1. Markenson, David MD, FAAP, EMT-P
  2. Westphal, Robert G. MD, MPH, FACP

Article Content

The US government has recognized the importance of a healthcare workforce that is competent to respond to bioterrorism and other public health emergencies. A number of congressional acts, most notably the 2002 Homeland Security Bill and the Nunn-Lugar-Domenici Amendment of 1997, specifically call for a national level of readiness that addresses the need for well-trained and well-prepared healthcare professionals. 1,2


Public health systems need the capacity to detect, respond to, control, and recover from emergencies. The continuing threat of terrorism, in general, and bioterrorism, in particular, added to disasters and public health emergencies, makes imperative the ability to act as rapidly and effectively as humanly and technically possible. Despite this reality, many in the public health workforce have insufficient training in core concepts of emergency preparedness and response. In addition, those in the broader healthcare community, including emergency medical services, may be insufficiently trained in public health emergency preparedness. Therefore, providing educational opportunities that build emergency response competencies in our public health workforce and the entire healthcare community is a priority for improving our nation's all-hazards preparedness.


Because of the important role that public health professionals and healthcare providers play with respect to early and local efforts in response to bioterrorism and other public health emergencies, it is essential that they be appropriately and adequately prepared. The target population that requires education and training to meet the programmatic goals is diverse, challenged in a multitude of ways, and very large. The healthcare workforce is the second largest workforce in the United States, second only to the US military. Currently, there are nearly 2.43 million registered nurses, 700,000 physicians, 350,000 dentists, 450,000 public health workers, and numerous students enrolled in hundreds of different professional school programs.


Educational efforts are being led by federal agencies, state and local public health departments, as well as medical, dental, nursing, and public health schools, and many curricula are incorporating the recently published Centers for Disease Control and Prevention (CDC) competencies on bioterrorism. 3 The recently enacted Public Health Security and Bioterrorism Response Act provides funding assistance to ensure state and local public health preparedness. 1 In addition, the CDC Centers for Public Health Preparedness (CPHPs) have developed web-based training programs, seminars, and conferences for the public health workforce, public safety employee seminars, graduate-level public health courses, and medical and dental educational curricula.


Although many people believe that bioterrorism preparedness programs were a result of the events of September 11, 2001, and the subsequent anthrax attacks, Department of Health and Human Services funding for these issues began at least 2 years earlier. This funding was provided through the CDC grants to state health departments. This is not to deny the fact that 9/11 made a big difference: federal funding for state public health preparedness programs was $67 million in the 2001 fiscal year and about $1 billion in the following year. 4 Funding for the Department of Homeland Security has increased from $19.5 billion in 2002 to $40.2 billion in 2005 (proposed). Funding for civilian biodefense through the Department of Health and Human Services has also increased, from $2.9 billion to $4 billion. 5


Approximately 2 years ago, Dr Stephen Morse outlined in this journal the relationship that was developed between the Center for Public Health Preparedness (CPHP) at Columbia University, begun in the fall of 2000, and the New York City Department of Health and Mental Hygiene. 6 Subsequent to the establishment of the first three such centers, the CDC, working through the Association of Schools of Public Health (ASPH), has now funded 43 CPHPs, 23 at schools of public health and 20 at other institutions.


The majority of these centers have been in existence now for at least 3 years with many resulting benefits. Individually, the centers have worked with their state and local health partners, as well as with other members of the response community who are no longer puzzled as to what we do in public health, to improve education, develop competence, and provide direct training in issues related to the broader field of bioterrorism preparedness and public health. Certificated programs, courses for credit, and integration of preparedness issues into public health education have been accomplished in many locations around the country.


Collectively, the centers have worked to develop a national resource center, located on the ASPH Web site, that details course offerings, formal and informal syllabi, training aids for drills and exercises, and filmed broadcasts on specific topics related to terrorism, public health, and preparedness issues. Exemplar groups formed within the CPHP membership are developing standards for curricula, coursework, and materials that can be used for providing training on a variety of topics, including rural and agricultural issues; cross-border issues; discipline-specific training; community-based clinician preparedness education; Incident Command System (ICS) for public health; mental and psychosocial preparedness; exercises and drills; public health worker certification; public health law; distance learning; and others. Each of these exemplar groups is developing toolkits and standards for using them. To serve as resources that can be used by all who are involved in public health emergency preparedness.


This special supplement to the Journal of Public Health Management and Practice is devoted solely to articles on public health preparedness education. Many of the contributors are members of one of the currently active CPHPs, but there are also contributions from others in academia, local and state health departments, and the broader healthcare and emergency management communities involved in public health preparedness education. The purpose of this supplement is to bring information about the evolving and important field of public health preparedness education, including, but not limited to, needs assessment, program development and implementation, exercises and drills, and outcome evaluation.


You will see from a review of the topics and authors that a variety of approaches have been used in developing or utilizing training and educational materials and programs. Distance learning programs that use the Internet have gotten a lot of "play" and seem to be an effective way to reach a diverse-and dispersed-audience. As with all educational efforts, standards and evaluation tools are critical. Several articles also look at what public health and healthcare workers feel they need, or would like, regarding both content and method of teaching. Reading carefully, one can see that the workforce is pressed for time and that unique methods that consider the specific needs of specific audiences need still further development.


This issue documents the training underway to provide for preparedness and appropriate responses to terrorism, disasters, and public health emergencies. We believe it is an effective counterpoint that contrasts with the shrillness and overstatement that often accompanies such information in some public media. Honest approaches to scenarios, drills, and exercises by using realistic examples with practical objectives are valued-and needed. Some interesting developments, not reported on in this issue, involving computer simulations with variables that can be adjusted to fit local capacities will likely play a larger training role in the future. It is also clear that what we have here is only a slice in time of what is available for training in public health preparedness; what we hope to see before long is an increase in the rate and frequency of the use of these products by the public health workforce and increased research in the effectiveness of these programs and measures of improved outcome. Readers are specifically urged to visit the resource center established at so as to identify items, tools, training, or people who might be of use to them in developing or improving their preparedness plans and activities.


In the meantime, we are grateful to the authors of these reports for the information they are sharing, and we believe that the public health community at large will be well-served by these efforts and by the educational resource center noted above. Clearly, none of this would have happened without a lot of work on the part of the CsPHP, their academic community partners in public health, and the contribution from staff at ASPH and CDC. We express our thanks to all of these colleagues.




1. Public Health Security and Bioterrorism Response Act. H.R. 3448. 2002. [Context Link]


2. Defense Against Weapons of Mass Destruction Act of 1996. Public Law 104-201. Available at: Accessed June 30, 2003. [Context Link]


3. Columbia University School of Nursing Center for Health Policy. Bioterrorism and emergency readiness: competencies for all public health workers. Available at: Accessed July 21, 2005. [Context Link]


4. Boulton ML, Abellera J, Lemmings J, Robinson L. Terrorism and emergency preparedness in state and territorial public health departments-United States, 2004. Morb Mortal Wkly Rep. 2005;54:459-460. [Context Link]


5. Schuler A. Billions for biodefense: federal agency biodefense funding, FY2001-FY2005. Biosecur Bioterror. 2004;2:86-96. [Context Link]


6. Morse SS. Building academic-practice partnerships: The Center for Public Health Preparedness at the Columbia University Mailman School of Public Health, before and after 9/11. J Public Health Manag Pract. 2003;9(5):427-432. [Context Link]