Ready or Not? 2011

Report Finds Preparedness for Bioterror and Health Emergencies Eroding in California

Cuts to Key Programs Could Hurt Ability to Detect and Respond to Crises

Washington, DC, December 20, 2011 – The Trust for America’s Health (TFAH) and Robert Wood Johnson Foundation (RWJF) released the ninth annual Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism today, which finds key California programs that detect and respond to bioterrorism, new disease outbreaks and natural or accidental disasters are at risk due to federal and state budget cuts.

Some key programs at risk due to continued cuts to federal public health emergency preparedness funds include:

  • 51 of the 72 cities, including Fresno, Riverside, Sacramento and San Jose, in the Cities Readiness Initiative are at risk for elimination; the Initiative supports the ability to rapidly distribute and administer vaccines and medications during emergencies;
  • California is one of 10 state labs at risk to lose “Level 1” chemical testing capabilities. This would leave the U.S. Centers for Disease Control and Prevention (CDC) with the only public health lab in the country with full ability to test for chemical terrorism and accidents;
  • 24 states, including California, are at risk for losing the support of Career Epidemiology Field Officers – CDC experts who supplement state and local gaps to rapidly prevent and respond to outbreaks and disasters, such as during the H1N1 flu pandemic and responding to the health impact of the Gulf Oil Spill in 2010;
  • Support for all of the nation’s preparedness research and training centers is at risk for elimination, including the University of California at Berkeley and Los Angeles; and
  • The ability for CDC to mount a comprehensive response to nuclear, radiologic and chemical threats as well as natural disasters is at risk due to potential cuts to the National Center for Environmental Health. All 50 states and Washington, D.C. would lose the support CDC provides during these emergencies.

At the state level over the past year, California cut public health funds by 5.1 percent. California is one of 15 states to cut funding for three years in a row.

“We’re seeing a decade’s worth of progress eroding in front of our eyes,” said Jeff Levi, PhD, Executive Director of TFAH. “Preparedness had been on an upward trajectory, but now some of the most elementary capabilities – including the ability to identify and contain outbreaks, provide vaccines and medications during emergencies, and treat people during mass traumas – are experiencing cuts in every state across the country.”

Combined federal, state and local budget cuts mean public health departments can no longer sustain a number of basic elements of preparedness. In the past year, 40 states and Washington, D.C. cut state public health funds – with 29 of those states and D.C. cutting their budgets for a second year in a row and 15 states for three years in a row. Federal funds for state and local preparedness declined by 38 percent from fiscal year (FY) 2005 to 2012 (adjusted for inflation) – and additional cuts are expected under budget sequestration.

“Americans expect the public health system to have the capability to competently protect their health during emergencies. This is not an optional service,” said Mel Kohn, MD, MPH, State Health Officer and Public Health Director of the Oregon Health Authority. “We will be unable to absorb reductions of this magnitude simply by finding efficiencies. We have reached the point where our ability to do this work will be seriously compromised, with life and death consequences.”

“During the anthrax attacks and Hurricane Katrina, we witnessed what happens when public health doesn’t have the technology, resources, workforce or training needed to respond to emergencies,” said James S. Marks, Senior Vice President and Director of the Health Group of RWJF. “The old adage is that it’s better to be safe than sorry. Unfortunately if we ignore preparedness now, we’ll be sorry later when the next emergency strikes.”

The report includes a series of recommendations that will be important for improving America’s preparedness, including:

  • Assuring dedicated funding and strengthening the public health preparedness core capabilities;
  • Improving biosurveillance to rapidly detect and track outbreaks or attacks;
  • Improving research, development and manufacturing of vaccines and medications;
  • Enhancing the ability to provide care for a mass influx of patients during emergencies;
  • Providing better support to help communities cope with and recover from disasters; and
  • Coordinating food safety with other preparedness efforts through the strategic implementation of the FDA Food Safety Modernization Act of 2011.

Detailed Findings Summary

The 51 cities at risk for elimination from the Cities Readiness Initiative include: Albany and Buffalo, NY; Albuquerque, NM; Anchorage, AK, Baltimore, MD; Baton Rouge and New Orleans, LA; Billings, MT; Birmingham, AL; Boise, ID; Burlington, VT; Charleston, WV; Charlotte, NC; Cheyenne, WY; Cincinnati and Columbus, OH; Columbia SC; Des Moines, IA: Dover, DE; Fargo, ND; Fresno, Riverside, Sacramento and San Jose, CA; Hartford and New Haven, CT; Honolulu, HI; Indianapolis, IN; Jackson, MS; Kansas City, MO: Little Rock, AR; Louisville, KY; Manchester, NH; Memphis and Nashville, TN; Milwaukee, WI; Oklahoma City, OK; Omaha, NE: Orlando and Tampa, FL; Peoria, IL; Portland, ME; Portland, OR; Providence, RI; Richmond and Virginia Beach, VA; Salt Lake City, UT; San Antonio, TX; Sioux Falls, SD; Trenton, NJ; Wichita, KS.

The 21 cities NOT at risk for elimination from the Cities Readiness Initiative include: Atlanta, GA; Boston, MA; Chicago, IL; Cleveland, OH; Dallas, TX; Denver, CO; Detroit, MI; District of Columbia; Houston, TX; Las Vegas, NV; Los Angeles, San Diego and San Francisco, CA; Miami, FL; Minneapolis, MN; New York City, NY; Philadelphia and Pittsburgh, PA; Phoenix, AZ; Seattle, WA; St. Louis, MO.

The 10 state labs at risk for losing “Level 1” chemical testing abilities: California, Florida, Massachusetts, Michigan, Minnesota, New Mexico, New York, South Carolina, Virginia, Wisconsin.

The 24 states at risk to lose Career Epidemiology Field Officers: Alabama, Arizona, California, Florida, Idaho, Kentucky, Maine, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New York, North Carolina, North Dakota, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Virginia, West Virginia, Wyoming.

The 14 universities at risk to lose Preparedness and Emergency Response Learning Center funds: Columbia University Mailman School of Public Health; Harvard University School of Public Health; Johns Hopkins University Bloomberg School of Public Health; Texas A&M School of Rural Public Health; University of Alabama at Birmingham School of Public Health; University of Albany SUNY School of Public Health; University of Arizona College of Public Health; University of Illinois at Chicago School of Public Health; University of Iowa College of Public Health; University of Minnesota School of Public Health; University of North Carolina Gillings School of Global Public Health; University of Oklahoma College of Public Health; University of South Florida College of Public Health; University of Washington School of Public Health.

The nine universities at risk to lose Preparedness and Emergency Response Research Center fund: Emory University; Harvard School of Public Health; Johns Hopkins University Bloomberg School of Public Health; University of California at Berkley and Los Angeles; University of Minnesota; University of North Carolina; university of Pittsburgh; University of Washington.

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