Ready or Not? 2008

New Report: Illinois Earns Grade of 7 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.

Illinois achieved 7 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 Illinois 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 Y 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 Y 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 N/A 26
4 State public health lab can meet the expectations of the state’s pandemic flu plan Y 47 and D.C.
5 Uses a disease surveillance system that is compatible with CDC’s National Electronic Disease Surveillance System (NEDSS) Y 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 Y 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 N/A 24 and D.C.
8 State has a Medical Reserve Corps Coordinator Y 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 N/A 30
10 Increased or maintained level of funding for public health services from FY 2006-07 to FY 2007-08 Y 39
Total 7

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 and RWJF’s Web site at 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