Shortly after Maine was praised for keeping its tobacco-settlement money focused on reducing smoking, the state received a negative mark in a report card on its readiness to confront bioterrorism, bird flu and assorted disaster. The negative mark was over the state’s apparent failure to maintain funding for public health, but the rating didn’t take into account the tobacco money.

That, in miniature, is the challenge for health officials: How does a state balance its efforts between potential swift catastrophe from a pandemic flu or terrorism attack vs. the slow-moving but certain catastrophes of lung cancer and heart disease, which kill thousands in Maine each year?

The mark on maintaining funding for public health was one of 10 in a report card by the group Trust for America’s Health, which said Maine had made sufficient progress in five areas, putting it among several states. Only Oklahoma, with a tragic attack in its recent background, passed on all 10 measures, which included such areas as the number of labs, nurses and hospital beds. What it didn’t measure was how well a state performs its day-to-day services and how well its prevention programs work.

These measures seem at least as important because Maine loses 2,500 people a year to early death from tobacco – if even one-tenth that many died from bird flu, the nation would be in a panic. But each year, heart disease, preventable cancers and auto accidents kill Maine citizens not only without the public panicking; unless it happens to a friend or relative, few even notice.

Of course emergency preparation is important, and this isn’t to knock the trust’s work. Several of its recommendations support needed public health care beyond the rare emergency. But in addition to guessing which vaccine will be needed for the next flu outbreak or what sort of bioterror risk a small, thinly populated state might encounter is whether health care facilities here work well together and with other states and the federal government.

If the state’s programs to reduce smoking, encourage healthy living, stress early intervention, etc., work in an effective, coordinated way, it is much more likely that any emergency that arrives will also be addressed in a reasonable, thoughtful manner. That’s hard to measure in a report card but essential to care, whether chronic or acute.