State Category: Virginia

At One Year Mark Data Show 988 Suicide and Crisis Lifeline Has Improved Crisis Care Access and Response, and that Sustained and Increased Funding is Needed

This month marks the one-year anniversary of the 988 Suicide and Crisis Lifeline, which replaced the previous National Suicide Prevention Lifeline with a single three-digit number for mental health, substance misuse, and crisis services. With oversight and funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) and assistance from partners like Crisis Text Line and The Trevor Project, 988 consists of independently operated and funded call and text/chat centers across the country. When individuals in crisis contact 988, trained crisis counselors at these centers listen, provide support, and share resources if necessary. Access to 988 can play a critical role in improving depressed, suicidal, or overwhelming feelings—in fact, SAMHSA estimates that 98% of individuals contacting 988 receive the crisis support they need in the moment. SAMHSA has also identified the current 988 system as a first step toward evolving crisis care to include mobile crisis units, which provide in-person responses, and stabilization centers, which provide a safe place to stay for individuals in crisis.

Even its current form, however, 988 represents a momentous advancement in the effort to connect more Americans with crisis services. In May 2023, for example, 988 answered 45% more calls, 52% more chats, and 938% texts compared to the previous lifeline in May 2022. In total, 988 answered nearly 160,000 more contacts in May 2023 compared to May 2022, and the average time to answer these contacts decreased from 140 seconds to 35 seconds. 988 has also launched specialized services for the LGBTQ+ population, and SAMHSA just announced the addition Spanish language text and chat services. Other specialized services will likely follow for hearing impaired individuals and American Indian/Alaska Native people.

 

In 2022, Congress supplemented the establishment of 988 with several pieces of legislation containing significant investments and policies to advance behavioral health. The Bipartisan Safer Communities Act (BSCA), passed in June 2022, for example, provided onetime support for 988 and increased support for the National Child Traumatic Stress Network. The BSCA also provided funding for Project AWARE at SAMHSA, which empowers education agencies through training for school personnel, increases awareness and detection of mental health issues, and connects youth and families to needed services. In addition, Congress directed the Centers for Medicare and Medicaid Services to assist schools with expanding school-based health services through Medicaid and funded initiatives at the U.S. Department of Education to hire and retain mental health professionals providing these services.

 

In the Consolidated Appropriations Act (CAA), enacted in December 2022, Congress built on these accomplishments by reauthorizing the Garrett Lee Smith Suicide Prevention Program, which funds mental health programs for college-age students, as well as several programs to improve the behavioral health workforce. The CAA also bolstered crisis-intervention programs by directing guidance and funding to providers and improving payment for their services.

 

The U.S. Department of Health and Human Services (HHS) also acted throughout 2022 to expand access to community-based mental health services. In partnership with the Department of Education, for example, HHS has worked to facilitate the use of Medicaid and Children’s Health Insurance Program funds to support school-based behavioral health services. SAMHSA also launched the Mental Health Crisis Response Partnership Pilot Program to improve access to mobile crisis services in high-need areas.

988 is part of a series of investments to address Americans’ mental health needs

Despite this progress, significant challenges remain in the effort to strengthen 988 and connect individuals in crisis to behavioral health services. For example, although state governments carry the responsibility for funding and operating 988 call centers, only a handful of states have passed legislation to secure long-term financial support for the lifeline through telecommunications fees. A recent study, moreover, found that only around half of states have earmarked sufficient funding to meet increased 988 center costs. Due in part to insufficient funding, call centers can also struggle to hire and retain qualified staff and answer rates can vary significantly by state. Improved data collection and analysis concerning 988 services is also necessary to help identify gaps in crisis care and improve lifeline implementation.

On the federal level, ongoing negotiations in Congress could result in cuts to appropriations for 988, which is an alarming prospect given that SAMHSA estimates outreach to the lifeline will increase by up to 50%—to a total of around 9 million contacts—in FY 2024. States will also require additional federal support to develop and implement mobile responses and stabilization units and publicize the full range of 988 services. A recent survey by the Pew Charitable Trusts, for example, found that only 13% of U.S. adults knew about the existence and purpose of 988; awareness was higher among white adults and individuals with a college education compared to Black adults and individuals with a high school degree or less.

