Prepared by the Trust for America's Health (TFAH), the report contains state-by-state health preparedness scores based on 10 key indicators to assess health emergency preparedness capabilities.
All 50 U.S. states and the District of Columbia were evaluated. Half the states scored six or less on the scale of 10 indicators. Oklahoma scored highest with 10 out of 10; California, Iowa, Maryland and New Jersey scored the lowest with four out of10. States with stronger surge capacity capabilities and immunization programs scored higher, since four of the measures focus on these areas.
"The nation is nowhere near as prepared as we should be for bioterrorism, bird flu and other health disasters," said Jeff Levi, PhD, executive director of TFAH. "We continue to make progress each year, but it is limited. As a whole, Americans face unnecessary and unacceptable levels of risk."
For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator, making zero the lowest possible overall score and 10 the highest. Data for the public health indicators are from publicly available sources or public officials in 2006.
Among the key findings are:
- Only 15 states are rated at the highest preparedness level to provide emergency vaccines, antidotes and medical supplies from the Strategic National Stockpile.
- Twenty-five states would run out of hospital beds within 2 weeks of a moderate pandemic flu outbreak.
- Forty states face a shortage of nurses.
- Rates for vaccinating seniors for the seasonal flu decreased in 13 states.
- Eleven states and Washington, D.C. lack sufficient capabilities to test for biological threats.
- Four states do not test year-round for the flu, which is necessary to monitor for a pandemic outbreak.
- Six states cut their public health budgets from FY 2005 to FY 2006; the median rate for state public health spending is $31 per person per year.
"Sept. 11, the anthrax attacks, and Hurricane Katrina were all wake-up calls to the country, putting us on notice that the nation's response capabilities were weak and that we needed to improve preparedness," said Levi. "But, across the board, it is clear that we haven't learned the lessons from these tragedies - we are still too vulnerable to what might come next."
The report also examines the need to strengthen funding and accountability for public health preparedness. Preparedness is a shared responsibility among the federal, state and local governments, with the Centers for Disease Control and Prevention (CDC) and Health Resource Services Administration (HRSA) at the U.S. Department of Health and Human Services (HHS) in charge for overseeing the use of federal funds devoted to health emergency readiness.
Since 2004, over $90 million have been cut from the CDC's preparedness funds that are allocated to states, and over $23 million have been cut from HRSA funds allocated for state hospital preparedness. These cuts have occurred before many basic preparedness goals have been met. This threatens to halt or reverse progress that has been achieved. Additionally, the federal government currently does not consistently, objectively measure or provide state-by-state information to help Americans and policymakers assess how prepared their communities are to respond to health threats.
The report also offers a series of recommendations to help improve preparedness. Some key recommendations include:
- The federal government should establish improved "optimally achievable" standards that every state should be accountable for reaching to better protect the public, and the results should be made publicly available. Appropriate levels of funding should be provided to the states to achieve these standards.
- The establishment of temporary health benefits for the uninsured or underinsured during states of emergency. This benefit is necessary to ensure that sick people will stay home, and the uninsured and underinsured will seek treatment in times of emergency, helping to prevent the unnecessary spread of infectious diseases, including resulting from acts of bioterrorism or a pandemic flu outbreak.
- A single senior official within the HHS should be designated in charge of and accountable for all public health programs. The senior official would streamline government efforts and be the clear leader during times of crisis.
- Emergency surge capacity capabilities should be improved by integrating all health resources and partnering with businesses and community groups in planning, and increasing stockpiles of needed equipment and medications.
- The volunteer medical workforce should be expanded and an investment must be made in the recruitment of the next generation of the public health workforce.
- Technology and equipment must be modernized and research and development must be strengthened.
- The public should be better included in emergency planning, and risk communication must be modernized.
TFAH's report was supported by grants from the Robert Wood Johnson Foundation and the Bauman Foundation. The report and state-by-state materials are available at www.healthyamericans.org.
- 10 out of 10: Oklahoma
- 9 out of 10: Kansas
- 8 out of 10: Alabama, Kentucky, Michigan, Missouri, Montana, Nebraska, South Dakota, Texas, Virginia, Washington, West Virginia, Wyoming
- 7 out of 10: Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Minnesota, New Hampshire, New York, North Dakota, Tennessee
- 6 out of 10: Colorado, Indiana, Louisiana, Massachusetts, Mississippi, Nevada, New Mexico, North Carolina, Oregon, Rhode Island, Utah, Vermont, Wisconsin
- 5 out of 10: Alaska, Arizona, Arkansas, Connecticut, D.C., Maine, Ohio, Pennsylvania, South Carolina
- 4 out of 10: California, Iowa, Maryland, New Jersey