Issue Category: Public Health Preparedness

Ready or Not? 2009

New Report: «state» Scored «Score» out of 10 Key Indicators for Emergency Health Preparedness; New Report Finds H1N1 Reveals Gaps in Readiness

Washington, D.C., December 15, 2009 – The seventh annual Ready or Not? Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism report, released today by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), found that the H1N1 flu outbreak has exposed serious underlying gaps in the nation’s ability to respond to public health emergencies and that the economic crisis is straining an already fragile public health system.

«state» achieved «Score» out of 10 key indicators of public health emergency preparedness.

Overall, the report found that 20 states scored six or less out of 10 key indicators of public health emergency preparedness. Nearly two-thirds of states scored seven or less. Eight states tied for the highest score of nine out of 10: Arkansas, Delaware, New York, North Carolina, North Dakota, Oklahoma, Texas, and Vermont. Montana had the lowest score at three out of 10. The preparedness indicators are developed in consultation with leading public health experts based on data from publicly available sources or information provided by public officials.

“The H1N1 outbreak has vividly revealed existing gaps in public health emergency preparedness,” said Richard Hamburg, Deputy Director of TFAH. “The Ready or Not? report shows that a band-aid approach to public health is inadequate. As the second wave of H1N1 starts to dissipate, it doesn’t mean we can let down our defenses. In fact, it’s time to double down and provide a sustained investment in the underlying infrastructure, so we will be prepared for the next emergency and the one after that.”

Overall, the report found that the investments made in pandemic and public health preparedness over the past several years dramatically improved U.S. readiness for the H1N1 outbreak. But it also found that decades of chronic underfunding meant that many core systems were not at-the-ready. Some key infrastructure concerns were a lack of real-time coordinated disease surveillance and laboratory testing, outdated vaccine production capabilities, limited hospital surge capacity, and a shrinking public health workforce. In addition, the report found that more than half of states experienced cuts to their public health funding and federal preparedness funds have been cut by 27 percent since fiscal year (FY) 2005, which puts improvements that have been made since the September 11, 2001 tragedies at risk.

No. Indicator «state» Number of States Receiving Points
A checkmark means the state received a point for that indicator
1 Purchased 50 percent or more of its share of federally-subsidized antiviral medications to prepare for a potential pandemic flu outbreak «Indicator1» 37 and D.C.
2 Submitted data on available hospital beds weekly for at least 50 percent of the facilities within the state to the U.S. Department of Health and Human Services during the 2009 H1N1 response. «Indicator2» 40
3 Public health lab has the capacity in place to assure the timely pick-up and delivery of disease samples on a 24/7, 365 day basis. «asterisk_wa» «Indicator3» 36 and D.C.
4 Public health lab reports having enough staff to work the intense hours needed during an emergency, like H1N1 (five, 12-hour days for six to eight weeks). «Indicator4» 39
5 Tracks diseases through an Internet system used by the CDC. «Indicator5» 44 and D.C.
6 Identified the pathogen responsible for reported food-borne disease outbreaks at a rate that met or exceeded the national average of 46 percent (combined data 2005-2007). «Indicator6» 36 and D.C.
7 Meets the Medical Reserve Corps (MRC) readiness criteria for medical volunteers during an emergency. «Indicator7» 41 and D.C.
8 Requires all licensed childcare facilities to have a multi-hazard written evacuation and relocation plan for emergencies, and verification that the laws are implemented. «Indicator8» 20 and D.C.
9 Has a law or legal opinion in place to limit liability against organizations that provide volunteer help during emergencies. «asterisk_hi» «Indicator9» 33 and D.C.
10 Increased or maintained level of funding for public health services from FY 2007-08 to FY 2008-09 «Indicator10» 23 and D.C.
Total «Score»

«footnote»

“State and local health departments around the country are being asked to do more with less during the H1N1 outbreak as budgets continue to be stretched beyond their limits,” said Michelle Larkin, J.D., Public Health Team Director and Senior Program Officer at the Robert Wood Johnson Foundation. “Public health provides essential prevention and preparedness services that help us lead healthier lives — without sustained and stable funding, Americans will continue to be needlessly at risk from the next public health threat.”