Trust for America’s Health (TFAH) will continue to advocate for additional funding and resources to bolster the 988 lifeline and transform the behavioral health crisis system more broadly. Continued bipartisan support is necessary not only to ensure access to existing services, but also to build the next generation of care to meet the growing demand from Americans in crisis.

Recommendations for addressing Americans’ mental health needs and other issues are available in TFAH’s 2023 Pain in the Nation report.

 

 

 

Indicators of Healthy Aging: A Guide to Explore Healthy Aging Data through Community Health Improvement

Collecting, analyzing, and translating relevant and robust data on older adults.

For over a century, public health interventions – from vaccines to food safety and vector control – have contributed to Americans’ longevity, and state and local health departments play a key role in supporting their communities by promoting healthy living. Healthy aging programs uniquely dovetail with local health department Community Health Improvement Plans (CHIPs).  Both allow health departments and partnering organizations to understand and address healthy aging priorities through data.

An analysis conducted by the National Association of County and City Health Officials (NACCHO), found that most CHIPs include priorities that, while not specifically addressing older adults (e.g., 65 years of age and older), could be adapted for healthy aging programs. These priorities include chronic diseases, including heart disease, diabetes, stroke, and cancer, as well as substance use, depression, and other mental health conditions.

To develop and strengthen age-friendly public health systems, a more comprehensive set of healthy aging indicators is needed to help health departments and community partners at the local, state, tribal, and territorial levels measure and identify population-level health disparities and inequities. Additionally, Community Health Improvement (CHI) partners need a robust, unified source of secondary data that aligns with healthy aging indicators to inform strategic and action planning.

This guide, developed by Trust for America’s Health (TFAH) and the National Association of County and City Health Officials (NACCHO) and with funding from The John A. Hartford Foundation, is designed to augment NACCHO’s Mobilizing for Action through Planning and Partnerships (MAPP) framework. MAPP is the most widely used CHI framework among governmental public health departments and, increasingly, community-based organizations, nonprofit hospital systems, and community health centers that lead or engage in CHI processes. This also serves as a resource for health departments seeking to attain Age-Friendly Public Health Systems (AFPHS) recognition.

Download your free copy of the Guide.

New Report: Under-Investment in Public Health Leaves Nation Less Prepared for Current and Future Health Risks

COVID-19 Emergency Funding Helped Control the Pandemic, but Did Not Address Structural Weaknesses in the Nation’s Public Health System

(Washington, DC – June 14, 2023) – Decades of underfunding have left the nation’s public health system ill-equipped to protect the health of Americans, according to a new report, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2023, being released today by Trust for America’s Health.

Insufficient funding for public health programs has been a long-standing problem. The COVID-19 crisis illuminated weaknesses in the nation’s public health infrastructure, including antiquated data systems, insufficient public health laboratory capacity, an under-resourced public health workforce, and the need for improved public health communications. These foundational public health capacities require increased, flexible, and sustained funding.

While pandemic response emergency funding was critical for addressing the crisis, it represented one-time funding and was often limited to COVID-19-specific spending, i.e., it could not be spent on underlying infrastructure needs. Furthermore, in most instances, this funding has now ended or was rescinded in the recent debt limit agreement. The nation is therefore at risk of returning to a boom-and-bust pattern of sporadic funding increases for public health during emergencies followed by insufficient funding in non-emergency periods.

The U.S. Centers for Disease Control and Prevention (CDC), the primary source of public health funding for state, local, tribal, and territorial health departments, is itself reliant on the annual federal appropriations process. Over the past two decades (FY 2014 – 2023), the CDC’s budget has increased by just 6 percent after adjusting for inflation, leading to insufficient funding in key program areas such as emergency preparedness and chronic disease prevention.

Two CDC programs focused on public health preparedness and response, the Public Health Emergency Preparedness Program (PHEP) and the Healthcare Readiness and Recovery Program, have both experienced major budget cuts over the past two decades. After adjusting for inflation, PHEP funding has been reduced by about half since 2003, and the budget for the Healthcare Readiness and Recovery Program has decreased by nearly two-thirds during the same period.

