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Are We Ready?

Public Health since 9/11

David Rosner

Publication Year: 2006

A contemporary history of a critical period, Are We Ready? analyzes the impact of 9/11, the anthrax attacks that followed, and preparations for a possible smallpox attack on the nation's public health infrastructure. David Rosner and Gerald Markowitz interviewed local, state, and federal officials to determine the immediate reactions of key participants in these events. The authors explore the extent to which these emergencies permanently altered the political, cultural, and organizational life of the country and consider whether the nation is now better prepared to withstand another potentially devastating attack. This well-reasoned and well-researched book presents compelling evidence that few with hands-on experience with disease and emergency preparedness believe that an adequate response to terrorism—whether biological, chemical, or radiological—is possible without a strong and vibrant infrastructure to provide everyday services as well as emergency responses.

Are We Ready? begins with an examination of the experiences of local New York officials who were the first responders to 9/11 and follows them as events unfolded and as state and national authorities arrived. It goes on to analyze how various states dealt with changing federal funding for a variety of public health services. Using oral histories of CDC and other federal officials, the book then focuses on the federal reaction to 9/11 and anthrax. What emerges is a picture of dedicated public servants who were overcome by the emotions of the moment yet who were able to react in ways that significantly reduced the public anxiety and public health threat. Despite the extraordinary opportunity to revitalize and reinvigorate the nation’s public health infrastructure, the growing federal and state budget deficits, the refocusing of national attention on the war in Iraq, and the passage of time all combined to undermine many of the needed reforms to the nation’s public health defenses.

Copub: Milbank Memorial Fund

Published by: University of California Press

Series: California/Milbank Books on Health and the Public


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p. 1-1

Title Page, Copyright

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pp. 2-5


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pp. v-vi

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pp. vii-viii

The Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. ...

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pp. ix-xii

This book was completed before the tragedy that destroyed much of New Orleans and the Gulf Coast in the late summer of 2005, when thousands were left homeless and hundreds dead after Hurricane Katrina struck. Like those who responded to the attacks of September 11, 2001, those on the ground in the days after the hurricane ...

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pp. xiii-xvi

The terrorist attacks on September 11, 2001, shocked all Americans. In just a few moments our sense of safety shattered as four airplanes attacked the American mainland for the first time in history. These attacks and the concerns about the possibility of bioterrorism following the anthrax episode a month later, ...

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Introduction: Remembering the Moment

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pp. 1-5

How can we understand the emotionally charged events surrounding September 11, 2001? How can we begin to comprehend the impact on our psyches, our institutions, and our people of the World Trade Center collapse, the attack on the Pentagon, and the crash of a jetliner in the fields of Pennsylvania? ...

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1. September 11 and the Shifting Priorities of Public and Population Health in New York City

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pp. 6-54

September 11, 2001, affected virtually all aspects of American life, from foreign policy and domestic security to philanthropy, social services, and health policy. Social welfare, public health, health care, and environmental issues, generally seen as separate spheres, are now increasingly understood as interrelated components ...

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2. Emergency Preparedness, Bioterrorism, and the States

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pp. 55-118

The newspaper headlines were stark and eerie: “Efforts to Calm the Nation’s Fears Spin Out of Control,” “Local Public Health Officials Seek Help,” “This Is Not a Test,” “State Can’t Handle Bioterrorist Attack,” “Scared into Action.” And the pictures that accompanied them were worse: investigators in moon suits; ..

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3. Emergency Preparedness, Bioterrorism, and the CDC: Federal Involvement before and after 9/11

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pp. 119-155

Public health activities have traditionally been understood as state and local functions. Throughout the nineteenth and twentieth centuries, disease surveillance and reporting, quarantine, vaccination campaigns, and treatment—as well as sanitation and other preventive strategies—were carried out largely by local and state health departments. ...

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Conclusion: What Lessons Have We Learned?

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pp. 156-162

What lessons are to be drawn from this historical account? September 11 presented the public health community and those involved with population health more generally an immense opportunity to revitalize and rethink the nation’s health agenda. ...


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pp. 163-180


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pp. 181-194

E-ISBN-13: 9780520940475
Print-ISBN-13: 9780520250383

Page Count: 210
Publication Year: 2006

Series Title: California/Milbank Books on Health and the Public