Why Our Public Health System Isn’t Ready for Another 9/11

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Rescue workers at Ground Zero after 9/11 Credit: Lynn Johnson / National Geographic

As we look back over the decade since 9/11, perhaps the most pressing question is this: are we ready for another one?

When it comes to national security, we’ve certainly spent a lot — by some estimates, more than $1 trillion since Sept. 11, 2001. We’ve added a whole new Cabinet-level office, the Department of Homeland Security. And we can see how much airport security has changed, at least for the time being, each time we take off our shoes before going through the scanner.

But there’s more to preparing for a post-9/11 world than better airport screening, and when it comes to public health, we may actually be worse off than we were a decade ago. That’s the conclusion of Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health. Between persistent budget cuts and the loss of staff, from the federal level on down, we’re not ready to respond to a massive disaster, whether it’s due to terrorism or Mother Nature.

“There have been tremendous cuts in virtually every program that has to do with preparedness,” Redlener told me. “It really undermines our ability to respond and to recover.”

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What’s gone wrong? A new report by the Trust for America’s Health and the Robert Wood Johnson Foundation explains:

  •  Thirty-three states have cut funding for public health, with 18 of those states cutting funding for two years in a row.
  • Local public health departments have cut about 29,000 jobs, representing 19% of the public health workforce.
  • Federal support for public health preparedness has been slashed by 37%.
  • The United States has 50,000 fewer public health workers than it did 20 years ago, and one-third of public health workers may retire within five years.
  • The medical system’s ability to care for a “massive influx of patients remains one of the most serious challenges for emergency preparedness.”

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Redlener, who spends his days thinking about catastrophe, puts it bluntly: “We are less able to respond today than we were 10 years ago. Hospitals have far fewer resources for preparedness, and there are fewer trained public health professionals.”

And this has an impact well beyond the threat of terrorism. Take the response to Hurricane Irene. Many New Yorkers felt the storm was overhyped because it mostly bypassed Manhattan, but it has caused a slow-motion disaster in the towns surrounding the city, which suffered massive floods that cut off whole communities — communities that lack New York City’s resources for disaster response.

But had a full-scale Irene actually hit it, even New York would have been overwhelmed. Redlener points out that in the city’s Zone A — the low-lying areas that were under a mandatory evacuation — large numbers of people stayed put or were unable to leave. In the case of a major storm, with sustained floods and winds, New York City simply wouldn’t have had the resources available to meet everyone’s needs, perhaps for days. In other words, says Redlener, “it would have been hell on Earth.”

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The point here is that we shouldn’t be balancing the budget on the back of public health and disaster response — a lesson for the likes of Eric Cantor, who has suggested that all the money spent on Irene victims needs to be made up with cuts elsewhere in federal spending.

“We need to strengthen our public health infrastructure at the state and local level, even in difficult times,” said Dr. Margaret Hamburg, the head of the U.S. Food and Drug Administration, at a disaster response conference on Sept. 8 sponsored by the Mailman School.

But 10 years after 9/11, every American should realize this as well: ultimately, you are the first responder for your family, and you need to prepare for that responsibility. “There is a huge dependency on the emergency response system, on 911, but that’s a delusion,” says Redlener. “In a large-scale disaster, it would be virtually shut down.”

That means you need to think about how you and your family would survive for several days if a storm, earthquake, terrorist attack or some other incident separated you from help. Just before Hurricane Irene hit, I wrote about some straightforward steps you could take to prepare; you can skip the stuff about falling trees and flying garbage bags, but focus on the advice to put together go bags of essentials for every member of your family and to ensure that you keep a supply of prescription drugs on hand if you need them.

New Yorkers who are angry that all their emergency preparations before Irene were unnecessary, take note: you can hold onto the extra bottles of water and canned food for next time, and keep those go bags on hand. The nation needs to be prepared for the next 9/11 — but so do you.

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Bryan Walsh is a senior writer at TIME. Find him on Twitter at @bryanrwalsh. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME