Measuring Preparedness

Environmental
& Occupational Health

National
Confidence Interval
6.6 - 7.2
National
Preparedness Level
6.9

What it Means

Actions to maintain the security and safety of water and food supplies, to test for hazards and contaminants in the environment, and to protect workers and emergency responders from health hazards while on the job.

How we Measure it

Environmental & Occupational Health Sub-domains

fws: food water security

em: environmental monitoring

pei: physical environment and infrastructure

wr: workforce resiliency

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The sufficient availability, access, use, and protection of safe and clean food and water resources to support human well-being and health.

Measure
Measure Description
Source
m275_dw
State public health laboratory provides or assures testing for drinking water
Measure Name

M275_DW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Inclusion of this measure ensures that the Index is consistent with national expert opinion and federal recommendations concerning comprehensive public health laboratory testing capabilities. However, the measure does not assess the quality of the testing, the timeliness of results reporting to enable responses to public health threats, nor whether sufficient capacity exists to test the volume of samples required during a health security event.

m275_pww
State public health laboratory provides or assures testing for private well water
Measure Name

M275_PWW

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

m275_rec
State public health laboratory provides or assures testing for recreational water
Measure Name

M275_REC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

m275_sur
State public health laboratory provides or assures testing for surface water
Measure Name

M275_SUR

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

m275_wst
State public health laboratory provides or assures testing for waste water
Measure Name

M275_WST

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

m276
Percent of 16 tests for different organisms or toxins that the state public health laboratory provides or assures to assist with foodborne disease outbreak investigations, including Bacillus cereus, Brucella sp., Campylobacter sp., Clostridium botulinum, Clostridium perfringens, Cryptosporidium sp., Cyclospora cayetanensis, Listeria monocytogenes, norovirus, Salmonella, Shigella, Staphylococcus aureus, STEC non-O157, STEC O157, Vibrio sp., Yersinia enterocolitica.
Measure Name

M276

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

m195
Percentage of community water systems in a state that meet all applicable health-based standards
Measure Name

M195

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012 - 2018

Limitations

The measure does not evaluate drinking water supplies that are non-public (private), or provide information on community water supplies that were adversely affected by emergencies or disasters.

m925
Percentage of community water systems in a state that meet all applicable non-health-based standards
Measure Name

M925

Measure Source

Environmental Protection Agency (EPA), Safe Drinking Water Information System Federal (SDWIS/FED) Drinking Water Data

Data date(s)

2012 - 2018

Limitations

The measure does not cover drinking water supplies that are non-public (private) and does not directly provide information on community water supplies that were adversely affected by emergencies or disasters.

m23pc
Estimated total number of foodborne individual illness cases reported to CDC by state and local public health departments for which a causative infectious agent is confirmed (per 1 million population).
Measure Name

M23PC

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date Jan. 15, 2020.

Data date(s)

2012 - 2018

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of foodborne illness outbreaks.

The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends

Measure
Measure Description
Source
m202
State public health laboratory provides or assures testing for air samples
Measure Name

M202

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

m257_aiha
State public health laboratory is certified or accredited by the American Industrial Hygiene Association (AIHA)
Measure Name

M257_AIHA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

m257_epa
State public health laboratory is certified or accredited by the Environmental Protection Agency (EPA)
Measure Name

M257_EPA

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

m257_nelac
State public health laboratory is certified or accredited by the National Environmental Laboratory Accreditation Conference (NELAC)
Measure Name

M257_NELAC

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

Data are self-reported by public health laboratory representatives and may reflect differences in awareness, perspective and interpretation among respondents.

m196
State public health laboratory provides or assures testing for environmental samples in the event of suspected chemical terrorism
Measure Name

M196

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012 & 2014

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

m272
Percent of 10 tests for different contaminants in environmental samples that the state public health laboratory provides or assures, including asbestos, gross alpha and gross beta, inorganic compounds (e.g., nitrates), metals, lead, persistent organic pollutants, pesticides (including organophosphates), pharmaceuticals, radon, or volatile organic compounds
Measure Name

M272

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/).

m273
State public health laboratory provides or assures testing for hazardous waste
Measure Name

M273

Measure Source

Association of Public Health Laboratories (APHL), Comprehensive Laboratory Services Survey (CLSS)

Data date(s)