The report also offers a series of recommendations for improving preparedness, including:

  • Ensure Stable and Sufficient Funding. The 27 percent cut to federal support for public health preparedness since FY 2005 must be restored, and funding must be stabilized at a sufficient level to support core activities and emergency planning. Increased funding must also be provided to modernize flu vaccine production, improve vaccine and antiviral research and development, and fully support the Hospital Preparedness Program.
  • Conduct an H1N1 After-Action Report and Update Preparedness Plans with Lessons Learned. Strengths and weaknesses of the H1N1 response should be evaluated and used to revise and strengthen federal, state, and local preparedness planning, including assessing what additional resources are needed to be sufficiently prepared. Identified gaps in core systems, including communications, surveillance, and laboratories much be addressed. In addition, continued surge capacity concerns, including establishing crisis standards of care, must be addressed.
  • Increase Accountability and Transparency. Federal and state health departments should regularly make updates on progress made on benchmarks and deliverables identified in the Pandemic and All Hazards Preparedness Act available to the public so they can see how tax dollars are being used and how well protected their communities are from health threats.
  • Improve Community Preparedness. Additional measures must be taken to reach out quickly and effectively to high-risk populations, including strengthening culturally competent communications around the safety of vaccines. Health disparities among low-income and racial/ethnic minorities, who are often at higher risk during emergencies, must also be addressed.

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s web site at www.healthyamericans.org and RWJF’s Web site at www.rwjf.org. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials.

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

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need–the Foundation expects to make a difference in our lifetime. For more information, visit rwjf.org

Health Problems Heat Up: Climate Change and the Public’s Health

«state» «haveNotHave»

Media Contact: Laura Segal (202) 223-9870 x 27 or [email protected].

(October 26, 2009, Washington, DC) — Trust for America’s Health (TFAH) released a new report today that finds only five states have published a strategic climate change plan that includes a public health response. The five states include California, Maryland, New Hampshire, Virginia, and Washington. This includes planning for health challenges and emergencies expected to develop from natural disasters, pollution, and infectious diseases as temperatures and sea levels rise.

Twenty-eight additional states«haveaplan» have published a strategic climate change plan, but the plan does not include a public health response to climate change. Seventeen states«donthaveaplan» have not published a strategic climate change plan.

The Health Problems Heat Up: Climate Change and the Public’s Health report examines U.S. planning for changing health threats posed by climate change, such as heat-related sickness, respiratory infections, natural disasters, changes to the food supply, and infectious diseases carried by insects.

“The changing environment has serious ramifications for our health,” said Jeff Levi, PhD, Executive Director of TFAH. “In the near future, more extreme weather events, rising temperatures, and worsening air quality mean we’ll see an upswing in climate-related illnesses and injuries. As countries around the world work to address climate change, federal, state, and local governments around the United States need to ramp up activities to protect people from the harms it poses to our health.”

“States are already overwhelmed by existing public health responsibilities, so we face a serious challenge as we see these new climate change related problems on the horizon. States and communities will need more resources to effectively plan and prepare for them,” Levi continued.

The report contains a number of state-based indicators related to efforts in the state or federal funding the state has received to prepare for public health implications of climate change.

«state»: Climate Change Public Health Indicators
1. Is «state» one of five states that have published a climate change plan detailing the role of public health in preventing and preparing for climate change? «publicRole»
2. Is «state» one of 12 states that have a climate change commission or advisory panel that includes a representative from the state department of public health? «stateCommission»
3. Is «state» one of 22 states that received grants from the U.S. Centers for Disease Control and Prevention (CDC) for Environmental Health Tracking in 2009? «cdcEnvironmental»
4. Is «state» one of 33 states that received grants from the CDC for asthma prevention in 2009? «cdcAsthma»
5. Is «state» one of 49 states that received funding for an Arbovirus Vector-borne Disease Surveillance System (ArboNET) — used to track diseases spread through mosquitoes and other insects — in 2009? «arbovirus»

According to Health Problems Heat Up, communities across the United States are at-risk for negative health effects associated with climate change. Urban communities face natural disasters, such as floods and heat waves. Rural communities may be threatened by food insecurity due to shifts in crop growing conditions, reduced water resources, heat, and storm damage. Costal and low-lying areas could see an increase in floods, hurricanes, and tropical storms. Mountain regions are at risk of increasing heat and vector-borne diseases due to the melting of mountain glaciers and changes in snow melt. And communities around the country could experience new insect-based infectious diseases that used to only be affiliated with high temperature regions.

The report contains a series of policy recommendations, including:

  • Congress should provide funding for state and local health departments to conduct needs assessments and strategic planning for public health considerations of climate change;
  • The White House and the federal interagency working group on climate change should take into account the potential health implications of policies and programs under consideration;
  • Congress should increase support for tracking of environmental effects on health and research into the health effects of climate change;
  • CDC should set national guidelines and measures for core public health functions related to climate change, and in exchange for federal funding for climate change planning and response, CDC should require states and localities to report the findings to both the public and the federal government;
  • All state and local health departments should include public health considerations as part of climate change plans, including conducting needs assessments, developing strategic plans, and creating public education campaigns; and
  • Special efforts must be made to address the impact of climate change on at-risk and vulnerable communities.

