Nineteen states and the District of Columbia scored higher than Hawaii in a study of public health emergency preparedness released today.

Hawaii is one of 11 states that achieved seven out of 10 key indicators of preparedness in the report, “;Ready or Not? Protecting the Public's Health from Diseases, Disasters and Bioterrorism.

“;The H1N1 flu outbreak has exposed serious underlying gaps in the nation's ability to respond to public health emergencies and ... the economic crisis is straining an already fragile public health system,”; reported the Trust for America's Health and the Robert Wood Johnson Foundation.

Hawaii scored points concerning the state laboratory's ability to assure timely pick up and  delivery of disease samples around the clock and having enough staff to work hours needed in an emergency like H1N1.

It also scored points for:

>> Purchasing at least half of its share of federally subsidized antiviral medications to prepare for a potential pandemic flu outbreak.

>> Tracking diseases through an Internet system used by the U.S. Centers for disease Control and Prevention.

>> Identifying the pathogen responsible for reported food-borne disease outbreaks at a rate meeting or exceeding the national average of 45 percent (based on combined data for 2005-2007).

>> Meeting Medical Reserve Corps readiness criteria for medical volunteers during an emergency.

>> Requiring all licensed childcare facilities to have written plans for multi-hazard evacuation and relocation emergencies.

But Hawaii lost points for:

>> Not submitting weekly data  on available hospital beds for at least half of the facilities within the state to the U.S. Department of Health and Human Services during the H1N1 response.

>> Not having a law or legal opinion to limit liability against organizations providing volunteer help in emergencies.

>> Not increasing or maintaining the funding level for public health services from 2007-08 to 2008-09.

“;We're particularly pleased to note and highlight our accomplishments in the area of public health lab capacity,”; state Health Director Chiyome Fukino said in an e-mail response.

Since the 2008 report, she said, the state laboratories “;have established local partners, policies and procedures to enable timely pick up and delivery of disease samples. As a result of these improvements, the state labs have been able to successfully meet many of the laboratory challenges presented by the 2009 H1N1 pandemic and scored well this year.

“;More importantly, the public has been well served throughout this very real test of lab capacity.”;

However, federal and state budget cuts “;continue to have a significant impact on our ability to maintain and grow our emergency preparedness capacities,”; Fukino added.

Richard Hamburg, deputy director of the Trust for America's Health, said in a news release, “;The H1N1 outbreak has vividly revealed existing gaps in public health emergency preparedness.”; 

He said the report “;shows that a Band-Aid approach to public health is inadequate. As the second wave of H1N1 starts to dissipate, it doesn't mean we can let down our defenses. In fact, its 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.”;

Key infrastructure concerns highlighted by the study were lack of real-time coordinated disease surveillance and laboratory testing, outdated vaccine production capabilities, limited hospital surge capacity and a shrinking public health workforce.

More than half of the states had experienced public health funding cuts and a 27 percent cut in federal preparedness funds since fiscal year 2005, “;which puts improvements that have been made since the Sept. 11, 2001 tragedies at risk,”; the report said.

No state received points on all 10 indicators. Eight states tied for the highest score of 9 out of 10: Arkansas, Delaware, New York, North Carolina, Oklahoma, Texas, Vermont and North Dakota. Montana had the lowest score of three out of 10.

Recommendations in the report include: Ensuring stable and sufficient funding; identifying and addressing gaps in core systems from H1N1 response; and improving community preparedness.