In addition to the risks associated with health emergencies, the country faces a growing number of people living with chronic diseases and the associated healthcare costs. Today, roughly 60 percent of the U.S. adult population has at least one chronic disease, such as obesity, diabetes, or heart disease. Treating these chronic diseases, along with mental health conditions, accounts for the vast majority of U.S. healthcare spending. While evidence-based public health programs that help prevent chronic disease are doing important work, insufficient funding has limited their accessibility and impact in many communities.

“We must address the serious mismatch between the nation’s public health needs and its public health investment,” said J. Nadine Gracia, M.D. MSCE, President and CEO of Trust for America’s Health. “Public health and prevention represent only a small fraction of the more than $4 trillion in annual health spending in our nation. Increased and sustained investment in public health would not only better prepare us for future public health emergencies, it would also help address the root causes of poor health and health disparities.”

TFAH is calling for annual funding for CDC of at least $11.581 billion in FY 2024, the level requested in the President’s FY 24 budget (FY 2023 CDC funding is $9.2 billion).

Other policy recommendations within the report include:

  • Increase and sustain disease-agnostic funding to strengthen public health infrastructure. Public health experts estimate an annual shortfall of $4.5 billion in necessary funding for state and local health departments to provide comprehensive public health services in their communities.
  • Strengthen public health emergency preparedness, including within the healthcare system. Investments should include the restoration of funding to the Public Health Emergency Preparedness Cooperative Agreement, the Healthcare Readiness and Recovery Program, and programs designed to support vaccine infrastructure as well as prevent, detect, and contain antimicrobial-resistant infections.
  • Modernize the public health data system to ensure comprehensive and real-time data sharing during public health emergencies. Public health experts estimate that at least $7.84 billion is needed over the next five years for CDC’s Data Modernization Initiative to strengthen public health data collection and reporting at the state and local levels. Congress should also provide sustained funding for CDC’s new Center for Forecasting and Outbreak Analytics.
  • Bolster the recruitment and retention of the public health workforce. In 2021, it was estimated that state and local public health departments needed to hire an additional 80,000 employees to be able to deliver a minimum set of public health services. The one-time nature of short-term emergency funding means that health departments will continue to experience understaffing.
  • Address health disparities and the root causes of disease by addressing the social determinants of health and investing in chronic disease prevention.
  • Invest in programs to prepare for and mitigate the impacts of climate change.

Read the full report

 

 

 

U.S. Death Rate Due to Alcohol, Drugs, and Suicide Increased by 11 Percent in 2021

Increases occurred among all ages, races, and geographic groups, but were particularly high for youth suicides and overdoses among certain populations of color

(Washington, DC – May 24, 2023) – The rate of U.S. deaths due to alcohol, drugs, and suicide climbed 11 percent in 2021, according to Pain in the Nation 2023: The Epidemics of Alcohol, Drug, and Suicide Deaths, a new report released today by Trust for America’s Health (TFAH).

While an all-time record, 209,225 Americans lost their lives due to alcohol, drugs or suicide last year these deaths are part of a two-decade trend of sharply increasing fatalities due to substance misuse and suicide in the U.S. The 2021 data showed such deaths were up across the U.S. population, with the largest increases occurring among certain populations of color as well as people living in the South, West, and rural regions of the country.

  • Drug overdose deaths increased by 14 percent between 2020 and 2021, with larger increases among Native Hawaiians and Pacific Islanders, American Indian/Alaska Native people, and among youth and older adults. For the year, drug overdose rates were highest among adults ages 35 to 54, males, Black people, and young adults ages 18 to 34.
  • Alcohol-induced deaths increased by 10 percent between 2020 and 2021, with the highest increases among Native Hawaiians and Pacific Islanders, Latino people, and American Indian/Alaska Native people.
  • Suicide mortality increased by 4 percent between 2020 and 2021, with the highest increases among American Indian/Alaska Native people and Black people.

While the 2021 trends were not good news, they were an improvement over the 2020 data. For 2020, the number of alcohol, drug, and suicide deaths was up 20 percent as compared with 2019.

