COVID_National_Health_Security_Preparedness_Index: NHSPI_measure_metadata: 129 rows where sorted by verbose_data

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Link	rowid	obsid	index	item_code	domain_code	domain_name	domain_description	subdomain_code	subdomain_name	subdomain_description	subdomain_long_desc	measure_name	measure_description	measure_rationale	data_source	verbose_data_source ▼	data_dates	limitations
47	47	85.0	Index	2.3.15	2.0	CPE	Community Planning & Engagement Coordination	5.0	MVDE	Management of Volunteers during Emergencies	The ability to coordinate the identification, recruitment, registration, credential verification, training, and engagement of healthcare, medical, and support staff volunteers to support the jurisdiction’s response to incidents of health significance	M186	Number of Medical Reserve Corps (MRC) members who are other health professionals per 100,000 population in the state	The Medical Reserve Corps (MRC) is a national system of local, community-based teams of volunteers—medical and public health professionals and others without health backgrounds—who are identified, credentialed, trained, and prepared in advance of an emergency. Other public health and medical professionals (e.g., epidemiologists, environmental engineers, toxicologists) can provide logistical support and information technology support as well as staff information hotlines and mass clinics, assist with registration, and perform health screening.	MRC	Medical Reserve Corps (MRC), MRC Units Database and Census Bureau data analyzed by PMO personnel.	2015—2018	The measure does not evaluate the quality of the MRC management and current status of other health professionals who are licensed, credentialed, and received emergency response training.
66	66	170.3	Index	4.2.23	3.0	IIM	Incident & Information Management	8.0	INFM	Information Management	The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.	M1001	. The state's 911 authorities are capable of processing and interpreting location and caller information using Next Generation 911 infrastructure.	Digital 911 capabilities can transmit more information and process larger call volumes at faster speeds, with fewer risks of disruption, possibly enabling faster emergency response.	NG911	National 911 Program, Office of Emergency Medical Services (OEMS), National Highway Traffic Safety Administration (NHTSA), U.S. Department of Transportation (USDOT).	2014—2017	Call centers and first responders may vary in the extent to which Next Generation 911 capabilities are implemented and used.
12	12	14.0	Index	1.1.12	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M265	State uses an Electronic Death Registration System (EDRS)	The measure indicates a state's adoption and use of an electronic death registration system (EDRS). This capability may reduce the time require to process and access death certificates during an emergency.	NAPHSIS	National Association for Public Health Statistics and Information Systems (NAPHSIS), Electronic Death Registration Systems by Jurisdiction (State)	2014—2018	The measure does not evaluate the quality or comprehensiveness of the state's death registration system, or indicate other redundant systems that might be used if the EDRS is not available such as in the event of cyber-attacks and power outages.
53	53	107.0	Index	3.1.7	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M107	Percent of local health departments in the state with an emergency preparedness coordinator for states with local health departments, excludes Rhode Island and Hawaii	The measure estimates the capacity of the public health emergency management system by using emergency preparedness coordinators employed at local public health departments, or regional or district offices within the state, as the criteria.	NACCHO Profile	National Association of County and City Health Officials (NACCHO), 2013 National Profile of Local Health Departments	2013 & 2016	The measure does not apply to states that do not have local health departments. The measure does not evaluate the quality or robustness of the local emergency management system.
69	69	149.1	Index	4.1.12	4.0	HD	Healthcare Delivery	10.0	PC	Prehospital Care	Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities.	M349	State has adopted EMS Personnel Licensure Interstate CompAct (REPLICA) legislation	REPLICA may expand the availability of qualified EMS professionals during emergencies by providing a legal mechanism for licensed professionals to practice outside the state in which they are licensed.	NASEMSO	National Association of State EMS Officials	2013—2018	Other legal actions such as EMAC and state emergency declarations may enable cross-border EMS practice without REPLICA.
