Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) 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.

The report contains state-by-state health preparedness scores based on 10 key indicators to assess 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 the 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 cuts in federal funding for state and local preparedness since 2005, coupled with the cuts states are making to their budgets in response to the economic crisis, put that progress at risk.

"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."

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.

Key Findings

Among the key findings:

• Budget Cuts: Federal funding for state and local preparedness has been cut more than 25 percent from fiscal year (FY) 2005, and states are no longer receiving any supplemental funding for pandemic flu preparedness, despite increased responsibilities.
• In addition to the federal decreases, 11 states and D.C. cut their public health budgets in the past year. In the coming year, according to the Center on Budget and Policy and Priorities, 33 states are facing shortfalls in their 2009 budgets and 16 states are already projecting shortfalls to their 2010 budgets.
• Rapid Disease Detection: Since September 11, 2001, the country has made significant progress in improving disease detection capabilities, but major gaps still remain.
• Only six states do not have a disease surveillance system compatible with the U.S. Centers for Disease Control and Prevention's (CDC) National Electronic Disease Surveillance System.
• Twenty-four states and D.C. lack the capacity to deliver and receive lab specimens, such as suspected bioterror agents or new disease outbreak samples, on a 24/7 basis.
• Only three state public health laboratories are not able to meet the expectations of their state's pandemic flu plans.
• Food Safety: America's food safety system has not been fundamentally modernized in more than 100 years.
• Twenty states and D.C. did not meet or exceed the national average rate for being able to identify the pathogens responsible for foodborne disease outbreaks in their states.
• Surge Capacity: Many states do not have mechanisms in place to support and protect the community assistance that is often required during a major emergency.
• Twenty-six states do not have laws that reduce or limit liability for businesses and non-profit organizations that help