By: Alonzo Plough, PhD, MPH

The COVID-19 pandemic has challenged the nation’s public health systems like no event in modern history. Nearly two years after the initial outbreak kickstarted surging caseloads that continue to push hospitals to the brink, the coronavirus spread continues—with a particularly deadly toll on historically excluded communities.

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.


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.