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Terrorism and public health: a balanced approach to strengthening systems and protecting the public
  1. G Trotter

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    Barry S Levy, Victor W Sidel, editors. (Pp 377; £35.00). Oxford University Press, New York, 2003. ISBN 0-19-515834-2

    The preface states: “we believe this is the first book that addresses terrorism from a public health perspective that is both comprehensive and balanced” (page xi). To a large extent, the book fulfils this promise, offering an informative, up to date, and highly readable summary of a broad range of public health issues that interface with the problem of international terrorism.

    Part I has an introductory chapter followed by seven chapters examining public health challenges emerging after the September 11th attacks. Four of these chapters summarise events in New York City, one covers the anthrax epidemic, one covers public health problems in war strapped Afghanistan, and one chapter offers an erudite and much needed account of the prospects for educating, informing, and mobilising the public. Much of the material in part I is based on firsthand experience, and it is packed with information and insights that are unlikely to be found elsewhere. Part II covers conventional, biological, chemical, nuclear, and radiological terrorist weapons. Attention often focuses on arms control and its political underpinnings, but clinical aspects are also covered (though in too little detail to provide an important reference for clinicians). Part III addresses terrorism related “challenges and opportunities,” with chapters aimed at public health systems, epidemiology, therapeutic interventions, research, environmental protection, civil liberties, roots of terrorism, and the promotion of international law. The comprehensiveness of the text suffers slightly from the lack of attention to methods of decontamination, structure and function of Incident Command Systems, and the coordination of disaster services under the Federal Emergency Management Agency.

    The text is well “balanced” in the manner intended by the authors in so far as it nicely situates the need for terrorism prevention and response capabilities within the context of other, potentially competing public health needs, and it balances these needs against the imperative to avoid “inappropriate or hazardous responses to threats of future terrorism.” On the other hand, there is little balance between competing viewpoints on ethical or policy issues. The book is structured by liberal cosmopolitan ideology—including numerous attacks on the Bush administration—with no attempt to fairly represent the range of credible, diverging opinions about the nature of justice or the intricacies of international collaboration and arms control.