Public Health Crises: US Often Caught Off Guard, Report Shows

Megan Brooks

December 20, 2016

The United States needs to do a better job of preparing to respond to public health emergencies, according to the annual "Ready or Not?" report from the Trust for America's Health (TFAH).

"Our nation simply isn't as prepared as it could be," Eric Toner, MD, senior associate, UPMC Center for Health Security, Baltimore, Maryland, said today during a media briefing releasing the report.

Since the first "Ready or Not?" report was released in 2003 in the wake of September 11th, "we've documented progress that has been made and identified remaining gaps in the nation's preparedness for health emergencies," added Rich Hamburg, TFAH interim president and CEO.

Overall, the new report finds that the nation has "an inconsistent approach to preparing for health emergencies, which creates a situation where we are often caught off guard when new threats arise such as Zika or the Ebola outbreak or bioterror threat," Hamburg said.

"Then to be able to respond we end up having to scramble, diverting attention and resources away from other serious ongoing health priorities. After the sense of emergency dissipates, we once again become complacent, cutting funds, programs and the trained public health workforce, perpetuating this cycle. We aren't adequately maintaining a strong and steady defense," he warned.

Massachusetts Most Prepared; Alaska, Idaho Least Prepared

The "Ready or Not?" report ranks states' preparedness to handle public health emergencies resulting from natural disasters, disease outbreaks, and bioterrorism attacks.

The rankings are based on 10 key indicators, and only Massachusetts scored a perfect 10. North Carolina and Washington rated the next highest, each scoring 9 out of 10.

California, Connecticut, Iowa, New Jersey, Tennessee, and Virginia scored 8 out of 10, while Colorado, Delaware, Florida, Indiana, Maryland, Michigan, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Carolina, Utah, and Wisconsin scored 7 out of 10.

Achieving a score of 6 are Arizona, Arkansas, District of Columbia, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, Ohio, Pennsylvania, Texas and Vermont.

Alabama, Missouri, Oklahoma, South Dakota and West Virginia scored 5 out of 10; Nevada and Wyoming, 4 out of 10; and Alaska and Idaho had the lowest score of 3 out of 10.

This year's 10 key indicators are:

  1. Whether the state increased or maintained public health funding from fiscal year (FY) 2014-2015 to FY 2015-2016 (26 states did).

  2. Whether the state met or exceeded the overall national average score (6.7) of the National Health Security Preparedness Index as of 2016 (30 states and Washington, DC, did).

  3. Whether the state has at least one accredited public health department (43 states and DC do).

  4. Whether the state vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from fall 2015 to spring 2016 (only 10 states did).

  5. Whether the state received a grade A or B in States at Risk: America's Preparedness Report Card, a national assessment of state-level preparedness for climate change–related threats (32 states and Washington, DC, received a grade of C or above).

  6. Whether the state increased the speed of DNA fingerprinting using pulsed-field gel electrophoresis testing for all reported cases of Escherichia coli, a measure of a state's ability to respond to food borne outbreaks (45 states and Washington, DC, did).

  7. Whether the state implemented all four recommended activities to build capacity for healthcare-associated infection prevention (35 states and DC did).

  8. Whether the state public health laboratory provided biosafety training and/or provided information about biosafety training courses for sentinel clinical labs (from July 1, 2015, to June 30, 2016) (44 states did).

  9. Whether state public health laboratories reported having a biosafety professional on staff (from July 1, 2015, to June 30, 2016) (47 states and DC did).

  10. Whether the state has a formal access program or a program in progress for getting private sector healthcare staff and supplies to restricted areas during a disaster (10 states do).

The report notes that health emergency preparedness funding for states has been cut from $940 million in FY 2002 to $660 million in FY 2016, while healthcare system preparedness funding for states has been cut by more than half since FY 2005 — down to $255 million.

"Major areas of accomplishment," Hamburg noted, include 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 laboratories and foodborne illness detection capabilities; and improvements in legal and liability protections during emergencies.

"Major ongoing gaps," he said, include a lack of a coordinated, interoperable, near real-time biosurveillance systems; 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 recommends several strategies to address gaps in emergency health preparedness:

  • Require strong, consistent baseline public health foundational capabilities in regions, states and communities.

  • Ensure 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.

  • Improve federal leadership before, during, and after disasters.

  • Recruit and train a "next-generation" public health work force that can harness and use technological advances along with critical thinking and management skills to serve as the "chief health strategist" for a community.

  • Reconsider health system preparedness for new threats and mass outbreaks by developing stronger coalitions among providers, hospitals, insurance providers, pharmaceutical and health equipment businesses, emergency management, and public health agencies.

  • Prioritize efforts to address one of the most serious threats to human health by expanding efforts to stop multidrug-resistant infections and antibiotic resistance.

  • Improve rates of vaccinations for children and adults.

The "Ready or Not?" report is funded by a grant from the Robert Wood Johnson Foundation.

"Ready or Not?" Trust for America's Health. Published December 20, 2016. Full text

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