States Show Improvements but Remain Unprepared for Public-Health Emergencies

An analysis of U.S. public-health resources shows that states can do more to prepare for potential disease outbreaks and natural disasters

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An analysis of public-health resources shows that states can do more to prepare for potential disease outbreaks and natural disasters.

The Sept. 11 attacks in 2001 and the anthrax attacks soon after spurred a renewed commitment to enhance public-health services to respond to potential threats such as bioterrorism events and natural disasters that can trigger disease outbreaks. Government health officials continue to stock the Strategic National Stockpile with antibiotics and vaccines to supply public-health labs, but a report from the Robert Wood Johnson Foundation and Trust for America’s Health shows continued gaps in emergency responsiveness among states.

The report scored states on a scale of 1 to 10, with one point awarded for each indicator of public-health preparedness that states had in place, including increasing or maintaining public-health funding, meeting vaccination goals, having a response plan for health changes caused by climate change (including severe-weather events) and states’ ability to quickly assemble a public-health staff for medically related incidents.

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“The good news is that considerable progress has been made to effectively prepare for and respond to public-health emergencies of all types and sizes, and much of what it takes to prepare for bioterrorism or major disasters is also essential to respond to ongoing ‘everyday’ health emergencies,” the report’s authors wrote. “The bad news is that the accomplishments achieved over the past decade to improve public-health preparedness for all hazards are now being undermined due to severe budget cuts and lack of prioritization.”

States scoring an 8 out of 10 were Maryland, Mississippi, North Carolina, Vermont and Wisconsin. Kansas and Montana ranked lowest, with a score of 3.

Among the factors contributing to lower scores were incomplete or nonexistent evacuation plans for specific groups; 20 U.S. states have not mandated that licensed child-care facilities, for example, have written evacuation plans. Poor compliance with childhood vaccination schedules also added to lower preparedness scores; only two states — Hawaii and Nebraska — met the national goal of vaccinating 90% of young kids ages 19 to 36 months.

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Why are so many states falling short? Budget cuts are the primary reason; the report shows 29 states cut public-health funding from 2010 to 2012. In 2011, 57% of all local health departments reduced or eliminated at least one program, and since 2008, more than 45,700 state and local public-health jobs have been cut.

However, Jeff Levi, executive director of Trust for America’s Health, says there are several low-cost changes states can adopt to improve their standings.

“A lot of these indicators are about policies and not programs,” says Levi. “One of the places where states did the worst was in whooping-cough vaccinations. It’s not necessarily expensive because states don’t need to pay for that, but they need to educate parents and providers to make it a priority. Once a disease is under control, that doesn’t mean you no longer need to be vigilant.”

Other inexpensive policy changes that could boost rankings include creating plans to accommodate potential health changes resulting from climate change, such as preparing for disease outbreaks or lack of clean water resulting from severe-weather events. States can also improve their participation in the Nurse Licensure Compact, which allows nurses to practice in states other than those in which they are licensed in order to meet emergency health care demands. “These can be done with low costs and little resources,” says Levi. “I think we’ve had enough climate events for people to be well aware that there is a need for [climate-change-adaptation plans]. Public-health organizations are thinking about this, but it’s now about making sure these are integrated in overall state plans.”

(MORE: Protection from Whooping-Cough Vaccine Wanes Over Time)

The report authors offer other recommendations for closing the gaps in health-emergency preparation such as providing ongoing support to communities coping with recovery from unexpected events, pushing for updates in the nation’s food-safety system, addressing antibiotic resistance and modernizing response and detection technologies.

Want to know where your state falls in public-health emergency responsiveness? Here is the list of state rankings:

  • 8 out of 10: Maryland, Mississippi, North Carolina, Vermont and Wisconsin
  • 7 out of 10: Alabama, Arkansas, California, Delaware, Nebraska, New Hampshire, New Mexico, New York, North Dakota and Virginia
  • 6 out of 10: Connecticut, Idaho, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Missouri, Ohio, Oklahoma, South Carolina, Tennessee, Utah, Washington and Wyoming
  • 5 out of 10: Alaska, Arizona, Washington, D.C., Florida, Illinois, Indiana, Michigan, Minnesota, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas and West Virginia
  • 4 out of 10: Colorado, Georgia, Hawaii, Nevada and New Jersey
  • 3 out of 10: Kansas and Montana