Issue Category: Environmental Health

Preparedness for Public Health Emergencies at Risk Amid Federal Funding and Workforce Instability, New Report Finds

Ready or Not 2026 finds wide variation in state preparedness and warns that federal disruption could weaken emergency readiness nationwide

(Washington, DC – May 7, 2026) – Amid deep federal staffing cuts, grant terminations, and other far-reaching changes to the federal public health system, a new report from Trust for America’s Health (TFAH) finds wide variation in states’ readiness for disease outbreaks, natural disasters, and other health emergencies. The report warns that national preparedness depends not only on state capacity, but also on strong and stable federal health and preparedness systems, sustained intergovernmental coordination, and long-term investment in public health infrastructure.

Ready or Not 2026: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism measures the nation’s readiness for public health emergencies through 10 indicators of state preparedness, including healthcare workforce mobility, state public health funding, laboratory surge planning, access to paid sick leave, and community water system safety. This year’s report also includes a special feature on how federal workforce reductions and funding instability could weaken preparedness nationwide.

“The nation faced the most severe flu season in nearly a decade, the highest annual measles case count since 1991, and devastating weather-related emergencies, even as federal public health funding, staffing, and operational support were destabilized,” said Dr. J. Nadine Gracia, President and CEO of TFAH. “These challenges make clear that emergency preparedness cannot rely on a patchwork of limited and unpredictable resources. Effective readiness requires strong federal leadership, stable investment, and coordinated action across states and communities, especially as the United States prepares to host matches during the 2026 World Cup.”

As TFAH marks its 25th anniversary, the report highlights how decades of federal investment, policy development, and programmatic progress helped build the preparedness systems now under strain. The report places states and the District of Columbia into three performance tiers for emergency preparedness: 20 states in the high-performance tier, 17 states and the District of Columbia in the middle-performance tier, and 13 states in the low-performance tier.

High-Performance Tier – 20 states

CA, CO, CT, DE, FL, IL, KS, MA, MD, ME, MT, NC, NH, NJ, PA, RI, UT, VA, VT, WI

Middle-Performance Tier – 17 states and the District of Columbia

AR, AZ, DC, GA, HI, ID, IN, LA, MO, ND, NE, NV, NY, OH, OR, SC, TN, WA

Low-Performance Tier – 13 states

AL, AK, IA, KY, MI, MN, MS, NM, OK, SD, TX, WV, WY

These benchmarks provide policymakers and health officials with a roadmap for strengthening emergency preparedness in their jurisdictions.

Other key findings from the report include:

Public Health Funding: Most states increased or maintained their public health funding in fiscal year 2025. At least 12 states reduced state public health funding.

Water Safety: On average, 6 percent of residents in each state were served by a community water system with at least one health-based violation, mainly concentrated in smaller, rural, and socioeconomically disadvantaged communities. A federal assessment also found critical or high-risk cybersecurity vulnerabilities in dozens of drinking water systems.

Seasonal Flu Vaccination: The percentage of U.S. residents who received a vaccination against influenza continued to decrease from pre-COVID-19 pandemic levels. The 2024-25 flu season saw the highest hospitalization rates since 2010–2011 and the most pediatric deaths in any non-pandemic season since reporting began in 2004.

Avoidable Mortality: Wide variation persists across states in deaths from preventable and treatable causes before age 75. Rates in the highest-burden states are more than twice those in the lowest. Racial and ethnic disparities compound these gaps in most states, and low overall rates do not necessarily indicate equitable outcomes.

Paid Sick Leave: Access to paid sick leave varies widely across U.S. regions—from 98 percent of workers in Pacific states to 67 percent in East South Central states—and gaps are most concentrated among low-wage, part-time, and service-sector workers. Paid sick leave reduces disease transmission, supports business continuity, and is increasingly recognized by employers as an important part of preparedness infrastructure.

Policy Recommendations for Improving Emergency Preparedness:

The report outlines steps the Administration, Congress and federal agencies should take to strengthen the nation’s health and economic security:

  • Provide stable, flexible, and sufficient funding for public health preparedness, workforce, and data modernization to help ensure every state has the systems needed to protect residents.
  • Restore the federal public health workforce and capabilities reduced in 2025.
  • Reauthorize the Pandemic and All-Hazards Preparedness Act.
  • Strengthen outbreak and pandemic readiness by supporting immunization, public health surveillance, and antimicrobial resistance efforts.
  • All levels of government should adopt strategies and accountability metrics to incorporate community resilience and health equity into preparedness.
  • Accelerate development, stockpiling, and distribution of vaccines, therapeutics, diagnostics, and other medical countermeasures.
  • Bolster healthcare system readiness, including cross-state credentialing and investment in Health Care Readiness programs.
  • Expand preparedness for extreme weather and environmental health threats.

