Colorado joins 25 other states and the District of Columbia in having a high degree of emergency public health preparedness, a new report found.

The Trust for America’s Health, a Washington, D.C.-based nonprofit, released its annual “Ready or Not” report, ranking states on such factors as their public health spending, percentage of people receiving flu vaccinations, and the amount of employees with paid time off – the lack of which is correlated with infectious disease outbreaks.

The Trust found that 100% of Colorado’s hospitals participated in healthcare coalitions as of 2017, and state public health spending increased by 3% from 2018 to 2019. Only 1% of the population used a community water system that was in violation of health-based standards.

Nationally, 7% of Americans use water systems not totally in compliance, the U.S. Environmental Protection Agency found. The lead contamination of water in Flint, Mich. is a high-profile example. “These incidents could have long-term consequences on the health and brain development of children, as well as the mental health and trust of the community,” the Trust wrote.

The report did call out Colorado, however, for its low rate of childhood vaccinations against the measles, mumps, and rubella. Colorado was one of nine states with under a 92% vaccination rate for kindergartners. The World Health Organization recommends a 95% rate for the protection of the entire population. 

Legislation was introduced this week in the Colorado General Assembly to address the vaccination issue.