“The data continue to show alarming increases in deaths due to substance misuse and suicide,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “What is needed is urgent and sustained investment in policies and programs that prevent the root causes of substance misuse and suicidality. We need to prevent adverse childhood experiences and trauma and support mental health services in schools, within healthcare settings, and in community settings for all populations.”

Two Decades Overview
Deaths due to alcohol, drugs, and suicide have been on the rise for over two decades, doubling over the period from 104,379 deaths in 2011 to 209,225 in 2021.  Between 2016 and 2021, the escalation in the rate of drug overdose deaths was more than 60 percent. These increases disproportionately impacted Black and Latino populations.

Most of the upturn in deaths due to drug overdose involved opioid overdose, with additional deaths due to cocaine and psychostimulants. In addition, a new and growing threat is xylazine, a tranquilizer approved for veterinary use but mixed with fentanyl to create a highly toxic illicit drug combination.

During the last two decades alcohol and suicide deaths have also increased, but not as sharply as drug deaths.

Youth Suicide Risk
Over the last decade, alcohol, drug, and suicide deaths among youth ages 10 to 17 increased by 65 percent. While youth have a much lower suicide rate than the general population, the upward trend of youth suicide, beginning well before the COVID-19 pandemic—a 71 percent increase tween 2010 and 2021—is tragic and warrants immediate attention. Unlike for other age groups, an increase in suicide deaths among young people was the primary driver for the age group’s increased overall mortality.

American Indian/Alaska Native and LGBTQ youth are most at risk for poor mental health and suicidal behaviors.

Veteran Suicide Risk
Veteran suicide risk also needs immediate attention.  The suicide mortality rate for veterans was 32 deaths per 100,000 veterans in 2020, a much higher rate than the general population.

Evidence-based Programs Can Help Reverse Deaths of Despair Trends

In response to the growing deaths of despair crisis, a multifaceted approach to improving mental health and well-being in every community is needed. The report includes recommendations for steps federal, state, and local government and other stakeholders should take to address substance misuse and suicide deaths. The recommendations include:

  • Invest in prevention programs and conditions that promote health including programs that prevent or reduce adverse childhood experiences and provide trauma-informed services, student mental health services in schools, and strengthened crisis intervention programs, including the 988 crisis lifeline.
  • Prevent substance misuse and overdose by supporting syringe service programs, increasing naloxone and fentanyl test strips availability, and expanding funding for the Drug-Free Communities Support Program to bolster prevention programs for youth specifically.
  • Transform the mental health and substance use prevention system by increasing access to mental health and substance use healthcare through full enforcement of the Mental Health Parity and Addiction Equity Act, integrating mental health and substance use treatment with other healthcare services, and expanding culturally and linguistically appropriate care for populations of color and other underserved populations.

Read the full report

 

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

 

 

 

 

 

 

 

 

 

 

 

 

Improving Minority Health Requires Addressing Social and Economic Disparities

The data tell the story. Members of certain racial and ethnic groups in the U.S. have, on average, worse health outcomes, including higher rates of chronic and infectious disease, than do their white counterparts. According to the National Institutes of Health, American Indian and Alaska Native people have a greater chance of having diabetes than any other racial group and are twice as likely as whites to have diabetes. Black adults in the U.S. are nearly twice as likely to develop diabetes compared to white adults. Asian Americans are 40 percent more likely to have diabetes than are whites, and Hispanic and Latino adults are also more likely to have diabetes than are whites.

Cancer is another disease for which people of color experience higher disease and death rates than do white people, according to the National Cancer Institute, typically due to social, environmental, and economic disadvantages. People of color also often have less access to healthcare screening and services, experience a lower quality of care, and face discrimination and bias when they do seek care. Black men have the highest prostate cancer mortality rate among all U.S. population groups, Black women have a lower incidence of breast cancer than white women but a higher mortality rate, and American Indian and Alaska Native people have higher death rates from kidney cancer than other racial and ethnic groups.

