Act of 2002 established a system of federal grants to state and local health departments to upgrade their readiness and response capabilities for bioterrorism and other public health emergencies.1 From FY 2001 to FY 2012, an estimated $8.95 billion has been awarded to support state and local public health preparedness activities (Franco and Sell, 2012). This infusion of funds has drastically improved the country’s ability to handle extreme health events (Nuzzo, 2009; CDC, 2011a,b; Trust for America’s Health, 2011). All state health departments, for instance, have staff on call all day and every day to evaluate urgent disease reports (Nuzzo, 2009). In 1999, only 12 states had this capability. All 50 states and the District of Columbia now have staff trained in their roles and responsibilities during an emergency (Nuzzo, 2009). Again, in 1999, only 12 states had this capability.

State and local health departments continue to work hard at enhancing the full range of preparedness capabilities including biosurveillance, medical countermeasure dispensing, emergency operations coordination, emergency public information and warning, and medical surge management (CDC, 2011c). Measurable advances in public health preparedness over the last decade, however, are now in jeopardy because of declines in federal, state, and local government budgets, cuts in the public health workforce, and an evolving list of public health threats (Nuzzo, 2009; CDC, 2011a,b,c; Trust for America’s Health, 2011). Projected pressures on public health by 2020 include an increase in the U.S. population from 308 million to 336 million, the demands of more diversified age groups (e.g., a 54 percent increase of citizens over 65) on an already overburdened health care system, and mass migrations due to extreme weather events (CDC, 2011a).

Community health networks are another example of linking private and public infrastructure interests at the local level to foster resilience. Over the past decade, health care coalitions have emerged as an adaptive mechanism to overcome differences between the individualized nature of health care delivery and the large-scale, population-based demands for care in a public health emergency (Courtney et al., 2009). As institutionalized entities, healthcare coalitions are more frequent now across the United States since the establishment in 2002 of the Hospital Preparedness Program (HPP, though variously named over the years), a federal grant initiative mandated by Congress to upgrade local healthcare readiness for biological attacks and other public health emergencies (HRSA, 2002). Though initially focused on enhancing the preparedness of individual hospitals for biological incidents, the program has evolved and expanded to encourage greater all-hazards coordination among healthcare facilities in the same community or region (Courtney et al., 2009).


1 Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Pub. L. No. 107-188, 107th Cong., June 12, 2002. Available at Accessed June 17, 2012.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement