Roosevelt Institute | Cornell University

Ebola: A Local Approach to a National Problem

By Woojin ChoiPublished November 9, 2014

Discussion of the policy response to Ebola nowadays seems to focus on criticizing the federal government. An emphasis on the locality, however, in dealing with diseases like Ebola may constitute a more sound response to health crises like this.

By Woojin Choi, 11/9/2014

According to a recent Gallup poll, Americans have become less confident in the federal government's ability to deal with the Ebola outbreak. Politicians themselves agree: Congressman Darrel Issa (R-CA) expressed the public's waning confidence in the Obama Administration. As such, discussion of the response to Ebola has, for the most part, revolved around blaming the federal government for its mishaps. Although the crisis is far from resolved, we can begin to conclude that local levels are more adept at treating health crises like the one we have at hand.

The widely varying responses in dealing with Ebola contraction in New York and Dallas show us that dealing with public health is contingent upon local capabilities more so than national ones. The local medical care that Duncan first sought when he came down with Ebola was at the Texas Health Presbyterian Hospital in Dallas. Unfortunately, it turned out that the hospital wasn't adequately prepared to recognize and treat the virus, and the hospital released Duncan even though he exhibited clear symptoms of Ebola. It also failed to take adequate precautions for his caretakers, including the two nurses who contracted the disease. But on the other side of the country when Dr. Craig Spencer showed signs of Ebola in New York City, the response was drastically different. After notifying authorities, he was quickly transferred by trained paramedics fully encased in protective suits to an isolation ward at Bellevue Hospital Center. From there, he was placed in an isolation ward that is one of eight hospitals in New York State declared "Ebola-ready."

Rather than harping on the response from Washington, the real criticism should be focused on state capitals and city halls. Improving the currently dilapidated public health infrastructure requires a bottom-up effort. As Stephen E. Flynn, a former advisor to the Department of Homeland Security, said, "The federal government can support this [improving public health infrastructure], but cannot be a substitute for it." The Ebola crisis has demonstrated to us the importance of state and local public health policy. In the New York and Dallas cases, Dallas was more prone to such a mishap due to the wide gap in public health spending between New York State and Texas. Rather than solely providing the CDC with resources, we need larger budgets for public health at the state and local levels. Citizens seek and are dependent on public health infrastructure at the local level when disease strikes, rather than looking toward federal programs.

The federal government is not absolved of responsibility in fighting diseases like Ebola, however. In addition to a shift of focus to the state and local levels, the federal government should standardize infection control procedures and push the CDC to adopt more reliable and efficient guidelines to treat such infections. As Dr. Friedan said, "What's needed to fight Ebola is not fancy equipment. What's needed is standard infection control, rigorously applied." We need to encourage cooperation between different levels of government and discourage counterproductive responses by our elected officials like finger-pointing and name-calling.