Thirty-two states have cut their own spending on public health even as Congress sent massive federal aid to shore up the long-crumbling systems, the report found.
Yet the Centers for Disease Control and Prevention does no tracking to ensure that states are using the federal money to supplement, not supplant, their own public health spending, said the nonprofit Trust for America's Health, which released the report Thursday.
In many states, the federal grants themselves have been caught up in red tape that limits how much has reached local authorities who need them for such things as hiring staff, the report said. One result: By the government's own measure, only Florida and Illinois are fully prepared to distribute and administer vaccinations and antidotes shipped from the nation's emergency stockpile in event of a bioterrorist attack.
The overall money crisis has even greater implications, because the same basic systems crucial to battling bioterrorism are needed for today's health emergencies. Yet only 13 states have plans for how to handle a flu pandemic and only 11 states provided their doctors and citizens easily accessible information during last spring's outbreak of the new respiratory killer SARS — two measures that the report says raise serious concerns about overall preparedness.
"Hallelujah that the federal government made this critical investment in bioterrorism, but let's not be foolish and say our responsibility is only if it's a terrorist and not Mother Nature," said Shelley Hearne, executive director of the Trust, a Washington-based nonprofit group that pushes disease prevention efforts.
"Mother Nature has been throwing the biggest curveballs at us yet."
Next year, the CDC will begin the first comprehensive assessment of how well every state is prepared for bioterrorism and other health emergencies.
Like previous reports that have urged preparedness improvements, the Trust's attempt is based on a handful of somewhat arbitrary measures. But this latest report does go further in asking whether the budget crises that have hit most states are undermining the almost $2 billion federal investment in bioterrorism preparedness.
State-generated public health spending dropped by almost a quarter in Massachusetts and Michigan, the worst of the 32 state cuts, the report said.
Massachusetts in particular has faced an outcry that the cuts are decimating a program long considered a national leader.
But Suzanne Condon, the Massachusetts health department's associate commissioner, insists that the incoming CDC funds didn't mean state spending on preparedness was disproportionately targeted. Health officials actually have withheld spending much of the CDC money until next spring to figure out which localities need it most, she said.
The CDC is examining whether states are effectively using their federal bioterrorism grants, but spokesman Von Roebuck couldn't say if part of that assessment would examine cuts in states' own public health spending.