In the 10th annual "Ready or Not? Protecting the Public from Diseases, Disasters, and Bioterrorism" report, 35 states and Washington, D.C., scored a six or lower on 10 key indicators of public health preparedness. The report, issued in December by the Trust for America's Health and the Robert Wood Johnson Foundation, found that while there has been significant progress toward improving public health preparedness over the past 10 years, there continues to be persistent gaps in the country's ability to respond to health emergencies, ranging from bioterrorist threats to serious disease outbreaks to extreme weather events. In the report, Kansas and Montana scored lowest — three out of 10 — and Maryland, Mississippi, North Carolina, Vermont and Wisconsin scored highest — eight out of 10.

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