Ready or Not 2010

Nation Scored N/A out of Ten Key Indicators for Emergency Health Preparedness in New Report

Report Finds States Achieve Highest Ever Scores for Public Health Preparedness, But Progress Threatened by Budget Cuts

Washington, D.C., December 14, 2010 – In the eighth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism report, Nation achieved N/A out of 10 key indicators of public health emergency preparedness. Overall, states achieved the highest scores ever for health emergency preparedness with 14 states scoring nine or higher. Three states (Arkansas, North Dakota, and Washington State) scored 10 out of 10. Another 25 states and Washington, D.C. scored in the 7 to 8 range. No state scored lower than a five

The scores reflect nearly ten years of progress to improve how the nation prevents, identifies, and contains new disease outbreaks and bioterrorism threats and responds to the aftermath of natural disasters in the wake of the September 11, 2001 and anthrax tragedies. In addition, the real-world experience responding to the H1N1 flu pandemic – supported by emergency supplemental funding – also helped bring preparedness to the next level.

However the Ready or Not? report, released today by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation notes that the almost decade of gains is in real jeopardy due to severe budget cuts by federal, state, and local governments. The economic climate change has led to cuts in public health staffing and basic capabilities, which are needed to successfully respond to crises. Thirty-three states and Washington, D.C. cut public health funding from fiscal years (FY) 2008-09 to 2009-10, with 18 of these states cutting funding for the second year in a row. The report also notes that just eight states (Alabama, Arkansas, Kentucky, Nebraska, North Dakota, South Dakota, Texas, and West Virginia) have increased funding for two or more consecutive years.

Nation N/A its public health budget from FY 2008-09 to 2009-10N/A. The Center on Budget and Policy Priorities has found that states have experienced overall budgetary shortfalls of $425 billion since FY 2009.

In addition to state cuts, federal support for public health preparedness has been cut by 27 percent since FY 2005 (adjusted for inflation). Local public health departments report losing 23,000 jobs – totaling 15 percent of the local public health workforce – since January 2008. The impact of the recession were not as drastically felt by public health until more recently because of supplemental funds received to support the H1N1 pandemic flu response and from the American Recovery and Reinvestment Act.

“There is an emergency for emergency health preparedness in the United States,” said Jeff Levi, PhD, Executive Director of TFAH. “This year, the Great Recession is taking its toll on emergency health preparedness. Unfortunately, the recent and continued budget cuts will exacerbate the vulnerable areas in U.S. crisis response capabilities and have the potential to reverse the progress we have made over the last decade.”

No. Indicator Nation Number of States Receiving Points
A checkmark means the state received a point for that indicator
1 Funding Commitment – Did the state maintain or increase funding for public health programs from FY 2008-09 to FY 2009-2010? N/A 17
2 Health Information Technology – Does the state currently send and receive electronic health information to health care providers and community health centers? N/A 43 and D.C.
3 Electronic Syndromic Surveillance – Does the state health department have an electronic syndromic surveillance system that can report and exchange information? N/A 40 and D.C.
4 Incident Response Capacity – Did the state acknowledge pre-identified staff of emergency exercises or incidents within the target time of 60 minutes at least twice during 2007-08? N/A 44 and D.C.
5 Emergency Operations Center (EOC) – Did the state public health department activate its EOC as part of a drill, exercise, or real incident a minimum of two times in 2007-08? N/A 44 and D.C.
6 After Action Reports – Did the state develop at least two After-Action Report/Improvement Plans (AAR/IPs) after exercise or real incident in 2007-08? N/A 48 and D.C.
7 Community Resilience – Children and Preparedness – Does the state require all licensed child care facilities to have a multi-hazard written evacuation and relocation plan? N/A 25 and D.C.
8 Foodborne disease detection and reporting – Was the state able to rapidly identify disease-causing E.coli O157:H7 and submit results by PulseNet within four working days 90% of the time? N/A 29
9 Public Health Laboratories – Surge Workforce – Does the state have the necessary lab workforce staffing to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A H1N1? N/A 47
10 Public Health Laboratories – Did the state increase Laboratory Response Network for Chemical Treat (LRN-C) capability? N/A 49 and D.C.
Total N/A

Note: Indicators 4, 5, 6, and 8 are based on findings from a recently released report from the U.S. Centers for Disease Control and Prevention (CDC) based on activities in 2007-08.


According to the report, while states have made progress, there are still a series of major ongoing gaps in preparedness, including in basic infrastructure and funding, biosurveillance, maintaining an adequate and expertly trained workforce, developing and manufacturing vaccines and medicines, surge capacity for providing care in major emergencies, and helping communities cope with and recover from emergencies.

Ready or Not? provides a series of recommendations that address the ongoing major gaps in emergency health preparedness, including:

  • Gaps in Funding and Infrastructure:The resources required to truly modernize public heath systems must be made available to bring public health into 21st century and improve preparedness;
  • A Surveillance Gap: The United States lacks an integrated, national approach to biosurveillance, and there are major variations in how quickly states collect and report data which hamper bioterrorism and disease outbreak response capabilities;
  • A Workforce Gap: The United States has 50,000 fewer public health workers than it did 20 years ago – and one-third of current workers are eligible to retire within five years. Policies must be supported that ensure there are a sufficient number of adequately trained public health experts – including epidemiologists, physicians, nurses, and other workers – to respond to all threats to the public’s health;
  • Gaps in Vaccine and Pharmaceutical Research, Development, and Manufacturing: The United States must improve the research and development of vaccines and medications;
  • A Surge Capacity Gap: In the event of a major disease outbreak or attack, the public health and health care systems would be severely overstretched. Policymakers must address the ability of the health care system to quickly expand beyond normal services during a major emergency;
  • Gaps in Community Resiliency Support: The United States must close the existing day-to-day gaps in public health departments which make it difficult to identify and service the most vulnerable Americans, who often need the most help during emergencies.

According to James Marks, Senior Vice President and Director of the Health Group at the Robert Wood Johnson Foundation, the gaps that remain and the risks of loss of our nation’s ability to respond during emergencies call out for an ongoing investment to rebuild and modernize our public health system. “This report makes it clear that not enough Americans are protected against health emergencies. And those whose health departments have done a good job preparing are at great risk of losing ground. The American public needs to know if their state and local health agency has the resources and expertise to respond to any health crisis. Detecting weaknesses and identifying how to fix those are why independent accreditation with specific, measurable standards of quality and performance are so critical to helping the public and their leaders know what more is needed to protect their families and communities.”

Score Summary:

A full list of all of the indicators and scores and the full report are available on TFAH’s web site at and RWJF’s Web site at 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.

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