Public Health Systems and Emerging Infections Assessing the Capabilities of the Public and Private Sectors: Workshop Summary (2000) / Chapter Skim
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Summary and Assessment
Summary and Assessment
Pages 1-23
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From page 1... ...
That outbreaks and epidemics of infectious diseases have been successfully prevented or controlled leads to the common misconception that the public health system is more than sufficient. Such misconceptions, however, belie the true risks to public health, and reinforce the public's expectations in the face of increasingly complex emerging infections and the changing health care environment.
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A renewed commitment to a national approach to infectious disease surveillance is needed both to support new requests for funding and to sustain the full range of activities related to infectious diseases that confront public health today. To help inform the debate about the capability of the public health system to respond to and control emerging infections, the Forum on Emerging Infections convened a workshop—the subject of this workshop summary to identify, clarify, and solidify some of the current and potential best practices in the public health arena to combat the threat of emerging infectious diseases.
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, are available to assist in infectious disease investigations, but they can do so only if state and local public health agencies have the infrastructures in place to detect and report unusual disease occurrences. Investigators at the federal level, largely through CDC, have better investigational tools, such as computerized databases, computational technology, and electronic mail, which has allowed individuals and federal agencies to recognize and report incidents that might not otherwise have been detected.
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has been created to facilitate a prompt, effective, and coordinated response to food emergencies by the many USDA agencies. State health departments are often at the front line of outbreak investigations and receive news about an illness from many sources, such as the medical care system, the public, the disease surveillance systems of other public health institutions, or the news media.
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Long before the causative agents of infectious diseases were known, the observations of medical practitioners served to alert the community to unusual medical occurrences. Even after the etiologies of infectious diseases were unraveled and laboratory tests made available, clinicians still played an essential role in providing patients for study and assisting in some epidemiological investigations.
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Accordingly, there is a need to integrate existing public health surveillance systems. For example, 50 to 60 different infectious disease surveillance systems exist nationwide.
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Moreover, these tests can be costly because of the equipment, specialized reagents, and skilled technical staff that are required. Yet these tests are a critical weapon in the public health armamentarium as a means of combating emerging infectious disease outbreaks because modern epidemiological investigations rely on the modern laboratory tools of molecular biology for outbreak investigations.
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Continuing education and training programs developed from an advocacy group perspective and targeted to the promotion of public health surveillance within states may generate the intellectual and financial commitments needed to strengthen the public health infrastructure. In this case, opportunities exist for the private sector to participate in the direct support of the infection control infrastructure.
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The U.S. Congress is generally supportive of public health activities that involve emerging infectious diseases.
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Congress, state legislators, and managed care organizations must be educated about the needs of the public health system, particularly the public health infrastructure and its role in combating emerging infections. Emerging infectious diseases are but one concern of the public health system.
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Variations in the capabilities of public health departments to detect and respond to disease outbreaks point to the need for public health departments at all levels to define their core capacities for epidemiological investigations, particularly as those capabilities relate to the activities of the public health laboratory. For example, surge capacity in response to an outbreak is one area in which the public health laboratory can begin to define its core capability and standards.
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The need to integrate national, state, and local public health systems, including those from the private sector, is one of the most daunting challenges confronting epidemiological investigations and laboratory surveillance. An unexpected disease outbreak or act of bioterrorism, the role that microbes play in chronic diseases, and the blurring of the traditional distinction between infectious diseases in hospital and community settings stress an already fragmented public health system.
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Specific considerations promoting the integration of public health systems toward the development of a nationwide infectious diseases surveillance system are discussed, as follows: . Increase the use of novel surveillance systems and modeling techniques to help predict, detect, or monitor disease trends, environmental and climatic conditions, or genetic shifts that suggest disease outbreaks and facilitate epidemiological investigations.
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On the technical side of communications, public health systems need to be fully integrated with modern computer information systems. Internet-based communications systems have the promise of linking local and state health departments, hospitals, managed care organizations, and federal agencies respon
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Further consideration must be given to the validity of the information shared. Rapid linkage of public health departments and laboratories with other health care providers, managed care organizations, and national centers is only as valuable as the quality of the data collected and the capacities of the epidemiological and laboratory surveillance systems.
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Each public health laboratory resides in a fairly unique health care and public health system, and each operates a fairly unique information system. Problems of further fragmentation of a system of laboratory networks are evident as laboratories whether they are local, commercial, or public conduct increasingly smaller numbers of routine tests for the diagnosis of infectious diseases.
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Multidisciplinary approaches are needed to educate medical and public health professionals on the pathobiology of infectious diseases. Additionally, there is a lack of public health professionals trained in epidemiology, which undermines the capabilities of public health.
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Cost-containment factors, increased patient loads, and new demands in the outpatient setting are placing increased pressures on providers' time and expertise. The resulting trend of the greater use of empiric treatment, which helps to alleviate some of those pressures, may actually be decreasing the level of reporting of information on infectious diseases.
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Although commercial interests have unique capabilities to conduct the type of testing required by the public sector, they do not have the incentives or resources. On the other hand, detailed epidemiological follow-up studies are most suitable for the public health sector.
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Managed care plans have integrated databases that could be used by public health systems to track infectious diseases among the plans' populations. Likewise, there is a potential for seamless communication between public and commercial laboratories, managed care organizations, and public health officials.
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Issues related to emerging infectious diseases, including bioterrorism, food safety, antimicrobial resistance, and vaccination programs, could be used to promote the need to build the fundamental capacity for integrated infectious disease surveillance as an important first line of action in detecting and responding to infectious diseases. This is an opportunity for the public health community to create partnerships with patient advocacy groups.
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CONCLUDING REMARKS The changing face of health care poses new challenges for the detection, treatment, and prevention of infectious diseases. Historically, public health departments, hospitals, and clinics have been the main sources for the detection and treatment of infectious disease outbreak.
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It is also critical for health departments to have electronic linkages with other health care providers in their communities and with national centers such as CDC, as well as to explore the issue of data integration and data comparability both across systems within a health department and across the various levels of the public health systems. Public health systems also need to enhance their capability to communicate critical information, particularly information about the risk of an infectious disease outbreak.
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