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Arkansas is about as prepared as other states for emergencies that affect health, but it recently slipped below the national average in measures of health care delivery, according to a report released Wednesday by the Robert Wood Johnson Foundation.

Tracking readiness for disasters, outbreaks and emergencies that threaten health and well-being, the National Health Security Preparedness Index provides a "big-picture view" across state and federal agencies, says study director and University of Kentucky health policy professor Glen Mays.

The report found that Arkansas' overall preparedness rating, which the researchers call health security, is 6.6. The national rating is 6.7.

But within those findings, the state fell short in several measures of health care delivery, a category that assesses the ability to provide health care in emergency events.

Overall, the state's health care delivery score declined by 10% between 2017 and 2018, its biggest drop and poorest rating across six broad assessment categories. The other measures are health security surveillance, community planning and engagement coordination, incident and information management, countermeasure management, and environmental and occupational health.

Low marks in the health delivery category included the number of physicians and surgeons per 100,000 residents that's hardly budged since 2013 and a low percentage of hospitals with the highest safety rating -- fewer than one in five across the state, researchers found.

Though Arkansas used to score above the national average in the category, Mays said researchers aren't seeing "signals of improvement" -- such as shorter local emergency room wait times and shorter ambulance arrival times for fatal crashes in rural areas -- that have lately appeared in other states.

Health care delivery is the weakest area of preparedness nationwide, he said.

The annual health security assessment uses more than 120 unique metrics weighted by a panel of experts to assess state and national readiness for a spectrum of dangers, including tornadoes, hurricanes, fires, extreme temperatures, violence in public places and health events such as hepatitis A and measles outbreaks.

Overall, those incidents caused more than $91 billion in damages in communities across America last year, the report said.

Researchers found that since 2013, nationwide readiness for emergencies with the potential to affect health has improved by more than 10%, which they said might be attributed to an updated National Health Security Strategy (a U.S. Department of Health and Human Services initiative); more clearly defined responsibilities within relevant sectors; or better community planning, including preparedness exercises and drills.

While progress has been steady, recurring threats such as California wildfires, strong hurricanes on the Gulf Coast and upticks in infectious diseases, such as measles, have researchers wondering why they aren't seeing accelerating preparedness work over time.

"One surprise is that we're not seeing faster progress ... despite the fact that some of these hazards are more visible," Mays said.

He hopes to see better momentum as new emergency preparedness rules from the Centers for Medicare and Medicaid Services are implemented at health care facilities.

The analysis is conducted through the foundation in partnership with regulators and federal entities such as the Centers for Disease Control and Prevention and the Department of Defense, as well as state agencies.

This year's report also found intensifying regional disparities in health security across the U.S., where the south-central, upper mountain west, Pacific Coast and Midwest show overall lower levels of health security.

In Arkansas' immediate region, the state joined Tennessee and Missouri in having health security levels that tracked close to the national average, while Texas, Oklahoma, Louisiana and Mississippi were below it.

Below-average regions tend to have disproportionate numbers of low-income and rural residents with fewer resources to draw on in emergencies, researchers said.

"Large differences in health security across states weaken the nation as a whole by limiting the ability of state, federal, and local stakeholders to work together and share information and resources," they wrote.

"These gaps are particularly troubling because they leave some communities more vulnerable to disasters and emergencies than others, contributing to inequities in population health."

Arkansas' most-improved area was in the category of environmental and occupational health, which included an increased variety of tests for contaminants -- such as asbestos, radon and lead -- since 2015 and the adoption of a climate change adaptation plan, the report said.

One notable finding in Arkansas included marks below the national average for several metrics assessing the percentage of the population who had received vaccinations, including against the flu.

According to the report, Arkansas has consistently been below the national average in its percentage of children under 35 months old who received routine childhood vaccinations. Also, the percentage of senior citizens and adults who are getting the flu vaccine has fallen during the past few years.

Dr. Jennifer Dillaha, medical director for immunizations at the state Department of Health, says the number of people getting the flu vaccine each year varies, but that poor public understanding of media reports about the treatment's efficacy sometimes suppress vaccination rates.

For childhood immunizations, she said a big factor limiting vaccination rates is poor vaccine infrastructure in the state.

"We do not have convenient places for parents to go and get their children immunized," she said.

State data that accompanied the report also tracked the most expensive and dangerous health security hazards in the state between 2012 and 2017.

Of listed hazards -- which included such things as drought, flooding, fog, hail and landslides -- tornadoes caused the most property damage in Arkansas with $275,384,000 in damage reported during that period.

They also caused 21 deaths. The next-highest category for fatalities from the threats examined was from flooding, which killed 17 people.

Overall, health security hazards in the U.S. caused 2,852 deaths, 12,249 injuries and $191 billion in property damage in the six-year period studied, according to the summary.

Recommendations for improving health security outcomes include gathering better data, enhancing preparedness training, engaging the private sector in health security initiatives and targeting regions that have fallen behind, researchers wrote.

"Health security is improving at a relatively slow and uneven pace across the United States, leaving large segments of the American population under-protected," they wrote.

"The gains achieved to date are not sufficient to keep all communities safe and healthy in the face of rising risks of disasters and emergencies."

Metro on 05/09/2019

Print Headline: State's preparedness for health crises slips

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