One lesson from recent events is that emergencies happen. And happen often. From disease outbreaks to natural disasters to man-made crises, the stakes are high: Americans face serious health risks and even death with increasing regularity. Therefore, as a nation, it's critical to ask, "Are we prepared?" The public health emergencies of the past year--an unusually severe flu season, confounding cases of acute flaccid myelitis, two major hurricanes, and the deadliest fire season in California's history--reinforce the need for every jurisdiction to be vigilant about preparing for emergencies in order to safeguard the public's health. The Ready or Not: Protecting the Public's Health from Diseases, Disasters and Bioterrorism series from Trust for America's Health (TFAH) has tracked public health emergency preparedness in the United States since 2003. The series has documented significant progress in the nation's level of preparedness as well as those areas still in need of improvement. A fundamental role of the public health community is to protect communities from disasters and disease outbreaks. To this end, the nation's health security infrastructure has made tremendous strides since 2001 by building modern laboratories, maintaining a pipeline of medical countermeasures, and recruiting and retaining a workforce trained in emergency operations. Yet, unstable and insufficient funding puts this progress at risk, and a familiar pattern takes shape: underfunding, followed by a disaster or outbreak, then an infusion of onetime supplemental funds, and finally a retrenchment of money once attention wanes. What's more, states are uneven in their levels of preparedness. Some--often those that most frequently face emergencies--have the personnel, systems, and resources needed to protect the public. But others are less prepared and less experienced, elevating the likelihood of preventable harms. This unstable funding and uneven preparation undermines America's health security. Ready or Not examines the country's level of public health emergency preparedness on a state-by-state basis using 10 priority indicators. (See Table 1.) Taken together, the indicators are a checklist of priority aspects of states' readiness for public health emergencies. However, these indicators do not necessarily reflect the effectiveness of states' public health departments. Improvement in these priority areas often requires action from other agencies, elected officials, or the private sector. This edition of the series finds that states have made progress in key areas, including public health funding and participation in provider compacts and coalitions. However, performance in other areas--such as flu vaccination, hospital patient safety, and paid time off for workers--has stalled or lost ground.
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