Group: America Unprepared for Disaster

Dec. 15, 2009 - America is unprepared for a wide range of disasters, a public health group warns.

The warning repeats six earlier calls to action from the nonprofit, nonpartisan Trust for America's Health (TFAH) and from the Robert Wood Johnson Foundation, which advocate for stronger U.S. public health policies.

This year's seventh annual "Ready or Not?" report evaluates each state in the U.S. Many states are found lacking. Nearly all have gaps in their ability to respond to various public health emergencies, ranging from pandemics to natural disasters to nuclear terror.

"Decades of chronic underfunding means many core systems are not at the ready," TFAH deputy director Richard Hamburg said at a news conference. "The nation has a history of responding to the emergency of the moment. This Band-Aid approach as to change."

Irwin Redlener, MD, director of the National Center for Disaster Preparedness at New York's Columbia University, said the recession has eroded U.S. public health infrastructure, leaving the nation vulnerable to a wide range of potential threats.

"Budget cuts that have been ubiquitous throughout the country have led to layoffs of 15,000 public health workers -- and half of state health departments say they expect to lose more staff through layoffs or attrition going forward," Redlener said at the news conference. "With these kinds of cuts in the public health workforce, it means we will have even more struggles and problems meeting our preparedness goals."

TFAH's 96-page report calls for increased federal funding to bring the nation back up to 2005 levels of preparedness -- and then for continued, reliable federal funding to continue to build disaster preparedness in every state.

Some states are doing better than others. TFAH rated all 50 states and the District of Columbia on 10 preparedness indicators, ranging from hospital preparedness to food safety to public health budgets. The scores:

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

How much will it cost to bring the nation up to standard? 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 a year to prepare U.S. hospitals for a disaster.

In 2005, Redlener said, the U.S. put $500 million into hospital preparedness, with an annual federal budget near $400 million.

"We are talking about magnitudes of difference between what is needed and what is provided," Redlener said. "We can't even come close to saying hospitals are going to be prepared for a major pandemic or major terrorism or whatever in the near future. It really is a big problem."

The TFAH report makes several recommendations:

• Ensure stable and sufficient federal funding to support core activities and emergency planning.
• Conduct a "lessons learned" report on H1N1 swine flu, and update pandemic preparedness plans accordingly.
• Increase accountability for federal and state health departments -- and make a public accounting of all tax funds spent.
• Improve community preparedness by ensuring delivery of services to high-risk populations, promoting vaccine safety, and addressing health disparities.