The number of first responders available in any given state compared to that state’s population varies widely across America, according to Glen Mays, director of the national program office for the National Health Security Preparedness Index.
“This is a critically important area where we see an area of inequity across the country. Some states have expanded their numbers of first responders, but some states have actually lost ground,” said Mays, who leads a team of researchers at the University of Kentucky in developing the index, created by the U.S. Centers for Disease Control and Prevention (CDC) and supported by the Robert Wood Johnson Foundation (RWJF).
“States serving with fewer first responders are at a disadvantage,” Mays told Homeland Preparedness News.
The numbers of first responders also tracks closely with a state’s rate of health insurance coverage, Mays added, since these positions are largely funded through the operating revenues of health insurance.
“Health insurance coverage and resources flowing into the system affects the numbers of first responders,” said Mays, the Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky’s College of Public Health.
These numbers also are among the many measures within the six domains analyzed by Mays’ team to help them score the United States’ health security and ability to handle a host of threats.
According to the 2017 Preparedness Index released April 20 by RWJF, the U.S. is not so well prepared.
“Overall, it’s a mixed bag. We’re moving in the right direction but it’s concerning that our progress is pretty slow,” said Mays, who also directs the RWJF-funded Systems for Action Research Program, which tests strategies for aligning delivery and financing systems for medical care, public health and social services in ways that improve population health.
The United States has roughly two-thirds of its needed protections in place across the country. “We need to find a way to accelerate the pace. Some states are showing you can do it, so I’m cautiously optimistic,” Mays said.
Detailed domains
Researchers for the index collect, aggregate and measure preparedness data from sources across public health, emergency management, government, academia, healthcare and other sectors. The final measures fall into six domains: incident and information management, health security surveillance, community planning and engagement coordination, healthcare delivery, countermeasure management, and environmental and occupational health.
Each domain is assessed independently. There are more than 130 measures—such as hazard planning in public schools, monitoring food and water safety, wireless 9-1-1 capabilities, flu vaccination rates, and numbers of paramedics and hospitals—analyzed in the Preparedness Index that are calculated to reach a composite score. The score then provides a comprehensive picture of health security and preparedness in the United States.
The 2017 results found the United States scored a 6.8 on a 10-point scale for preparedness—a 1.5 percent improvement over 2016 and a 6.3 percent improvement since the index started four years ago.
Though slight, this is positive, Mays said, because it shows that the nation’s day-to-day preparedness for managing community health emergencies has improved.
“This falls within the incident management domain of the index and being able to manage the response to emergency or disaster—the strongest area of health security on the index overall, so that’s good news,” he said.
A way to improve preparedness
Mays said even with the country’s preparedness improvement, deep regional inequities remain.
Generally, states in the South and West—many of which face elevated risks of disasters and contain disproportionate numbers of low-income residents in the southernmost and mountain states—lag behind Northeast and Pacific Coast states. For example, there is a gap of 32 percent separating the highest state (Vermont, 7.8) and the lowest state (Alaska, 5.9), according to the index.
“Equal protection remains an elusive goal in health security, as rural and low-resource regions have fewer and weaker protections in place,” Mays said.
The reason why is a “multifaceted answer,” he explained, because no single organization has full responsibility for installing an overall national plan.
“Everybody has to play a role in this; it’s a big challenge, a big responsibility. It’s a complex system. But we absolutely could do it with focus and attention,” Mays said.
Improving these types of protections, he said, “is definitely achievable. You can see improvements happening all over the country, which proves it’s possible.” In fact, 18 states achieved preparedness levels that significantly exceeded the national average in 2016, according to the index.
One example Mays pointed to is Health Care Coalitions, which are one of the measures analyzed under the community planning and engagement coordination domain on the index. These coalitions are supported through the federal Hospital Preparedness Program of the Office of the Assistant Secretary for Preparedness and Response.
Funded partly with federal funds, every state has a coalition, he said. But some states have formed multiple coalitions that involve many different actors using common protocols and communicating and working well together during emergencies.
“If you do it well, it can help you improve in other areas of health security,” Mays said.
For the 20 states that remain below the national average in preparedness, Mays suggested that their improvements may be context-specific and vary by state.
“Some common themes showed up in the healthcare delivery domain, where some states have low scores,” he said.
For instance, people living in rural states don’t have sufficient access to health care providers or trauma centers. In other examples, states may have found it too expensive to extend facilities, use electronic health records or train new workers.
For the more than a dozen states that declined in their rankings on the index, Mays said it was not because they lost ground, it was because they are not able to move as fast.
“Closing the gaps in preparedness among states and regions remains a national priority,” he said.
As a way for index users to spread best practices going forward, Mays has launched the Preparedness Innovator Challenge as part of the Preparedness Index. Users may submit their stories about how they have used index findings as a tool to focus their efforts toward improving health security in their communities through July 31.