Terrorism and public health: a balanced approach to strengthening systems and protecting people



Robert Beaglehole

Ad interim Director, Knowledge Management and Sharing, World Health Organization, Geneva, Switzerland



Editors: Barry S Levy & Victor W Sidel
Publisher: New York: Oxford University Press; 2002
ISBN: 0-19515-834-2; hardback; 408 pages; price US$ 49.95

The photograph on the front cover of this book — a crowd gazing in awe at the collapse of the South Tower of the World Trade Center on September 11, 2001 — says it all. Thus, the book has as its main focus the events surrounding the attacks on the World Trade Center in New York — and elsewhere in the USA — and the response to these attacks. The editors and chapter authors are to be congratulated on producing the first extended monograph on terrorism and its implications for public health, so soon after the September 11. The book consists of 19 chapters contributed by 36 experts, all but two from the USA and Canada; it was published in cooperation with the American Public Health Association.

The material in the book is organized into three parts. Part 1 (eight chapters) is devoted to September 11 and its aftermath, although it includes — rather incongruously — an excellent chapter on the response to the public health crisis in Afghanistan. Part 2 (four chapters) describes the vast array of weapons in the arsenals of today's terrorists, from small arms, to chemical and biological weapons, to nuclear weapons. Part 3 (seven chapters) addresses the critical need to strengthen the public health system in the USA. Included is a stirring chapter on protecting civil liberties — within the USA — and a brief chapter that explores the roots of international terrorism.

This book accomplishes its primary task: to provide a comprehensive review of lessons learned from September 11 and the dissemination of anthrax and their aftermath. However, from a global public health perspective, it misses a major opportunity. It says surprisingly little about the origins of terrorism and its roots in poverty, alienation, and cultural and religious differences. This omission will unfortunately reduce the appeal of the book for general public health audiences outside the USA. In contrast, the specialist audience concerned with responses to terrorist attacks will find the book invaluable, in so far as lessons from the USA have a more general applicability — and many of them do.

Two other major omissions might be rectified in a second edition. First, there could be a more in-depth exploration of the reasons for the weak state of public health practice in the USA (and many other relatively wealthy countries), how it can be strengthened to respond to the full range of public health challenges, and how this weakness affected the responses to September 11. Second, there could be a discussion of what are the prospects that the new resources to fight terrorism will contribute to a strengthening of public health practice in the USA and elsewhere.

World Health Organization Genebra - Genebra - Switzerland