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Ready or Not?

     The fourth annual report from Trust for America's Health (TFAH)--Ready or Not? Protecting the Public's Health from Disease, Disasters and Bioterrorism--makes for grim reading.

     The report provides state-by-state health preparedness scores based on 10 key indicators to assess health emergency preparedness capabilities. And these grades are nothing to write home about. Only one state--Oklahoma--scored 10 out of 10; half of states scored six or less; and if you live in California, Iowa, Maryland or New Jersey, you came in rock bottom, scoring a measly four points. Some of the indicators used to assess states' prepareness levels include hospital bed surge capacity, compatibility with the Centers for Disease Control's (CDC) National Electronic Disease Surveillance System and capability to deliver emergency vaccines from the Strategic National Stockpile.

     TFAH--a non-profit, non-partisan organization dedicated to promoting the health of every American--endorses the concept of all-hazards preparedness, which includes rapid detection of emergency disease threats, surge capacity and mass containment strategies. According to the TFAH, meeting these goals requires leadership, planning and coordination; a fully staffed workforce; modernized technology; and tested emergency response plans. With the median state spending on public health only $31 per person each year, financial support for public health programs remains limited. TFAH estimates it would take $2.6 billion to bring public health spending to a level that would address disparities across the states.

     In this month's issue, we focus on some of the areas discussed in the TFAH report, including the role of surveillance programs in the prehospital environment (EMS and Medical Surveillance, p. 44) and emergency preparedness assessment (Are You Ready to Respond? p. 68). Obviously, we have a long way to go before our public safety and health systems are ready to respond. There's no lack of education as to what we need to do to achieve our goals; the key to success remains money.

     To find out where your state ranks, visit

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