Trust for America's Health report ranks Alabama in top tier for public health preparedness


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Alabama placed in the high-performance tier in comparison with other states in the Trust for America’s Health 2022 report on public health preparedness, Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism. This report measures states’ performance on 10 key emergency preparedness indicators and identifies gaps in states’ readiness to respond to emergencies. The report also includes policy recommendations for strengthening the nation’s health security.

Controlling the COVID-19 pandemic has been extremely challenging in every state, the report notes. The COVID-19 pandemic continues to illustrate the critical need to invest in public health infrastructure and the social determinants of health to protect all Americans’ health during emergencies. The report measures states’ degree of preparedness to respond to a wide spectrum of health emergencies and to provide ongoing public health services, including disease surveillance, seasonal flu vaccination, safe water, and expanded healthcare services during emergencies.

State Health Officer Dr. Scott Harris said, “Alabama’s public health preparedness and response infrastructure has been crucial during the pandemic by ensuring lifesaving supplies, equipment, vaccines and medications reach the state’s residents on a timely basis and on a large and unprecedented scale. These capabilities are vital in responding to a wide range of health emergencies now and in the future.”

States’ performance was measured during a year that presented intense demands on the nation’s public health system. In addition to the ongoing COVID-19 pandemic, 2021 saw record heat in many places, extensive flooding, wildfires throughout the Western U.S., a highly active hurricane season, and unusual and deadly December tornados in eight states. At the same time, the report stated, hundreds of public health officials having experienced burn-out, threats to their safety, and attempts to limit their public health authorities have resigned, retired or been fired.

While critical progress was made in fighting COVID-19 during 2021, particularly through the widespread availability of vaccines and a more coordinated federal response, the pandemic continued to illuminate the ways in which health inequities put communities of color and low-income communities at heightened risk for worse health outcomes during an emergency.

“Social, economic and health inequities undermine a community’s ability to prepare for, respond to, and recover from a public health emergency. If we enter the next public health crisis with the same magnitude of health inequities in our communities as has been evident during this pandemic, the impact will be similar: preventable loss of life, disproportionate impact on communities of color and low-income communities, and widespread social and economic disruption. It is impossible to separate strong public health emergency preparedness and health equity,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health.

The report tiers states and the District of Columbia into three performance levels: high, middle and low, placing 17 states and the District of Columbia in the high-performance tier, 20 states in the middle performance tier, and 13 states in the low performance tier based on their 2021 performance.

Overall, 12 states improved their performance while 16 states slipped in their ranking. Three states, Ohio, Pennsylvania and South Carolina, improved their performance by two tiers. Nine states improved by one tier: Alabama, Arizona, Florida, Illinois, Iowa, Missouri, New Hampshire, New Jersey, and New York.

Sixteen states fell one tier: Delaware, Georgia, Idaho, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Montana, Nebraska, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, and Wisconsin. The nation’s public health emergency preparedness has been tracked since 2003.

Among the report's policy recommendations were the following:

  • Congress and states should provide stable, flexible, and sufficient funding for public health, including for infrastructure, data systems, and the public health workforce.
  • Congress should create a COVID-19 Commission to review and address gaps in the pandemic response, and leaders at all levels of government should reject attempts to weaken public health authorities.
  • Policymakers should take steps to prevent disease outbreaks by investing in vaccination infrastructure, antibiotic resistance programs, and by providing paid leave for all workers.
  • Congress should create programs to help build resilient communities by investing in health equity and the social determinants of health, including anti-poverty programs and programs that build financial security for families.
  • Congress should invest in the development and distribution of medical countermeasures to enable rapid development and effective deployment of life-saving products during emergencies and federal and state policymakers and healthcare systems leaders should work together to prioritize effective coordination and communication during emergencies.
  • The White House, Congress and states should develop plans and provide funding to minimize the health impacts of climate change and do so in ways that address health equity.

Trust for America’s Health is a nonprofit, non-partisan health policy advocacy organization which focuses on addressing the social determinants of health and correcting health inequities. The full report may be viewed at



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