Until November 12, 2002

For more information, contact:
Linda Loranger or Janet Firshein, (301) 652-1558
Jon Gardner at Health Affairs, (301) 656-7401, ext. 230


November/December Issue of Health Affairs
Devoted To Public Health and Bioterrorism

Washington, D.C.—To coincide with the one-year anniversary of the first anthrax attacks in the U.S., Health Affairs examines the state of public health in an era of bioterrorism and amid worries about homeland security. The November/December issue of the nation's leading health policy journal, set for release on November 12, features articles on a range of topics related to public health and bioterrorism from a group of leading public health policymakers, legislators and researchers. Topics covered include: the challenges and opportunities for supporting the public health infrastructure, the state of public health law after September 11, the role of risk communications during public health crises, the importance of transforming the public health information infrastructure, and the importance of an adequately prepared public health workforce. This issue also includes an interview with former Surgeon General David Satcher, MD, and an article by Sen. Bill Frist (R-TN) on the role of the federal government in assuring public health and safety.

Here are highlights of some of the articles featured in this issue:

• Strengthening the Nation's Public Health Infrastructure: Historic Challenge, Unprecedented Opportunity. Former Centers for Disease Control and Prevention Director Jeffrey Koplan and current Assistant Surgeon General Edward Baker examine progress that's been made in the past decade for strengthening the public health system and the challenges and opportunities that lie ahead. The authors warn that as revenues shrink and memories of the events of 2001 grow distant, "the needs and requests for education, highways, prisons, basic research, and indigent care may push long-term support for repairing long-neglected public health needs off the priority list." As a result, they say the "dual-purpose nature" of the public health system must be communicated. The authors say that public health leaders will need to embrace "a new language" that better communicates the story of public health and why sustaining a strong system is important for bioterrorism as well as other potential public health problems. Baker and Koplan also predict that over the next decade there will be greater pressure on the public health sector to be accountable and document their competencies. They maintain that "sustained interest in and support for the public health infrastructure" over the coming years will require health departments to produce "meaningful" case reports and studies that show how investments have made a difference for local communities.

• Public Health and National Security: The Critical Role of Increased Federal Support. Sen. Bill Frist (R-TN) examines the importance of public health preparedness for homeland security and how investing in public health activities pays off in the long run. Acknowledging that the public health infrastructure "has greatly deteriorated" over the past 20 years, Frist warns that "the current reality of terrorist threats means that we can no longer afford to neglect" the public health system. Frist hopes that the $1 billion Congress appropriated last year to upgrade state and local public health capabilities and hospital preparedness will go far, however, he says that "it will require an enhanced and prolonged strategy for America to regain and maintain the capacity necessary to respond to today's increased bioterrorist threats." Frist predicts that continued support for public health infrastructure needs will be more likely if dedicated funds are used to develop programs and activities to respond to a threat to the public and the national security. "If funds are used by states and local public health agencies to supplant their current funding or to create dual use for more controversial programs that do not enjoy broad support," Frist warns that continued funding will be jeopardized. Frist says that there is a "strong national security interest in developing and maintaining a strong public health system," adding that the federal government will have to sustain an elevated level of support for that system if the country is to meet the growing threats of bioterrorism.

• Public Health Law in An Age of Terrorism: Rethinking Individual Rights and Common Goods. Georgetown Law Professor Lawrence O. Gostin defends efforts to bring public health law into the 21st century. Gostin shows why existing public health laws need to be changed and defends the controversial Model State Emergency Health Powers Act and why it took on such new urgency after the terrorist attacks on September 11. The Model Act, which is still in draft form, has been criticized as a law that could significantly infringe on personal liberties and give states and public health authorities too much authority. Gostin presents arguments against these attacks, arguing that the Act was designed to "defend personal as well as collective interests." He calls existing public health laws "obsolete, fragmented and inadequate" and "a weak foundation for the effective identification and control of serious health threats." The Model Act, he adds, "provides a modern framework for effective identification and response to emerging health threats, while also demonstrating respect for individuals and tolerance of groups."

• Dealing with the Dangers of Fear: The Role of Risk Communication. George Gray and David Ropeik of the Harvard Center for Risk Analysis examine why effective risk communication is needed to fight fears associated with the war on terrorism. In an analysis of the public health implications associated with the fears spurred by the events of September 11, Gray and Ropeik argue that "government could, and should, be doing more to recognize and combat the risks we face from being afraid." The authors contend that the country's "emotional response to the attacks may have imperiled more of us than the number of victims" on September 11. For example, people choosing to avoid flying on airplanes engaged in a far riskier behavior - driving. In addition, thousands of people were buying antibiotics prophylactically to ward off anthrax, contributing to antibiotic resistance and increasing the risk of serious disease. The authors examine what factors lead to emotional reactions to the risk of terrorism and offer suggestions on how to make risk communications about terrorism more effective with the public. They conclude that government leaders must embed risk communication into all policymaking. They also say that risk communications is more likely to succeed if it helps people understand the facts "in ways that are relevant to their own lives, feelings and values, so they are empowered to put the risk in perspective and make more informed choices."


Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the November/December 2002 issue will be provided free to interested members of the press. Address inquiries to Jon Gardner at Health Affairs, 301-656-7401, ext. 230, or via email, press@healthaffairs.org. Selected articles from the November/December issue are available free on the journal's Web site, www.healthaffairs.org.

©2002 Project HOPE–The People-to-People Health Foundation, Inc.