Reported by Dr. Jennifer Austin:

There are persistent gaps in the nation's ability to respond to public health emergencies, according to a new study from the Robert Wood Johnson Foundation and Trust for America's Health, despite a series of recent tragic events like 9-11, anthrax threats and Hurricane Katrina.

One of the most notable findings is that 20 U.S. states do not currently mandate written evacuation plans for all licensed child care facilities, should the need arise.

"Most school systems have plans in place, but we also need to recognize that child care facilities need plans as well," said Dr. Jeffrey Levi, executive director of Trust for America's Health.

Planning to care for the 67 million children in American schools and childcare settings presents complex considerations and challenges, the study authors wrote. And while 42 states require all K-12 schools to have a disaster plan in place for emergency events including gun violence, only 23 states mandate these plans for facilities caring for infants, toddlers, or special needs children.

"That's surprising," says Lynsey Barkoff, a public school nurse working in New York City. "All levels of education, including preschool, should have emergency plans in place."

The report scored states on a scale of one to 10, with one point assigned for each public health marker the state achieved. These markers included level of public health funding, community response time to public health incidents, percent of vaccination goals met, and climate change adaptation plans.

The states with the highest scores - eight out of 10 points - were Maryland, Mississippi, North Carolina, Vermont, and Wisconsin.

"This is only a snapshot of preparedness," said Levi. "But [these states have] made a long term commitment to protecting public health through their leadership."

Ranking lowest in public health emergency preparedness were Kansas and Montana, with only three out of 10 points.

These rankings are in large part due to lasting effects of the economic crisis. From the 2010-2011 to 2011-2012 fiscal year alone, 29 states cut public health funding. This was the second year in a row of budget cuts for 23 of these states and the third year in a row for 14 states.

While certain areas of public health funding have made huge strides over the last decade, severe budget cuts at the federal, state, and local levels are slowly eating away at this progress, the authors said.

"The distressing part is that we are not making sustained commitments," said Levi. "You can't create the response commitment you need overnight. This isn't a one-time commitment."