The United States is still underprepared for a major disaster, such as a biological attack or a pandemic, and the current economic crisis could make things worse, health experts said on Tuesday.
Federal funding for state and local preparedness has been cut more than 25 percent compared to 2005 budgets, while at the same time state and local officials are being asked to do more, the report from the Trust for America's Health and the Robert Wood Johnson Foundation found.
"The economic crisis could result in a serious rollback of the progress we've made since September 11, 2001, and Hurricane Katrina to better prepare the nation for emergencies," said Jeff Levi, executive director of the non-profit Trust.
"The 25 percent cut in federal support to protect Americans from diseases, disasters, and bioterrorism is already hurting state response capabilities," he added. "States will be hard-pressed to take on these new and expanded roles and responsibilities."
Levi's group reports every year on the readiness to deal with disasters, attacks and pandemics and noted that the September 11 attacks and the 2005 hurricane season created momentary interest in better preparation.
But the administration of President George W. Bush has also stressed responsibility on the part of state and local governments and has said repeatedly that the federal government will not bail out states after disasters.
The report found that hospitals still lack so-called surge capacity — the ability to quickly expand space and staff to deal with an influx of ill or injured patients.
Many reports have found that most are already operating above capacity, with emergency room patients often waiting for hours in hallways to be seen on an average day.
The report calls for large increases in federal funding for public health, including state health departments.
"We all have a stake in strengthening America's public health system, because it is our first line of defense against health emergencies," said Dr. Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation.
The joint report from the two non-profit groups found that 11 states and Washington, D.C., cut their public health budgets in the past year.
It said 16 states have bought less than half their share of antiviral drugs under a federal subsidy plan aimed at building stockpiles of the drugs in case of an influenza pandemic.
The food-safety system is antiquated and has not been upgraded in more than 100 years, the report found. The result has been a series of emergencies with little response until after the fact - such as an outbreak of Salmonella food poisoning this year that sickened at least 1,400 people in the United States before it was traced to peppers from Mexico.
The National Association of County and City Health Officials said the report fit in with its own survey of local health departments.
"Nationally, 27 percent of local health departments are working under a current budget that is less than the previous year and 44 percent expect to do the same next year," the group said in a statement.
"Furthermore, among the nation's largest local health departments, 84 percent experienced workforce reductions in 2008 and 45 expect layoffs during 2009."