11	11	13.0	Index	1.1.11	1.0	HSS	Health Security Surveillance	1.0	PHSEI	Health Surveillance & Epidemiological Investigation	The creation, maintenance, support, and strengthening of passive and active surveillance to: identify, discover, locate, and monitor threats, disease agents, incidents, and outbreaks provide relevant information to stakeholders monitoring/investigating adverse events related to medical countermeasures. The sub-domain includes the ability to successfully expand these systems and processes in response to incidents of health significance.	M290	State has a public health veterinarian	This measure indicates a state’s ability to access veterinarian expertise in preventing, preparing for, detecting, responding to, and recovering from hazardous events that may originate in or spread through animal populations, ultimately creating health risks for humans.	NASPHV	National Association of State Public Health Veterinarians (NASPHV), Designated and Acting State Public Health Veterinarians	2014 & 2015, 2017—2019	The measure does not evaluate the quality or comprehensiveness of the veterinarian's integration into an animal response plan or coordination with other animal-related resources, such as a board of animal health, particularly in an emergency response situation.
76	76	158.0	Index	4.2.8	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M167	Number of active registered nurse (RN) and licensed practical nurse (LPN) licenses per 100,000 population in the state	Registered nurses (RNs) and licensed practical nurses (LPNs) are an important part of the medical workforce that provides medical care in the acute and primary care settings. An increased number of these actively practicing and licensed healthcare workers would be needed to respond to a mass casualty or emerging disease epidemic/pandemic. The measure focuses on the state's workforce capacity of current, active registered and practical nurses (PNs).	NCSBN	National Council of State Boards of Nursing (NCSBN), National Nursing Database	2013-2016, 2018 & 2019	The measure does not consider mutual aid plans that may be in place to supplement the number of available RNs and LPNs in the event of an emergency. The source data may undercount the RNs and LPNs available to provide care during an emergency due to limited or non-reporting by some states.
57	57	116.0	Index	3.1.16	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M344	State has adopted the Nurse Licensure Compact (NLC)	The Nurse Licensure Compact allows licensed nurses residing in participating states the ability to practice in other participating states without applying for a new license. In the event of a significant disaster, Nurse Licensure Compact member states do not face licensing barriers when incorporating licensed nursing staff from other Nurse Licensure Compact member states into medical surge responses. States not party to this compact face increased administrative barriers when incorporating licensed nurses from other states into responses.	NCSBN NLC	National Council of State Boards of Nursing (NCSBN), Nurse Licensure Compact (NLC) Member States	2014—2018	The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state nurses into medical surge responses. Some states have other limited regional agreements precluding the need for participation in the national Nurse Licensure Compact.
61	61	135.0	Foundational	3.3.9	3.0	IIM	Incident & Information Management	7.0	INCM	Incident Management	The ability to establish and maintain a unified and coordinated operational structure with processes that appropriately integrate all critical stakeholders and support the execution of core capabilities and incident objectives. This sub-domain includes the capability to direct and support an event or incident with public health or medical implications by establishing a standardized, scalable management system consistent with the National Incident Management System and coordinating activities above the field level by sharing information, developing strategy and tactics, and managing resources to assist with coordination of operations in the field.	M345	State has adopted Emergency Management Assistance Compact (EMAC) legislation	The Emergency Management Assistance Compact (EMAC) establishes a legislative and legal foundation for interstate assistance in the event of a governor-declared emergency. This foundation settles issues of liability, responsibility, licensing, and credentialing prior to an emergency. This prior arrangement allows impacted states a more efficient means of identifying and securing assistance following an emergency.	NEMA EMAC	National Emergency Management Association (NEMA)	2014	The measure does not evaluate state capacity to implement the agreement and incorporate out-of-state health care providers into medical surge responses.
70	70	149.2	Index	4.1.13	4.0	HD	Healthcare Delivery	10.0	PC	Prehospital Care	Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities.	M350U	The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in urban areas (reverse coded).	The response time of EMS may be indicative of first-responder capabilities and capacities during large-scale disasters.	NHTSA FARS	National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)	2015—2017	Selected states fail to record response times for all fatal events.
