International Journal of Epidemiology 2003;32:887-888
© International Epidemiological Association 2003
Book Review |
Terrorism and Public Health: A Balanced Approach to Strengthening Systems and Protecting People.
Barry S Levy and Victor W Sidel (eds). New York: Oxford University Press, 2002, pp. 377, £35.00 (HB) ISBN: 0-19-515834-2.
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In the words of the editors, ‘this is the first book that addresses terrorism from a public-health perspective that is both comprehensive and balanced’. The scope is wide, and spread over three sections: I. The public health response to September 11 and its aftermath; II. Terrorist weapons; and III. Challenges and opportunities. Thirty-six experts contribute, including both eminent public health leaders and frontline public health responders. David Satcher writes the Forward.
As the first to publish a book on this topic after September 11, the editors are well positioned to promote a balanced public health response. We must all hope they are successful in this endeavour. Especially in the US, the profession faces political pressures after September 11, which could undermine its overriding commitment to population health, both national and international.1
Some of the chapters provide a concise and useful synopsis of what public health professionals can learn from the recent events in the US. One is Phil Brachman’s elegant description of the 2001 anthrax attacks, detailing the detection and investigation of the anthrax cases. Though giving the Centers for Disease Control and Prevention (CDC) high marks in some areas, Brachman notes critical gaps in others. In its communication with the public, for example, the CDC lacked a single, authoritative voice, and a price was paid in the confusion and turmoil this failure produced. Another excellent chapter is the contribution by Jack Geiger on the protection of civil liberties. It offers a short and compelling summary of the historical antecedents of current US legislation to restrict civil liberties, and the reasons public health professionals need to be concerned about it.
Though of great advantage to the book’s primary mission of influencing the public health agenda, the rush to publication was probably also responsible for a number of weaknesses. Although many of the authors (based on their past work) have a deep knowledge of the history of public health, and a fundamentally international perspective, this is not reflected in the content. In general, the chapters do not draw on the history of public health to illuminate the current crisis. There is much to learn, for example, from the rich historical analyses of epidemic terror in the 19th century.2 The book also does not utilize the important international experience with the consequences of and responses to terrorism, in Lebanon, Israel, and many other countries. Indeed, the near exclusive focus on the US makes the editors’ claim of a ‘comprehensive and balanced’ perspective seem overstated. The book may be of limited value to public health professionals outside the US.
With regard to September 11, the remarkable body of empirical and policy studies which have emerged in its aftermath are not included; no doubt most of them were not available in time for this publication (e.g. Neria and Gross, in press3). In addition, the lessons from September 11 are presented too gently for our liking, and do not convey the wide gaps that were revealed in the public health system, which impeded comprehensive and effective public health responses. One might get the impression from the book that we simply need to increase funding of the existing public health infrastructure. That is essential, but nowhere near sufficient. As but one example, to develop an effective public health response to terrorism requires the integration of public mental health.4 Failure to include mental health considerations in every aspect of public health preparedness and response squanders our opportunities to foster resilience, goodwill, and co-operation in the general population. Thus we would have to address the historic and persistent absence of mental health expertise in public health practice in the US, evident in the CDC, in public health academic departments, and in training alike. As another example, we would need to be more attuned to the questions of social justice that emerge in this context. During the anthrax epidemic, both Congress and postal workers were exposed; the former received immediate attention from the CDC, while the latter were initially neglected.
In summary, the timely publication of this book is a service to all of us in public health, and it will be a useful resource for health professionals, emergency response organizations, and policy makers, as well as for teaching. As we continuously absorb the lessons of September 11 and follow its impact on international public health, however, the book will surely be superseded by deeper and more comprehensive treatments of this important topic.
References
1 Susser E, Susser M. The aftermath of September 11: what’s an epidemiologist to do? Int J Epidemiol 2002;31:719–21.
2 Evans RJ. Death in Hamburg: Society and Politics in the Cholera Years, 1830–1910. Oxford: Clarendon Press; New York: Oxford University Press, 1987.
3 Neria Y, Gross R. Mental Health Consequences of the September 11, 2001 attacks. Trends in Evidence-based Neuropsychiatry (in press).
4 Susser E, Herman D, Aaron, B. Combating the terror of terrorism. Scientific American 2002;287:70–77[Web of Science][Medline]
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