New Report Measures States' Preparedness for Public Health Emergencies, Including Infectious Disease Outbreaks and Extreme Weather Events

Special Feature Examines the Threat of H5N1 Bird Flu and How to Guard Against Its Spread

WASHINGTON, March 27, 2025 /PRNewswire/ -- A new report assessing national and state preparedness to protect residents' health during emergencies found that 29 states placed in the middle or low-performance tier for emergency preparedness, and that all states can do more to strengthen their readiness.

During 2024, the nation experienced a significant number of public health emergencies, ranging from infectious disease outbreaks to weather-related disasters. These emergencies demonstrate the urgent need for sustained investment in public health infrastructure and emergency preparedness, both of which are critical to the nation's overall health and national and economic security.

Ready or Not 2025: Protecting the Public's Health from Diseases, Disasters, and Bioterrorism, released today by Trust for America's Health (TFAH), measures states' readiness for a range of health emergencies based on 10 indicators, including healthcare system readiness, state public health funding, public health laboratory surge capacity, employee access to paid time off, and community water system safety.

The report, now in its 22^nd year of publication, places states and the District of Columbia into three performance tiers for emergency preparedness. This year's report placed 21 states and DC in the high-performance tier, 16 states in the middle-performance tier, and 13 states in the low-performance tier.

High-Performance Tier – 21 states & DC

CO, CT, DC, DE, FL, GA, ID, MA, MD, ME, MO, NC, NH, NJ, OH, PA, RI, UT, VA, VT, WA, WI

Middle-Performance Tier – 16 states

AL, AR, AZ, CA, IA, IL, IN, KS, KY, ND, NE, NY, OK, SC, TN, TX

Low-Performance Tier – 13 states

AK, HI, LA, MI, MN, MS, MT, NV, NM, OR, SD, WV, WY

The report provides federal, state, and local policymakers and health officials with benchmarks and policy recommendations that outline how jurisdictions can strengthen their emergency preparedness.

"Strengthening communities for public health emergencies requires sustained investment, planning, and multi-sector cooperation," said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America's Health. "Recent public health emergencies, from measles and tuberculosis outbreaks to wildfires and extreme heat, demonstrate the need for consistent investment in public health infrastructure and workforce and programs that support health in every community – because a healthy community will be more resilient when emergencies happen."

The report includes a special feature on H5N1 bird flu, including recommendations from public health experts on steps the country should take to protect against the outbreak evolving into a pandemic. The feature discusses the importance of extensive testing programs and collaborative efforts including ways in which public health officials are working with partners in the agriculture and veterinary medicine sectors to control the outbreak.

New to the report this year is a performance indicator measuring avoidable mortality—deaths caused by preventable or treatable conditions. This indicator measures deaths before age 75 that could be prevented through effective public health measures or averted with timely healthcare interventions. Higher rates of avoidable mortality indicate gaps in public health and healthcare systems, which can weaken a community's ability to respond to and recover from public health emergencies.

Overall, the report finds areas of strength and areas for improvement.

Areas of strong performance include:

• Nurse Licensure Compact: More states have adopted the nurse licensure compact that allows nurses to work in any member state with a single multistate license. The compact is a tool for enabling healthcare facilities to surge nursing staff during an emergency. As of January, 41 states belong to the nurse licensure compact, an increase from the previous year.
  
  
• Public Health and Emergency Management Accreditation: Most states have achieved accreditation through the Public Health Accreditation Board (PHAB) and/or the Emergency Management Accreditation Program (EMAP). Accreditation helps agencies strengthen emergency readiness by fostering continuous improvement, establishing clear governance structures, and enhancing coordination. Accredited states also benefit from well-defined processes and robust monitoring and evaluation systems—key factors in effectively responding to public health emergencies and disasters.
  
  
• Water Safety: In most states, 95 percent of households get their water from a municipal water system that did not have any water safety violations.

Areas for improvement include:

• Avoidable Mortality: Avoidable mortality—deaths from preventable or treatable causes—varies widely across the country, reflecting differences in healthcare access, public health infrastructure, and underlying social and economic factors. Some states have significantly lower rates of avoidable deaths, while others face persistently high burdens. Geographic disparities are evident, with avoidable mortality rates highest in parts of the Southeast and Appalachia. Some states in the Great Plains and Mountain West also experience high rates. In contrast, states in the Northeast and Upper Midwest generally have lower rates. Additionally, Black and American Indian/Alaska Native populations frequently experience the highest rates of avoidable deaths, often due to barriers to good health within their communities. These disparities underscore the importance of ensuring that all residents have access to effective public health and healthcare services.
  
  
• State Public Health Funding: Fourteen states reduced public health funding in FY 2024, three more than the eleven that reduced funding in FY 2023. The reduction may be related to the loss of COVID-19 response funding but is important to track particularly as states are also facing reductions in federal health and emergency preparedness funding.
  
  
• Limited Access to Paid Time Off: On average, only about half of workers in each state used some form of paid time off during a given month. Access to paid time off allows people to avoid spreading illness in the workplace. Employers who provide employees with paid sick leave are not only helping to control the spread of infections within their community, they are also supporting their business stability and helping to safeguard the local economy.
  
  
• Low Flu Vaccination Rates: Too few people are vaccinated against seasonal flu. During the 2023 – 2024 flu season only 47 percent of the population (ages six months and older) were vaccinated against the flu, down from the previous year and well short of the 70 percent goal established by Healthy People 2030. Improving flu vaccination rates can protect health, particularly for people at higher risk of serious flu outcomes and can reduce demand on the healthcare system. Improved rates also help guard against the potential for significant economic toll of a severe flu outbreak due to higher healthcare costs and lost business productivity.

Recommendations for Improving Emergency Preparedness:

• Provide stable, sufficient funding for public health capabilities, including Centers for Disease Control and Prevention's (CDC) public health emergency preparedness funds that go to states, territories, and localities, and continue to modernize health data systems to improve detection of new threats.
• Reauthorize the Pandemic and All-Hazards Preparedness Act (PAHPA) to improve the nation's readiness to manage a spectrum of health threats.
• Prevent and respond to infectious disease threats by funding CDC's National Immunization Program and Antimicrobial Resistance Solutions Initiative.
• Reduce health disparities in the impact of emergencies by improving demographic data collection and reporting and by targeting health investments where they are most needed. Community readiness can also be improved by engaging populations that are disproportionately impacted into the emergency planning process.
• Accelerate the development and stockpiling of vaccines, therapeutic medicine, and diagnostic testing for faster distribution during emergencies.
• Ensure healthcare system readiness through increased cross-state credentialing for nurses and other healthcare professionals and by fortifying the Administration for Strategic Preparedness and Response's Health Care Readiness program.
• Expand and fully fund CDC's initiatives to address extreme weather and other environmental threats.

Read the full report at: https://www.tfah.org/report-details/ready-or-not-2025

Trust for America's Health is a nonprofit, nonpartisan public health policy, research, and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.

SOURCE Trust for America's Health