71	71	149.3	Index	4.1.14	4.0	HD	Healthcare Delivery	10.0	PC	Prehospital Care	Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities.	M350R	The average length of time in minutes between EMS notification and arrival at a fatal motor vehicle crash (MVC) in rural areas (reverse coded).	The response time of EMS may be indicative of first-responder capabilities and capacities during large-scale disasters.	NHTSA FARS	National Highway Traffic Safety Administration (NHTSA), Fatality Analysis and Reporting System (FARS)	2015—2017	Selected states fail to record response times for all fatal events.
68	68	149.0	Index	4.1.11	4.0	HD	Healthcare Delivery	10.0	PC	Prehospital Care	Prehospital care is generally provided by emergency medical services (EMS) and, includes 911 and dispatch, emergency medical response, field assessment and care, and transport (usually by ambulance or helicopter) to a hospital and between healthcare facilities.	M331	Percent of local emergency medical services (EMS) agencies that submit National EMS Information System (NEMSIS) compliant data (e.g., Version 2 in earlier years, Version 3 in later years) to the state	The submission of EMS data to the national database allows state and federal officials to assess the timeliness and quality of EMS care. States can use the data to implement and evaluate improvements in EMS care, which may strengthen the ability to respond and recover from large-scale hazardous events.	NHTSA	National Highway Traffic Safety Administration (NHTSA), State NEMIS Progress Reports: State & Territory Version 2 Information	2015 & 2019	The quality of local data submissions is not well documented and may vary across communities and states. Data submissions may not reflect the extent to which data are used to inform EMS system improvements.
33	33	48.0	Index	2.1.8	2.0	CPE	Community Planning & Engagement Coordination	3.0	CSCC	Cross-Sector / Community Collaboration	The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.	M501	Percent of the state’s population served by a comprehensive public health system, as determined through the National Longitudinal Survey of Public Health Systems	Inter‐organizational connectedness can be an indicator of community resilience.	NLSPHS	National Longitudinal Survey of Public Health Systems (NLSPHS), National Association of County and City Health Officials (NACCHO), and Area Resource File (ARF) data analyzed by PMO and affiliated personnel.	2012, 2014 & 2016	Data are self-reported by local health department representatives and may reflect differences in perspective and interpretation among respondents.
119	119	257.0	Foundational	6.2.9	6.0	EOH	Environmental & Occupational Health	18.0	EM	Environmental Monitoring	The systematic collection and continuous or frequent standardized measurement and observation of: environmental specimens (air, water, land/soil, and plants) analyzing the presence of an indicator, exposure, or response (warning and control), including monitoring the environment for vectors of disease to give information about the environment to assess past and current status and predict future trends	M274	State participates in the National Plant Diagnostic Network (NPDN)	The National Plant Diagnostic Network (NPDN) was established in 2002 in response to the need to enhance agricultural security through protecting health and productivity of plants in agricultural and natural ecosystems in the U.S. The NPDN is a national consortium of plant diagnostic laboratories with the specific purpose of quickly detecting and identifying plant pests and pathogens of concern.	NPDN	National Plant Diagnostic Network (NPDN), National Plant Diagnostic website	2014	The measure does not evaluate the level or effectiveness of the state participation, including the resources committed and state success in quickly detecting and identifying pathogens.
32	32	42.0	Index	2.1.2	2.0	CPE	Community Planning & Engagement Coordination	3.0	CSCC	Cross-Sector / Community Collaboration	The coordination necessary to engage community-based organizations and social networks through collaboration among agencies primarily responsible for providing direct health-related services; partners include public health, healthcare, business, education, and emergency management in addition to federal and nonfederal entities necessary to facilitate an effective and efficient return to routine delivery of services.	M87	State health department is accredited by the Public Health Accreditation Board (PHAB)	The measure indicates state health department conformance with national standards that support continuous improvements in the implementation of public health programs and policies.	PHAB	Public Health Accreditation Board (PHAB), Health Departments in e-PHAB	2013—2018	The measure does not reflect health departments that are in process of achieving accreditation.
