A new report card from the Trust for America’s Health examines emergency preparedness on a state-by-state basis. “Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism,” scored states, as well as Washington, DC, on 10 key indicators of public health preparedness, including public health funding commitment, flu vaccination rate, reducing healthcare-associated infections and emergency health care access. Overall, the report found improved emergency operations, communication and coordination; support for the Strategic National Stockpile and the ability to distribute medicines and vaccines during crises; upgrades in public health laboratories and foodborne illness detection capabilities; and improvements in legal and liability protections during emergencies. However, there remains a lack of a coordinated, interoperable, near real-time biosurveillance system; insufficient support for research and development of new medicines, vaccines and medical equipment to keep pace with emerging threats; gaps in the ability of the system to care for a mass influx of patients during a major outbreak or attack; and cuts to the public health workforce, according to the report.Health emergency preparedness funding for states has been cut by $280 million since fiscal year 2002, while health system preparedness funding for states has been cut by more than half since FY 2005 – down to $255 million, the report notes.