Funding for Hawaii’s infectious disease emergency preparedness has dropped by millions of dollars, putting public health at greater risk of a potential outbreak, a report released Monday shows.

Hawaii scored six out of 10 — above the nation’s average — on key indicators of policies and capabilities to protect against infectious disease threats in the study by Trust for America’s Health and the Robert Wood Johnson Foundation but was one of 33 states and Washington, D.C., that saw significant declines in public health funding in recent years.

State epidemiologist Sarah Park, chief of the Department of Health’s disease outbreak control division, said Hawaii depends heavily on the federal government, which provides about 90 percent of the budget for her division.

"Every year, federal funding has been pretty much relentlessly decreasing, and that includes for disease investigations," Park said, adding that the division must limit its testing due to budget restrictions. "Every year, I have to get together with my staff and decide what we’re going to drop. We don’t test everything that comes across like we used to. We have to be really selective about the tests we do. Any time you start limiting increasingly what you do in terms of what you actually follow up on, test, investigate … you’re acknowledging that you’re going to ignore something."

Hawaii’s grant funding from the Centers for Disease Control and Prevention for public health emergency preparedness, for example, fell to $4.8 million in 2013 from $6.4 million in 2005, according to the nonprofit Trust for America’s Health. While state spending on public health is the highest per capita in Hawaii, that funding fell to $201.8 million in 2012 and 2013 from $215.8 million in 2011 and 2012 and $233 million in 2009 and 2010.

The cuts have forced the state to decrease staff by about a third over the past decade, Park said.

"Any time you have to make choices and constantly limit things and make sacrifices, it gets harder and harder," she said. "Every year, it gets a little bit harder to try to do what we do and maintain the same level of protecting the public’s health."

Hawaii also didn’t meet the goal of vaccinating 90 percent of infants and young children against whooping cough or requiring the HPV vaccine for teens and having a climate change plan focusing on the impact of human health.

The report, "Outbreaks: Protecting Americans from Infectious Diseases," found major gaps in the country’s ability to prevent, control and treat outbreaks due to outdated systems and limited resources, leaving Americans "at an unacceptable level of unnecessary risk."

Rich Hamburg, deputy director of the Trust for America’s Health, added that being a travel destination puts Hawaii at greater risk for tropical diseases.

"Any time you have a place with a high rate of tourism, you have a real threat of diseases traveling, not just between states," he said. "We’re in an era of decreasing public health budgets. The purpose of this report … is to really make the case that while the country has made huge advancements preventing and controlling infectious disease since the 1940s, we can’t become complacent against the various threats."

The study scored the majority of states — 34 — at five or lower out of 10 key indicators that included vaccinations of infants, young children and teens, and the capacity of public health laboratories to conduct tests during outbreaks.

Colorado, the District of Columbia, Hawaii, Maryland, Minnesota, Missouri, Pennsylvania, Tennessee, Virginia, Connecticut, Dela­ware, New York, North Caro­lina, Oregon, Rhode Island and Washington scored above average, while three states — Georgia, Nebraska and New Jersey — tied for the lowest score. New Hampshire had the highest grade.