Half of States Scored 5 or Lower Out of 10 Indicators in Report on Health Emergency Preparedness

Report Finds Funding to Support Base Level of Preparedness Cut More than Half Since 2002

 

Washington, D.C., December 19, 2017 – In Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, 25 states scored a 5 or lower on 10 key indicators of public health preparedness. Alaska scored lowest at 2 out of 10, and Massachusetts and Rhode Island scored the highest at 9 out of 10.

The report, issued today by the Trust for America’s Health (TFAH), found the country does not invest enough to maintain strong, basic core capabilities for health security readiness and, instead, is in a continued state of inefficiently reacting with federal emergency supplemental funding packages each time a disaster strikes.

According to Ready or Not?, federal funding to support the base level of preparedness has been cut by more than half since 2002, which has eroded advancements and reduced the country’s capabilities.

“While we’ve seen great public health preparedness advances, often at the state and community level, progress is continually stilted, halted and uneven,” said John Auerbach, president and CEO of TFAH.  “As a nation, we—year after year—fail to fully support public health and preparedness. If we don’t improve our baseline funding and capabilities, we’ll continue to be caught completely off-guard when hurricanes, wildfires and infectious disease outbreaks hit.”

Ready or Not? features six expert commentaries from public health officials who share perspectives on and experiences from the historic hurricanes, wildfires and other events of 2017, including from California, Florida, Louisiana and Texas.

The report also examines the nation’s ability to respond to public health emergencies, tracks progress and vulnerabilities, and includes a review of state and federal public health preparedness policies. Some key findings include:

  • Just 19 states and Washington, D.C. increased or maintained funding for public health from Fiscal Year (FY) 2015-2016 to FY 2016-2017.
  • The primary source for state and local preparedness for health emergencies has been cut by about one-third (from $940 million in FY 2002 to $667 million in FY 2017) and hospital emergency preparedness funds have been cut in half ($514 million in FY 2003 to $254 million in FY 2017).
  • In 20 states and Washington, D.C. 70 percent or more of hospitals reported meeting Antibiotic Stewardship Program core elements in 2016.
  • Just 20 states vaccinated at least half of their population (ages 6 months and older) for the seasonal flu from Fall 2016 to Spring 2017—and no state was above 56 percent.
  • 47 state labs and Washington, D.C. provided biosafety training and/or provided information about biosafety training courses (July 1, 2016 to June 30, 2017).

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

  • Communities should maintain a key set of foundational capabilities and focus on performance outcomes in exchange for increased flexibility and reduced bureaucracy.
  • Ensuring stable, sufficient health emergency preparedness funding to maintain a standing set of core capabilities so they are ready when needed. In addition, a complementary Public Health Emergency Fund is needed to provide immediate surge funding for specific action for major emerging threats.
  • Strengthening and maintaining consistent support for global health security as an effective strategy for preventing and controlling health crises. Germs know no borders.
  • Innovating and modernizing infrastructure needs – including a more focused investment strategy to support science and technology upgrades that leverage recent breakthroughs and hold the promise of transforming the nation’s ability to promptly detect and contain disease outbreaks and respond to other health emergencies.
  • Recruiting and training a next generation public health workforce with expert scientific abilities to harness and use technological advances along with critical thinking and management skills to serve as Chief Health Strategist for a community.
  • Reconsidering health system preparedness for new threats and mass outbreaks.  Develop stronger coalitions and partnerships among providers, hospitals and healthcare facilities, insurance providers, pharmaceutical and health equipment businesses, emergency management and public health agencies.
  • Preventing the negative health consequences of climate change and weather-related threats. It is essential to build the capacity to anticipate, plan for and respond to climate-related events.
  • Prioritizing efforts to address one of the most serious threats to human health by expanding efforts to stop superbugs and antibiotic resistance. 
  • Improving rates of vaccinations for children and adults – which are one of the most effective public health tools against many infectious diseases.
  • Supporting a culture of resilience so all communities are better prepared to cope with and recover from emergencies, particularly focusing on those who are most vulnerable.   Sometimes the aftermath of an emergency situation may be more harmful than the initial event.  This must also include support for local organizations and small businesses to prepare for and to respond to emergencies.

The report was supported by a grant from the Robert Wood Johnson Foundation (RWJF).

Score Summary: 

A full list of all of the indicators and scores and the full report are available on TFAH’s website.  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: Massachusetts and Rhode Island

8 out of 10: Delaware, North Carolina and Virginia

7 out of 10: Arizona, Colorado, Connecticut, Hawaii, Minnesota, New York, Oregon and Washington

6 out of 10: California, District of Columbia, Florida, Illinois, Maryland, Nebraska, New Jersey, North Dakota, South Carolina, South Dakota, Utah, Vermont and West Virginia

5 out of 10: Georgia, Idaho, Maine, Mississippi, Montana and Tennessee

4 out of 10: Alabama, Arkansas, Iowa, Louisiana, Missouri, New Hampshire, Oklahoma and Pennsylvania

3 out of 10: Indiana, Kansas, Kentucky, Michigan, Nevada, New Mexico, Ohio, Texas, Wisconsin and Wyoming

2 out of 10: Alaska

 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.

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The Salt Lake Metropolitan Area: Both Sprawling and Walkable, Depending On Where You Look

Salt Lake City has a reputation as a city whose residents are physically active. Many people there hike, bike, ski, walk, and run in the hills, canyons, and mountains surrounding the city.

