The recent release of the National Health Security Preparedness Index, a comprehensive snapshot of the nation’s readiness for large-scale emergencies, provides necessary context to the current moment and can be used for ongoing relief efforts. In short, more data on every state’s level of emergency preparedness can help create a better integrated and more equitable public health system for the long-term.

The Index illustrates disparate preparedness levels across the country, driven by long-standing geographic and historical inequities. It shows a 32-percent gap in overall health security levels between the highest performing state and the lowest. Researchers from the Colorado School of Public Health and the University of Kentucky note that states with higher health security levels experienced significantly lower COVID-19 deaths in the opening year of the pandemic. Where a person lives should not dictate if, or for how long, they live.

Leading with a public health response will be key to an equitable long-term recovery, but other sectors and systems must follow suit. This rings particularly true as many public health officials find themselves continuing to serve on the frontlines of care – conducting contact tracing, testing, vaccinations, and more – while also being asked to rebuild and improve the public health and emergency response infrastructure in their communities. To reduce inequities in protection, leaders in healthcare, government, and business can use the up-to-date data from the Index to determine how to best tailor relief for the communities that need it most. For example, the Index includes state- and county-level medical staffing data that can inform where manpower and fiscal resources should be directed to shore up current workforce shortages. Simply put, the geographic, racial, and socioeconomic disparities uncovered by the Index demand to be taken into greater account. In theory many of us know that these disparities persist but it’s difficult to pinpoint exactly where they are occurring. The Index empowers public health and emergency preparedness professionals to do just that.

Establishing a robust, permanent emergency preparedness infrastructure is vital and will help ensure the country is prepared for future crises like the next pandemic or natural disaster. Climate-related disasters are expected to increase in the years ahead while the link between climate change and health grows. Now is the time to be proactive in taking on these pressing issues and preparing for the future.

The federal government appears prepared to continue directing relief to states and municipalities while deferring to local officials to pave the path forward for a healthier and more secure future. Local leaders from all backgrounds can seize the opportunity to pair the influx of federal investments with evidence-based data included in the Index to improve population health and advance health equity. Data is an incredibly valuable tool that should inform smart, targeted investments in both the short- and long-term. This Index is a helpful starting point.

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Alonzo Plough, PhD, MPH is the chief science officer and vice president, Research-Evaluation-Learning at the Robert Wood Johnson Foundation. He is a national leader in public health and emergency preparedness, previously working as director of public health in Boston and Seattle-King County.

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The Colorado Department of Public Health and Environment (CDPHE) was tops in our recent Innovator Challenge for using the National Health Security Preparedness Index to stimulate intra- and multi-sectorial communication, collaboration, and action to improve health security. The Index team spoke with Dane Matthew, director of Colorado’s Office of Emergency Response, about how the Index is helping the department meet its goals. Below is a snapshot of the conversation.

INDEX TEAM: How did improving Colorado’s health security and preparedness become a priority and how did you translate this into action?

MATTHEW: One of the goals in our strategic plan is to prepare and respond to emerging issues, but assessing readiness and preparedness is a pretty nebulous thing. There are so many factors. The National Health Security Preparedness Index has done that hard work and given us a sense of where we stand and where we can improve.

We decided that to use the Index, we have to figure out how to improve our score—so we formed an internal team to dig into the data and measures to understand where we were successful, where we could make improvements, and where there are missing data that we know exists somewhere. From there, we set goals and benchmarks using the Index measures and weaved them into our implementation plan and our overall strategic plan.

You mention homing in on missing data. Can you tell us what data you are working to collect?

First, we had to identify exactly where there were missing data to understand why. When we looked more closely at the data, we found measures where data were labeled “missing” that CDPHE could add. We realized that the “missing data” could be due to reporting data in a way that was not captured in the Index, potentially lowering our overall score. For example, the number of epidemiologists per 100,000 people was a low-scoring item for us, but we realized this is a measure in Colorado that is collected by the state’s Department of Labor, even though it’s a public health profession. In this case, we just needed to find out where the data are to report accurately. We now know that we have a high number of epidemiologists in the state and our score has improved.

