Press Room

ASTHO Announces Release of 2014 National Health Security Preparedness Index

New data reflect the nation’s preparedness for health security threats

(Dec. 9, 2014) Washington, D.C. - The Association of State and Territorial Health Officials (ASTHO), in partnership with the Centers for Disease Control and Prevention (CDC) and more than 35 development partners, released today the 2014 National Health Security Preparedness Index™ (NHSPI™), which measures and advances the nation's readiness to protect people during a health emergency or disaster. The 2014 Index includes updated data and new content, especially in the areas of health care delivery and environmental health.

The 2014 national result, 7.4 on a scale of 10, suggests that substantial health security preparedness capability exists across the nation with progress to sustain and build upon. It also suggests significant work still needs to be done. As with 2013 findings, 2014 areas of relative strength include countermeasure management, incident and information management, and health security surveillance. Areas suggesting need for greater development include the new domain of environmental and occupational health, and health care delivery (previously surge management) and community planning and engagement.

"This year's Index more fully reflects the range of components influencing health security of our states and the nation," says Dr. Tom Inglesby, chair of the NHSPI Steering Committee. "With Ebola in West Africa, a resurgent strain of enterovirus in the United States, floods, mudslides, and wildfires in 2014, the importance of preparedness is all the more visible. We hope the 2014 NHSPI will be used to drive dialogue, build partnerships, and strengthen preparedness across the United States for these and many other disasters."

The value of NHSPI is not only in its results but also in its design and ability to drive conversation. Field users report that the 2013 Index is useful for describing the many factors influencing health security preparedness, the development of new collaborations, and mobilization improvements.

The NHSPI is now in its second year of development. Given its methodology and structure are rapidly evolving, the NHSPI is not yet ready for trend analysis, a year-to-year comparisons of Index results. As it continues to mature, however, trend analysis will become feasible.

Measuring the readiness of states and the nation for health security threats has long proved challenging. The NHSPI is designed to compile objective information about how well states and the nation are prepared for public health and other emergency situations. The NHSPI represents the most comprehensive set of health security preparedness measures to date. It aims to capture the health security preparedness of the nation by looking collectively at existing state-level data from a variety of sources.

2014 NHSPI advancements and additions include:

  • 75 new measures
  • Updated data for 90 existing measures
  • Addition of a new environmental and occupational health domain to capture critical areas, such as food and water security and environmental monitoring
  • Major revisions to the health care delivery domain to more fully align its structure with that of the health care system and to better reflect how disaster response capability is built upon the strength of everyday systems
  • Addition of a legal and administrative preparedness sub-domain emphasizing the importance of legal authorities and principles being established in advance of an event

Uses of the Index include guiding quality improvement, informing policy and resource decisions, and encouraging shared responsibility for preparedness across a community.

The NHSPI will continue to evolve in 2015 and beyond under new leadership from the Robert Wood Johnson Foundation (RWJF). RWJF is planning multiple activities to continue to grow the Index, including: engaging and incorporating other sectors that influence health security preparedness into the Index, incorporating model analysis and validation studies to inform Index improvement, and developing new web-based features and tools. The Foundation has engaged the University of Kentucky to help manage this important project.

A public briefing on the release of the 2014 NHSPI is taking place at the U.S. Capitol Visitor Center from 2-3:30 p.m. Tuesday, Dec. 9. The briefing will include key presentations from the NHSPI project leadership.

To learn more about the NHSPI and the 2014 results, visit

NHSPI Development Partners include:

  • American Hospital Association
  • American Public Health Association
  • American Red Cross
  • Association of Public Health Laboratories
  • Association of Schools and Programs of Public Health
  • Association of State and Territorial Health Officials
  • California Emergency Medical Services Authority
  • California Healthcare Association
  • Center for Infectious Disease Research and Policy
  • Centers for Disease Control and Prevention
  • Council of State and Territorial Epidemiologists
  • Department of Defense
  • Department of Homeland Security
  • Federal Emergency Management Agency
  • FleishmanHillard
  • Great Lakes Inter-Tribal Epidemiology Center
  • Indiana University School of Nursing
  • International Association of Emergency Managers


  • Kaiser Permanente
  • Mayo Clinic
  • National Association of County and City Health Officials
  • National Association of State EMS Officials
  • National Emergency Management Association
  • National Indian Health Board
  • National Public Health Information Coalition
  • Oak Ridge Associated Universities
  • Office of the Assistant Secretary for Preparedness and Response
  • Robert Wood Johnson Foundation
  • Trust for America's Health
  • UPMC Center for Health Security
  • Preparedness and Emergency Response Research Centers (PERRCs) from the following institutions: Emory University, Harvard University, Johns Hopkins University, University of California - Los Angeles, University of Minnesota, University of North Carolina - Chapel Hill, University of Pittsburgh, University of Washington


ASTHO is the national nonprofit organization representing the public health agencies of the United States, the U.S. territories, and the District of Columbia, as well as the more than 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in state-based public health practice.

 For questions related to NHSPI's transition to RWJF: Contact Alexis Levy, Communications Officer, RWJF (609) 627-5702;