Policy and Position Statements


Preparedness Policy Statement

State and territorial health agencies are critical to our nation's ability to prepare for, respond to, and recover from public health emergencies and threats. Principally, they ensure the public health of their jurisdictions through their inherent authority to protect and promote the health, safety, and general welfare of their populations. In the last decade, virtually all state and territorial health agencies have developed the robust infrastructure needed for a 24/7 posture. However, individuals, communities, and the private sector, in partnership with all levels and sectors of government including emergency management and homeland security, must concertedly participate in community and public health preparedness to ensure the public health resiliency of our nation.

A collaborative national effort in preparedness is critical and requires the clear understanding of roles and responsibilities among federal, state, local, territorial, and tribal agencies in public health preparedness. As the national nonprofit organization representing the state and territorial public health agencies of the United States, its territories, and the District of Columbia, the Association of State and Territorial Health Officials (ASTHO) recognizes the need for strong federal support for state and territorial public health preparedness to maintain and advance this hard-won public health emergency response capacity. State and territorial and local public health have repeatedly demonstrated their robust capabilities to protect the health and safety of their populations from the effects of natural and man-made disasters. Yet these capacities can degrade rapidly without the support of federal grant policies and community and business practices that foster coordinated planning and response.


The ability of a community to recover from a disaster originates in "its efforts in pre-disaster preparedness, mitigation, and recovery capacity building."1 State, territorial, and local public health leaders must work to provide the education, tools, continuous training, policies, and programs to equip their jurisdictions with critical capabilities to prevent and mitigate threats to the public's health and respond to and recover from a potential disaster. A structure and mindset dedicated to recovery should influence activities at all levels of the preparedness cycle.2

ASTHO strongly supports the continued development and adoption of federal guidance, collaboration, training, support, and resources to assist state and territorial jurisdictions in becoming more resilient communities.


Public health preparedness requires the long-term development of continuously improving public health systems that can be used to respond to all hazards. These systems are built only through flexible, sustained federal support. Federal grants such as CDC's Public Health Emergency Preparedness (PHEP) cooperative agreement and ASPR's Hospital Preparedness Program (HPP) help develop emergency-ready public health departments that are flexible, adaptable, and resilient. These grants provide the needed resources to conduct exercises, develop corrective action plans, implement improvements, train the dwindling skilled workforce, and support systems for communications, biosurveillance, information sharing, and more. As these valuable funding sources are cut, state and territorial health departments are faced with tough decisions to reduce, limit, or eliminate activities required to ensure the safety of their jurisdictions. It is vital that federal funding to states and territories continue, so that a systematic approach can be taken to building preparedness across all communities and hospitals. This strategy will ensure that the necessary resources to respond quickly and collaboratively to public health emergencies are in place across the country.


Health equity is achieved when the public health and medical needs of all individuals are taken into account in the planning for, response to, and long-term recovery from of a public health emergency. Emergency situations can compromise a range of nonclinical services that are essential to many individuals' daily survival and wellbeing (e.g., low-cost meals, language interpretation, or care for service animals). The inclusion and consideration of individuals who may have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency or are non-English speaking, are transportation disadvantaged, have chronic medical disorders, or have pharmacological dependencies3 is vital to the resiliency of a community. It is important for public health decision makers to recognize the assets and skills of vulnerable populations and the systems, organizations, and individuals that support them.


ASTHO recognizes the critical importance of collaboration with all sectors having mission-related roles and responsibilities in protecting the public during all phases of the disaster cycle. To fully prepare, mitigate, respond, and recover, public health agencies need to establish, maintain, and enhance collaborations with emergency management, homeland security, and other relevant public agencies.

The private sector also has an important role in ensuring the preparedness and resilience of its workforce, stakeholders, and the communities where they reside. ASTHO encourages state and territorial health departments to involve private-sector representatives in all stages of preparedness planning because the private sector provides valuable resources such as human capital, critical infrastructure, data, community trust, economic stability, and other national interests. In return, ASTHO encourages the private sector to increase its investments in prevention, security, threat resilience, and collaboration with state, local, tribal, and territorial health departments.4 These collective partnerships may act as a model to help stakeholder collaboration expand to other traditional and nontraditional partners.


Federal funding to public health should include adequate resources to measure preparedness efforts through flexible, valid, and meaningful performance metrics that demonstrate progress and areas of greatest need for future development and to maintain accountability and drive improvement. CDC PHEP and ASPR HPP capabilities currently allow state and territorial health agencies to assess their level of preparedness and provide an aggregated snapshot of the nation's preparedness capabilities. Additionally, the National Health Security Preparedness Index5 is a promising development to measure health security preparedness in states. The public health community and its stakeholders must continue to guide the collaborative development, implementation, and evaluation of appropriate and consistent performance measurement tools that use relevant, actionable information to achieve a higher level of health security preparedness, support quality improvement, inform resource and policy decision making, enhance collaboration and shared responsibility, and advance the science of measuring health security preparedness.

Approval History:

Preparedness Policy Committee Review and Approval: March 2014.
Board of Directors' Review and Approval: December 2014
Ratified by the ASTHO Membership: December 2014
Policy Expires: December 2017

ASTHO policies are broad statements of enduring principles related to particular policy areas that are used to guide ASTHO's actions and external communications.

Related ASTHO Documents:

Workforce Development Policy Statement
Voluntary Emergency Personnel Position Statement


  1. Federal Emergency Management Agency. National Disaster Recovery Framework. 2011. Available at http://www.fema.gov/media-library-data/20130726-1820-25045-5325/508_ndrf.pdf. Accessed 5-19-2014.
  2. The National Incident Management System defines preparedness as "a continuous cycle of planning, organizing, training, equipping, exercising, evaluating, and taking corrective action in an effort to ensure effective coordination during incident response." This "preparedness cycle" is one element of a broader national preparedness system to prevent, respond to, recover from, and mitigate damage from natural disasters, acts of terrorism, and other man-made disasters. Components of the preparedness cycle include: Plan, Organize and Equip, Train, Exercise, and Evaluate and Improve. More information is available at http://www.fema.gov/national-preparedness-cycle.
  3. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response, Division for At-Risk Individuals, Behavioral Health, and Community Resilience. "At-Risk, Behavioral Health, and Community Resilience (ABC)." Available at: http://www.phe.gov/Preparedness/planning/abc/Pages/default.aspx. Accessed 5-19-2014.
  4. One example of successful response partnership occurred in October 2011 during a dengue virus type 4 outbreak in the Marshall Islands. ASTHO worked with the nongovernmental organization Direct Relief USA and one of its corporate alliance members, Merck & Co., Inc., for the donation and shipment of insect repellents valued at $100,000 to the Marshall Islands and the Federated States of Micronesia, which were experiencing a discrete but concurrent dengue outbreak.
  5. For more information about the National Health Security Preparedness Index, visit NHSPI.org.