It was a year ago that we lost Dr. Bill Keene, Oregon’s senior state epidemiologist, to acute pancreatitis at age 56. We missed him in 2014. He was posthumously awarded the 2014 NSF Food Safety Leadership Lifetime Achievement Award last April in Baltimore.
Keene was a guy who did his job with passion and humor. He was never limited by somebody else’s expectations. He was a dogged and determined investigator who was usually thinking outside the box.
I was invited to speak to the California’s environmental health officers in Sacramento, and, as I was being introduced, my phone went off. It was Keene, who had discovered that we had overlooked a deadly outbreak that occurred nearly 100 year ago in Chicago. My audience did not mind waiting a moment so I could make the addition, and more than one explained it to others by saying, “Bill Keene’s talking to him before we get started.”
Bill traveled and was both known to his colleagues and open with the media. It got me thinking about where we are with state health departments. Because of the late Bill Keene and the extraordinary efforts of “Team Diarrhea,” conventional wisdom for several years was that Oregon and Minnesota were tops in capacity to combat foodborne illnesses.
Well, maybe it’s time to re-think the conventional wisdom. The second National Health Security Preparedness Index, a project of the Robert Wood Johnson Foundation for the Association of State and Territorial Health Officials (ASTHO), is out. The index measures how prepared state health departments are to handle emergencies, but it looks at the capacities in such detail that it can also be used to compare specific items for many functions.
For example, many of the items that we think are important to food-safety investigations fall under the Index’s “health security surveillance” section. That’s where they note the number of state epidemiologists per 100,000 population and whether state public health labs are tied into certain data and management systems.
On these surveillance measures, the top performers for 2014 were South Carolina, New York, Michigan, Massachusetts and Hawaii. There are several other parts of the Index, including incident and information management, healthcare delivery, national preparedness level, countermeasure management and community planning and engagement.
When I first learned of the Preparedness Index, I thought it might be one of those designed to give every state a star for something, but it does end up with a range of performances and there is a lot of information for comparing one state to another. When all measurements are tallied, the Index has Utah, New York and Virginia on top.
It’s not the end-all, or even enough to cause me to think that Oregon and Minnesota are not still the best. That’s because being the best is not just about the assets kept in the barn, but the experience that’s available once the fire alarm goes off. That’s why Bill Keene was so good at what he did.
What’s good is that ASTHO is willing to come up with measurements and come up with a way to spur more competition by the states. We’d like to see future reports specifically address outbreaks of disease as just as much of a preparedness challenge as a storm or a plane crash.
And what would be especially nice to see following my musings on the new Index report would be your thoughts on the subject. Which one or two states do you think are best at investigating foodborne illness outbreaks and why?