2012, 2014, 2016, and 2018

Limitations

The state public health laboratory testing “provide or assure” standard is based on national consensus expert opinion and is recommended by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services, and is reflected in the Healthy People 2020 goals concerning access to comprehensive public health and environmental health laboratory testing. This standard requires the state public health authority, through its laboratory, engage in the testing and reporting process – either by directly performing the tests or by assuring that alternative labs perform the tests adequately. This standard is designed to ensure that laboratory testing, interpretation, and reporting is guided by specialized public health knowledge and expertise found within the state public health agency, and that timely, effective public health responses and protective actions occur based on test results. States that provide testing through another type of laboratory, with no assurance role performed by the public health laboratory, do not meet this standard. (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846798/). Selected responses from the 2016 survey have been corrected for North Carolina and therefore no longer correspond to the originally published survey results.

m274
State participates in the National Plant Diagnostic Network (NPDN)
Measure Name

M274

Measure Source

National Plant Diagnostic Network (NPDN), National Plant Diagnostic website

Data date(s)

2014

Limitations

The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.

m904
Number of environmental scientists and specialists (including health) per 100,000 population in the state
Measure Name

M904

Measure Source

Bureau of Labor Statistics (BLS), Occupational Employment Statistics (OES), OES 19-2041

Data date(s)

2012 - 2018

Limitations

The measure does not evaluate the level of training of the environmental and health scientists. The measure does not consider mutual aid plans that may be in place for agencies to supplement the number of available environmental and health scientists in the event of an emergency. Also, BLS and other national data sources on health provider supply have been shown to undercount certain types of health professionals, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.

m23a
Number of disease outbreaks due to animal contact in a state where the etiological agent is confirm (per 1 million population)
Measure Name

M23A

Measure Source

Centers for Disease Control and Prevention (CDC). National Outbreak Reporting System. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Update date Jan. 15, 2020.

Data date(s)

2012 - 2018

Limitations

The measure does not evaluate the quality or comprehensiveness of the state's reporting of illness outbreaks.

Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.

Measure
Measure Description
Source
m922
Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor)
Measure Name

M922

Measure Source

U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures

Data date(s)

2012 - 2017

Limitations

The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.

m923
Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition
Measure Name

M923

Measure Source

U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)

Data date(s)

2016 & 2018

Limitations

A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type.  Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states.

m928
Housing Mitigation for Flood Hazards, population living in a community participating in the FEMA Community Rating System (communities with a CRS of 1 through 9) as a percent of all communities participating in the National Flood Insurance Program
Measure Name

M928

Measure Source

FEMA National Flood Insurance Program (NFIP) Community Rating System (CRS)

Data date(s)

2017 - 2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP. 

m929
Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains
Measure Name

M929

Measure Source

U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)

Data date(s)

2013 - 2018

Limitations

Participation in the National Flood Insurance Program (NFIP) is voluntary.  It is possible that some communities located in flood zones are not part of the NFIP.  Also, many flood zone maps are outdated.

m334
State has a climate change adaptation plan
Measure Name

M334

Measure Source

Center for Climate and Energy Solutions (C2ES), State and Local Climate Adaptation

Data date(s)

2014 - 2019

Limitations

The measure does not evaluate the quality or comprehensiveness of the plan, or the degree to which the plan is implemented.

Actions taken to protect workers and emergency responders from health hazards while on the job.

Measure
Measure Description
Source
m530
Percent of employed workers in the state who used some type of paid time off (PTO) benefit.
Measure Name

M530

Measure Source

Current Population Survey (CPS), Annual Social and Economic Supplement (ASEC) data analyzed by PMO personnel.

Data date(s)

2013 - 2019

Limitations

Workers who use their paid time off benefits are only a subset of the total workers who have access to a PTO benefit and could use this benefit in the event of an emergency.

m531
Percent of employed population in the state engaging in some work from home by telecommuting
Measure Name

M531

Measure Source

Current Population Survey (CPS), Work Schedules Supplement data analyzed by PMO personnel.

Data date(s)

2011 - 2013, 2015, 2017

Limitations

The measure data is estimated based on a survey of a sample of the general population.

m705
Percent of employed population (16 and older) in the state who work from home
Measure Name

M705

Measure Source

American Community Survey (ACS), 1-year estimate (Table B08128)

Data date(s)

2012 - 2018

Limitations

The measure data does not include all individuals who can work at home on a "part-time" basis.