How does this fit into the future goals of the department?

A future step for us will be to look outside of the department. We know some of the measures are beyond public health’s direct control. For example, one measure is the number of doctors per 100,000 people. Now we are thinking, “How can we encourage our local hospital associations to improve this score?” Understanding where the data come from is helping us understand what specific improvements can be made and which community partners we need to speak with.

What are the top preparedness activities in Colorado that you’re looking to improve?

We are very focused on improving a number of preparedness efforts in the state, specifically improving syndromic surveillance capabilities and sharing the generated data. Currently, we do not maintain this information at the state level, only within the Denver metro area. We are working to provide this at the local level across the state to prevent and respond to emerging threats.

Another area to improve, and this ties back into our conversations with community partners, is the number of pediatricians in the state. We are looking to partner with our local hospital associations and other health care stakeholders to improve our pediatrics capabilities—for day-to-day health and well-being, and in the event of a disaster.

What is one of the barriers to preparedness?

One challenge that I’ve been concerned about is the philosophy that just because you don’t have major events requiring massive evacuations on a continual basis, that doesn’t mean you don’t need to prepare for smaller, more localized events. When a community has something happen, we are pretty good about making sure we have a much improved response the next time something similar happens. But it’s easy to lose sight of the need to continually prepare, especially if we haven’t experienced any major emergencies or disasters for a period of time.

What advice would you give to other states using the Index?

Measuring preparedness is incredibly difficult, but the Index is a foundational piece. You can use the Index to better understand your state and departments and begin crucial conversations. Having a tool to help you articulate your readiness is important. I would urge my health security and preparedness peers to utilize the Index and dig into the data and ask, “Did that score equate to a better response or not? Are there small changes that can make a big difference?” Start with the low-hanging fruit and focus on making incremental change.

Dane Matthew, MAEd, MMAS, is the director of the Office of Emergency Preparedness and Response at the Colorado Department of Public Health & Environment.  Since June of 2016, he has led the state’s public health and medical emergency preparedness and response program.  He is ensuring all 64 counties and the nine regional healthcare coalitions in Colorado are prepared to respond to and recover from incidents adversely impacting health and the environment. Matthew’s experience as a military officer, combined with the skills he developed while a firefighter and executive director of a Colorado Special District, make him a skilled strategic planner, leader, and consensus builder. He continues to grow his knowledge of public health and medical EPR and propel Colorado’s program forward to ensure the state is prepared for when someday is today.

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The Colorado Department of Public Health and Environment (CDPHE) is exemplary in its use of Index data to communicate the importance of preparedness across government agencies and with community stakeholders. The CDPHE team leverages Index data to establish priorities, identify gaps, and galvanize support for community wide preparedness across Colorado.

The CDPHE used Index data to create preparedness goals, and incorporated the data into its Implementation Plan and overall Strategic Plan. Through an analysis of the measures and data sources, the CDPHE is targeting areas of improvement within the department and identifying measures where more data are needed from community partners, such as hospitals, businesses, and school districts.

We asked Dane Matthew, director of CDPHE’s Office of Emergency Preparedness and Response, how the Index was helpful to his agency’s work, and he said, “Measuring preparedness is extremely difficult because there are a number of factors, but you can’t improve what you haven’t measured. The Index has done the hard work for us. We know where we need to improve and have a starting point to build upon.”

Seeing this practical application of the Index is exciting and we are eager to follow CDPHE’s progress as the staff apply it to their work. Stay tuned for blog updates to learn more about how CDPHE is integrating measures into their strategic goals in our upcoming interview with Dane Matthew.

Glen P. Mays PhD, MPH is the Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health. His research examines delivery and financing systems for health services, with a focus on estimating their effects on population health and economic efficiency.

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