A new Trust for America's Health report, released Thursday, finds that only 20 states scored 'high' on national public health emergency preparedness — meaning 30 states and the District of Columbia are either middling or outright unprepared as the United States prepares to host the 2026 World Cup and its millions of international visitors.
Seventeen states and D.C. landed in the 'middle tier'; 13 states fell below even that threshold, per the TFAH annual scoring.
The historian's note: the United States has run this same experiment before. After the 1918 influenza pandemic exposed catastrophic gaps in state-level public health infrastructure, Congress built the Public Health Service into something functional — then spent the following century episodically defunding it between crises. The 2025 federal appropriations cuts to CDC and public health grants are the latest iteration of that cycle. Thirty states being unprepared is not a surprise; it is the predictable output of a funding structure that treats public health as discretionary spending.