NIOSH. DHHS. CDC. NIH. No, NIOSH isn't what you do to your bagel and cream cheese. And no, I didn't fall asleep on my keyboard. But up until about a month ago, it wouldn't have made a difference. For many of us, these public health agencies remained only obscure acronyms. As long as it was FDA approved, we were in good shape.
But the recent bioterrorism attacks on the United States have flung these federal agencies onto the front page and forced them onto the front line of what threatens to be a war against national health.
Since the anthrax bacteria has infected 50 Americans and caused three deaths over the past two months, public health departments nationwide have roared into motion, working on the threat of bioterrorism with an unabated sense of urgency and utilizing all available stockpiles, manpower and funding to meet a need that was barely in the national viewfinder before now.
But any unpreparedness the public health sector is experiencing isn't due to poor planning, naivete or a cavalier attitude about the improbability of bioterrorism. When it comes to fighting wars, public health is a battle-weary veteran.
You see, the public health system in this country has been fighting a war for a long time - one far less cinematic than anthrax but every bit as lethal and as critical to the lifeblood of the nation. It has been fighting the fundamental maxim of Western medical ideology: Cure, don't prevent.
Americans love to cure disease, to treat the sick, to fix the broken - and, on the whole, we're really good at it. We have the best medical schools in the world, the most sophisticated medical research facilities and a string of the latest scientific breakthroughs as long as a strand of sequenced human DNA (we did that, too!)
A regal sheen has always accompanied the medical profession in America. People stay in school for two decades to become doctors, and those two initials, which can be modestly trotted out at the end of any business card or cocktail party, are incredibly powerful. Being a doctor in America has all the nobility of knighthood in the time of Chaucer.
As a culture, we are obsessed: We played doctor with our stuffed animals as kids, watch Hollywood in the ER, then flip to a real open-heart surgery on The Learning Channel. Heck, we even buy scrubs to wear as pajamas. (The mentality behind this move is: I may not be a doctor, but at least I can fool all those folks down at Savers!) Furthermore, the American Medical Association is one of the most powerful private interest groups in the nation, and it secures reactionary/treatment-based health care at the top of virtually every political agenda (though it remains substantially flawed because it ignores preventive care).
If doctors are the modern American knights, then public health officials are the yeomen. Kids don't play epidemiologist with dolls - spelling the title alone is a feat of post-baccalaureate proportions. And if anyone does go to college with the lifelong dream of being a public health officer (the few, the proud), they're not as likely to toss it out over cocktails.
Modern education isn't targeted to teach kids about risk-assessment, planning healthy lifestyles and taking modest precautionary measures - it teaches about getting sick and about how going to a doctor makes you well.
The Center for Disease Control's mission states that its purpose is to "develop and advocate sound public health policies, implement prevention strategies, and promote healthy behavior." Public health works to increase child immunization, promote the use of bicycle helmets and seat belts and convince people to stop smoking.
But in the drama of modern medicine and the search for life-saving cures, the average American isn't very impressed by the fact that the leading cause of death for Americans between ages 1 and 44 is injury. From the start, public health has been up against the monolith of medicine and has always been on the losing end of the power struggle.
So, in some ways, it's refreshing to see that Tommy Thompson's name is no longer being mistaken for that running back from OSU. And I am pleased that public health departments have garnered some political leverage and brought attention to the lack of resources with which they have been working in the shadow of the American medical community for decades. It has come through unfortunate means. As a department that has historically been overshadowed by the big leaguers of defense and state in the executive branch, bioterrorism has dusted off the Department of Health and Human Services and put it on the top shelf of the Presidential Cabinet.
Last year, Congress and the President allocated just $297 million of HHS's $429 billion budget for bioterrorism research and preparation. Out of President Bush's $5.1 billion emergency relief fund created in the wake of Sept. 11, $1.9 billion has been earmarked for HHS, whose 11 sub-agencies and over 60,000 workers have been scrambling around the clock to meet reactionary demands to the attacks and to implement rapid response systems.
The FDA has been furiously approving generic anti-anthrax medications, while the National Institute of Health has been working to create new, more effective vaccinations for bacteria that hadn't presented a real threat since the Cold War. Public health departments are also responsible for coordinating emergency response system efforts between local, state, and federal agencies and have been nervously trying to expand hospital and health worker capacities that are not currently equipped to stand up to large-scale biological warfare. Still, the makeover is the most radical deployment the Center for Disease Control has ever seen in its 50 years of existence, said Jeffrey Koplan, director of CDC.
But with this rapid mobilization to emergency response mode, local, state and national public health agencies have been slammed against a wall - media visibility may be high, but all of their resources are being exhausted and over-extended in what is just one more reactionary solution to a health problem.
And while reaction and preparatory analysis for future threats is the only viable method to deal with the anthrax cases that have cropped up, they set public health another step back in its arduous campaign to prove that prevention is the future of health care in America. When the bioterrorism crusade is over, I'm afraid that public health will find itself right back behind the plow.
Katie Petersen is a journalism sophomore. Reach her at limerick132@hotmail.com.
