Focus on bioterror shelves other federal health efforts

Before the terror attacks on Sept. 11, 2001, and the anthrax contamination scare a month later, public health advocates were clamoring for attention on Capitol Hill for a full plate of issues-ranging from more nutritious school lunches to lowering diabetes rates.

Since then, domestic public health initiatives have skyrocketed to prominence-but efforts have focused almost exclusively on bioterrorism preparedness, a trend that critics fear has forced traditional public health concerns into the legislative backseat.

"Bioterrorism is a serious issue, and we support all the funding the administration has provided for it," said Don Hoppert, director of federal and congressional affairs for the American Public Health Association. "At the same time, we don't want that to eclipse everything else."

This year, increases in general public health funding have been scant. Funding for the Centers for Disease Control is slated to be nearly $4.6 billion for fiscal 2004, up slightly from about $4.3 billion in 2003. But the overall increases are largely targeted to bioterror readiness, and accompany cuts to other key areas. For example, public health workforce development funding under the Health Resources and Services Administration is down by $1.3 million in 2004 legislation.

And public health legislative policy initiatives primarily have been security-related-including a bill to compensate those who become ill from side effects of vaccines protecting health care workers against smallpox, which many fear could be used as a biological weapon in a terrorist attack.

Lawmakers are now considering legislation enacting President Bush's "Project Bioshield" designed to encourage commercial development of countermeasures to biological or chemical weapons.

Some observers argue that strengthening the public health infrastructure in preparation for a possible biological attack means the system will be better able to handle other emerging diseases and outbreaks that are part of the regular public health mission.

The outbreak of SARS, or severe acute respiratory syndrome, was a "test case" for an attack, CDC officials told lawmakers during recent hearings focused on the illness. Federal dollars doled out to states for bioterrorism preparedness have helped pay for infrastructure like hospital equipment and better communication systems.

That may be so, Hoppert said. But he contended that the day-to-day work of the CDC-encompassing initiatives aimed at a gamut of common killers such as heart disease and strokes-also needs more of a focus.

"Our goal should be one health system that can handle anything, whether it's SARS or a biological attack," Hoppert said. "We need to be looking at the diseases that are actually killing Americans today."

One non-security related bright spot in the public health landscape is legislation expected soon from Senate Majority Leader Bill Frist, R-Tenn., and Sen. Edward Kennedy, D-Mass., addressing disparities in health care among minority populations.

Blacks, Hispanics and other minority groups have disproportionately higher rates of many diseases, including heart disease, breast cancer and HIV/AIDs. Statistics also show minorities are more likely to die as a result of such diseases.

Work on targeting the disparities among those populations began before the terrorist attacks and subsequent focus on security measures took center stage-with Frist and Kennedy co-authoring legislation in 2000 beginning to study and provide education on minority health problems.

Now both senators are again considering legislation on the issue, although it is unclear whether they will again collaborate on a bill.

Frist vowed in June to introduce legislation improving access to health care for minorities and increasing diversity among health care workers. A Frist spokesman said the bill likely would debut sometime after the August recess.

Members of the Congressional Black Caucus have been providing suggestions on potential legislation, a CBC spokesman said, and one CBC member, Del. Donna Christian-Christensen, D-V.I., may introduce companion legislation in the House.