January 2002, Vol 92, No. 1 | American Journal of Public Health 10-11
© 2002 American Public Health Association
September 11: The Response and Role of Public Health
Allan Rosenfield, MD,
Stephen S. Morse, PhD and
Katy Yanda, BA
The authors are with the Mailman School of Public Health, Columbia University, New York, NY.
Correspondence: Requests for reprints should be sent to Allan Rosenfield, MD, Mailman School of Public Health, 600 W 168th St, New York, NY 10032 (e-mail: ar32{at}columbia.edu).
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INTRODUCTION
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The horrific terrorist attacks on the World Trade Center, the Pentagon, and 4 commercial airliners have seared unspeakable images into our memories. In the wake of the attacks, various sectors of our society—including public health professionals, academics, and community workers—have been reexamining their preparedness for future assaults. Now, more than ever, there is an urgent need to strengthen the US public health infrastructure.
The initial response to the World Trade Center attacks was swift and generous. The health care community joined with firefighters, the police, rescue groups, and an outpouring of volunteers from all sections of New York City and beyond. It was tremendously moving to see large numbers of people volunteering their time, resources, and blood; it was reassuring to witness the skill and competence of health care professionals at work.
The tragedy has also posed long-term challenges to people living not only in New York City but also throughout the United States and, indeed, the world. During this extraordinarily trying period, it is important to review the range of issues in which the field of public health plays a special role in dealing with future threats, as well as to emphasize the skills and information that public health supplies at all times. It is also critical that we continue to underscore our commitment to basic health care and to a livable and secure environment for everyone, in the United States and abroad. Further, these violent acts committed against innocent civilians do not justify other violent responses against other innocent civilians.
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"BE PREPARED"
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Public health preparedness is a key part of a sound public health infrastructure. The Centers for Disease Control and Prevention (CDC) established a national network for public health preparedness in October 2000. Seven schools of public health (at Columbia University, University of Illinois at Chicago, University of North Carolina–Chapel Hill, University of Washington, University of Iowa, St. Louis University, and University of Southern Florida) were enlisted as partners. These centers were established to ensure that public health workers have the skills and competencies required to effectively respond to emerging public health threats.
Just 2 weeks before the attack, 800 nurses were trained in emergency preparedness by the center at the Mailman School of Public Health of Columbia University, with the participation of the New York City Department of Health. This training helped the nurses understand their role in New York City's response to the September 11 emergency. But the events of that day only highlighted the need for disaster planning and training for our entire health care workforce, as well as the need to improve coordination among agencies to ensure efficient and appropriate reactions.
The anthrax incidents in Florida, New York, New Jersey, Washington, and elsewhere have heightened the nation's concern about the threat of biological and chemical weapons. While concern is warranted, it is important to put the threat of biological warfare in context. Even with sophisticated equipment and expertise, it is extremely difficult to grow sufficient material and even more difficult to disseminate it on a massive scale. It is important to remember that, in the month since the first case of anthrax was identified in Florida, there were only 17 confirmed cases of anthrax, 4 of which resulted in death.
Any biological attack would appear as an infectious disease outbreak, and public health is our first line of defense.1 The public health system has considerable experience in dealing with such outbreaks and is presently at a high state of readiness. As part of the nation's response and surveillance efforts, the CDC dispatches epidemiologists, as needed, to assist state and local health departments. Yet the recent threats have strained the resources of the CDC and state and local health departments, intensifying concern about the capacity of the nation's public health system to respond in the event of a much larger bioterrorist attack. There is an urgent need for a dramatic increase in federal and state funding to support a stronger public health infrastructure for monitoring and controlling unexpected outbreaks of infectious disease, enhancing preparedness through professional and public education, and stockpiling the necessary vaccines and antibiotics.
Strengthening our ability to respond to infectious disease, like strengthening the public health workforce, will pay huge dividends in lives saved. Investment in developing the public health infrastructure—through research, resources, and preparedness—will benefit the public on a daily basis.
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AFTEREFFECTS OF THE ATTACKS
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Environmental health issues and biological contamination related to the September 11 attacks remain concerns for New York City residents and rescue workers. The New York City and New York State health departments, along with the CDC and the Environmental Protection Agency, are closely monitoring air and water quality in the area of the World Trade Center and throughout the city. Currently it is believed that residents of lower Manhattan, and New Yorkers in general, are not at increased risk from the dust, asbestos, and chemical contaminants from the debris. Emergency crews working at or near ground zero have been urged to use respiratory masks because of the amount of dust in the air.
Air quality indicators will have to be closely monitored in the coming months to determine the short- and long-term health implications. Specifically, health care professionals will be looking for increases in the rates of asthma and other respiratory and immune system conditions, as well as possible vulnerability to infectious disease because of air and water conditions. Health agencies are making this information available to the public, and they need sufficient resources to be able to continue to do so.
In the aftermath of September 11, the mental health field displayed its readiness to deal with trauma. Rarely in recent memory have the skills of mental health professionals been so needed or so evident. Leading academic institutions and the city and state departments of health and mental health coordinated their efforts to address the needs of New York City's multiple trauma victims and diverse populations, providing the highest quality of services possible. These programs are making use of the expertise and experience gained from dealing with other terrorist attacks, such as the Oklahoma City bombing.
The breadth of this tragedy has left an entire city, and indeed the world, in grief. Levels of care address a wide range of responses: the distress of families and friends of the victims, posttraumatic stress disorder among rescuers and survivors, and the fears of people who were not directly affected by the attacks. A concerted effort is being made to meet the needs of children in explaining the event, providing emotional and physical support, and ensuring that teachers and counselors are trained to give age-appropriate responses in the schools. Mental health care workers will deal with increased anger, depression, and anxiety long after the debris is cleared away.
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RISING TO THE CHALLENGE
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The New York City Department of Health, having been displaced from its own offices in lower Manhattan, responded to the World Trade Center tragedy with what resources it could muster, with assistance from the New York State Department of Health, the CDC, the Mayor's Office of Emergency Management, and many, many others. Their response gives a certain degree of comfort that commited professionals stand ready to respond to public health threats. Yet a clear need for much greater attention to the public health infrastructure remains.
With the eyes and hearts of the world turned toward health and safety issues, now is the choice moment to involve the public in public health. A crucial component of preparedness is cooperation and a spirit of partnership among individuals, communities, and agencies. People are encouraged to donate blood and to volunteer on an ongoing basis, as these efforts are sorely needed even absent catastrophic events. Public health professionals can promote tolerance and diversity in their workplaces as well as in the public sphere. The New York City Department of Health has closely collaborated with universities, hospitals, and community-based organizations throughout New York City. Such partnerships, the necessity and potential effectiveness of which have been highlighted in the wake of the attacks, may be transformed to address ongoing needs with new energy and ideas.
Accepted for publication October 16, 2001.
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Reference
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1.
Morse SS. Factors in the emergence of infectious disease. Emerg Infect Dis.1995;1:7–15.[Medline]
Copyright © 2002 by the American Public Health Association
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INTRODUCTION
"BE PREPARED"
