As a global community, the United States is not prepared to respond to a bioterrorism attack, a mass casualty event, or a significant disease outbreak. The country's public health infrastructure is not prepared for the global health threats of the 21st century. The article claims that part of the reason State and local public health and health care systems, including emergency medical systems, are underprepared for a major health event is a lack of adequate, stable funding. The United States spends nearly 15 percent of its gross national product on health care, but only an estimated 1 percent of total health care expenditures goes to the public health system. Of this sum, an ever-increasing share is devoted to expensive, high-tech procedures and pharmaceuticals. Disproportionately little goes to primary and emergency care--the professionals and facilities that would be among the first responders in a bioterrorist attack or major infectious disease outbreak. The paper contains specific recommendations for Washington State's emergency preparedness planners. Notes, appendix