Are We Ready? Public Health Since 9/11 (review)

Professors David Rosner and Gerald Markowitz examine how the attacks on 9/11 and the subsequent anthrax attacks affected the nation’s public health system. Are We Ready? Public Health Since 9/11 places the reader on the scene of the World Trade Center via the recollections of the on-the-ground participants (local, state, federal) of Sept 11th. It explores these participants’ strengths, their weaknesses, and the systems surrounding them.

Are We Ready allocates one chapter to each level of government and its response to the terrorist attacks. Chapter one is dedicated to the response to 9/11 and its aftermath by the New York City public health systems. Chapter two focuses on the state response and preparedness for bioterrorism and competition for limited resources. Chapter three analyses how the Centers for Disease Control and Prevention (CDC) evolved during the disaster from an advice-only organization to having a greater involvement in response and command. Drs. Rosner and Markowitz conclude their history with a very valuable lessons-learned chapter.

Lessons learned from the 9/11 incident include these:

1. 1. Existing infrastructure: The “success of the public health response to 9/11 . . . had less to do with formal emergency planning . . . than with the presence of an existing infrastructure of health services, laboratories, and personnel.”

2. 2. Mental health services: Jurisdictions must “develop a more expansive understanding of mental health services” and the broader integration of that system into the public health infrastructure.

3. 3. Communication: The “failure to communicate honestly about uncertainty” is a serious mistake.

4. 4. Chain of command: There must be “clear lines of federal and other authority.”

As no other type of book can, a contemporary history logs the opinions, views, and paradigms of those who directly participate in the historic event into a literary form. Taken as a whole, this history is very useful. Unfortunately, disasters occur in poor areas just as much as anywhere else, and often more often (witness recent hurricanes, cyclones, and earthquakes). Those who create policy with underserved populations should not only read this history but also apply it. Are We Ready? provides insight and perspective that is missing to those of us who saw 9/11 from our desks or homes.