The U.S. Senate is in the process of developing comprehensive climate change legislation. The U.S. House of Representatives recently passed a climate change bill that would direct the U.S. Secretary of Health and Human Services to create a national strategic action plan on climate change. This plan would encourage health professionals to prepare for and respond to the impact of climate change on public health in the United States and globally. The House bill also includes a Climate Change Health Protection and Promotion Fund to provide the funds needed to develop and carry out the strategic plan.

The full Health Problems Heat Up report, including state-specific information, is available on TFAH’s web site www.healthyamericans.org. The report was supported by a grant from The Pew Environment Group, which is the conservation arm of The Pew Charitable Trusts.

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Ready or Not? 2008

New Report: «state» Earns Grade of «Score» out of 10 on Disaster Preparedness

Economic Crisis Hurting U.S. Preparedness for Health Emergencies; More Than Half of States Score 7 or Lower out of 10 in Readiness Rankings

Washington, D.C., December 9, 2008 – Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) today 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.

«state» achieved «Score» out of 10 possible indicators for health emergency preparedness capabilities. More than half of states and D.C. achieved a score of seven or less out of 10 key indicators. Louisiana, New Hampshire, North Carolina, Virginia, and Wisconsin scored highest with 10 out of 10. Arizona, Connecticut, Florida, Maryland, Montana, and Nebraska tied for the lowest score with five out of 10.

Over the past six years, the Ready or Not? report has documented steady progress toward improved public health preparedness. This year however, TFAH found that federal funding for state and local preparedness has been cut 25 percent since 2005, and that these cut backs coupled with the cuts states are making to their budgets in response to the economic crisis, put that progress at risk. In the coming year, according to the Center on Budget and Policy Priorities, 33 states are facing shortfalls in the 2009 budgets and 16 states are already projecting shortfalls to their 2010 budgets.

“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, PhD, Executive Director of TFAH. “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 preparedness scores for all 50 states and Washington, D.C. States received one point for each indicator they achieved and zero points for each indicator they did not achieve, therefore zero is the lowest possible overall score and 10 the highest. Data for the public health indicators were collected from publicly available sources or public officials in 2007.

Indicator «state» Number of States Receiving Points
A checkmark means the state received a point for that indicator
1 Has adequate plans to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile «Indicator1» 50 and D.C.
2 Purchased 50 percent or more of its share of federally-subsidized antiviral medications to prepare for a potential pandemic flu outbreak «Indicator2» 34 and D.C.
3 Public health lab has an intra-state courier system that operates 24 hours a day for specimen pick up and delivery «Indicator3» 26
4 State public health lab can meet the expectations of the state’s pandemic flu plan «Indicator4» 47 and D.C.
5 Uses a disease surveillance system that is compatible with CDC’s National Electronic Disease Surveillance System (NEDSS) «Indicator5» 44 and D.C.
6 Has laws that reduce or limit the liability exposure for health care volunteers who serve in a public health emergency «Indicator6» 42 and D.C.
7 Has laws that reduce or limit the liability for businesses and non-profit organizations that serve in a public health emergency «Indicator7» 24 and D.C.
8 State has a Medical Reserve Corps Coordinator «Indicator8» 34* and D.C.
9 State identified the pathogen responsible for reported foodborne disease outbreaks at a rate that met or exceeded the national average of 44 percent «Indicator9» 30
10 Increased or maintained level of funding for public health services from FY 2006-07 to FY 2007-08 «Indicator10» 39
Total «Score»

Some serious 2008 health emergencies include a Salmonella outbreak in jalapeno and Serrano peppers that sickened 1,442 people in 43 states, the largest beef recall in history in February, Hurricanes Gustav and Ike, severe flooding in the Midwest, major wildfires in California in June and November, and a ricin scare in Las Vegas.

“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 the Robert Wood Johnson Foundation. “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 also offers a series of recommendations for improving preparedness, including:

  • Restoring Full Funding. At a minimum, federal, state, and local funding for public health emergency preparedness capabilities should be restored to FY 2005 levels.
  • Strengthening 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.
  • Enhancing 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.
  • Modernizing Technology and Equipment. Communications and surveillance systems and laboratories need increased resources for modernization.
  • Improving Community Engagement. Additional measures must be taken to engage communities in emergency planning and to improve protections for at-risk communities.
  • Incorporating Preparedness into Health Care Reform and Creating 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.

Score Summary:

For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest. The data for the indicators are from publicly available sources or were provided from public officials. More information on each indicator is available in the full report on TFAH’s Web site at www.healthyamericans.org and RWJF’s Web site at www.rwjf.org. The report was supported by a grant from RWJF.

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

*Note: Arkansas’s score has been revised. The state provided information confirming they have a Medical Reserve Corps Coordinator after the original release of the report.

Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need–the Foundation expects to make a difference in our lifetime. For more information, visit rwjf.org