A Quantitative Analysis of National Public Health and Preparedness Frameworks and Their Impact on Community and At-Risk Population Preparedness in Fifty States and Washington, D.C.
Authors:   , Parrado Meredith Gilman , Chiatti Beth D. 
Published: March 2023

Introduction: To date, there have been no published research regarding how state public health department accreditation status impacts a state's overall public health preparedness level. Furthermore, no research has been conducted to date that reviews how states utilize their Public Health Emergency Preparedness (PHEP) funding to address community preparedness or at-risk population preparedness issues, or if this funding impacts a state's overall preparedness level. The purpose of this scholarly project is to analyze all fifty states and Washington, DC to identify quantitative trends that are compared to an unbiased, external standard: state National Health Security Preparedness Index (NHSPI) scores. My research is designed to offer a novel, low-burden method of quantitative analysis on community preparedness, however, this method could also theoretically be replicated to see how PHEP impacts other preparedness areas that NHSPI scores states on as well. Therefore, the primary purpose of my scholarly project is to use the aforementioned information to determine if PHEP funds significantly impact state NHSPI scores and thus state preparedness levels, and to determine if state public health accreditation status has a significant impact on community preparedness level. Methods: These two observational studies analyzed retrospective data from all states in the United States and Washington, D.C. Accredited (n=36) and non-accredited (n=15) state NHSPI scores were analyzed. One sample t-tests for all states compared to the NHSPI national mean were calculated using SPSS Statistical Software (SPSS 26.0.1 for Windows) to determine if their means were significantly different. Since there are more than double accredited state health departments when compared to non-accredited state health departments, we also analyzed a random, smaller sample (n=15) of accredited health departments to see if we could verify our initial results. Additionally, three years of PHEP funding data were provided by the Centers for Disease Control and Prevention, Center for Preparedness and Response, Division of State and Local Readiness for FY17, FY18, and FY19. 2018 NHPSI data, including the overall NHSPI score, Domain 2 NHSPI score and At-Risk Population NHSPI score were used for both analyses. Graphical displays and Pearson correlation coefficients and were calculated using SPSS. Results: Non-accredited state health departments have significantly lower overall NHSPI scores (p-value = 0.031) when compared to the national mean NHSPI score. In addition, accredited states have significantly higher Community Planning and Engagement NHSPI scores (p-value=0.031) while non-accredited states have significantly lower Community Planning and Engagement NHSPI scores (p-value=0.001). Additionally, a random, smaller sample size of 15 accredited health departments were analyzed and verified that accredited health departments have a significantly higher Community Planning and Engagement NHSPI score (p-value = 0.004). All 50 states and Washington, D.C. used PHEP funding to address Capability 1: Community Preparedness at varying levels. However, there was no correlation found between FY17, FY18, FY19 Capability 1 funding data and NHSPI Overall score, Domain 2: Community Planning and Engagement Score, or NHSPI At-Risk Population Score. Correlation coefficients were consistently low and ranged from -0.087-0.077. The relationships were also graphed for each fiscal year and NHSPI score, which consistently demonstrate no correlation. Discussion and Conclusion: This is the first study that has identified a relationship between public health department accreditation and increased public health preparedness. This serves as evidence that those states that invest in public health accreditation, simultaneously are also increasing their preparedness level when assessed by the NHSPI. Conversely, the amount of PHEP funding spent on Capability 1: Community Preparedness is not correlated to higher NHSPI scores. Therefore, in order to measure improvements in Capability 1: Community Preparedness, another external standard, other than NHSPI, should be used.