Remarks of Tommy G. Thompson
Secretary of Health and Human Services
to the joint meeting of
the Association of State and Territorial Health Officials (ASTHO)
and the National Association of County and City Health Officials (NACCHO)
Phoenix

Thank you, Mary, for that kind introduction. (Mary Selecki, President of ASTHO)

I would also like to thank Patrick Lenihan (President of NACCHO), George Hardy (Executive Director of ASTHO), and Patrick Libby (Executive Director of NACCHO)

You are lucky to have Julie Gerberding and Betty Duke on your program.

It's been exactly a year since our last meeting. I think it's important for me to meet with you because I support what you're doing and I'm committed to helping you. I know the challenges you face because I work with you on them. After working in state government for more than 30 years, I'll never forget the budget pressures that state and local governments face every year.

So much about our lives and our jobs changed after the terrorist attacks in New York, Virginia, and Pennsylvania two years ago today. I lost my colleague Paul Ambrose in the attacks, and I join many of you in remembering the victims of that terrible day. We know that we can't afford to be off guard. We must achieve not just preparedness, but readiness. We must be ready not just to respond to a crisis, but to recover.

And we're showing that we can. In the two years since 911, you've had many challenges thrown at you. Anthrax. SARS. Smallpox vaccines. Influenza. West Nile virus. Monkeypox. Each challenge made its share of news. At the same time AIDS, obesity, diabetes, aging, water quality, and many other health and quality of life issues demanded your attention as well. I've watched you respond to challenges large and small, famous and everyday, and I want to tell you, you're doing a great job.

Even though many people forget about you when times are good, they lead safer lives every day because you always remember them.

We are starting to get used to the idea that we always need to be alert. That's our job. We must always be poised to react, so ordinary Americans can lead their lives in peace and security.

My goal as Secretary is to do everything I can ensure that Americans stay strong, healthy, and independent. And I rely on you, my equal partners, to tell me what you need to do your jobs, and realize this goal together.

The partnerships we have formed among our respective agencies will allow us to cooperate with confidence as we continue building our preparedness. We know that working together we can respond to any crisis we confront. You're on the front lines, and I will back you up-before, during, and after every crisis you face.

Last year, HHS provided a total of $1.1 billion to the states, territories and three major metropolitan areas for these preparedness activities. About three quarters of those FY2002 funds went directly to local governments and hospitals, or to benefit local and hospital infrastructure and support systems. State governments are still drawing down on these funds as they ramp up their preparedness activities. So far, states have drawn around $600 million of last year's total.

And last fall, we got more help when the President signed the Public Health Security and Bioterrorism bill, which was drafted by my department. This bill led to a 45 percent increase in bioterror spending over the last fiscal year - the biggest one-time investment in bioterrorism preparedness ever.

We have given states almost half a billion dollars ($498mm) for hospital readiness, and they are spending the money on surge capacity, quarantine and decontamination needs, hospital lab capacity, personal protective equipment, and personnel training.

What you and I are building with all of this money is a stronger and tougher public health system. And through CDC we are defining critical levels of emergency public health readiness and developing performance indicators to go with them. These indicators will give us a much clearer understanding of national public health readiness.

We want to control infectious diseases from every source, terrorists and nature. We have worked very hard to develop vaccines and provide them, as well as antibiotics and preventive measures, to the people who need them most.

And our successes have been striking. Earlier this year, our crack researchers at CDC discovered that SARS is caused by a coronavirus we had never seen before. We stayed ahead of SARS in the United States, and it never got out of control here. I'm proud of what we did, but we all know that if SARS comes back this fall, it will be a real challenge to contain it again.

President Bush proposed Project Bioshield to encourage the delivery of effective next-generation countermeasures. We estimate that $5.6 billion over ten years would be available for the biomedical countermeasures in Bioshield.

As you know, we have more to do on smallpox. We've made progress, but we need to make more progress to be completely ready. And we will.

The Strategic National Stockpile now includes a dozen 50-ton push packs. Each push pack contains a variety of drugs and medical equipment, and can be delivered to any domestic location in 12 hours.

Last week I released almost $1.4 billion in grants to states, territories, and three metropolitan areas. These grants will help strengthen your capacity to respond to terrorism and other public health emergencies. These grants will upgrade infectious disease surveillance and investigation. They will enhance surge capacity in hospitals. They will expand public health laboratory and communications capacities. And they will improve connectivity between hospitals and health departments to enhance disease reporting. Public health systems, hospitals, and other health care providers keep us safe and healthy, and this money will allow the states to keep improving them.

The federal investment in bioterrorism readiness is up 15 times from just two years ago. That is a measure of our seriousness. And we've asked for $5.6 billion for 2004.

