Bioterrorism Response, Unintended Consequences, and the Role of Environmental Health. (Managing Editor's Desk)

Article excerpt

When I read about change, the one point that always unnerves me is that the speed of change is increasing. To say that we live in a world moving at breakneck speed is to pretty much put the exclamation point at the end of the sentence of modern-day life.

We can't change this reality but we can learn to adapt. I would argue that adaptation means that we must vigilantly monitor, analyze feedback, and continually adjust.

We can't avoid change or slow down its pace. We can, however, influence it by making continuous adjustments so that as change pushes forward, it gets steered in positive directions.

Right now what is on my mind are the major changes occurring in public and environmental health and the speed with which those changes are taking place. I am more specifically concerned with what is happening (and, in many instances, not happening) to our profession as the outlines of our nation's approach to bioterrorism response planning take shape.

This is the third column I've written on bioterrorism response since September 11. (I wrote several before 9/11 as well.) Each time I comment on current events, more change takes place quickly thereafter. It is hard to keep up with everything, but keep up--and influence it--we must. If we (meaning our profession) don't engage this issue and make the effort to steer events in a way that is consistent with our mission, then we will be guilty of dereliction both of our professional heritage and of our professional credo.

I don't have to tell anyone reading this column that bioterrorism (BT) response is arguably the most significant public-health issue of our lifetime (including even the creation of the U.S. Environmental Protection Agency). As this issue has begun to unfold, it concerns me that local environmental health is too often relegated to a status of being outside looking in. To me, it is utterly inconceivable that any bioterrorism response planning would not include local environmental health. After the anthrax attacks of last year-not to mention the role that many in our profession played in both Washington, D.C., and New York-ask anyone anywhere who works in local environmental health if we are not involved, and involved at the front lines.

Following September 11, Congress acted with dispatch to set up a program to build a bioterrorism response capability in this country Almost a billion dollars were appropriated for this undertaking. The Centers for Disease Control and Prevention (CDC) acted with equally impressive speed to develop considered guidelines for the 50 states to follow in putting such plans into place. And the money quickly flowed.

Many of us in environmental health watched and smiled, for surely this infusion of dollars would mean more funding support for local environmental health. As I wrote several months ago, that initial optimism may have been misplaced. Many local environmental health people with whom I have spoken have shared that they have seen little if any of this money Similarly, many have not been consulted about allocation of the money.

Let me return to the concept of speed and change for a second. So much is happening so fast right now as we, as a nation, mobilize to defend our communities against a potential bioweapons terrorist strike--which, as our AEC keynote speaker in Minneapolis emphasized, is a sure bet. Many good people, with many equally good intentions, are designing systems, making funding decisions, setting priorities, and establishing response protocols. All of this is unarguably good and necessary

Still, as is always the case when things are done so quickly (that speed-of-change thing again), there has to be a monitoring and feedback loop to the system to ensure that the overall objective being pursued gets attained. When things happen so quickly, it is virtually a foregone conclusion that adjustments will have to be made as the final product begins to take shape. …