Last year, Men’s Health magazine chose Salt Lake City as the “fittest city in the country.”

Even so, the Salt Lake City area has not escaped the obesity epidemic that has swept the country over the past few decades. Almost a quarter of all residents are obese.

One reason for this contradictory mix of fit and fat is the area’s physical environment. It offers ample outdoor recreation options, it has a robust mass transit system, and several neighborhoods that encourage people to walk and bike.

At the same time, it also includes a good number of sprawling, disconnected suburbs that make it difficult for residents to be active.

Many American cities face similar issues. But in Salt Lake City the contrast between the two kinds of environments — those that encourage physical activity, and those that discourage it — is particularly striking.

Overall, the Salt Lake area has several features that increase opportunities for everyday walking. The region has a growing transit system that includes commuter rail, light rail, and buses. More than 143,000 trips are taken on the system each day.

That number will soon grow. The Utah Transit Authority (UTA), the state agency in charge of rail transportation, is now in the middle of a $2.6 billion project that will add four more light rail lines and another commuter line, more than doubling the current 64 miles of track. 

In addition, Salt Lake City will soon begin building a $55 million streetcar line, that will extend over two miles through the downtown Sugar House neighborhood. The project has received significant support from Salt Lake City Mayor Ralph Becker, who sees it as a cornerstone of downtown revitalization. The city is working on plans for two additional streetcar lines.

A former city planner who rides his bike to work nearly every day, Becker has played a major role supporting policies that encourage physical activity.

Under Becker, Salt Lake City has increased its budget for bicycling from $50,000 to $500,000, and hired a bicycle coordinator. The city now has 170 miles of bike lanes, 47 miles of bike trails, and 26 miles of walking trails. This

year it will add another 65 miles of bike lanes. “We are taking a comprehensive approach,” said Becker. “We want to increase biking, walking, and transit service. We’ve got a long way to go, but we’re making good progress.”

Last year, the mayor initiated a review of all city ordinances to identify those that impede active living. So far, officials have identified more than 300 that they hope to change, including laws that discourage urban agriculture, and mixed use zoning. Blending retail and residential use can help increase walking and biking; when stores are close to homes, people don’t have to drive to go shopping.

The city also boasts several areas specifically designed to encourage physical activity. Gateway, a decade-old development west of downtown, features apartments built above a range of stores, as well as a nearby supermarket.

In recent decades, another neighborhood near downtown, The Avenues, has been revitalized. Built more than a century ago, the area has small lots, gridded street design and sidewalks— all of which make walking easier. And next spring, a new development will open, also downtown: City Creek will encompass 20 acres, and will include condominiums, department stores, and a 50,000-square-foot supermarket. Funded by the Mormon Church, it will cost $1.6 billion. Fifteen miles south of the city, another community is also emphasizing active living. Daybreak, a planned suburb, opened in 2005 and will eventually encompass 4,000 acres. Building will continue for another two decades; eventually Daybreak will include more than 162,000 houses.

Planners specifically overseeing the development specifically designed Daybreak so that residents can easily walk or bike. Houses are close together, and residential areas are close to shopping areas and schools. Streets are narrow and include sidewalks, which makes it easier to cross and slows vehicle speed. All houses will be a short walk to a park, and the development will eventually have nearly 40 miles of trails. In addition, Daybreak is linked by light rail to downtown Salt Lake City.

“It’s a more compact community, and that seems to produce more walking,” says University of Utah professor Barbara Brown, who studies the link between obesity and neighborhood layout. “It’s a nice example of how a city can be designed to produce more walkability.”

She and her colleagues found that children in Daybreak are much more likely to walk to school than kids in a more typical suburban community nearby. According to their research, more than 80 percent of Daybreak students walked to school at least some of the time, compared with about 20 percent in the other neighborhood.

“Judging from this, kids in Daybreak get significantly more physical activity from walking to school than kids in surrounding communities,” Brown said.

In another study, Brown looked at how the layout of different Salt Lake area neighborhoods affected the weight of residents. She rated the levels of sprawl in various neighborhoods throughout the area; among other measures, she looked at the density of homes; the mixture of homes and retail businesses; number of streets with sidewalks and crosswalks; the number of stores with ground-floor windows (makes being on foot more appealing); residents’ sense of safety from crime and traffic problems; and the degree to which a neighborhood had a central area that residents could reach by walking or biking.

According to her calculations, many Salt Lake area communities had high levels of sprawl. Among the most spread-out were large suburbs south of the city, such as Draper, Sandy, South Jordan, and Herriman.

These communities were part of the sweeping national trend that started in the 1940s and continues with the McMansions of today: “After World War II, the whole development business changed,” says Reid Ewing, a professor of planning at the University of Utah who studies environment and obesity. “Spreading out became much more important.”

Brown found that people who live in more compact, and hence more walkable, neighborhoods tended to weigh significantly less than those who lived in more sprawling neighborhoods. On average, a typical six-foot-tall male in a sprawling area weighs ten pounds more.

Overall, Ewing says, the Salt Lake area epitomizes what’s happening all over the country. As cities and counties begin to engineer and re-engineer communities to promote movement and exercise, they must also deal with the legacy of older areas that in many ways hinder activity.

“There’s now a lot of evidence that the built environment affects people’s weight,” Ewing says. “Sprawling communities produce heavier people.”