 

Read the full report

 

Trust for America’s Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.

 

 

 

 

Seven Strategies to Support State-level Health-Promoting Policies

Reductions in federal and state funding, infrastructure, and workforce have reduced capacity for states to support communities’ health and wellbeing. With less federal support, states and localities will play an even more critical role in advancing health promoting policy.

However, state leaders and advocates face an increasingly complex policy environment to advance community health in the current landscape. As part of TFAH’s Promoting Health and Cost Control in States (PHACCS) initiative, we asked policy advocates and government staff from around the U.S. how national organizations and other non-federal partners can support efforts to advance policies and programs that can promote health and reduce healthcare spending.

The following summarizes those individuals’ responses, framed as opportunities for national-level partners to deepen their state engagement toward policy change.

Support Area 1: Increase funding for organizations, especially flexible use of funds.

Lack of flexible funding at federal, state, and local levels slows efforts to advance policy goals and address community needs. With federal funding in flux, support from philanthropic funders at community, state and national levels, as well as other national partners, can help address some of the funding gaps faced by community organizations.

National-level partners can:

  • Provide seed funds to jumpstart implementation efforts.
  • Educate grantees about how to maximize philanthropic funds for advocacy.
  • Support flexible funding mechanisms for advocacy organizations to address their structural needs.
  • Set realistic expectations for funding support through manageable timelines and goals.
  • Allow for greater flexibility in how funds can be used so that organizations can address needs specific to their community.

Support Area 2: Provide targeted technical assistance to organizations with a specific need or problem.

Even as national-level partners face their own challenges, they can also help those at the local level meet the moment, especially as local resources and staff time are more constrained. Partners can invest in people and communities who can do the work effectively.

National-level partners can:

  • Help organizations navigate the grant proposal process and identify relevant funding opportunities.
  • Assist resource-strained organizations with developing funding proposals.
  • Modify reporting requirements so that organizations can satisfy grant requirements and increase their chances for continued funding.
  • Provide policy support and advice, especially in a fast-changing policy environment.
  • Provide support for organizations to evaluate their work to demonstrate impact.

Support Area 3: Encourage capacity building that allows advocates to invest in people and communities who can do the work effectively.

Capacity building should inform community strategies to train and build skills for organizations to meet needs on their own and increase operational, programmatic, financial, or organizational capacity to advance their goals.  National-level partners can:

  • Ensure there is authentic power sharing between national and state/local advocacy groups or governments.
  • Build governance expertise by helping state/local advocacy groups or governments understand their legal authorities and identify legal and policy tools to promote health.
  • Help build coalitions and networking opportunities to enhance cross-sector collaboration and strengthen relationships.
  • Provide resources that share best practices and evidence-based strategies to promote health.
  • Offer advocacy skills, strategies, and tools to help state policy efforts gain bipartisan support.

Support Area 4: Invest in community power building that encourages deeper synergy between community, state/local government, and national partners. 

Partnering with states to advance policy strategies can ensure there is a deeper throughline with community, state/local government, and national partners. National-level partners can:

  • Develop tools to guide community power building by centering community needs.
  • Incorporate community engagement efforts into funding.
  • Help build political electoral power at state levels to harness and leverage community power to advance local, community-driven policy solutions.
  • Help disengaged community members see systemic issues as solvable.
  • Reframe wins and losses as steps for a long-term agenda to avoid burnout and create a culture of well-being.

Support Area 5: Ensure better access to and use of data and research, especially to inform stories for both decisionmakers and residents.

Even with greater mistrust in data, science, and evidence, national partners should continue supporting advocates in accessing readily available and easily interpretable data and research to build a case for evidence-based policy. National-level partners can:

  • Improve the data and evidence base, considering how data is collected and shared back with communities.
  • Ensure accountability for data sovereignty for Tribal nations and state relationships.
  • Use local research and local examples of successful policy adoption and implementation to demonstrate the possibilities and benefits of pursuing a health-promoting policy.
  • Provide support to ensure that quantitative data is paired with lived experience narratives to provide context for advocacy.

Support Area 6: Exercise empathy and awareness about the challenges faced by states and localities. 