81	81	166.0	Index	4.2.16	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M299	Risk-adjusted 30-day survival rate (percent) among Medicare beneficiaries hospitalized in the state for heart attack, heart failure, or pneumonia	This measure is for risk-standardized all-cause 30-day mortality rates for Medicare patients aged 65 and older who are hospitalized with a principal diagnosis of heart attack, heart failure, or pneumonia. All-cause mortality is defined as death from any cause within 30 days after the index admission. This is a measure of the state's public health and healthcare system's programs, staffing, and requirements which influence recovery or mortality from an illness severe enough to require hospitalization.	CF Scorecard	The Commonwealth Fund, Aiming Higher: Results from a Scorecard on State health System Performance	2011-2013, 2015 & 2016	Variation in state population health, such as obesity or smoking rates, may have a greater effect on the measure results than prevention and preparedness programs.
90	90	191.0	Index	4.4.5	4.0	HD	Healthcare Delivery	13.0	MBH	Mental & Behavioral Healthcare	Mental and behavioral healthcare is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.	M317	Percent of need met for mental health care in health professional shortage areas (HPSA) in the state	It is reasonable to assume that if an area has existing shortages in key behavioral health personal, preparedness for and response to a disaster may not be as robust as in areas where there are not staff shortages. It might also be assumed that if there are shortages in mental health professionals, there may also be shortages in other specialty care professions, again indicating that overall disaster health and mental/behavioral health preparedness and response may be limited.	HRSA HPSA	The Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSA)	2014, 2016—2018	The measure data is based on the availability of psychiatrists, and does not include other behavioral health professionals (e.g., psychologists, social workers, licensed counselors, pastoral counselors, psychiatric nurses) who provide the majority of behavioral health services following disasters. The measure does not consider the ability of a state to temporarily move mental health resources within the state in response to a disaster, such as state trained and certified crisis teams that can be activated and deployed to disaster zones and rapidly supplement local resources. In addition, the measure does not evaluate lack of provider availability and readiness during disasters due to appointment waiting lists, contractual obligations to serve certain populations, or their status of skills and training necessary for optimal performance in disasters.
82	82	167.0	Index	4.2.17	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M300	Percent of hospitals in the state with a top quality ranking (Grade A) on the Hospital Safety Score	The Hospital Safety Score uses 28 national performance measures from the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS) to produce a single score representing the hospital's overall performance in keeping patients safe from preventable harm and medical errors. A grade "A" represents the best hospital safety score. Being able to provide patient safety and reduced medical errors during normal operations positions the hospital to perform better during health emergencies.	Leapfrog HSS	The Leapfrog Group, Hospital Safety Score (HSS)	2013—2018	The measure source data does not include critical access hospitals, specialty hospitals, pediatric hospitals, hospitals in Maryland, territories exempt from public reporting to CMS, and others. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.
64	64	170.1	Index	4.2.21	3.0	IIM	Incident & Information Management	8.0	INFM	Information Management	The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.	M906	Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.	Adoption and use of EHRs may enhance continuity of clinical care operations when emergencies disrupt routine clinical transactions, and may enhance early detection of and response to hazards through electronic reporting and syndromic surveillance.	HHS ONCHIT	The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services	2013—2016	The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
65	65	170.2	Index	4.2.22	3.0	IIM	Incident & Information Management	8.0	INFM	Information Management	The ability to develop systems and procedures that facilitate the communication of timely, accurate, and accessible information, alerts, warnings, and notifications to the public using a whole-community approach. This sub-domain includes using risk communication methods to support the use of clear, consistent, accessible, and culturally and linguistically appropriate methods to effectively relay information regarding any threat or hazard, the actions taken, and the assistance available.	M907	Percent of hospitals in the state that have demonstrated meaningful use of certified electronic health record technology (CEHRT). This includes the demonstration of meaningful use through either the Medicare or Medicaid EHR Incentive Programs. Critical Access hospitals are facilities with no more than 25 beds and located in a rural area further than 35 miles from the nearest hospital, and/or are located in a mountainous region.	Adoption and use of EHRs may enhance continuity of clinical care operations when emergencies disrupt routine clinical transactions, and may enhance early detection of and response to hazards through electronic reporting and syndromic surveillance.	HHS ONCHIT	The Office of the National Coordinator for Health Information Technology, a division of the U.S. Department of Health and Human Services	2013—2016	The measure reflects performance during routine care delivery and may not reflect capabilities in emergency situations.
