Montana, along with Iowa, ranked lowest of all 50 states when it comes to health emergency preparedness.
"We try to look at this as constructive feedback and try to benefit from the report," said Jim Murphy, Communicable Disease Control Bureau chief for the Montana Department of Public Health and Human Services.
The goal of the report is to help states determine their level of readiness for a disease outbreak, natural disaster or other unexpected event.
There are areas in which Murphy acknowledges the state needs improvement, and other areas where he said he is "comfortable."
Montana received five of 10 possible points in a state-by-state analysis. It is the second consecutive year that Montana has brought up the rear in the annual "Ready or Not? Protecting the Public from Diseases, Disasters, and Bio-terrorism" report. The report was released Tuesday by the Trust for America's Health and the Robert Wood Johnson Foundation.
There are "clearly areas of concern," said Jeffrey Levi, executive director of the Trust for America's Health, hastening to add that the scorecard should not be considered the "absolute level of preparedness." The report represents a single snapshot in time.
The trust is a Washington, D.C.-based health policy organization. Its website calls the group "a nonprofit, nonpartisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority."
"It is not a comprehensive analysis," Levi said.
The organization says it is important to conduct the report annually because the public deserves to know how prepared their states and communities are. Federal and state governments release only limited data about the status of emergency preparedness.
"We believe that all Americans have the right to expect fundamental health protections during public health emergencies, no matter where they live," Levi said.
James Blumenstock, chief program officer of Public Health Practice for the Association of State and Territorial Health Officials, said the Trust for America's Health chose to look at only 10 of what could easily have been 100 indicators. The public should not consider itself at any "increased risk" because of the low score, he said.
Wyoming scored eight out of 10 points. It scored six out of 10 last year.
Fourteen states scored nine or higher. Three states — Arkansas, North Dakota and Washington — scored perfect 10s. Another 25 states and Washington, D.C., scored in the range of seven to eight. No state scored lower than a five.
Montana, according to the report, missed on these indicators: health information technology, electronic syndromic surveillance, community resilience, food-borne-disease detection and reporting and public health laboratories.
Montana's Murphy — and Anne Weber, director of Montana's Public Health Laboratory — said several of the deficiencies wouldn't hold up if the survey were done today. Murphy speculates that the state would rank closer to a seven or eight.
Since the survey was conducted, some improvements have been made, including:
— Two public health lab staffers have been added in the past 30 days.
— Disease detection and reporting equipment that was broken at the time of the survey has been fixed.
— The state used syndromic surveillance about five years ago but switched to another type after finding it wasn't giving the department the information it hoped.
— The state has started the Best Beginnings STARS to Quality Program, a continuous quality improvement program for early childhood education in Montana.
The report notes that nearly a decade of gains are in jeopardy as economic conditions have forced federal, state and local governments to trim public-heath budgets.
Montana increased its public-health budget, one of 17 states to do so.
Wyoming decreased its public-health budget from fiscal year 2008-09 to 2009-10 and was one of the states that decreased funding for two years or more in a row. The Center on Budget and Policy Priorities has found that states have experienced overall budgetary shortfalls of $425 billion since fiscal year 2009.
In addition to state cuts, federal support for public-health preparedness has been cut by 27 percent since fiscal year 2005 (adjusted for inflation). Local public-health departments report losing 23,000 jobs — totaling 15 percent of the local public-health work force — since January 2008.
The report suggests that the United States has a history of responding to the "health crisis of the moment" instead of ensuring stable, reliable emergency response funding and resources on an ongoing basis, said Robert Pestronk, executive director of the National Association of County and City Health Officials.
"And the problem is exacerbated in today's economic climate," Pestronk said.