Helen Horton, MPH, School of Public and International Affairs, Virginia Polytechnic Institute and State University, 301 Architecture Annex, Blacksburg, VA 24061, 5408182411, hhorton1@vt.edu

Background: Traditionally public health agencies have documented disparities in health according to gender, race, geography, and income; however, many authors predict that this definition and the methods by which disparities are measured will change. With changing world patterns of terrorism, new vulnerable groups are likely to emerge and exacerbate existing health disparities. Disparities in health among populations may be observed not because of racial or ethnic construct, available income, or socio-political standings, rather differences in health status, particularly in cases of emergencies, may result from how well or ill equipped local public health agencies to address such events.

Significance: This paper focuses on the disparity in local public health preparedness and the implications for creating vulnerable groups. The reasons for the observed differences in local public health preparedness are analyzed according to funding, workforce development, roles in cases of emergencies, and organizational relationship with the state.

Methodology: The paper includes a comprehensive review of literature and recommendations are based on the literature and key informant interviews with local and state public health officials.

Conclusion: To date, most of the emphasis of U.S. preparedness for biological and chemical terrorism has been on improving the capacity of national and state public health systems. We need to go beyond these efforts, to shift the focus toward the front lines, and to make sure that local plans and systems are in place to make the best use of local assets. One thing is clear…local public health agencies will be on the frontlines…ready or not.

Learning Objectives: