4.  Finally, by following Incident Command System principles we were able to better coordinate communication activities across the several agencies involved.

Although we were successful in getting the message out, there were several factors that we felt slowed this outbreak response down:

1. Despite having several state and federal agencies collecting clues, we weren’t doing it together, which meant more time was spent on the backend to get everyone on the same page.
2. Not all staff had been trained on the laws and policies related to release of information, which was needed for rapid decision-making during the outbreak.
3. Oregon Public Health (as we suspect is the case with many state health departments) has no risk communication policy, which meant not everyone was on the same page about how and when we would share information and release information to our partners and the public.
4. Political happenings unrelated to the outbreak ended up blocking the release of important health messages by two days—another all too common experience for many risk communicators.

How Can We Improve?

Given these pros and cons, we still think much can be done to improve decision-making and risk communication during an outbreak. The federal Food Safety and Modernization Act of 2010 was an important step toward improving the safety of our nation’s food supply.  However, our experience responding to Salmonella Heidelberg outbreak in Oregon also suggests that additional state and federal policies are needed not only to prevent outbreaks, but also to help public health authorities implement best practices in risk communications and public health responses when outbreaks do occur.

No state health department funded with federal dollars—CDC or otherwise—should be without a well-developed risk communications plan that can be operationalized at a moment’s notice. Similarly, states should be held accountable to ensure information about emerging outbreaks is shared between epidemiologists, other partners, and response staff, and to identify the triggers for public warning and messaging about health risks. Depending on the risk, even a one day delay in response could mean more sick people, and in turn more health care and social costs.

We do know from our own experience that state and local public health agencies sometimes face unique challenges in balancing the need to be right and credible with the public’s need to know about potential health threats. In many states, there are laws that—very appropriately–prevent public health agencies from releasing certain types of identifiable or highly sensitive information. However, there are almost no laws that ensure public health officials with information about a health risk be allowed or even required to warn the public, free from interference by political forces or threats of litigation by the food industry.

Policies that encourage health departments to share what they know, possibly by providing immunity from lawsuits when warning the public about risky food products, are needed. Policies that ensure that all parties work together as early as possible in a suspected outbreak are needed, along with policies that ensure that health care technologies can capture and send essential data from the health care setting to public health officials.

Our Responsibility

The public health system is under more pressure than ever to be relevant, timely, and right. While important progress has been made over the past decade, identifying outbreaks, analyzing them, and disseminating information to the public requires the expertise of highly trained professionals with the tools and policies that enable them to do their jobs.

Health officials too must sometimes strike the difficult balance between the political realities of our work and the public’s health and safety. As Dr. Martin Luther King, Jr. said “[T]here comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must do it because Conscience tells him it is right.” As public health professionals, we have a responsibility to our colleagues, constituents, friends, families and ourselves to improve the quality and performance of our public health systems and services.

More Information

For more on this topic check out the Pew Charitable Trust report, “Too Slow” analyzing the detection and response to a 2011 outbreak linked to ground turkey.

Disclaimer: This blog post does not represent the official views of the Oregon Public Health Division or the Oregon Health Authority

Thanks to contributing authors:

Jean O’Connor, JD, DrPH, Former Oregon State Public Health Deputy Director (July 2011-April 2013) and Adjunct Associate Professor of Health Policy at Emory University.

Kathleen Vidoloff, PhD, Emergency Risk Communication Officer, Oregon Public Health Division and Adjunct Professor University of Oregon.