PRINCETON, NJ – A new report indicates 20 states aren't doing well in efforts to prepare for public health emergencies.

The seventh annual “Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism” report found that the states met six or less of the 10 key indicators of public health emergency preparedness.

Nearly two-thirds of the states met seven indicators or less. Eight states tied for the highest score of nine: Arkansas, Delaware, New York, North Carolina, North Dakota, Oklahoma, Texas and Vermont. Montana had the lowest score, meeting only three indicators.

The report, released by the Trust for America’s Health and the Robert Wood Johnson Foundation, also found that the H1N1 flu outbreak has exposed serious gaps in the nation’s ability to respond to public health emergencies and that the economic crisis is straining an already fragile public health system.

“The ‘Ready or Not?’ report shows that a band-aid approach to public health is inadequate,” said Richard Hamburg, deputy director of the TFAH. “As the second wave of H1N1 starts to dissipate, it doesn’t mean we can let down our defenses. In fact, it’s time to double down and provide a sustained investment in the underlying infrastructure, so we will be prepared for the next emergency and the one after that.”

The report found that investments made in pandemic and public health preparedness over the past several years have dramatically improved the nation's readiness for the H1N1 outbreak. but decades of chronic underfunding have left many core systems lacking in readiness.

According to officials, key infrastructure concerns include a lack of real-time coordinated disease surveillance and laboratory testing, outdated vaccine production capabilities, limited hospital surge capacity and a shrinking public health workforce.

In addition, the report found that more than half of all states experienced cuts to public health funding. With federal preparedness funds cut by 27 percent since fiscal year 2005, the report said, improvements that have been made since the Sept. 11, 2001 terrorist attacks are at risk.

According to the report:

• 27 states cut funding for public health from FY 2007-08 to 2008-09.
• 13 states have purchased less than half of their share of federally subsidized antiviral drugs to stockpile for use during an influenza pandemic.
• 14 states can't ensure the timely pickup and delivery of laboratory samples on a 24/7 basis to the Laboratory Response Network (LRN).
• 11 states and the District of Columbia don't have enough laboratory staffing capacity to work five 12-hour days for six to eight weeks in response to an infectious disease outbreak such as H1N1.

“State and local health departments around the country are being asked to do more with less during the H1N1 outbreak as budgets continue to be stretched beyond their limits,” said Michelle Larkin, public health team director and senior program officer at the Robert Wood Johnson Foundation. “Public health provides essential prevention and preparedness services that help us lead healthier lives. Without sustained and stable funding, Americans will continue to be needlessly at risk for the next public health threat.”

The report offered recommendations for improving preparedness:

• Ensure stable and sufficient funding.
• Conduct an H1N1 after-action report and update preparedness plans with lessons learned.
• Increase accountability and transparency.
• Improve community preparedness.