A great part of that funding goes either directly or indirectly to state, regional, and local assets. These compose the "nerve system" that can detect a biological attack-and the "reserve system" that can immediately bring national resources to any community when they may be overwhelmed.

All states have established systems to detect a terrorist event rapidly through mandatory reportable disease surveillance systems. All 50 states have bioterrorism preparedness plans, including plans for mass vaccination in case of attack. All states are prepared to launch epidemiological field examinations within six hours of receiving an urgent disease report -- on a 24/7 basis.

All states have developed cooperative plans with their hospitals for dealing with mass casualty events. And each of those plans addresses communications needs between hospitals and emergency responders.

This kind of planning is as crucial as it is complex -- and it is a new feature of our national capacity in the last two years.

We have expanded our public health laboratory capacity: our national Laboratory Response Network spans all 50 states and will soon include 235 labs.

Our grants to states have helped finance 3,850 new public health staff positions at the state and local levels. And CDC is making more of its own staff available to assist states.

Our communications systems have improved. CDC's Health Alert Network can reach a million recipients quickly. Our EPI-X system used to reach 200 of you; it now connects nearly 2000 of you. Our Public Health Information Network (PHIN) covers 90% of counties, up from 68% a few years ago.

Our National Disaster Medical System has grown by a third in two years. And our Public Health Service Commissioned Corps Readiness Force has quadrupled. We are also building a new system of qualified volunteers with health expertise.

In the area of food safety and security, we have made the most fundamental enhancements to FDA's activities in many years. We added 635 staff to address food safety, especially for food imports. Today, we are in twice as many ports of entry, conducting four times as many food inspections. FDA will also establish a new registry of some 425,000 food shipping facilities. And we will receive prior notice of all food import shipments -- about 20,000 a day-- even as food imports continue to escalate rapidly.

In the area of research, NIH is undertaking the largest single increase in support for any single initiative in its history -- with more that $700 million in new research facilities, as well.

At HHS overall, we have 1,700 staff currently dedicated to bioterrorism activities, up from 212 in 2001. And we have a new Assistant Secretary for Public Health Emergency Preparedness to help coordinate this comprehensive effort.

Bioterrorism presents unprecedented challenges. We are responding, together, with unprecedented resources and resolve.

Of course, terrorism gets the headlines, but I know that each of you works and worries every day about the health and well-being of the people in your charge. As you know and as you remind everyone who will listen, the fastest growing cause of illness and death in America today is obesity. The good news is that obesity is preventable-preventable by applying the best of public health practice. Eating right helps. And so does exercise.

That's why, everywhere I go, I tell people to exercise. And eat right. And quit smoking. And get the right screenings. And avoid risky behavior. We've launched an initiative, called HealthierUS, to spread the word. But I'd like to enlist all of you as well. I'd like to challenge every one of you to examine your policies and your communications and make sure they are consistent with healthy habits.

Conclusion

Of course, our public health and our readiness are only as good as our people. We all need to work together to recruit and retain good people in the public health field. Overall, we spend about $140 million directly to train and recruit public health officials. This includes $60 million for bioterrorism and another $80 million for public health matters. In addition to that money, we make other grants for training and recruiting, including a portion of our $870 million cooperative agreement on BT preparedness.

For example, to give bioterror training to 38,000 health care professionals in the first two years, HRSA is spending $28 million this year, and, as I mentioned, we've asked for $60 million for next year. And last year, our CDC provided training for more than 1.5 million health professionals, in addition to specific training for 8800 clinical lab workers.

But training is only part of the picture. A bigger problem is the size of the workforce in public health. We need to attract and retain more people in medicine and more people in public health. As you know, in many fields at CDC, NIH, and FDA, about half of our workforce will be eligible to retire in the next five years.

I know that your labs and public health offices face similar shortages. And all of us need to be very clear about what kind of people we will need over the next 5 and 10 and 15 years, and very clear about how we plan to get them and keep them. We need to understand why people choose medicine as a career, and why they go into public health. If the right candidates don't understand the appeal of public health, we need to tell them. If the appeal isn't there, we need to change that. I want to work with your outstanding organizations, ASTHO and NACCHO, on creative ways we can increase the quantity and quality of our workforce.

We need to step back and have a comprehensive and wide-ranging discussion. We need to ask questions like:

1. What are the health and quality of life issues facing the people of every state over the next few decades?
2. Which challenges or parts of challenges are best handled by public health offices instead of the free market?
3. How many people, and what kinds of people with what kinds of training will we need to address those challenges?

I hope all of you will talk with the hospitals and medical societies in your states and ask these questions. And I want to hear your goals, your concerns, and your questions, and I'm going to put a team together to listen to you and to work with you on solving them.

Our work is exciting. Our work is challenging. Our work improves the security and the quality of life in America. And the people who work with us in public health enjoy it. I want all of you to help me spread the word.

Last Revised: September 15, 2003

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