sure that any new systems are tested by local and State health agencies and determined to be usable and effective. Despite the progress made since the Institute of Medicine report, much more needs to be done, and you've already heard some of that. We have a number of health professionals, and Dr. Fleming already mentioned that, that are due to retire in the next 5 years. We must pay attention to our work force. To illustrate my points about the importance of public health surveillance, I'll give you three quick examples from Washington State. SARS, in Washington State today we have 24 cases; 22 of those are suspected, 2 are probable. That's a fairly high number across the United States when you look at our map. The systems that we have in place now were dealing with rapid identification; using common case definitions; the reporting mechanisms we have in place from our local health departments, from our clinicians to our local health departments, to us at the State and us in real time to the Federal Government, so that we all got a handle on this. We've been able to use the systems that we have enhanced over our State's emergency preparedness efforts. West Nile virus. Washington State has not yet been hit with a human case occurring in our State. We know the mosquito is there. We've had dead birds. We've had dead horses. But for West Nile what we're doing right now is we're doing that real-time educating. We are using Webcast. We're using our information systems to enhance what people need to watch for, how to diagnose, how to report to our colleagues at the local level, and what it is we need to do as a State and work with the Federal Government at the Centers for Disease Control and Prevention [CDC]. And one other example is E. Coli O157:H7. Washington State unfortunately has a lot of practice. It was Burger King back in the early 1990's. It actually was a number of cases in 1985. Our public health lab created the 1-day test, what used to take 5 days, in Washington State. We were working together with the scientists at the Centers for Disease Control, because the real-time reporting, that happens through PulseNET, through our public health laboratory system, and then to capitalize on that with the National Electronic Disease Surveillance System really means that we deal with this very quickly. Last summer we had a multistate outbreak that had to do with a meat packer in Colorado. We worked very closely together with the systems that are in place to make sure the public is protected. In closing, I want to reiterate a few points. First, thank you to Congress for investments. They hadn't come in the near past. The investments have become more real more recently. They must be sustained. State and local public health working together with our partners at the Federal level need to have that investment. Second, public health work force issues must be addressed, whether it's through our schools of public health, whether it's through routine training available using, for example, Webcast satellite downlinks or whatever the case is. And the third is the continuing effort to coordinate the systems. A clinician and a local community is the first place where this starts, the local health department connectivity to that local clini Now, there are systems in place, and the reason you don't have a one-size-fits-all is the fact that you have had things develop; whether it's in Pittsburgh or an area of Texas, we've got to have common standards so that we can report commonly. Again, thank you for the opportunity to be here, and I'd be happy to answer questions when we're done with the panel. Mr. SHAYS. Thank you Ms. Selecky. [The prepared statement of Ms. Selecky follows:] Statement of MARY C. SELECKY SECRETARY WASHINGTON STATE DEPARTMENT OF HEALTH And ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS Before the SUBCOMMITTEE ON NATIONAL SECURITY, EMERGING THREATS, AND INTERNATIONAL RELATIONS of the UNITED STATES HOUSE OF REPRESENTATIVES Hearing on "HOMELAND SECURITY: IMPROVING PUBLIC HEALTH SURVEILLANCE" MAY 5, 2003 Representing THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS (ASTHO) Mr. Chairman and distinguished members of the Subcommittee, my name is Mary C. Selecky. I am the Secretary of the Washington State Department of Health, and I am honored to be testifying before you today as the President of the Association of State and Territorial Health Officials (ASTHO). I would like to thank the Chair and subcommittee members for your past support for public health matters, including public health preparedness. This hearing focuses on one of our most important, although often invisible and forgotten, public health tools - public health surveillance. As early as 1878, Congress recognized the important of surveillance when it authorized the U.S. Marine Hospital Service to collect morbidity reports concerning cholera, smallpox, plague, and yellow fever from U.S. consuls overseas. These data were to be used for instituting quarantine measures to prevent the introduction and spread of these diseases into our nation. By 1928, all states, the District of Columbia, Hawaii, and Puerto Rico were participating in national surveillance and reporting on 29 specific diseases. In 1950, ASTHO created its affiliate, the Council of State and Territorial Epidemiologists, one of the group's purposes was to determine which diseases should be reported nationally to the Public Health Service. All states now voluntarily report nationally notifiable diseases to the Centers for Disease Control and Prevention (CDC). One of the core functions of state health departments is to collect, analyze, interpret, and disseminate public health data. States do this to identify health problems, determine the programs or other responses needed to address specific public health concerns, and evaluate the effectiveness of the responses. Health departments depend upon the receipt of quality public health data to identify and track emerging infectious diseases such as SARS and West Nile virus. Equally important, although often overlooked, is the collection of public health surveillance data that identifies the burden and causes of our nation's leading causes of death - chronic diseases (such as heart disease and diabetes) injury, and risk factor analysis. State health departments have a unique role to play in public health surveillance. Public health threats do not respect political borders. Reporting of disease entities, therefore, needs to be uniform within any given state in order to work with federal and local colleagues to assure an adequate, immediate response to public health emergencies. In many parts of the country, only the state health department has the sophisticated laboratory and highly trained laboratorians, epidemiologists and other public health professionals needed to tackle the most serious public health challenges. As a former health officer for the Northeast Tri-County Health District in rural eastern Washington state, I know firsthand about the importance of the critical synergies that must be in place to assure that all citizens are protected. Just as there are differences in capacities among states, there are differing response capacities within communities in every state. As a local health official, I worked hand in hand with the state health department on foodborne outbreaks and other public health emergencies. Local, state, and federal health agencies, including the CDC, each have a distinct and important role in public health surveillance activities. In this testimony, I would like to make four points: 1) Since the 1988 Institute of Medicine's Future of Public Health Report recognized the inadequacies of our public health infrastructure in general, and public |