Health disparities are preventable differences in the burden of disease or in opportunities to achieve optimal health as experienced by racial and ethnic groups. Health disparities are among the many ways in which both the legacy of and present-day structural racism impact the disease burden and life expectancy of people of color. At the root of these disproportional health burdens are historic patterns of systematic inequities which have led to communities disadvantaged by poverty, exposure to pollution and environmental risks, unstable housing, limited employment opportunities and lack of access to healthy food, quality education, transportation, and healthcare. These differential disease burdens are rooted in differences that go beyond personal choices. They occur at the systems level, are rooted in centuries of structural racism, and were exacerbated by the COVID-19 pandemic.

Solutions can be found in policy action to create conditions in every community that allow all residents to achieve optimal health. Conditions such as access to safe and affordable housing; access to healthy foods, transportation, education, employment, and healthcare; jobs that pay a living wage and a built environment that supports physical activity. Building such communities will require a multi-sector and intentional focus on health equity and should start by targeting resources to communities most in need.

Trust for America’s Health’s (TFAH) recommendations for policy action that will advance health equity include:

  • The Federal government should be a leader in advancing health equity by making it a priority and by ensuring accountability to health equity goals in all federal agencies, policies, and programs.
    • Update: The Biden-Harris Administration’s American Rescue Plan and other COVID-19 response measures were designed to mitigate the impacts of the pandemic, with households of color being at particular risk for negative health and economic impacts during the emergency. Numerous programs including cash relief to low-and-middle income people, expansion of food and nutrition security programs, rent payment programs, and lower health insurance marketplace premiums helped Americans weather the pandemic. Of concern, is that many of these programs and program flexibilities will expire with the end of the public health emergency in May 2023.
    • Update: On his first day in office, President Biden signed Executive Order 13985 Further Advancing Racial Equity and Support for Underserved Communities Through the Federal Government which instructed Federal agencies “to redress inequities in their policies and programs that serve as barriers to equal opportunity”.
  • Congress should further develop and expand funding for programs that serve communities that are under-resourced and marginalized, including enacting and funding the Health Equity and Accountability Act and expanding investment for the Centers for Disease Control and Prevention’s (CDC) Racial and Ethnic Approaches to Community Health (REACH) program and its Healthy Tribes program so that all approved applicants are funded.
  • Government at all levels and the healthcare sector should work together to ensure that health data is complete, shareable, and disaggregated (while still protecting individual privacy) so that the impact of health conditions, disease threats, health policies and interventions on specific population groups are known. All health data should be collected and disaggregated by race and ethnicity and other demographic factors. Investments in modernizing the nation’s public health data infrastructure are needed to meet these goals.
  • The Biden Administration should create, and Congress should fund, a strategy and programs to address the root causes of health inequities including providing at least $100 million in FY 2024 for the expansion of the social determinants of health program at CDC.
  • The federal government should prioritize the elimination of poverty by raising the national minimum wage, expanding programs to make higher education more accessible to lower-income people, growing federal supports for affordable housing and childcare and by expanding nutrition support programs such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
  • Federal and state governments should ensure that all Americans have access to health insurance and have job-protected paid leave for illness or to care for a family member who is ill.
  • Federal and state governments should expand programs that support families including child tax credits, earned income tax credits, and programs that support childcare, early childhood education programs, school meal programs, and school-based Medicaid health services programs.

For more information about the data and policy solutions summarized in this news feature see TFAH’s Blueprint report for the 2021 Administration and Congress, The Promise of Good Health for All: Transforming Public Health in America.

 

Unseen Guardians: Measles Outbreak Highlights Public Health’s Crucial Role and Evolving Challenges

Local health officials and CDC work together to stamp out Ohio measles outbreak

In 1912, the United States formally recognized measles—a highly contagious viral infection causing fever, cough, runny nose, red eyes, and a characteristic rash in milder cases, while leading to pneumonia, encephalitis, and death in more severe instances—as a nationally notifiable disease. For centuries, this ubiquitous childhood ailment afflicted millions. In the first decade of reporting, an annual average of 6,000 measles-related fatalities were recorded in the U.S.

