Ready or Not?

Protecting the Public's Health from Diseases, Disasters, and Bioterrorism, 2010

In the eighth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism report, 14 states scored nine or higher on 10 key indicators of public health preparedness. Three states (Arkansas, North Dakota, and Washington State) scored 10 out of 10. Another 25 states and Washington, D.C. scored in the 7 to 8 range. No state scored lower than a five. (Listen to a podcast about the new report with Jeff Levi of Trust for America's Health, at right.)

The scores reflect nearly 10 years of progress to improve how the nation prevents, identifies, and contains new disease outbreaks and bioterrorism threats and responds to the aftermath of natural disasters in the wake of the September 11th and anthrax tragedies. In addition, the real-world experience responding to the H1N1 flu pandemic—supported by emergency supplemental funding—also helped bring preparedness to the next level.

However, the Ready or Not? report, released today by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation, notes that the almost decade of gains is in real jeopardy due to severe budget cuts by federal, state, and local governments. The economic recession has led to cuts in public health staffing and eroded the basic capabilities of state and local health departments, which are needed to successfully respond to crises. Thirty-three states and Washington, D.C., cut public health funding from fiscal years (FY) 2008-09 to 2009-10, with 18 of these states cutting funding for the second year in a row. The report also notes that just eight states raised funding for two or more consecutive years. The Center on Budget and Policy Priorities has found that states have experienced overall budgetary shortfalls of $425 billion since FY 2009.

In addition to state cuts, federal support for public health preparedness has been cut by 27 percent since FY 2005 (adjusted for inflation). Local public health departments report losing 23,000 jobs—totaling 15 percent of the local public health workforce—since January 2008. The impact of the recession was not as drastically felt by the public health workforce until more recently because supplemental funds received to support the H1N1 pandemic flu response and from the American Recovery and Reinvestment Act have almost entirely been used.

“There is an emergency for emergency health preparedness in the United States,” said Jeff Levi, Ph.D., executive director of TFAH. “This year, the Great Recession is taking its toll on emergency health preparedness. Unfortunately, the recent and continued budget cuts will exacerbate the vulnerable areas in U.S. crisis response capabilities and have the potential to reverse the progress we have made over the last decade.”

Ready or Not? provides the public and policy-makers with an independent analysis of the progress and vulnerabilities in the nation’s public health preparedness. Some key findings include:

  • Seven states cannot currently share data electronically with health care providers;
  • 10 states do not have an electronic syndromic surveillance system that can report and exchange information to rapidly detect disease outbreaks;
  • Half of states do not mandate all licensed child care facilities have a multi-hazard written evacuation and relocation plan;
  • Only four states report not having enough staffing capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A H1N1; and
  • Only one state decreased their Laboratory Response Network for Chemical Threats (LRN-C) chemical capability from August 10, 2009, to August 9, 2010.

The report also looked at findings from a recently released report from the U.S. Centers for Disease Control and Prevention (CDC) based on activities in 2007-08 that focus on emergency operations and food outbreak identification.

  • Only two states reported that pre-identified staff were not able to acknowledge notification of emergency exercises or incidents within 60 minutes a minimum of two times, the target established by the CDC;
  • Six states did not activate their emergency operations center (EOC) a minimum of two times, the target established by the CDC;
  • Only two states did not develop After-Action Report/Improvement Plans within 60 days of exercises or real incidents a minimum of two times, the target established by the CDC; and
  • 21 states were not able to rapidly identify disease-causing E.coli O157:H7 and submit the lab results in 90 percent of cases within four days.

According to the report, while states have made progress, there are still a series of major ongoing gaps in preparedness, including in basic infrastructure and funding, biosurveillance, maintaining an adequate and expertly trained workforce, developing and manufacturing vaccines and medicines, surge capacity for providing care in major emergencies, and helping communities cope with and recover from emergencies.

Ready or Not? provides a series of recommendations that address the ongoing major gaps in emergency health preparedness, including:

  • Gaps in Funding and Infrastructure: The resources required to truly modernize public heath systems must be made available to bring public health into 21st century and improve preparedness;
  • A Surveillance Gap: The United States lacks an integrated, national approach to biosurveillance, and there are major variations in how quickly states collect and report data which hamper bioterrorism and disease outbreak response capabilities;
  • A Workforce Gap: The United States has 50,000 fewer public health workers than it did 20 years ago—and one-third of current workers are eligible to retire within five years. Policies must be supported that ensure there are a sufficient number of adequately trained public health experts—including epidemiologists, physicians, nurses, and other workers—to respond to all threats to the public’s health;
  • Gaps in Vaccine and Pharmaceutical Research, Development, and Manufacturing: The United States must improve the research and development of vaccines and medications;
  • A Surge Capacity Gap: In the event of a major disease outbreak or attack, the public health and health care systems would be severely overstretched. Policy-makers must address the ability of the health care system to quickly expand beyond normal services during a major emergency;
  • Gaps in Community Resiliency Support: The United States must close the existing day-to-day gaps in public health departments which make it difficult to identify and service the most vulnerable Americans, who often need the most help during emergencies.

According to James Marks, senior vice president and director of the Health Group at the Robert Wood Johnson Foundation, the gaps that remain and the risks of loss of our nation’s ability to respond during emergencies call out for an ongoing investment to rebuild and modernize our public health system. “This report makes it clear that not enough Americans are protected against health emergencies. And those whose health departments have done a good job preparing are at great risk of losing ground. The American public needs to know if their state and local health agency has the resources and expertise to respond to any health crisis. Detecting weaknesses and identifying how to fix those are why independent accreditation with specific, measurable standards of quality and performance are so critical to helping the public and their leaders know what more is needed to protect their families and communities.”

The report was supported by a grant from the Robert Wood Johnson Foundation.

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH's Web site at www.healthyamericans.org and RWJF's Web site at www.rwjf.org. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

10 out of 10: Arkansas, North Dakota Washington state,

9 out of 10: Alabama, California, Kentucky, Louisiana, Maryland, Mississippi, Ohio, Utah, Virginia, West Virginia, Wisconsin

8 out of 10: Alaska, Arizona, Colorado, Connecticut, Delaware, Florida, Indiana, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Pennsylvania, Vermont, Wyoming

7 out of 10: Washington, D.C., Georgia, Hawaii, Maine, Missouri, Oregon, Tennessee, Texas

6 out of 10: Idaho, Illinois, Kansas, Massachusetts, Nevada, New Mexico, Rhode Island, South Carolina, South Dakota

5 out of 10: Iowa, Montana

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need—the Foundation expects to make a difference in our lifetime.