Assessing Public Health Preparedness of States

Trust for America’s Health (TFAH) recently published its annual report for 2019, titled “Ready or Not: Protecting the Public’s Health From Diseases, Disasters and Bioterrorism,” which assesses states’ readiness to protect its residents based on ten criteria. Using data for 2017, the report concludes that, while overall emergency preparedness for health care providers has significantly increased since the 11 September 2001 attacks, certain states remain vulnerable to future disasters. This indeed raises serious concerns, as the report notes, since 2017 showed a rise in the frequency of extreme weather events as well as outbreaks of highly infectious diseases–both of which are predicted to increase in the coming years.

The report’s methodology assessed states based on the following ten indicators:

  1. “Incident Management: Adoption of the Nurse Licensure Compact
  2. Cross-Sector Community Collaboration: Percentage of hospitals participating in healthcare coalitions
  3. Institutional Quality: Accreditation by the Public Health Accreditation Board
  4. Institutional Quality: Accreditation by the Emergency Management Accreditation Program
  5. Institutional Quality: Size of the state public health budget, compared with the past year
  6. Water Security: Percentage of the population who used a community water system that failed to meet all applicable health-based standards
  7. Workforce Resiliency and Infection Control: Percentage of employed population with paid time off.
  8. Countermeasure Utilization: Percentage of people ages 6 months or older who received a seasonal flu vaccination.
  9. Patient Safety: Percentage of hospitals with a top-quality ranking (Grade A) on the Leapfrog Hospital Safety Grade.
  10. Health Security Surveillance: The public health laboratory has a plan for a six- to eight-week surge in testing capacity.”

As for the findings, “Ready or Not” praised collaboration efforts by health care providers and hospitals from different states to build mutual preparedness capabilities through various healthcare coalitions and other interactions. In addition, the report notes the increasing number of states that are accredited by either the Public Health Accreditation Board, the Emergency Management Accreditation Program, or both.

However, the report found that six percent of state residents who used the community water system did not have access to safe water that lived up to appropriate health standards. More alarming is the declining seasonal flu vaccination rate that fell from 47 percent of all Americans (6 or older) in the 2016-2017 season to 42 percent in the 2017-2018 season.

Another issue is the declining access of employed state residents to paid time off who, in turn, are more likely to go to work when they are sick and potentially spread infectious diseases. Lastly, was the issue that only 28 percent of hospitals received a top-quality patient safety grade.

To address these issues, the report provides the following recommendations:

  • “Providing stable, dedicated, and sufficient funding for preparedness activities and a significant funding increase for core public health capabilities.
  • Establishing a complementary emergency response fund to accelerate crisis responses.
  • Maintaining a long-term investment in the Global Health Security Agenda framework and global preparedness and response programs to help prevent infectious disease threats from becoming global crises.
  • Following the National Biodefense Strategy (NBS) with transparent goals, implementation plans, and budgets for all relevant agencies.
  • Closely monitoring the transition of the Strategic National Stockpile and significantly strengthening the “last mile” of distribution and dispensing.
  • Developing a multiyear strategic vision and fully funding surveillance infrastructure, for fast, accurate outbreak detection at all levels of government.
  • Bolstering the Hospital Preparedness Program and multisector healthcare collaboration as well as adopting state policies to improve healthcare delivery during disasters.
  • Adopting comprehensive climate change adaptation plans, including a public health assessment and response.
  • Increasing public and private investments in efforts to combat antimicrobial resistance, including through diagnostic, stewardship, detection, and treatment methods.
  • Supporting vaccine infrastructure and first-dollar coverage of recommended vaccines.
  • Promoting health equity in emergency preparedness planning, response, and recovery, including through the appointment of a chief equity or resilience officer. Taken together, action on TFAH’s recommendations would make the United States safer for all its residents.”

For more information on issues raised in this piece, please see the HSDL featured topics on pandemics and epidemics, hurricanes, and wildfires.


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