Twenty-six states and Washington, D.C. scored a six or lower on 10 key indicators of public health preparedness.

The Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism report, issued by the Trust for America's Health (TFAH), found that the nation is often caught off guard when a new threat arises, such a Zika or the Ebola outbreak or bioterrorist threat, which then requires diverting attention and resources away from other priorities. 

In the report, Alaska and Idaho scored lowest at 3 out of 10, and Massachusetts scored the highest at 10 out of 10, with North Carolina and Washington State scoring 9's. 

"Health emergencies can quickly disrupt, derail and divert resources from other ongoing priorities and efforts from across the government," said Rich Hamburg, interim president and CEO, TFAH.  "Many areas of progress that were made after 9/11 and the anthrax attacks to improve health security have been undercut.  We aren't adequately maintaining a strong and steady defense, leaving us unnecessarily vulnerable when new threats arise."

Ready or Not? examines the nation's ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies.  Some key findings include:

  • 26 states increased or maintained funding for public health from Fiscal Year (FY) 2014-2015 to FY 2015-2016.
  • Just 10 states vaccinated at least half of their population (ages 6 months and older) against the seasonal flu during the 2015-2016 flu season (from July 2015 to May 2016).
  • 45 states and Washington, D.C. increased the speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of Shiga toxin-producing E. coli O157, a measure of a state's ability to detect foodborne outbreaks.
  • 10 states have a formal access program or a program in progress for getting private sector healthcare staff and supplies into restricted areas during a disaster.
  • 30 states and Washington, D.C. met or exceeded the overall national average score (6.7) of the National Health Security Preparedness Index™ (as of 2016).
  • 32 states and Washington, D.C. received a grade of C or above in States at Risk: America's Preparedness Report Card, a national assessment of state-level preparedness for climate change-related threats – which have an impact on human health.

In addition, the report examined trends in public health preparedness over the last 15 years, finding successes and ongoing concerns. 

  • One-third of funds for health security and half of funds for healthcare system preparedness have been cut:  Health emergency preparedness funding for states has been cut from $940 million in fiscal year (FY) 2002 to $660 million in FY 2016; and healthcare system preparedness funding for states has been cut by more than half since FY 2005 – down to $255 million.
  • Some major areas of accomplishment:  Improved emergency operations, communication and coordination; support for the Strategic National Stockpile and the ability to distribute medicines and vaccines during crises; major upgrades in public health labs and foodborne illness detection capabilities; and improvements in legal and liability protections during emergencies.
  • Some major ongoing gaps: Lack of a coordinated, interoperable, near real-time biosurveillance system; insufficient support for research and development of new medicines, vaccines and medical equipment to keep pace with modern threats; gaps in the ability of the healthcare system to care for a mass influx of patients during a major outbreak or attack; and cuts to the public health workforce across states.

The report provides a series of recommendations that address many of the major gaps in emergency health preparedness, including:

  • Requiring strong, consistent baseline public health Foundational Capabilities in regions, states and communities—so that everyone is protected.
  • Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of foundational capabilities alongside a complementary Public Health Emergency Fund which would provide immediate surge funding during an emergency. 
  • Improving federal leadership before, during and after disasters – including at the White House level. 
  • Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as the Chief Health Strategist for a community. 
  • Reconsidering health system preparedness for new threats and mass outbreaks by developing stronger coalitions and partnerships among providers, hospitals, insurance providers, pharmaceutical and health equipment businesses, emergency management, and public health agencies. 
  • Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop Superbugs and antibiotic resistance.
  • Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.

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