WASHINGTON, Oct 20, 2004 (United Press International via COMTEX) -- A majority of public health experts surveyed for a recent biodefense report thinks state and local public health departments should stop being a provider of last resort for medical care in the United States.

The reason, over 60 percent of study participants said, is the overall size of the public health workforce is insufficient to handle the job in the face of budget deficits and increasing demands -- particularly those made by biodefense programs.

About 30 percent of public health departments provide comprehensive primary care services, according to a survey of 694 local public health agencies done by the National Association of County and City Health Officials in 2000. Such care is the rough equivalent of going to a pediatrician or the family doctor and does not generally refer to care at public hospitals. Comprehensive primary care services were most often provided by agencies in large metropolitan areas, according to the survey.

The mission of public health has changed since Sept. 11, 2001, said more than two-thirds of the experts surveyed by the Washington-based think tank ANSER for the report, "Drafted to Fight Terror: U.S. Public Health on the Front Lines of Biological Defense."

The report is based on a survey of 54 public health experts and discussions with seven focus groups held during the combined 2003 convention of two groups: the National Association of County and City Health Officials and the Association of State and Territorial Health Officials.

Nearly all those in the study -- 95 percent - said public health departments should let go of their role as a safety net. Direct delivery of primary care and personal health services should be withdrawn from the public health sector, they said.

"As it is, they don't have the money or the time to (fulfill) some of their basic needs," said Dr. Paul Biddinger, assistant director of science and technology at the Center for Public Health Preparedness in the Harvard School of Public Health. "Now they're asked to add on additional responsibilities."

The challenge is to focus on the core competencies, those front line defenses geared to preventing disease in this country, while trying to cover so many fronts, said Shelley Hearne, executive director of Trust for America's Health an advocacy organization for public health in Washington.

"It is probably appropriate that the public health agencies should focus first and foremost on what they do best," Hearne said, "tracking the health of citizens, investigating outbreaks, running the laboratory ... and leave healthcare in the hands of providers that can focus in on those jobs."

The public health system, a collection of state and locally funded offices developed piecemeal over time, was understaffed and overtaxed long before being asked to take on biodefense, the study said. Recent infusions of biodefense money often went to basics, such as upgrading phone and computer systems.

"Four years ago we had a large percentage of the health departments working on rotary phones," Hearne told United Press International. "These guys didn't have computers. They didn't have fax machines. You had emergency events occurring and they are finding out from CNN -- not the (Centers for Disease Control and Prevention)CDC."

Biodefense money may have fixed the phones but, counter to expectations, it was not enough to help address larger issues.

"Federal resources for biodefense have not necessarily resulted in a dual benefit that we had talked about earlier on," Elin Gursky, the report's author, told UPI. "The federal money that went in was not matched or enhanced necessarily by state money, because the states have been dealing with such deficits. You had federal money in, but you also had state money out. So it didn't result in 'more.'"

More is needed, experts told UPI, for personnel to watch for outbreaks of disease.

"We need things similar to the 100,000 cops on the beat; you need the equivalent of something like 10,000 epidemiologists on the hunt," Hearne said.

"There still just aren't enough people," Biddinger told UPI. "There aren't enough dollars to pay them and attract enough people into a public health field."

Part of the reason is salaries are too low, he said.

"Many, many local public health jobs are part-time and are poorly funded. Much of the funding comes from the local level. As you know cities and towns are hurting quite a bit."

In fact, state and local budgets are in their worst shape in 50 years, said Patrick Libbey, executive director of the National Association of County and City Health Officials. He was careful to note, however, that although biodefense dollars rose at the same time as other pubic health budgets were cut, the two are from separate funding sources and not directly connected.

Their connection, Hearne said, is state and local officials in some cases used bioterrorism dollars as a ruse to hide cuts being made elsewhere.

"That was a political decision that was hidden under the cover of bioterrorism dollars," Hearne said.

Now, shortages are forcing public health officials to reconsider their mission. Nearly all who took part in the survey said primary care and personal health services should not be provided by the public health system. Over 50 percent suggested public health clinics take over, while 20 percent suggested some sort of tax incentive and 25 percent thought partnerships with local healthcare providers were the answer.

"The actual delivery of the healthcare is not part of (public health's) core mission and definitely distracts both focus and dollars from the core missions of treating the health of the community," Biddinger said. If there is someone else available to provide healthcare services, he added, public health should "absolutely" let go of the role.

"The problem as always," he said, is "there isn't anyone else willing to carry the torch usually."

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E-mail ddivis@upi.com

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