Report: Economic Crisis Affects U.S. Preparedness for Health Emergencies

Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) on Dec. 9 released the sixth annual “Ready or Not? Protecting the Public's Health from Diseases, Disasters, and Bioterrorism” report, which finds that progress made to better protect the country from disease outbreaks, natural disasters and bioterrorism is now at risk, due to budget cuts and the economic crisis. In addition, the report concludes that major gaps remain in many critical areas of preparedness, including surge capacity, rapid disease detection and food safety.

Over the past 6 years, the “Ready or Not?” report has documented steady progress toward improved public health preparedness. This year, however, 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.

"The economic crisis could result in a serious rollback of the progress we've made since September 11, 2001 and Hurricane Katrina to better prepare the nation for emergencies," said Jeff Levi, Ph.D., TFAH executive director. "The 25 percent cut in federal support to protect Americans from diseases, disasters, and bioterrorism is already hurting state response capabilities. The cuts to state budgets in the next few years could lead to a disaster for the nation's disaster 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 the District of Columbia achieved a score of seven or less out of 10 key indicators. Louisiana, New Hampshire, North Carolina, Virginia and Wisconsin scored the highest with 10 out of 10. Arizona, Connecticut, Florida, Maryland, Montana and Nebraska tied for the lowest score with five out of 10.

Key Findings

  • Budget Cuts. Federal funding for state and local preparedness has been cut more than 25 percent from FY 2005, and states are no longer receiving any supplemental funding for pandemic flu preparedness, despite increased responsibilities. In addition to the federal decreases, 11 states and D.C. cut their public health budgets in the past year. In the coming year, according to the Center on Budget and Policy and Priorities, 33 states are facing shortfalls in their 2009 budgets and 16 states are already projecting shortfalls to their 2010 budgets.
  • Disease Detection. The nation has made significant progress in improving disease detection capabilities since 9/11, but major gaps still remain. For example, 24 states and the district lack the capacity to deliver and receive lab specimens, such as suspected bioterror agents or new disease outbreak samples, on a 24/7 basis.
  • Food Safety. The nation’s food safety system has not been fundamentally modernized in more than 100 years. Twenty states and the district did not meet or exceed the national average rate for being able to identify the pathogens responsible for food borne disease outbreaks in their states.
  • Surge Capacity. Many states also do not have mechanisms in place to support and protect the community assistance that is often required during a major emergency. For example, 26 states do not have laws that reduce or limit liability for businesses and non-profit organizations that help during a public health emergency, and 17 states do not have State Medical Reserve Corps Coordinators.
  • Medication Supply/Distribution. Finally, ensuring the public can quickly and safely receive medications during a major health emergency is one of the most serious challenges facing public health officials. Sixteen states have purchased fewer than half of their share of federally subsidized antivirals to use during a pandemic flu outbreak. Every state, however, now has an adequate plan for distributing emergency vaccines, antidotes and medical supplies from the Strategic National Stockpile, according to the CDC – compared to 2005, when only seven states had adequate plans.

"States are being asked to do more with less, jeopardizing our safety, security, and health," said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of RWJF. "We all have a stake in strengthening America's public health system, because it is our first line of defense against health emergencies."


The report offered a series of recommendations for improving preparedness:

  • Restore full funding. At a minimum, federal, state, and local funding for public health emergency preparedness capabilities should be restored to FY 2005 levels.
  • Strengthen leadership and accountability. The next administration must clarify the public health emergency preparedness roles and responsibilities at the U.S. Department of Health and Human Services and U.S. Department of Homeland Security.
  • Enhance surge capacity and the public health workforce. Federal, state, and local governments and health care providers must better address altered standards of care, alternative care sites, legal concerns to protect community assistance and surge workforce issues.
  • Modernize technology and equipment. Communications and surveillance systems and laboratories need increased resources for modernization.
  • Improve community engagement. Additional measures must be taken to engage communities in emergency planning and to improve protections for at-risk communities.
  • Incorporate preparedness into health care reform and create an emergency health benefit. This is needed to contain the spread of disease by providing care to the uninsured and underinsured Americans during major disasters and disease outbreaks.
A 5-minute video about the report is available at
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