The recent anthrax attack led to the realization that resources are needed at state and local levels to deal effectively with bioterrorism. It was recognized early that state and local health departments would be called on to assume major responsibility for the identification, analysis, and control of agents used in such attacks. There also was recognition that public health agencies are not adequately funded to carry out their responsibilities. Often, a crisis is needed to get the attention of those responsible for funding. This is unfortunate, as strong public health capabilities are needed to deal effectively with the many problems that threaten the public's health, not just the bioterrorism threat. Fortunately, when Palm Beach County, Florida, became "ground zero" for the anthrax attack, the state and county health departments, in cooperation with private resources, were able to identify and analyze the problem and play a major role in controlling it.
Although there has been belated appreciation of the inadequateness of funding of the public health infrastructure, there has been too little recognition of the need for personnel trained in preventive medicine and public health. In regard to physicians, their medical degrees must be supplemented by additional training in epidemiology, biostatistics, administration (including development of leadership skills), environmental science, behavioral science, and clinical preventive medicine. As with other areas requiring specialized competencies, training in the prevention and control of bioterrorism is needed. Training in public health practice must include development of the ability to work well with various disciplines and agencies, particularly in combating bioterrorism because law enforcement and other agencies play important roles.
The Palm Beach County Health Department's Residency in Preventive Medicine/Public Health
Early in its program's development, Palm Beach County Health Department decided to establish and seek accreditation for a residency training program in preventive medicine/public health. The department felt that this program would attract the most desirable physicians for training in public health practice. The department applied to the national accrediting body, which sent a site team to review health department programs and services. In 1956, the department received accreditation, and it has continued until the present time. Over 80 physicians have been trained; many have become board certified in preventive medicine and public health. The health department has retained a number of these physicians to fill key positions; others have gone to other agencies, including Secretary of Health for Florida.
The training received by these physicians has been a key factor in developing high-quality programs designed to meet public health needs. The residency program has improved performance of the total staff of the Palm Beach County Health Department, enabling this agency to meet numerous difficult challenges, including bioterrorism.
Physicians accepted for residency training must have at least one year of primary care training in an accredited program. A master's degree in public health is required, which can be obtained through affiliation with several accredited university programs in Florida. The health department provides the practicum year where competencies are developed through application of the knowledge and skills acquired through training.
Training in the residency program concentrates on core areas: administration (including problem identification and analysis, program planning and evaluation, policy development and analysis, program management, fiscal and personnel aspects, legislative and political aspects, and inter-agency cooperation); epidemiology and biostatistics; environmental science; behavioral science; and clinical preventive medicine. The training is accomplished by means of rotations through the various programs and services of the health department, lectures and seminars, program and service development, clinical assignments, and research projects. Residents are involved in dealing with crises (e.g., outbreak investigation and control), including playing important roles in all aspects of the recent anthrax attack incident.
State and local health departments are vital resources for dealing with bioterrorism. To be successful in the war against terrorism, adequate funding of public health services is imperative. Another key factor is ensuring that all public health physicians are appropriately trained. This training must include preparation in leadership, administration, epidemiology, biostatistics, environmental and behavioral sciences, and clinical preventive medicine. In addition, special training is required in the areas of prevention, identification, analysis, and control of bioterrorism.