As states brace for possible outbreaks of the mosquito-borne Zika virus, Louisiana is the state least prepared to respond adequately to a public health emergency, according to the 2016 National Health Security Preparedness Index (NHSPI).
The index, published in April by the Robert Wood Johnson Foundation, awarded a “confidence level” based on six preparedness factors. Overall, the states scored highest in “Incident & Information Management,” “Health Security & Surveillance,” and “Countermeasure Management,” which is the readiness and effectiveness of a state’s programs and systems for weathering chemical, biological, nuclear, and explosive threats, according to the index.
The index also scored states’ “Environmental & Occupational Health,” “Community Planning & Engagement,” and “Healthcare Delivery.”
The average state confidence level, comprising all six categories, was 6.7 out of 10 possible points.
Louisiana scored below average in all six categories, earning an average confidence level of 5.6.
Prevalence of Natural Disasters
Maureen Lichtveld, a professor at Tulane University’s School of Public Health and Tropical Medicine, says Louisiana’s score should be viewed in the context of the state’s above-average exposure to natural disasters.
“The index, while helpful, doesn’t take into account Louisiana’s special situation,” Lichtveld told The Times-Picayune (New Orleans). “We’re a disaster-prone area with a history of persistent environmental and health threats. And no other state has dealt with what we’ve had to deal with in the aftermath of Hurricane Katrina.”
‘Plenty of Experience’
Louisiana’s experience in responding to public health crises is an asset, says Scott Whelchel, senior emergency services and security manager at the Dow Chemical Company and president of the Louisiana Emergency Preparedness Association.
“There is a high level of coordination, training, and planning that goes into protecting Louisiana citizens,” Whelchel said. “The State of Louisiana has plenty of experience in emergency events.”
Whelchel questioned the ability of the index’s six categories to capture Louisiana’s preparedness.
“We need to have more data on these metrics,” Whelchel said. “Do these metrics measure all aspects of a public health emergency?”
Lowest Score: Current Care Delivery
NHSPI gave Louisiana a confidence level of 3.1 out of 10 for “Healthcare Delivery,” the state’s lowest category score, which the index characterizes as the state’s capacity to provide health care under normal conditions.
“The delivery of healthcare services under crisis conditions in a disaster will likely be related to the ability to deliver such services under conventional conditions,” the index states. “The Healthcare Task Force felt it important to link national health security preparedness to the ability to provide care on a day-to-day basis.”
Neighboring Arkansas and Mississippi also were given below-average aggregate confidence scores, as were nearby Alabama, Georgia, and Oklahoma. Like Louisiana, these states scored either below average or average for “Healthcare Delivery.”
By comparison, California also scored lowest in the Healthcare Delivery category (3.9), although the state scored above average in three categories, leveling out to a confidence level of 6.8, slightly above the national average.
ACA Complicating Care Delivery
James Pagano, an emergency room doctor in Los Angeles, California and a member of the nonprofit health care advocacy organization Doc Squads, says medical emergency personnel are hard-pressed to treat increased emergency room (ER) patient loads, in part due to unintended consequences of the Affordable Care Act (ACA).
“ER volumes in Los Angeles are up anywhere from 10 to 20 percent, due mainly to the ACA, especially those patients insured under the expansion of Medicaid,” Pagano said. “They often cannot figure out who their primary care doctor is, and when they do know, they are unable to get appointments in a timely manner. Also, ER visits are free of charge for this patient group. As a result, we are doing much more primary care in the ER than we were previously.”
ACA has caused Los Angeles to become less equipped to respond to a mass public health crisis, Pagano says.
“As for emergency preparedness, it was always something of a myth in [Los Angeles], where there was little surge capacity before the ACA,” Pagano said. “Now, with the added patient volume, that capacity has become even less. We do our mandated disaster drills, but in the event of the real thing—massive earthquake, serious terror incident—it won’t be pretty.”
Michael McGrady ([email protected]) writes from Colorado Springs, Colorado.
2016 National Health Security Preparedness Index, Robert Wood Johnson Foundation, April 25, 2016: http://nhspi.org/
Ben Johnson, “Louisiana Lawmakers Fail in Effort to Contain Medicaid Expansion Costs,” Health Care News, The Heartland Institute, August 2016: https://heartland.org/news-opinion/news/louisiana-lawmakers-fail-in-effort-to-contain-medicaid-expansion-costs
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