Forward

This report is the second of three by Gerald Markowitz and David Rosner on how the terrible events of September 11, 2001, and the subsequent cases of anthrax, SARS, and monkeypox are affecting policy for the health of populations in the United States. The first report in this series was titled September 11 and the Shifting Priorities of Public and Population Health in New York. In this report Markowitz and Rosner examine the experience of officials of the legislative and executive branches of state government who are making and implementing policy to respond to health emergencies. Their final report will examine the response of the federal government to recent health emergencies.

This series of reports is contemporary history, which the authors describe as the “first attempt to place the story that people experienced in a longer and broader historical context.” Markowitz and Rosner are distinguished historians who have written extensively about recent events. They base their history on interviews, accounts by journalists, and available public documents. As professional historians they avoid evaluating what state officials have done or recommending what they should do.

Markowitz and Rosner introduce the major themes and findings of this report in an executive summary and elaborate them in the body of the report. Their most important finding is that Americans have reason to worry about the adequacy of our public health infrastructure despite recent attention to its shortcomings. They conclude, “The financial crises of the various states, combined with the shifting focus of the federal government from bioterrorism and terrorism in general to smallpox and the war in Iraq . . . lessened the early potential to enhance the system of services that are essential for the improvement of the nation’s efforts to address [both] bioterrorism preparedness and the overall health needs of the American people.”

The Milbank Memorial Fund is an endowed operating foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. Since 1905 the Fund has worked to improve and maintain health by encouraging and assisting persons who make and implement health policy to use the best available evidence. The Fund convenes meetings of leaders in the public and private sectors and publishes reports, articles, and books.

Each of the persons interviewed for this report reviewed it in draft. Other reviewers made many helpful comments. These generous individuals are listed in the Acknowledgments.

Daniel M. Fox
President

Samuel L. Milbank
Chairman