91	91	202.0	Index	4.4.16	4.0	HD	Healthcare Delivery	13.0	MBH	Mental & Behavioral Healthcare	Mental and behavioral healthcare is the provision and facilitation of access to medical and mental/behavioral health services including: medical treatment, substance abuse treatment, stress management, and medication with the intent to restore and improve the resilience and sustainability of health, mental and behavioral health, and social services networks. It includes access to information regarding available mass care services for at-risk individuals and the entire affected population.	M800	Percent of the state’s population not living in an HRSA Mental Health Professional Shortage Area	Following an emergency event, individuals, families, and disaster responders may experience distress and anxiety about safety, health, and recovery and may require mental and behavioral health assistance, specifically calling on social workers' unique skills and training. The measure reflects a state's capacity to cope with its citizens' mental health needs.	U.S. Census & Health Resources & Services Administration (HRSA).	U.S. Census Bureau and Health Resources & Services Administration (HRSA) data analyzed by PMO personnel.	2015—2017, 2019	The measure data is estimated based on matching U. S. Census area definitions with the geographic boundaries for HRSA Mental Health Professional Shortage Areas.
75	75	157.0	Index	4.2.7	4.0	HD	Healthcare Delivery	11.0	HPS	Hospital and Physician Services	Hospital and physician services refers to care for a patient who is formally admitted (or “hospitalized”) to an institution for treatment and/or care and stays for a minimum of one night in the hospital or other institution.	M160	Number of physicians and surgeons per 100,000 population in the state	Physicians and surgeons are important components of the workforce needed to diagnose and treat injuries and illnesses associated with mass casualty events and disease outbreaks. The size of the workforce is one indication of a state’s ability to surge (i.e., ramp up) the number of licensed professionals who provide rapid care during and after an emergency event.	ACS 1-Year Estimates	U.S. Census, American Community Survey	2012—2017	The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available physicians and surgeons in the event of an emergency. Also, BLS and other national data sources on physician supply have been shown to undercount certain types of physicians, and may differ considerably from the estimates available from state medical licensing boards. Since the measurement undercounting in the BLS data are expected to be relatively consistent across states, they should not cause significant bias in the Index state and national results. The Bureau of Labor Statistics (BLS) produces occupational estimates by surveying a sample of non-farm establishments. As such, estimates produced through the Occupational Employment Statistics (OES) program are subject to sampling error.
123	123	259.1	Index	6.3.2	6.0	EOH	Environmental & Occupational Health	19.0	PEI	Physical Environment and Infrastructure	Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.	M923	Surface Water Control Structural Integrity, percent of High-Hazard Potential Dams that are in Fair or Satisfactory condition	Core elements of surface water control infrastructure contribute to health security through mitigation of flood risks and protection of drinking water sources.	NID & ASDSO	U.S. Corp of Engineers, National Inventory of Dams (NID) and the Association of State Dam Safety Officials (ASDSO)	2016 & 2018	A small, but growing number of states exempt categories of dams from inspection based on the purpose of the impoundment or the owner type. Nationally roughly a quarter (22%) of the high-hazard dams are not rated for condition, with wide differences among the states
125	125	259.3	Index	6.3.4	6.0	EOH	Environmental & Occupational Health	19.0	PEI	Physical Environment and Infrastructure	Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.	M929	Flood Insurance Coverage, FEMA National Flood Insurance Policies (NFIP) in-force as a percentage of total housing units located in 100- and 500-year floodplains	NFIP participation indicates household and community awareness of flood risks and provides financial protections that accelerate community recovery after flood-related disasters.	FEMA & NYU Furman Center	U.S. Department of Homeland Security, FEMA, National Flood Insurance Program, and the NYU Furman Center (FloodzoneData.us)	2013—2018	Participation in the National Flood Insurance Program (NFIP) is voluntary. It is possible that some communities located in flood zones are not part of the NFIP. Also, many flood zone maps are outdated.
