How Does The Index Measure Health Security?

The National Health Security Preparedness Index collects, aggregates, and measures existing state-level health security data from a wide variety of sources. The Index then computes a range of key measures for all 50 states and the District of Columbia that, taken together, display the broadest and most comprehensive national- or state-level picture of health security available today. The Index is updated each year to better reflect the multitude of factors that impact U.S. health security.

What's New

The 2021 Index release retains the framework of the previous releases: it still includes six domains and allows for comparing and tracking improvements over time through the inclusion of comparable annual results back to the baseline year of 2013. The 2021 release includes data for the 50 states and the District of Columbia for eight years from 2013 to 2020. It assesses 130 measures across 19 sub-domains for all eight years. Each Index update provides greater clarity about strengths and gaps, as well as the ability to track improvements and declines in health security over time.


The National Health Security Preparedness Index tracks the nation’s progress in preparing for, responding to, and recovering from disasters and other large-scale emergencies that pose risks to health and well-being in the United States. Because health security is a responsibility shared by many different stakeholders in government and society, the Index combines measures from multiple sources and perspectives to offer a broad view of the health protections in place for nation as a whole and for each U.S. state.

Full details of the Index methodology for the 2021 release are available for download here.

Suggest New Measures

To continuously improve the Index, stakeholders are invited to recommend new measures for inclusion, to recommend changes to existing measure definitions and specifications, and to recommend deletion of existing measures from the Index.

Recommendations for new measures that reflect social, economic, and/or environmental dimensions of health security and resiliency are especially encouraged, as these constructs are currently under-represented in the Index structure. The Index gives priority to measures that can be constructed from existing, low-cost data sources such as surveys, records, registries, documents, images, sensors, or other automated monitoring systems. We are especially interested in measures that make use of novel electronic data sources such as data from web search engines, social media, satellite imagery, and commercial transactions. Measures that have been previously validated and that provide both national-level and state-level estimates of health security and resiliency are of primary interest.