Aren't we Prepared Yet?



When I first heard the proposal to create a national index of health security preparedness a few years ago, I was skeptical. I’d seen many large assessment tools crash on lift off or during development. The preparedness community was too diverse to get on the same page. The politics of measurement too challenging. The capabilities needing assessment too many. Consider the range of disasters with serious actual or possible health consequences from the last couple years:  hurricanes, tornadoes, mudslides, major industrial explosions, wildfires, floods, enterovirus D68, MERS, H7N9, Chikungunya, Ebola, along with the continued challenges of planning for pandemic flu, terrorism, and chemical, nuclear and biological threats.  Odds were against success for this index.  

But I was wrong. This time it was different. With encouragement and resources from CDC, a strong team was created that would eventually include support of 35 organizations from around the preparedness community. The level of effort and intensity was high. The people behind it were committed, and it had the support of a range of leaders in and out of government.  There was the potential to create something unique and important. 

There was also recognition of the urgency around building an index. For one thing, powerful people in government were asking questions like, "Is there really a need to continue supporting preparedness programs given all the resources already committed - aren't we prepared yet?"  Separately, on-the-ground professionals in the state and local preparedness communities were open to new ways to assess and improve the effectiveness of their programs. The ingredients were there to create something valuable for both to help gauge health security preparedness in the country.  

And so the National Health Security Preparedness Index was born and launched at the end of 2013.  Many communities have used it in this last year to help them examine what they are doing in preparedness. And last Tuesday, the 2014 National Health Security Preparedness Index  (NHSPI) was released at an event on Capitol Hill.   

What’s the index and what does it show?

The NHSPI is a tool that examines national health security preparedness by collectively looking at states. It is a composite of 194 measures that give a picture of how each state is doing in six areas of important capability – health security surveillance; community planning and engagement; incident and information management; healthcare delivery; countermeasures management; and, environmental and occupational health.   

The overall structure  is as important as any individual state score. It conveys the major components of health security preparedness. And it also makes clear how many programs and people in and out of government need to work together to build preparedness in a state. 

The index is a work in progress. It is not a perfect reflection of preparedness. All measures have strengths and weaknesses (for example, here). But the index is a better composite picture of the many facets of the work than we’ve had before. All of us who have worked on the index (I was privileged to be the chair of the steering group this past year) hope it will help drive dialogue about what still needs to be done and how all communities can get better. We want the Index to shine a light on those who are doing things really well and understand how they are doing it.  

Overall the country collectively scored 7.4 out of 10. Here are the details. There is clearly a lot of capability in the system. States are doing a lot right, day in day out. But it’s also pretty clear when you review the measures and the scores that there are many things that we’d like states to be able to do that aren't yet getting accomplished. For those who may have wondered if we are finished with the work of preparedness, they can see from the index the necessary work that remains.  

What’s next

What’s next for the index itself is a transition from CDC to the Robert Wood Johnson Foundation. That’s a great development for the long run. CDC was wise to start the effort, but government programs and people change over time. For this effort to be stable financially and organizationally for the long run, it makes great sense for it to reside in a foundation that will nurture and strengthen it over time.   

For preparedness writ large, ‘what’s next’ remains to be seen. If you ask practitioners of preparedness, they will say that a lot of what has been built in the last 10 years happened as a direct consequence of federal and state grants and resources to strengthen preparedness. But there has been a steady erosion of those programs over the years.   

Ebola has shown us how critical it is to be prepared for health security emergencies. It is the latest vivid example of how dependent all of our communities are on the strengths and abilities of our public health leaders, our doctors and nurses, our emergency managers, our community organizations. It shows again that support for preparedness programs shouldn’t swing up and down wildly from crisis to crisis. And it has made clear that the answer to the question “Aren't we prepared yet?” is that we are always going to be preparing to manage disasters. We don’t start and end that work. We commit to do it and build it for the long run. Over the long run, the NHSPI will help us be better builders.