Boosting health and the economy

Public health advocates are praising the $1 billion for disease prevention and wellness programs included in President Obama's economic stimulus package but say that it is only a fraction of the billions needed to keep the country  healthy.

The United States spent about $35 billion a year on disease prevention in 2008, or about $17 per person, according to Jeffrey Levi, executive director of Trust for America's Health, a Washington-based advocacy group. That compares with $2.4 trillion spent on treatment.

According to the ounce-of-prevention argument, spending on the former would help whittle down the latter.

Public health spending covers a wide variety of programs, including inspecting restaurants, tracking tuberculosis cases, providing vaccines, preparing for disasters and promoting exercise and nutrition.  Such services are intended to counter, among other things, food poisoning outbreaks, the spread of infectious diseases and the surge in chronic conditions such as obesity and diabetes.

But faced with a financial crisis, local and state governments are cutting public health spending. More than 11,000 public health jobs were eliminated in 2008, Robert M. Pestronk, executive director of the National Assn. of County and City Health Officials, said during a teleconference this morning. That, he said, is the equivalent of two states completely shutting down their public health departments.

The teleconference was called to publicize the release of a report called "Shortchanging America's Health: A State-By-State Look at How Federal Public Health Dollars Are Spent," produced by Trust for America's Health and the Robert Wood Johnson Foundation.

"It's essential that as the country considers ways to reform its health system, we not only think about providing quality healthcare to everyone but that a strong public health program has to be the cornerstone," Pestronk said.

-- Mary Engel

More worried than ready for disaster

Disaster preparedness officials, it seems, have their work cut out for them. Only 34% of people affected by Hurricane Katrina in 2005 said they were very prepared for another major hurricane, according to a survey by the Harvard School of Public Health.

When Hurricane Gustav was still just a thunderstorm ambling over warm, equatorial waters, researchers from the Harvard School of Public Health surveyed people affected by Hurricane Katrina or other hurricanes within the last five years. They asked 5,055 people who lived 20 miles from the coast in eight states -- Alabama, Florida, Georgia, Louisiana (including a sample from New Orleans), Mississippi, North Carolina, South Carolina and Texas. They compared responses from people who had been directly affected by Hurricane Katrina with those who had not been directly affected. Only 34% of all those interviewed said they were very prepared for a major hurricane, whether they had been directly affected or not.

But even if two-thirds of the respondents weren't ready, many were worried. Those not affected by Katrina were most worried about having enough gasoline in their cars to evacuate. Those who were in Katrina's path were worried about gasoline availability but were even more worried about having enough fresh water and medical care if disaster struck.

Some 17% of people living in mobile homes, at high risk of destruction in hurricanes and tornadoes, said they would not evacuate if officials told them to. Another 17% of mobile-home residents in hurricane country said they were not prepared at all for a major hurricane.

"The top concerns of people in high-risk hurricane areas -- having enough fresh water, getting medical care, and obtaining gas to evacuate -- are all things that public officials can plan for before the major storms of this season hit," Robert J. Blendon, professor of health policy and political analysis at the Harvard School of Public Health, said in a news release.

Given the orderly evacuation of nearly 2 million people from the Gulf Coast for Gustav compared with Katrina, it seems public officials, at least, have taken lessons from the school of experience. But there is still a significant number of unprepared individuals.

-- Susan Brink

Photo: NOAA satellite image of Hurricane Hanna over Nassau. Credit: HO / AFP / Getty Images