Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) have issued the Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism 2008 report, which examines the progress that has been made in improving America's ability to respond to public health emergencies since 2003.

This report, the sixth annual edition, finds that on some levels, significant progress has been made in the nation's preparedness. However, this year, TFAH found that cuts in federal funding for state and local preparedness since 2005, coupled with the cuts states are making to their budgets in response to the economic crisis, put that progress at risk.

There are important areas, however, where continued, concerted action is needed. From assuring an adequate stockpile of pandemic influenza countermeasures to having adequate laboratory capacity to respond to a chemical or radiological event, federal and state policies still fall short of their stated goals. In many other areas, a lack of transparency makes it hard for the American people and their elected representatives to know whether their government is protecting them.

The variation in preparedness among the states means that where one lives still determines how well one is protected. Until all states measure up, the United States is not safe. The report also helps identify ongoing areas of vulnerability. Some of the key areas of concern TFAH has raised include the need to:

• Increase accountability;
• Strengthen leadership;
• Enhance surge capacity and the public health workforce;
• Modernize technology and equipment

TFAH issues this report in order to provide an independent analysis to inform the public and policy-makers about progress and vulnerabilities in the nation’s public health preparedness, and foster greater accountability for the spending of taxpayer dollars on emergency preparedness. The report contains state-by-state health preparedness scores based on 10 key indicators to assess health emergency preparedness capabilities; more than half of states and D.C. achieved a score of seven or less out of 10 key indicators.