A December 2003 report by Trust for America's Health showed that the nation's public health system was insufficiently prepared for bioterrorism. The prognosis isn't much better more than a year later. A follow-up report concludes that "states across the country are still struggling to meet basic preparedness requirements and have inadequate resources to juggle the competing health priorities they face." Ranking states on ten "key indicators to assess the states' public health emergency preparedness capabilities," the report found Florida and North Carolina to be in the best of health, notching nine of the ten indicators. At the other extreme were Massachusetts and Alaska, which achieved the sickly score of three. Twenty states fell in the middle with a score of six, while another 19 garnered scores of 5 or 7. he ranking was based on indicators such as state spending of federal funds, level of state public-health budgets, bioterror capabilities of state labs, and surveillance and tracking capacity. For example, only five state public-health labs report the ability to adequately respond to a chemical terror threat, while two-thirds of states don't electronically track disease outbreak information using national standards, making early warning difficult. SM Online has the full 72-page report, as well as an executive summary.