The introduction of the first measles vaccine in 1963, with its near-perfect efficacy, marked a turning point. The vaccine was later combined with those for mumps and rubella (MMR) in 1971, and varicella (MMRV) in 2005, providing children protection against several diseases in a single shot. Bolstered by this potent new preventive tool, the Centers for Disease Control and Prevention (CDC) set a goal in 1978 to eliminate measles from the country. This objective was realized in 2000, thanks to robust vaccination campaigns, the introduction of a second dose in 1989 to increase efficacy, and rigorous disease surveillance systems.

In the new millennium, measles appeared a relic of the past, but the specter of outbreaks returned—first in the 2014-15 Disneyland episode, and then in the largest outbreak in decades in 2019. Declining vaccination rates, fueled by skepticism and misinformation, left vulnerable communities exposed. The 2019 outbreak primarily affected unvaccinated children in communities with low vaccination rates across 31 states, such as ultra-Orthodox Jewish communities in New York and vaccine hesitant regions in Washington. Travelers imported the virus, sparking infections among the unvaccinated.

One such measles outbreak erupted in Ohio in 2022. Between November 2022 and February 2023, when the outbreak was declared over, 85 cases were reported, primarily affecting children under five, with 36 hospitalizations. Among the 85 cases, 80 were unvaccinated, including 25 infants too young to receive their first dose.

To quell the outbreak, a team of epidemiologists from the CDC worked in concert with Columbus Public Health to track cases, identify and notify exposed residents, and understand the spread of the virus. Dr. Mysheika Roberts, Columbus’s health commissioner, led the outbreak response, raising awareness of the disease through public information and education, and promoting and easing access to vaccination.

In addition to the on-the-ground work of state and local health departments, the CDC plays a vital, often behind-the-scenes role in supporting those departments and safeguarding public health. It provides robust disease surveillance systems, expert guidance, technical assistance, and financial support, enabling locally targeted interventions and infrastructure improvements.

Though the latest outbreak was successfully contained, the Ohio measles episode may portend further challenges. Vaccine hesitancy, a complex and deeply ingrained phenomenon, threatens to erode hard-won public health gains and could precipitate resurgent outbreaks. The issue has multifaceted roots including mistrust in science and institutions, and misinformation amplified on digital platforms. In communities of color, vaccine hesitancy is compounded by longstanding health disparities and medical mistreatment.

The COVID-19 pandemic exacerbated the problem, with routine vaccination rates falling due to school closures and disrupted well-child doctor visits. A recent Kaiser Family Foundation poll revealed that, amid the politicization of COVID-19 vaccines and school mandates, over a third of parents with children under 18 believe they should have the choice to not vaccinate their children against measles, mumps, and rubella, even at the risk of others’ health. This represents a 52% increase compared to 2019. During the 2021-22 school year, kindergarten vaccination coverage fell to roughly 93%, leaving about 250,000 kindergartners potentially unprotected against measles.

Tackling vaccine hesitancy and strengthening our public health systems requires a multifaceted national approach. Federal, state, and local governments should invest in accessible, science-based education campaigns that dispel myths and foster trust. Working with local partners, public health agencies are developing tailored, culturally sensitive vaccine education and access programs that bridge gaps in understanding and acceptance.

The Ohio measles outbreak serves as a stark reminder that the fight against vaccine-preventable diseases remains ongoing, the indispensable role of the public health workforce, and the critical need for a robust public health system. Increased, sustained, and flexible public health funding is key to having such a system. As is growing a diverse workforce to ensure that those shaping policy and delivering services reflect the communities they serve. By taking these steps, among others, we can reduce vaccine hesitancy, create a more robust public health system, and foster an environment of trust in science. Doing so can protect the hard-won progress made against measles and other diseases, safeguard the health and well-being of generations to come, and pave the way for a more equitable future.

New Report Measures States’ Emergency Preparedness and Makes Recommendations About How to Strengthen the Nation’s Public Health System

Sustained Investment in Public Health Infrastructure and Preparedness is Needed to Protect Lives During Disease Outbreaks and Natural Disasters

(Washington, DC – March 23, 2023) – As infectious disease outbreaks and extreme weather events threaten the health of more Americans, a new report shows the need for strengthened national and state public health emergency preparedness.

