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Abstract
Dr Laura Kahn has produced a useful book that provides a brief historical background
on public health and terrorism, followed by interesting examples of leadership during
outbreaks and events that escalated to public health crises. The roles of astute clinicians,
public health professionals, appointed public health leaders, and elected officials
are described by the players themselves. These insights provide important perspectives
and are fascinating reading, but each event includes the voices of only a few of many
participants. This omission may leave the reader hungry for a wider variety of viewpoints.
Kahn takes the reader through a thought-provoking overview of the complexity of leadership
and some early milestones in public health. Kahn makes it clear that politics, economics,
communications, and interpersonal relations are as central to today’s public health
crises as they were in the past.
Persuasive examples support Kahn’s main thesis that political leadership is critical
during a public health crisis, whether the crisis results from natural causes or from
bioterrorism. Kahn says, “Questions about leaders and leadership have intrigued scholars
in both Western and Eastern civilizations for centuries. Plato, Confucius, and Machiavelli
all speculated about leaders… and the qualities of leadership.” Kahn concludes that
1) informed, engaged, and prepared elected officials are essential to effective response;
2) because crisis response decisions inevitably will be made in the absence of perfect
information, leaders require judgment and common sense; 3) elected and appointed leaders
must be effective; and 4) dual leadership during a crisis can cause confusion.
The author provides a convincing case for her conclusions with lively examples and
first-hand accounts and offers several concrete suggestions to prepare elected officials
for leadership roles. The same compelling case is not made for Kahn’s assertion of
a “legal conundrum when dealing with the bioterrorism attack.” She suggests that the
Centers for Disease Control and Prevention (CDC) should lead the public health response
to such episodes but alleges that legal and organizational impediments hinder CDC
from fulfilling that lead role.
Unquestionably, CDC must and does play a lead role during large-scale, multistate
public health events. The legal and organizational impediments to fulfilling that
role are not obvious to this reviewer, especially given CDC’s success in addressing
many such crises. Kahn may be referring to impediments within the federal structure
and chain of command. However, current law specifies the roles of CDC and the departments
of Health and Human Services, and Homeland Security. CDC has ample legal authority
to supplement its technical and scientific leadership during an emergency, especially
when state and local capacities are outstripped.
Kahn suggests federalizing and centralizing the national response system through changes
in the legal framework and organizational structures of the public health system,
arguing that if CDC were organized for response as the Environmental Protection Agency
or the Federal Bureau of Investigation is, delays, leadership confusion, and communication
issues would be resolved. She identifies some leadership problems but fails to acknowledge
the strong collegial relationship between state public health authorities and CDC
that has produced innumerable successful responses to crises. Restructuring the traditional
relationship between states and the federal government seems unnecessary.
This problem does not overshadow an otherwise informative and engrossing book. In
an era of emerging infectious diseases, bioterrorism, and large-scale natural disasters,
we will continue to have to address the types of events Dr. Kahn describes. Those
involved in responding to such events would benefit from studying the lessons of the
past to better manage future emergencies.
Publisher:
Centers for Disease Control and Prevention
ISSN
(Print):
1080-6040
ISSN
(Electronic):
1080-6059
Publication date
(Print):
June
2010
Volume: 16
Issue: 6
Pages: 1050-1051
Affiliations
[1]Council of State and Territorial Epidemiologists, Atlanta, Georgia, USA
Author notes
Address for correspondence: Patrick J. McConnon, Council of State and Territorial
Epidemiologists, 2872 Woodcock Blvd, Suite 303, Atlanta, GA 30341, USA; email:
pmcconnon@
123456cste.org
Article
Publisher ID:
10-0345
DOI: 10.3201/eid1606.100345
PMC ID: 3086244
SO-VID: 677ee2ff-fc55-489d-a7ba-e777dbd0e80e
History
Product
Laura H. Kahn Praeger Security International, Santa Barbara, CA, USA, 2009 ISBN 978-0275994853 Pages: 236; Price:
US $49.95