From hurricanes to swine flu and even bioterrorism, the United States has repeatedly faced public health threats in recent years. Adequately managing a crisis involves cooperation between many different organizations, both in the private and public sector.
State governments are one of the main bodies to take on the challenge of handling a disaster, and not all states are equally prepared. Trust for America’s Health (TFAH), a nonprofit organization dedicated to disease prevention, published a report in conjunction with the Robert Wood Johnson Foundation, a large healthcare philanthropy, scoring states based on their readiness for a public health threat. 24/7 Wall St. reviewed the seven states least prepared to deal with these kinds of disasters.
TFAH analysts looked at such indicators as public health funding — whether it increased from 2011 to 2012, and infectious disease control and vaccinations — whether vaccines for whooping cough have been administered to 90% of infants and whether Medicaid covers flu shot. These indicators were specifically designed to show the level of readiness of all states regardless of the different disasters they may face, Executive Director of TFAH Jeff Levi told 24/7 Wall St.
For instance, all states are experiencing challenges with climate change, making it necessary for each to have firm plan to deal with the problem, which is one of the indicators the analysts looked when examining the level of a state’s preparedness. Similarly, since all states are at risk for some sort of public health disaster, states would greatly benefit from getting certified from the Emergency Management Accreditation Program, a non-profit program that set up 64 standards to determine whether a state can deal with an emergency. Having such a program is yet another indicator the analysts checked to find the level of preparedness.
If a state met a specific standard, it received a point, for a total of a possible 10 points. Of the seven worst-prepared states, five scored just four points, while two scored a mere three points. The seven worst prepared states failed in areas where the majority of other states managed to meet the standard. For instance, 30 states require child-care facilities to have a written multi-hazard evacuation and relocation plan, which the TFAH argues is imperative for protecting children in a vulnerable environment. Yet the only states in the bottom seven to have this policy are Hawaii and Nevada. Another 37 states have state lab facilities with enough staffing to adequately deal with and contain a disease such as swine flu. Yet Montana is the only one of the seven states on this list to have that capability.
Much of a state’s disaster readiness comes down to funding, which has taken a significant hit recently. TFAH notes that federal funds for state and local preparedness declined 38% between 2005 and 2012. Statewide, public health budgets have been declining in the last several years as well. In 29 states, public health funding was cut at the state level in 2012, including five of the seven least-prepared states.
Many a state’s resources on disaster preparedness, however, are out of the state’s control. For instance, the all-hazards preparedness funding comes in the form of block grants from the Department of Health and Human Services. Levi said the combined funding declines at the federal level and the states level have hurt some states disproportionately.
“When you’ve lost 25,000 to 30,000 jobs in state and local health departments across the country, that is a very diminished workforce,” Levi said. “The underlying base of public health (at the federal level) has also contracted, and that’s where you get this double whammy.”
One recent disaster that could have lasting health consequences is Superstorm Sandy. Levi believes that New Jersey, a state on this list, did a reasonably good job dealing with the storm despite displaying shortcomings in a host of different areas. He noted that in recent years states have learned much about response and relief efforts from a variety of different disasters, most notably Hurricane Katrina.
Based on the the 10 indicators put together by The Trust For America’s Health (TFAH,) 24/7 Wall St. reviewed the seven states that were least prepared for a public health disaster. We reviewed areas of strong and weak performance to provide context for each state’s readiness. We also considered total all-hazards funding from the federal government and public health budgets at the state level in both fiscal year 2011 and 2012, also from the report.
These are the seven states least prepared for a public health disaster.