Public Health Preparedness Report Shows Improvements, But State Disparities Remain

The 2017 National Health Security Preparedness Index, released by the Robert Wood Johnson Foundation, indicates that the United States is slowly becoming more prepared to handle public health catastrophes, but some states are still lagging far behind.

Using a combination of 139 measures, the Index aims to assess health security in the US, which is the extent to which the country and its citizens are “prepared for, protected from, and resilient to events that can adversely impact health status.” These events could take the form of natural disasters, terrorist attacks, infectious diseases, or a number of other risks, according to the newly issued report.

The 139 security metrics are organized into 6 domains: health security surveillance, community planning and engagement, information and incident management, healthcare delivery, countermeasure management, and environmental and occupational health. Researchers have used these measures to compile an overall Preparedness Index on a 10-point scale annually since 2013.

According to the report, the US Preparedness Index was 6.8 in 2016, representing an increase of one-tenth of a point over the previous year, or a 1.5% improvement. At this rate, the country will not reach the 9.0 benchmark for strong health security until 2036. The fastest-improving domain was community planning and engagement, which has increased by 16.3% since the Index was first published in 2013—at the time, it had been the lowest-scoring domain. The report authors attributed these gains to enhanced efforts within states and communities to develop better collaborative plans for emergency response.

The nation’s strongest domain is that of incident management, or the capability to follow a standardized emergency response plan, partially thanks to ongoing preparation activities like training exercises and drills. The Index authors noted that from 2013 to 2016 the score for the healthcare delivery domain has remained stagnant, while the environmental/occupational health measure actually declined.

While the national Index improved overall, significant disparities were observed at the state level, as health security in 18 states remained level or decreased from the previous year. However, states’ improvements were generally greater in magnitude than backslides; for instance, Montana had the greatest increase at 20.4%, but the largest loss was just 1.5% in New Mexico.

Specifically, the researchers found that states’ health security scores were inversely associated with both poverty levels and rates of uninsured residents. They explained that the poverty link could be due to the fewer available resources to spend on health promotion efforts in poorer states and the declining levels of preparedness funding provided by the federal government.

“Equal protection remains an elusive goal in health security, as rural and low-resource regions have fewer and weaker protections in place,” Glen Mays, PhD, MPH, who leads a team of researchers at the University of Kentucky in developing the Index, said in a press release. “Closing the gaps in preparedness among states and regions remains a national priority.”

In its conclusion, the Index report listed several suggestions for eliminating the state-level disparities in health preparedness and helping improve the nation’s security as a whole. For instance, they suggested that multi-sector networks and coalitions should be formed and strengthened to harness the experience and capabilities of different health stakeholders, citing research showing that communities with comprehensive public health delivery systems report better health status and use fewer healthcare resources.

Other recommendations focused on strengthening the national and state infrastructure for emergency prevention and response, especially in light of the weaknesses exposed by recent public health concerns like the Zika virus epidemic or the water contamination in Flint, Michigan. The report suggested that a dedicated fund for health emergency response would allow communities to initiate countermeasures as soon as possible.