States and localities can feel isolated and misunderstood, especially as they face unique challenges amid evolving political and funding environments. To ensure states and localities feel heard and understood, national-level partners can:

  • Recognize and acknowledge unique state and local challenges.
  • Allow flexibility in reporting requirements and language, especially as some entities may be less able to pursue explicitly equity-focused efforts.
  • Help partners build an advocacy case by sharing successful efforts and lessons learned by similar states or localities.
  • Recognize the need to balance national and state and local expertise, knowing when to share leadership responsibilities in leading local efforts to advance policy.

Support Area 7: Maintain and nurture effective collaboration with partners to advance policy.

National-level organizations are uniquely positioned to help state entities identify partners to advance policy. Specifically, national groups can help build opportunities for brainstorming, collaboration and peer learning. To support collaboration, national-level partners can:

  • Create spaces for state and local leaders to share and amplify their stories.
  • Ensure authentic partnerships that offer equitable support for community partners.
  • Use their convening power and knowledge of the field to identify a unifying goal and vision for the future.
  • Provide resources for organizations and government partners to collaborate with others in similar states, political environments, and regions.

TFAH Reflections on the 20-year Anniversary of Hurricane Katrina

(Washington, DC – August 29, 2025) – This week marks 20 years since Hurricane Katrina hit the Gulf Coast and devastated communities in Louisiana, especially New Orleans and its surrounding areas, Mississippi, and other Gulf Coast states, including Alabama and Florida. Tragically, nearly 1,400 lives were lost in the storm. Entire areas were destroyed. Some neighborhoods, which are mostly historically Black or low-income, still haven’t fully recovered from the disaster. This somber milestone should serve as a reminder for government at every level to make necessary and consistent investments in the nation’s emergency preparedness capabilities. Extreme weather events have increased in frequency and intensity since the Category 5 storm ripped through the Gulf Coast in 2005. The lasting and often disparate impacts on the health, economy, and ecology of the region are a call to action that we must be better prepared for future emergencies.

We recognize that many jurisdictions have improved their public health infrastructure and preparedness over the last two decades, with support from the Centers for Disease Control and Prevention, the Administration for Strategic Preparedness and Response, and other federal agencies. TFAH’s annual report, Ready or Not: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, has chronicled this progress. But we’ve also found more work is needed to ensure every community is prepared. Furthermore, much of the progress that has been achieved is now at risk due to proposed cuts in federal support for the public health workforce and outbreak prevention and preparedness programs.

The loss of entire swaths of neighborhoods due to extreme weather events is unacceptable. This is a shared responsibility. The federal government has an important leadership role to play in emergency readiness and response. Federal, state, and local governments should collaborate with each other and with trusted local organizations and leaders to safeguard every community.

Hurricane Katrina showed us that our most under-resourced communities must be a focus of and have a role in emergency planning. Failure to do so will not only exacerbate health and economic disparities but will also have a ripple effect on the entire community’s ability to thrive.

TFAH’s Ready or Not report outlines specific policy recommendations for strengthening the nation’s preparedness. We encourage policymakers to act on these recommendations and make the necessary investments to safeguard our communities.

 

 

 

 

 

The Nation’s Public Health System is at an Inflection Point

New Report Provides the Next Administration and Congress a Policy Roadmap for Improving the Nation’s Health, Economy, and National Security

(October 8, 2024 – Washington, DC) – The public health system—responsible for protecting and promoting health in every community— needs sustained investment, policy support, and protection from political interference, according to a new report released today by Trust for America’s Health.

The report, Pathway to a Healthier America: A Blueprint for Strengthening Public Health for the Next Administration and Congress, identifies six priority areas and includes policy recommendations that, if adopted, will improve health outcomes and bolster the nation’s economic and national security.

Americans are living longer, thanks in part to public health. Public health interventions, such as improved sanitation, enhanced vaccination access and stronger infectious disease control, improved nutrition, tobacco use prevention, and addressing preventable injury, were the largest contributing factors to life expectancy increases over the last century.

However, too many Americans are still suffering from preventable health problems. Over the last few decades, increasing rates of chronic diseases and alarming levels of substance use disorder and suicides threaten the public’s health. Furthermore, weather-related emergencies are occurring more frequently, and population-level health disparities persist.

Public health is at risk on several fronts. Underfunding has weakened the public health infrastructure and its workforce. Mis- and disinformation and politicization have contributed to distrust of public health officials and guidance. Public health’s ability to protect communities is also at risk due to proposed or enacted policies that undermine the role of public health officials or access to preventive healthcare.

