Crisis vs. chronic: Paying the price of public health

After the 2001 terrorist attacks, the long-neglected public health system was promised additional resources to fulfill its new role as first responder to emergency situations as well as traditional responsibilities. How it's panned out has left some physicians disappointed.

By Victoria Stagg Elliott, AMNews staff. May 2, 2005.

When Wisconsin had a large pertussis outbreak last summer, Jonathan Temte, MD, PhD, a family physician in Madison, treated cases while public health workers struggled to trace contacts and reduce further spread.

"The state was swamped," said Dr. Temte, associate professor of family medicine at the University of Wisconsin Medical School -- describing how quickly the infrastructure can become taxed. "I would have loved to see sufficient funding to fully fund a public health system by a factor of 100%."

Just a few years ago, this idea seemed more a promise than a dream.

After the terrorist attacks of Sept. 11, 2001, and the anthrax scare that followed, it seemed that the nation's public health system, shabby from decades of neglect, finally might get its due. These two incidents did what numerous reports from esteemed institutions -- including the Institute of Medicine and the Centers for Disease Control and Prevention, as well as frequent declarations of need from the American Medical Association -- could not.

In a sense, public health had found not only the limelight but also a seeming pot of gold. Millions since have flowed from the federal government to state and local health departments.

"We're putting money in the hands of states and local communities so they can start building strong public health systems for responding to a bioterrorism attack," said then-Health and Human Services Secretary Tommy Thompson in a statement issued Jan. 31, 2002, that announced $1.1 billion in funding for bioterrorism preparedness.