An annual report from Trust for America’s Health calls for urgent investment to create a public health system able to protect all Americans’ health during emergencies. The report, Ready or Not 2022: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism (76 pages, PDF), measured states’ performance on 10 key emergency preparedness indicators for 2021 and found that only 17 states and the District of Columbia qualified as "high-performance" states, while 20 states were in the "middle-performance" tier and 13 states in the "low-performance" tier. While Ohio, Pennsylvania, and South Carolina jumped from "low-performance" in 2020 to "high-performance" last year, sixteen states' performance levels worsened. The report also found that only about half of the U.S. population is served by a comprehensive local public health system and that only 28 percent of hospitals, on average, earned a top-quality patient safety grade during the year, down from 31 percent the year prior. Policy recommendations for strengthening the nation’s health security include creating programs to help build resilient communities by investing in health equity and the social determinants of health, including anti-poverty programs and programs that build financial security for families.