The Biggest Problem Our Public Health System Faces Is That It’s Not A System

I’ve made this point many times, but with the possibility of Zika virus transmission due to inadequate control and the political consequences thereof, it probably bears repeating (boldface mine):

But there are huge disparities in readiness on the front lines of mosquito control.

“It’s a patchwork,” said Lyle Petersen, who heads CDC’s vector-borne diseases division, showing a map of counties in the continental United States with vector-control programs in place as of March 1. Many of those programs are stand-alone operations, which makes data sharing and planning coordination with health departments more difficult.

Through part of the country’s midsection, states like Nebraska and Missouri don’t appear to have anything in place. Even in states like Texas, which experts expect to be among the most likely locations for local transmission of Zika, vector-control programs are concentrated along the Gulf coast….

The bottom line, he said, is that the United States needs sustained mosquito control throughout the entire country. No state has enough money or staff to do the advanced preparation that’s necessary, Frieden said.

We don’t have a public health system: at best, we have 51 state* systems, but when we’re talking about mosquito control, it’s even more fragmented. And movie plots notwithstanding, the CDC has little or no control over these entities. To the extent it does, it’s largely the power of the purse (if CDC funds an initiative, it can call the shots). There’s no command-and-control here, only coordination at best.

Right now, luck is going to play a big role in whether Zika will become established in the continental U.S.–and that’s not a policy.

*On this blog, we refer to the District of Columbia as a state.

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2 Responses to The Biggest Problem Our Public Health System Faces Is That It’s Not A System

  1. zero says:

    The rural midwest, to make a sweeping generalization, deals with mosquito control as a municipal issue. City employees will drive fogger trucks around periodically, with high intensity near peak breeding season and before any large, outdoor public event. There are information campaigns that advertise how to eliminate mosquito spawning habitats on private property, but these are usually just a few posters stuck in high-traffic areas.
    Very little is spent and little to no data collection is done to determine effectiveness. Certainly gene sequencing pureed samples is out of the question on a shoestring budget. In other words, for a lot of territory that has no formal mosquito control, there is no data to share.

  2. jrkrideau says:

    we have 51 state* systems
    Oh you meant Washington DC. I thought you meant Porto Rico.
    In situation like this just what does happen to Porto Rico? Last I heard it was being left to slowly sink into the sea but in a health crisis what happens?

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