122	122	259.0	Index	6.3.1	6.0	EOH	Environmental & Occupational Health	19.0	PEI	Physical Environment and Infrastructure	Actions taken to reduce health hazards in the physical environment, including elements of the natural and built environment.	M922	Transportation Structural Integrity, percent of bridges that are in good or fair condition (not poor)	Core elements of transportation infrastructure shape many aspects of health security, including mitigation of health and safety risks due to bridge failures, timely mass evacuations, timely emergency responses, and timely restoration of economic and social activity.	US DOT	U.S. Department of Transportation, Federal Highway Administration, Office of Bridges and Structures	2012—2017	The frequency of bridge inspections varies according to numerous criteria. Most bridges are on a one-, two-, or four-year inspection cycle. Consequently, the data year does not necessarily coincide with the inspection year.
38	38	56.0	Index	2.2.7	2.0	CPE	Community Planning & Engagement Coordination	4.0	ARP	Children & Other At-Risk Populations	Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.	M163	Number of pediatricians per 100,000 population under 18 years old in the state	Pediatricians are specially trained to provide medical care to children. These skills are particularly needed to provide care to children that have serious injuries or illnesses associated with mass casualty events and disease outbreaks. The measure focuses on the state's workforce capacity of pediatricians capable of providing specialized children's medical care.	AHRF	U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)	2010, 2015-2016	The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available pediatricians in the event of an emergency.
39	39	57.0	Index	2.2.8	2.0	CPE	Community Planning & Engagement Coordination	4.0	ARP	Children & Other At-Risk Populations	Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.	M164	Number of obstetricians and gynecologists per 100,000 female population in the state	Obstetricians and gynecologists are specially trained to provide medical care to women, including during and after pregnancy. These skills are particularly needed to provide care to women who have serious injuries or illness associated with mass casualty events and disease outbreaks. The measure indicates a state's capacity to provide specialized women’s health services during emergencies and in routine care situations.	AHRF	U.S. Health Resources & Services Administration (HRSA), Area Health Resources Files (AHRF)	2010, 2015-2016	The measure does not consider mutual aid plans that may be in place for healthcare facilities to supplement the number of available obstetricians and gynecologists in the event of an emergency.
48	48	93.0	Index	2.4.2	2.0	CPE	Community Planning & Engagement Coordination	5.5	SCC	Social Capital & Cohesion	The community social capital that helps society function effectively, including social networks between individuals, neighbors, organizations, and governments, and the degree of connection and sense of “belongingness” among residents.	M175	Percent of voting-eligible population in the state participating in the highest office election	Voter participation is one proxy measure for social cohesion, which indicates the degree of connectedness and belonging that exists among members of a community. Cohesion is positively correlated with a community’s ability to recover from emergencies and disasters. Voter participation also is correlated with community involvement and trust in government.	USEP	United States Election Project, General Election Turnout Rates	2012, 2014 & 2016	The ideal numerator is total ballots counted (voting eligible population is the denominator), but these data are not available for all jurisdictions. Therefore, the Index uses a measure of the total votes cast for the highest office (e.g., presidential, gubernatorial, or congressional election).
41	41	70.1	Index	2.2.21	2.0	CPE	Community Planning & Engagement Coordination	4.0	ARP	Children & Other At-Risk Populations	Actions to protect individuals specifically recognized as at-risk in the Pandemic and All-Hazards Preparedness Act (i.e., children, senior citizens, and pregnant women), and those who may need additional response assistance including those who have disabilities, live in institutionalized settings, are from diverse cultures, have limited English proficiency (or are non-English-speaking), are transportation disadvantaged, have chronic medical disorders, and have pharmacological dependency; all of whom require additional needs before, during, and after an incident in the functional areas of communication, medical care, maintaining independence, supervision, and transportation.	M53B	Percent of youth who did not miss one or more days of school in past month due to concerns about safety	School safety practices can reduce student concerns about safety and improve student adherence to emergency plans and protocols.	CDC YRBS	Youth Risk Behavior Survey	2011, 2013, 2015 & 2017	The measure is self-reported and does not distinguish reasons for safety concerns.

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