Shrinking budgets continue to make the country ill prepared to respond to health disasters, including foodborne illness outbreaks, according to the latest analysis by the Trust for America’s Health and Robert Wood Johnson Foundation.

In the 10th annual Ready or Not? Protecting the Public from Disease, Disasters, and Bioterrorism report, released Wednesday, the vast majority of states received a 6 or lower out of 10 for health emergency preparedness. Kansas and Montana scored the lowest of all 50 states, receiving 3 out of 10. Maryland, Mississippi, North Carolina, Vermont, and Wisconsin scored highest with 8 out of 10.

The 80-page report highlights significant gaps in the nation’s ability to respond to the health consequences of major events like Superstorm Sandy, the Joplin Tornado, and ongoing disease outbreaks, whether it be due to Salmonella, whooping cough, or meningitis.

Jeffrey Levi, the executive director of the Trust for America’s Health, said budget cuts and complacency are the two biggest threats to public health preparedness.

“The progress that has been made in the past 10 years is starting to erode,” Levi told reporters.

The report is a reminder that health departments play a critical role in preparing for and responding to disasters.

“Communities can’t be healthy if their health departments aren’t ready to help protect them from emergencies,” said Paul Kuehnert, the senior program officer and director of the Robert Wood Johnson Foundation’s public health team.

Health departments have been hit especially hard by cutbacks in federal preparedness spending. According to Kuehnert, funding for such initiatives has dropped by about 40 percent, which is only exacerbated by public health cuts at the state and local level.

According to the groups’ analysis, the majority of states have cut their public health funding over the past two years — 14 of which have made cuts for three years in a row. Since the recession took hold in 2008, state and local health departments have eliminated more than 45,700 jobs.

“I think health departments have done a remarkable job at coping with the cuts, but by and large we’re beyond the point where efficiencies can cope with the cuts,” said Kuehnert. “There’s a limit to what you can do. Just like fire and policy departments, health departments need to be ready to respond to disasters 24/7, 365 days a year.”

Public health advocates argue that investing in preparedness, while it can seem expensive, can actually save the government money in the long term. For instance, if public health officials can detect and solve a foodborne illness outbreak more rapidly, they can limit the scope of illnesses by getting contaminated product off the market. Quickly identifying the specific product to blame is also extremely beneficial for the food industry, which has seen entire commodities suffer in the wake of outbreaks.

There are a multitude of disaster scenarios that could strike the food sector, and the costs could be enormous. According to the report, if a significant outbreak of bovine spongiform encephalopathy (BSE) occurred in the United States, for example, the U.S. Food and Drug Administration estimates there would be a loss of $15 billion due to a steep drop in domestic beef sales and an even sharper drop in exports. On top of that, the industry would be looking at an additional $12 billion for slaughter and disposal costs for at-risk cattle. These figures don’t include the health-related costs of such an outbreak.

The report makes several food safety recommendations:

Fully Fund and Implement the FDA Food Safety Modernization Act. Although the FDA Food Safety Modernization Act passed in 2011, the White House has yet to finalize key rules to implement the law, including preventive controls for food and feed facilities, produce safety, and a foreign supplier verification program. Congress and the Administration should also provide enough funding to FDA, CDC and relevant state agencies to be able to implement and enforce the law.

Improve Inspection Capacity. There are insufficient resources to support enough inspectors for foods regulated by FDA, and there is not enough authority for FDA to have oversight over state and third party inspections.

Move Toward a Unified Government Food Safety Agency. The government currently does not have a coordinated, cross-governmental approach to food safety. Right now, food safety activities are siloed across a range of agencies, and many priorities and practices are outdated. As a first step, food safety functions should continue to be unified within the FDA, and a plan with a set timeline should be developed for how to restructure food safety functions across the federal government into a single, unified food safety agency to carry out a prevention-focused, integrated food safety strategy. This same type of coordinated, cross-governmental approach to food safety is also needed at the state level.

Examine an Industry User-Fee Model for Food Safety. User fees for food and beverage industries, similar to those employed for drugs and devices at FDA, should be reviewed as a potential new model for raising additional resources to support modernized, more efficient food safety inspection practices.

Improve Surveillance of Foodborne Illnesses. Currently, foodborne illnesses are radically underreported in the United States and the quality of reporting varies dramatically by state. New standards and requirements should be put in place to incentivize states to improve reporting and penalize states for underreporting. Surveillance for foodborne illness outbreaks should be fully integrated with other HIT systems, which will help improve tracking and identification of the scope of problems as well as sources of outbreaks. FDA and CDC should also have a plan for requiring clinics to send cultures from rapid response tests showing problems to public health labs to allow for subtype pathogen testing.

Prevent the Tainting of Food by Environmental Contaminants. Measures should be implemented to prevent the tainting of food by environmental contaminants, such as untreated sewage or manure that enter waters and pollute crops downstream. Requirements should be established to strengthen controls on air and water discharges of mercury and other common pollutants that are widely found in the food supply. FDA should set limits for certain contaminants, such as arsenic in rice products and apple juice.

The report also recommends seriously tackling antibiotic resistance by curbing the overuse of antibiotics in livestock and poultry production and human medicine. Most experts agree that both sectors are contributing to the growing levels of drug resistance among important pathogens.

The groups recommend that the drug industry and FDA work together to foster the development and approval of new antibiotics to add to the medical arsenal, but also strongly recommends that doctors and farmers scale back their use of critical drugs to preserve their effectiveness.

“Mandatory guidance should be created for the use of antibiotics in food animals, but until then, the Administration should act to implement the voluntary FDA Guidance for Industry numbers 209 and 213 and Veterinary Feed Directive regarding the use of antimicrobials in food animals in a way that will lead to meaningful reduction of antibiotics critical to human health,” reads the report.

The authors recommend that FDA clarifies what constitutes appropriate “preventive use” of antibiotics and make it clear that using these drugs “in lieu of addressing animal overcrowding and sanitation is not a judicious use.” The report recommends that FDA collect better data to ensure that antibiotic use in food animal production is “significantly reduced” and seek verification that drug companies are changing their labels to eliminate references to growth promotion as an approved use of the drug.