HONOLULU (AP) — Hawaii scored in the top half of states in a study of government health preparations to deal with natural or man-made disasters.

The study being released Tuesday by the Trust for America's Health and the Robert Wood Johnson Foundation determined that Hawaii fulfilled eight of 10 categories of preparedness, as did nine other states.

Twelve states rated higher. Twenty-eight states and the District of Columbia scored lower.

The national recession "could result in a serious rollback of the progress we've made since September 11, 2001, and Hurricane Katrina to better prepare the nation for emergencies," Jeff Levi, executive director of the trust, said in a statement.

"The 25 percent cut in federal support to protect Americans from diseases, disasters, and bioterrorism is already hurting state response capabilities," he added. "Cuts to state budgets in the next few years could lead to a disaster for the nation's disaster preparedness."

For the last six years, the trust has reviewed state preparedness plans and released its annual "Ready or Not?" report. The trust is a nonprofit group that works on disease prevention issues. The mission of the Johnson Foundation, a philanthropic organization, is to improve health care for all Americans.

Like all other states and the District of Columbia, Hawaii has an adequate plan to distribute emergency vaccines, antidotes and medical supplies from the Strategic National Stockpile, the report found.

The report did not cover communications, evacuation plans, leadership roles, law enforcement or other nonhealth preparations needed for dealing with disasters that could lead to widespread public health problems.

Hawaii also got passing grades in seven other categories, including purchase of at least 50 percent of its share of federally subsidized antiviral drugs, its ability to electronically track diseases, its laws reducing or limiting the liability of health care volunteers that help in a public health emergency and four other health-related areas.

But Hawaii's public health lab lacks an around-the-clock courier system for specimen pickup and delivery, the report said.

"Such a service, whether state-owned and operated or contracted to a designated carrier, is essential to ensure the timeliness of laboratory testing and subsequent treatment or decontamination," the report stated.

Hawaii also has no law reducing or limiting the liability of businesses and nonprofit groups that help in a public health emergency, according to the report.

"The lack of liability protection is a serious deterrent to many businesses and non-profits that may want to offer their services but are fearful of doing so without clear liability laws," the report said.

Among the study's recommendations is restoration of federal, state, and local funding for public health emergency preparedness to 2005 levels; modernization of the technology available to state laboratories, and passage of national health care reform, which would provide care to under- and uninsured Americans who are the most vulnerable during major disasters or outbreaks of disease.

"States are being asked to do more with less, jeopardizing our safety, security, and health," Dr. Risa Lavizzo-Mourey, president and chief executive officer of the Robert Wood Johnson Foundation. "We all have a stake in strengthening America's public health system, because it is our first line of defense against health emergencies."