Trust for America’s Health report urges investment into public health system as readiness falls

In a new report released this week, the nonprofit Trust for America’s Health (TFAH) called out gaps in states’ emergency response capabilities and advocated for urgent investment in a new public health system.

The report, Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, chronicled every state’s degree of preparedness for health emergencies and sorted them into three tiers: high, middle, and low. There were steps forward and backward over the last year: 16 states fell in the rankings, while 12 improved. Of these, only 17 states and the District of Columbia placed in the high-performance tier, compared to the 20 states that had topped the charts early in 2021. 

“The major takeaway of this report is that underinvestment in the nation’s public health system, and attacks on its authority, have had deadly consequences during the COVID-19 pandemic,” J. Nadine Gracia, president and CEO of TFAH, said. “Action and investment are urgently needed. This report’s findings can help federal and state officials identify gaps in public health preparedness and the steps needed to better protect lives and the economy during the next health emergency.”

The report graded states based on a series of 10 emergency preparedness indicators, including items like disease surveillance, safe water, and seasonal flu vaccinations. This year, Ohio, Pennsylvania, and South Carolina produced the largest turnarounds, moving from low tier to high tier performance. 

Overall, TFAH determined that most states had plans ready to expand healthcare and public health lab capabilities during emergencies, and most were accredited in public health, emergency management, or both. In further good news, a great majority of Americans had access to safe water, thanks to community water systems, and a more coordinated federal health response made headway against the COVID-19 pandemic. On the bad side, though, only about half of Americans were found to have access to extensive local public health systems, and season flu vaccination rates, though rising, are lower than where they need to be. Further, the pandemic exposed the need for paid time off for workers. 

The report also showed that only 28 percent of hospitals on average had earned top-quality patient safety grades – a decrease of 3 percent from the previous year. This came at a time when hundreds of public health officials were resigning, retiring, or being fired.

In response, TFAH also made policy recommendations including: 

• Federal and state action to provide funding for public health
• Creation of a Congressional COVID-19 Commission to review and address gaps in pandemic response, while maintaining strong public health authorities
• Investment in vaccination infrastructure, antibiotic resistance programs, and worker paid leave
• Investment in health equity, anti-poverty programs, and familial financial security
• Investment in medical countermeasures for rapid development and deployment during emergencies, paired with increased coordination and communication
• Federal and state plans and funding to minimize health impacts of climate change while emphasizing health equity