Ready or Not 2023: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, released today by Trust for America’s Health, measures states’ readiness to respond to a spectrum of health emergencies and to provide ongoing public health services. The report gives federal and state health officials and policymakers actionable data and recommends policies to improve the nation’s emergency preparedness at a time when health emergencies are increasing. During 2022, the U.S. surpassed 1 million deaths due to COVID-19 and saw decreasing rates of routine vaccinations and increasing prevalence of health misinformation.  In addition, the past year was the eighth consecutive year the U.S. experienced 10 or more billion-dollar weather-related disasters.

The report tiers states and the District of Columbia into three performance levels for health emergency preparedness: high, middle, and low. This year’s report placed 19 states and DC in the high-performance tier, 16 states in the middle performance tier, and 15 states in the low performance tier.

High Tier – 19 states & DC

CO, CT, DC, DE, FL, GA, KS, ME, MD, MA, MS, NJ, NC, OH, PA, UT, VT, VA, WA, WI

Middle Tier – 16 states

AK, AL, AR, CA, IA, ID, IL, IN, MO, ND, NE, NH, NY, RI, SC, TX

Low Tier – 15 states

AZ, HI, KY, LA, MI, MN, MT, NM, NV, OK, OR, SD, TN, WV, WY

“Increased and sustained investment in public health infrastructure, emergency preparedness, and health equity will save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Federal, state, and local officials as well as leaders in the healthcare and business sectors should use our findings to identify and address gaps in public health preparedness. Neglecting to do so will mean that the country will not be as prepared as it needs to be for the next public health emergency.”

The report’s findings showed both areas of strength within the nation’s public health system and areas that need attention.

Areas of strong performance include:

  • A majority of states have made preparations to expand healthcare and public health laboratory capacity in an emergency.
  • Most states are accredited in the areas of public health or emergency management. Some states are accredited in both.
  • Most U.S. residents who received their household water through a community water system had access to safe water. However recent water system failures in Jackson, Mississippi and Newark, New Jersey demonstrate the importance of continued attention to the integrity of municipal water systems.

Areas that need attention include:

  • Too few people were vaccinated against seasonal flu last year despite significant improvement in flu vaccination rates in recent years. During the 2021-2022 flu season, 51 percent of Americans ages 6 months or older received a flu vaccine, well short of the 70 percent goal established by Healthy People 2030.
  • Only half the U.S. population is served by a comprehensive public health system. Comprehensive public health systems ensure that necessary health services are available to all residents.
  • Only 26 percent of hospitals in states, on average, earned a top-quality patient safety grade in 2022. Hospital safety scores measure performance on such issues as healthcare-associated infection rates, intensive-care capacity, and an overall culture of error prevention.

The report contains recommendations for policy actions that would create a stronger public health system at all levels, including:

  • The Administration, Congress, and state lawmakers should modernize public health infrastructure, including by investing $4.5 billion annually to support foundational public health capabilities. In addition, Congress should continue to increase funding for the Public Health Emergency Preparedness cooperative agreement and public health data modernization to allow for earlier and more accurate detection of emerging health threats.
  • Policymakers at all levels should act to protect and strengthen public health authorities and should prioritize rebuilding trust in public health agencies and leaders.
  • Congress and state legislatures should invest in effective public health communications, including countering misinformation.
  • Congress and states should ensure first-dollar coverage for all recommended vaccines under commercial insurance and for uninsured people. States should minimize vaccine exemptions for school children, and healthcare facilities should increase rates of vaccination for healthcare workers.
  • Congress and states should provide job-protected paid leave for employees due to illness or family caregiving demands.
  • Congress and states should invest in policies and capacity to address the social determinants of health such as secure housing, access to transportation, and access to healthy food.
  • Congress should fund the entire medical countermeasures (MCM) enterprise, including the distribution and dispensing of MCMs. Congress should also create incentives for new products to prevent and fight antibiotic-resistant infections.
  • Congress and states should strengthen readiness for climate change, extreme weather, and environmental health threats.

Read the full report

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