As the United States completes a second year of pandemic response activities, results from the 2021 release of the National Health Security Preparedness Index show that the nation’s protections from large-scale health threats remain highly variable across the country. The good news is that these protections have not eroded significantly during the extended response to the COVID-19 crisis. In fact, performance in selected domains of health security improved over the past year. One of the most notable improvements occurred in the domain of Countermeasure Management, which tracks the deployment of protective technologies, supplies, and equipment to places of greatest need.

The more troubling news from the 2021 Index release is that large differences in health security levels persist across states and communities, with the lowest levels of health security found in geographic areas with the highest levels of social and economic vulnerability. By producing the Index annually since 2013, we can clearly see that health security levels have improved at an uneven pace across the United States in recent years. As a result, large segments of the country are left under-protected and vulnerable to health and economic burdens triggered by COVID-19.

The 2021 release of the Index provides an important window into the consequences of failing to achieve a more equitable health security system across the United States. In earlier releases of the Index—prior to the COVID-19 pandemic—it was difficult to see the clear connections between health security levels and health outcomes as they varied across the country. Now, in the midst of the pandemic, the 2021 Index release clearly demonstrates that areas with lower health security levels experienced significantly higher mortality due to COVID-19. These results document how inequities in health security contribute to inequities in health outcomes within the context of a large-scale health emergency.

Most importantly, results from the 2021 release of the Index demonstrate that gaps and inequities in health security are amenable to solutions. Every state achieved improvements in health security levels in at least one domain over the past eight years and most states also bolstered their overall health security levels. For example, Louisiana achieved one of the largest gains in health security of any state in 2020 despite serving many residents with high levels of social and economic vulnerability and despite confronting simultaneous health emergencies. If all states achieve sustained rates of improvement observed in Louisiana, the nation as a whole can eliminate geographic inequities and reach a strong national health security level of at least 9.0 in as few as five years.

This year’s Index results show that inequities in health security are not inevitable. A uniformly high-functioning system is within reach by targeting additional resources and assistance to places that experience the lowest health security levels and by supporting meaningful approaches to regional coordination and cross-sector collaboration.

We hope the 2021 release of the Index can inform these types of improvements as the United States continues to recover from the pandemic. Please spend some time with the 2021 Key Findings report for a deeper dive into health security patterns and trends observed across the country. For a summary of the health security patterns in your specific area, take a look at the state profile for your individual state.  We invite you to conduct your own analyses of health security measures by downloading the Health Security Data Explorer. For ideas on using the Index data to mobilize change in your community, see the Innovator’s Guide to the National Health Security Preparedness Index and other resources on the Index website.

Glen P. Mays PhD, MPH is the chair and a professor in the Department of Health Systems, Management and Policy in the Colorado School of Public Health at CU Anschutz. His research examines delivery and financing systems for health services, with a focus on estimating their effects on population health and economic efficiency.