“This Blueprint Report provides a roadmap for the Administration and Congress taking office in January to improve the health and well-being of the nation. We know what works in public health and that when Congress and the Administration act in support of public health, the return is improved preparedness and individual and community health and safety,” said J. Nadine Gracia, M.D. MSCE, President and CEO, Trust for America’s Health. “The next Administration and Congress will have an important opportunity to enable all Americans to enjoy optimal health.”

2024 Blueprint Priority Areas and Highlighted Recommendations

This report includes recommendations across six priority areas to protect and strengthen public health, prevention, and our nation’s health security. The following are highlighted recommendations from the report. See the report for the inclusive set of recommendations.

Priority 1: Invest in Infrastructure and Workforce to Ensure Our Public Health System Can Meet the Challenges and Opportunities of the 21st Century.

  • Congress should protect and increase overall funding for the Centers for Disease Control and Prevention (CDC).
  • Congress should ensure continuous improvement of public health infrastructure.
  • Congress should invest in public health data modernization and enact the Improving DATA in Public Health Act to better detect and contain health threats.
  • Congress and HHS agencies should support efforts to bolster recruitment, retention, and resilience of the public health workforce.

Priority 2: Strengthen Prevention, Readiness, and Response to Health Security Threats.

  • The White House should maintain coordination and leadership around public health emergencies and biodefense, and the White House and Congress should renew the nation’s Global Health Security Commitment.
  • Congress should expand public health emergency preparedness funding for state, tribal, local, and territorial jurisdictions.
  • Congress and the Administration for Strategic Preparedness and Response should strengthen the emergency readiness of the healthcare delivery system.
  • Congress should enact legislation to ensure access to vaccines for uninsured and underinsured adults.
  • Congress should support nationwide efforts to protect against environmental and climate-related health threats, including extreme heat.

Priority 3: Promote the Health and Well-being of Individuals, Families, and Communities Across the Lifespan.

  • Congress should increase funding to CDC’s National Center for Chronic Disease Prevention and Health Promotion.
  • Congress should enhance benefits in and protect access to the Supplemental Nutrition Assistance Program and should make healthy school meals for all permanent.
  • Congress should create a national standard requiring employers to provide job-protected paid sick, family, and medical leave for all employees.
  • Congress and HHS should address Adverse Childhood Experiences (ACEs) by passing the Preventing Adverse Childhood Experiences Act and increasing the investment in the CDC ACEs program.
  • Congress should fund the nationwide implementation of CDC’s Comprehensive Suicide Prevention Program and support Substance Abuse and Mental Health Services Administration’s efforts to bolster the continuum of crisis care.
  • Congress and the Administration should fund CDC’s internal capacity for healthy aging efforts and its support to build and sustain age-friendly public health systems in state, local, tribal, and territorial public health departments.

Priority 4: Advance Health Equity by Addressing Structural Discrimination.

  • Federal agencies should regularly update and report progress on agency equity plans, ensuring metrics are inclusive of and extend beyond tracking disparities.
  • Congress and the Administration should ensure accurate and complete data collection to report health-related information by race/ethnicity, age, sex, disability, language, sexual orientation, gender identity, and geography.
  • Federal health agencies should focus funding on populations at elevated risk for chronic disease and poor health outcomes due to the impact of structural discrimination and disinvestment.

Priority 5: Address the Non-Medical Drivers of Health to Improve the Nation’s Health Outcomes.

  • Congress should increase funding to $150 million for the Social Determinants of Health program at CDC and pass the Improving Social Determinants of Health Act.
  • The Administration should continue to build on the Centers for Medicare & Medicaid Services’ (CMS) efforts to support Medicaid, Medicare, and Children’s Health Insurance Program coverage of patients’ health-related social needs.
  • CMS and Congress should explore opportunities to expand the capacity of healthcare providers and payers to screen and refer individuals to social services.
  • Congress should amend tax laws to increase economic opportunity for families by expanding access to the Child Tax Credit and Earned Income Tax Credit.

Priority 6: Enhance and Protect the Scientific Integrity, Effectiveness, and Accountability of the Agencies Charged with Protecting the Health of all Americans.

  • The Administration and Congress should maintain the existing structure of federal health agencies, which have specific roles and expertise in protecting the nation’s health.
  • The Administration should protect the scientific integrity of public health agencies and leaders.
  • Congress and HHS should invest in and prioritize effective public health communications and reducing the spread of misinformation and disinformation.
  • Lawmakers and courts should reject laws that weaken or preempt public health authorities, which could threaten basic public health protections such as outbreak detection, vaccination, and response.

 

Read the full report

Trust for America’s Health is a nonprofit, nonpartisan public health research, policy, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.