Important note: Information in this article was accurate in 2001. The state of the art may have changed since the publication date.
San Francisco Chronicle - Wednesday, October 17, 2001
Yet now, as the nation faces actual threats of bioterrorism -- as well as a cascade of hoaxes -- we are discovering how poorly prepared we are to deal with major threats to public health.
Once, Americans understood the importance of public health. In her award- winning book, "Betrayal of Trust," journalist Laurie Garrett describes how "the health of a community was the key measure of its success, and if pestilence and death stalked even one small segment of the population it was a stark indication of the community's political and social failure."
Between 1980 and 2000, however, the Reaganesque belief that "government is the problem" cast public health spending as just a waste of public money. As a result, both national and local public health systems eventually deteriorated into what Garrett calls "a hodgepodge of programs, bureaucracies and failings."
Yet, public health officials faced tougher challenges than ever. In addition to ensuring the safety of the nation's food and water, they confronted epidemics of HIV, hepatitis C and drug-resistant tuberculosis.
During his last years in office, President Clinton began to worry about the shocking neglect of the public health infrastructure. In their just-published book, "Germs," three New York Times reporters describe the former president's decision to ask Congress for $10 billion to thwart and prepare for terrorist attacks.
Among Clinton's initiatives were programs to train emergency workers; plans to protect government sites; efforts to strengthen the national public health surveillance system, additional stockpiles of antibiotics and medicines, and the creation of 25 urban medical-response teams in major American cities.
It was, as they say, too little, too late. Even in prosperious times, it was difficult to gain political support for funding public health.
For the past two years, for example, California's local health officers requested funds to fortify the state's tattered public health safety net. They repeatedly warned that counties no longer had sufficient nurses, laboratories and epidemiologists to track down, test and prevent new infectious diseases.
Despite their pleas, Gov. Gray Davis recently vetoed funds to beef up the state's public health infrastructure.
Public health, we are learning the hard way, is a necessity. Like the phone, we need it in good times, as well as for emergencies.
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