Five years after the tragic events of Sept. 11, 2001, U.S. emergency health preparedness is still wanting. That's according to the fourth annual report, "Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism."

Released this week by the non-profit Trust for America's Health (TFAH), the 84-page report, available online at: healthyamericans.org/reports/bioterror06/BioTerrorReport2006.pdf, provides state-by-state preparedness scores based on 10 indicators. Based on those 10 indicators, half of states scored six or less, Oklahoma scoring the highest with 10 out of 10; Kansas scored a nine. California, Iowa, Maryland and New Jersey scored the lowest with four out of 10.

TFAH's policy recommendations for agroterrorism and naturally occurring toxins are part of the all-hazards approach to public health preparedness and include:

• Leadership -- No single entity or person in government is designated as in charge of food-safety regulation and oversight.
  
• Creating a unified system -- Change from the current fragmented federal food-safety system to a single, independent food-safety agency.
  
• Surveillance and disease tracking -- Better integration and coordination of animal-borne disease tracking with human health surveillance is needed, as well as increased lab facilities and personnel better trained in detecting animal disease.
  
• Education and communication -- Better education of veterinarians and farm workers regarding terrorist threats (including learning about intelligence sharing and security measures) and naturally occurring disease (including symptoms, treatments and reporting practices).
  
• catastrophic planning, including scenario drills, are needed at every level of government and across sectors.