partner profile of the Affordable Care Act — that provides about 12 % of CDC ’ s annual budget and a good portion of the funding for CDC ’ s Epidemiology and Laboratory Capacity grants to states . We ’ re a vocal public health advocate and strive to make sure policymakers , the media and the public understand how crucial public health is to saving lives .
With a new federal administration in place , what do you foresee for public health over the next four years ? And what are TFAH ’ s priorities
during this time ?
We will continue to see many proposals from the new administration that will impact health . As I ’ ve mentioned , some of those relate to legislation , such as healthcare reform . But we ’ ll also be paying attention to the budget deliberations , as well as administrative decisions and regulations that can impact health . Because health is affected by many services outside the healthcare arena , we also pay close attention to policies such as housing , food security , clean air and clean water .
Another TFAH priority is modernizing the public health system and optimizing federal funding for that system . Over the past several years , a public health model has been put forth that describes the modern public health agency as “ chief health strategist .” That role requires a health department to have the most up-to-date information about the demographics and health concerns of the communities it serves , the evidence-based interventions that can be applied to address those concerns , and real-time , granular data to guide that work , along with all relevant partners from both health and non-health sectors . In general , disease prevention is about moving upstream to create conditions in peoples ’ lives that foster health and wellbeing , rather than focusing on treating health problems after they arise . We need to make the healthier behavior the easier choice . Some specific issues we ’ re focusing on at the moment are obesity , emergency preparedness and behavioral health .
You have had opportunity to interface with US public health laboratories in a few of your previous positions . What were some notable
I was public health commissioner in Boston during the 9 / 11 tragedy , and among my responsibilities was overseeing the city ’ s emergency medical services . For a period of time after 9 / 11 , there was great fear about the possibility of bioterrorism and anthrax exposure to the public . In a single month , we received over 1,000 calls from the general public related to white powders that might be anthrax . If we got a call like that , the EMTs and paramedics had to treat it very seriously . And we brought every single sample to the state public health laboratory . Despite the high volume , the public health laboratory was extraordinarily professional , effective and cooperative in working with the city and assuring the public was safe .
Later , as a state health commissioner , my department oversaw the Massachusetts state public health laboratory during the 2009 H1N1 influenza pandemic when , again , there was great fear among the public and laboratory tests were needed to assess exposure . There was a lot of pressure and a lot of urgency to turn those tests around quickly and to provide accurate information . The laboratory staff did an extraordinary job under difficult circumstances .
At the federal level , one of my CDC jobs was overseeing the office of State , Tribal , Local and Territorial Support . We spoke often with the health officials involved in Zika testing at regional or state laboratories . As with H1N1 , Zika was a new test for the labs ; they had a lot of pressure to develop expertise quickly , and they did a phenomenal job for public health .
As a non-laboratorian , what is your perspective on ( a ) what public health laboratories are doing well in their interactions with other public health leaders , and ( b ) what they could do better to increase their visibility and resources ?
I think they ’ re doing a terrific job interacting with public health leaders . A key need for health officials is accurate and up-to-date test data — no easy feat . It requires continually training people , getting the latest equipment and producing state-of-the art work . My experiences at CDC around new technologies — such as whole genome sequencing to investigate foodborne disease outbreaks — reinforced for me how central it is to have confidence in test data .
With regard to the second question , this is a problem because laboratories are often not visible to the public unless there ’ s a crisis , and that can lead to underfunding and a lack of appreciation for the effort required to maintain preparedness . I think public health laboratories are doing their best to make their case from the commissioner level to the grassroots level . Yet , I think we can do better . We need to highlight the importance of laboratories across all the disciplines of public health and make more effective use of communication tools , including social media .
What can APHL and its member laboratories do to enhance their partnership with TFAH ?
I think we have a strong partnership already . We work well together . Perhaps we can pay more attention to proposed policies that may affect the laboratory and make sure we ’ re unified in sending the right message to policymakers . TFAH ’ s most recent preparedness report , released in December , assesses whether states have met ten key preparedness indicators . Two of the ten come from APHL ’ s annual member survey , namely , providing biosafety training or information about training to sentinel clinical labs and having a biosafety professional on the staff of the state public health laboratory . Fortyfour states met the first goal , and 47 the second . This is a way for TFAH to contribute to the pressure on states to meet these goals .
The feature article in this issue of Lab Matters is devoted to cannabis . What is TFAH ’ s view of cannabis legalization ?
TFAH doesn ’ t have a formal position on that . We do think it ’ s important to pay attention to the experiences of states that have legalized cannabis . And clearly the labs have a role to make sure legal cannabis products are safe for consumers . TFAH will have a formal position once there is more data on the public health impacts of legalization .
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Spring 2017 LAB MATTERS 13