December. January 15, 2009 – The United States is unprepared for a widespread disaster, a public health group has warned.

The warning is repeated six times earlier from the nonprofit, nonpartisan Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation, advocating for stronger U.S. public health policy.

This year’s seventh annual “Ready or Not?” report assessed every state in the U.S. and found many were lacking. Almost all have gaps in their ability to respond to various public health emergencies, from epidemics to natural disasters to nuclear terrorism.

“Decades of chronic underfunding mean that many core systems are not ready,” TFAH deputy director Richard Hamburg said in a news release. “This country has a history of responding to the current emergency. This Band-Aid approach is for change.”

Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University in New York, said the recession has eroded America’s Public health infrastructure that makes the United States vulnerable to a variety of potential threats.

“Pervasive budget cuts across the country lead to layoffs of 15,000 public health workers — half of state health departments say they expect future layoffs or attrition Layoffs,” Redlener said in a news release. “With this reduction in the public health workforce, it means we face more struggles and problems to achieve our readiness goals.”

TFAH’s 96-page report calls for increased federal funding to Return the state to normal up to 2005 levels of preparedness – and then access sustained, reliable federal funding to continue building preparedness capabilities in every state.

Some states are doing better than others. TFAH rates all 50 states and the District of Columbia based on 10 readiness indicators, ranging from hospital readiness to food safety to public health budgets. Score:

• 9/10: Arkansas, Delaware, New York, North Carolina, North Dakota, Oklahoma, Texas, Vermont

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• 8/10: Alabama, California, Colorado, District of Columbia, Kentucky, Michigan, Mississippi, Ohio, Oregon, Pennsylvania, South Carolina, Wisconsin
• 7 / 10: Hawaii, Indiana, Iowa, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, South Dakota, Tennessee, Virginia
• 6 / 10: Connecticut, Georgia, Illinois, Kansas, Louisiana, Nebraska, Nevada, New Mexico, Rhode Island, Utah, West Virginia, Wyoming
• 5/10: Alaska, Arizona, Florida, Idaho, Maine, Washington
• 3/10: Montana

How much does it cost to bring the country up to par? Redlener said estimates from the University of Pittsburgh Center for Biosecurity and the American Hospital Association call for an initial investment of up to $15 billion, plus an ongoing $1 billion annually, to prepare U.S. hospitals for disaster.

In 2005, Redlener said, the United States spent $500 million on hospital readiness, with an annual federal budget approaching $400 million.

“We’re talking about a huge difference between what is needed and what is offered,” Redlener said. “We can’t even say that hospitals are going to be ready for a pandemic or major terrorism or anything in the near future. That’s really a big deal.”

The TFAH report makes several recommendations:

• Ensure stable and adequate federal funding to support core activities and contingency plans.
• Report on ‘Lessons Learned’ on H1N1 Swine Flu and Update Pandemic Preparedness Plan
• Strengthen accountability for federal and state health Expenses are publicly accounted for.
• Improve community preparedness, promote vaccine safety, and address health disparities by ensuring services reach at-risk populations.