Integrate physicians into biodefense through medicine-public health interface, says FP
A homeland security directive President Bush signed this spring seeks to enhance coordination of the nation's biodefense strategy by assigning responsibilities for specific duties among federal agencies. Shortly afterward, Homeland Security Secretary Tom Ridge reminded the nation's physicians of their biodefense responsibilities as "first preventers and first responders."
Ridge; HHS Secretary Tommy Thompson; and Deputy Defense Secretary Paul Wolfowitz, Ph.D., released a declassified version of the directive (available at http://www.whitehouse.gov/homeland/20040430.html) during an April 28 news briefing in Washington.
Among other items, the directive calls for the Homeland Security Department to establish a national biosurveillance group. The group would create a centralized system for collecting and evaluating information on bioterrorism threats.
Clearly, community-based physicians -- well-versed in recognizing and reporting diseases that threaten public health -- would be an integral part of such a system. "Health care providers and public health officers are among our first lines of defense," the directive acknowledged.
Ridge reinforced the message about health professionals' role in providing homeland security in an April 29 address at the annual meeting of the Federation of State Medical Boards in Arlington, Va.
"The medical community has responsibilities as first preventers and first responders -- critical elements of our nation's preparedness," said Ridge, referring to physicians' roles in the National Disaster Medical System (specially trained teams of medical professionals ready to activate during an incident) or as volunteers in the Medical Reserve Corps (retired health professionals augmenting local health officials' emergency response capacity).
Key to fully integrating community-based physicians into biodefense efforts is fostering recognition of the critical interface between medicine and public health, according to Doug Campos-Outcalt, M.D., M.P.H., clinical professor of family and community medicine at the University of Arizona, Phoenix.
A former medical director of the Maricopa County Department of Public Health, Campos-Outcalt has a special interest in bioterrorism and has served on the AAFP's Ad Hoc Terrorism Advisory Committee.
There's no question, said Campos-Outcalt: "Local doctors -- FPs and other primary care physicians -- should be a more integral part of the public health system. There's a lot that we could do better if medicine and public health were linked."
A study in the May/June Health Affairs that profiled the emergency preparedness status of a dozen communities nationwide helps drive home the need for such a link. Data gathered from visits to 12 nationally representative metropolitan areas between September 2002 and May 2003 found that progress had been made thanks to federal funds specifically slated for emergency preparedness activities, but "important challenges" remained.
"In most communities, the county health department became the lead organization for local preparedness planning and activities," the study noted. "Physician practices were reportedly less involved than other organizations in public health preparedness."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
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