Nothing else worked that day. The President was flying haplessly around the country looking distinctly unpresidential; the Vice President was in a bunkered panic. The military couldn't scramble armed jets and anything else that could go wrong did. But one thing worked, and it worked splendidly -- the New York City, as well as federal, public-health system.
While the World Trade Center was burning fiercely and about to become a vast cloud of toxic smoke and ash, public health officials were already mobilizing. Within hours, hospitals had readied themselves to receive the injured; hundreds of ambulances were lined up along the West Side Highway awaiting word to race to the scene; the city's public health department had opened its headquarters to receive hundreds of people stricken by smoke inhalation, heart attacks, or just pure terror; the Department of Health had already begun providing gas masks and other protective equipment to doctors, evacuation personnel, and first responders of all sorts. From bandages and surgical tools to antibiotics and radiation-detection equipment, the federal Centers for Disease Control readied immense plane-loads of emergency supplies, ferrying them up to New York's LaGuardia Airport aboard some of the few planes allowed to fly in the days after September 11th.
Despite the general panic and the staggering levels of destruction, even seemingly inconsequential or long-range potential health problems were attended to: Restaurants were broken into to empty thousands of pounds of rotting food from electricity-less refrigerators, counters tops, and refrigeration rooms; vermin infestations were averted; puddles were treated to stop mosquitoes from breeding so that West Nile virus would not affect the thousands of police, fire, and other search-and-rescue personnel working at Ground Zero.
In the face of a great and unexpected catastrophe, this is the way it was supposed to be -- and (for those who care to be nostalgic) after 5 years of the Bush administration's Global War on Terror, not the way it's ever likely to be again. One of the great ironies of 9/11 will pass unnoticed in the various memorials and remembrances now descending upon us: In the wake of the attacks, as the Bush administration claimed it was gearing up to protect us against any further such moments by pouring money into the Pentagon and the new Department of Homeland Security, its officials were also reorienting, privatizing, militarizing, and beginning to functionally dismantle the very public health system that made the catastrophe of 9/11 so much less disastrous than it might have been.
It took no time at all for the administration to start systematically undercutting the efforts of experienced health administrators in New York and at the national Centers for Disease Control. By pressing them to return the city to "normal" and feeding them doctored information about dust levels -- ignoring scientific uncertainties about the dangers that lingered in the air -- the administration lied to support a national policy of denial.
Putting in place a dysfunctional bureaucracy would soon undermine the public's trust in the whole health system in downtown Manhattan. In the process, it also effectively crippled systems already in existence to protect workers, local residents, and children attending school in the area. As a result, what promised to be an extraordinary example of a government bureaucracy actually working turned into a disaster and later became the de facto model for the Federal response to Hurricane Katrina.
Here's how it worked: First, Karl Rove and George Bush saw an opportunity -- mounting the pile of World Trade Center rubble -- for a public-relations coup in devastated Manhattan that could instantly reverse the President's distinctly unpresidential day on 9/11 and his administration's previously weak polling numbers. Second, Washington pushed New York Mayor Rudolf Giuliani and local officials to get with the program and re-open Wall Street (which the 9/11 attacks had shut down) faster than was advisable. Third, city officials were told by administration emissaries that, despite the pall hanging over Ground Zero, all was well with the air and water in lower Manhattan and normal life should resume.
Finally, although nearly the entire city could, for months to come, smell the rancid co-mingling of burning plastics, asbestos, lead, chromium, mercury, vinyl chloride, benzene, and scores of other toxic materials as well as decaying human flesh, Bush's appointees in the Environmental Protection Agency (EPA) continually bombarded city officials with reports claiming that the air was certifiably "safe" to breathe. As EPA Administrator Christy Whitman put it, "There's no need for the general public to be concerned." To this day we do not know the extent of contamination or level of exposure to which residents, workers, and students in the area were (and are still being) subjected.
Everyone got on the band wagon: the President mounted the pile of rubble without respiratory protection, signaling to firemen, policemen, and volunteers that he-men shouldn't worry about the towers having become a toxic waste-pile the likes of which the developed world hadn't seen since Chernobyl. Under the goading of EPA officials, even the venerable New York City Department of Health (despite internal dissention) began proclaiming lower Manhattan safe for the return of residents. (At that time, Lower Manhattan's congressional representative Jerrold Nadler was arguing that it was still dangerously toxic.) The Board of Education, feeling the heat from the Giuliani administration -- in turn, reacting to pressure from Washington -- ordered schools just a few blocks from Ground Zero reopened and thousands of students were sent back to the neighborhood.
New Yorkers, complaining of stinging and watery eyes, knew this was not, in any conventional sense, a "safe" area. Karl Rove and the President, however, were focused on solidifying the Republican Party's hold on the nation. In that context, the possible effects on the lives and lungs of a few hundred thousand New Yorkers was a minor matter.
The policy worked like a charm -- at least initially. The clearing of the pile was accomplished with miraculous speed. City authorities had estimated it would take two to three years, but thousands of city employees, undocumented workers, and volunteers labored feverishly and often without protection, in part inspired by the patriotic fervor that gripped Americans. The 1.8 million tons of debris was gone in a mere eight and a half months. And, miraculously, the President's poll numbers, down in the toxic dumps just weeks before the 9/11 attacks, rose dramatically.
Residents of the area, at first wary that their apartments had been polluted, began to accept official reassurances and soon streamed back to the co-ops of Battery Park City and the lofts north and south of the Trade Center site. Despite their fears, parents, clinging to the consoling pronouncements that poured from the EPA, the city administration, and even the Department of Health, sent their children back into what some were calling a "war-zone."
The Bush administration's triumph in bringing "normalcy" back to the area around Ground Zero would, however, turn out to be a victory of style over substance -- of a sort that would become far more familiar to Americans in the years ahead. Just as the challenging questions and assessments of intelligence analysts and State Department experts would be ignored or drowned out by administration pronouncements on supposed Iraqi weapons of mass destruction as well as Saddam Hussein's alleged links to al-Qaeda, so, in those first weeks, the EPA's official pronouncements of safety trumped the skepticism of scientists at Mt. Sinai and other area medical schools, reporters like Juan Gonzalez of the Daily News and even local residents and politicians all of whom knew something was wrong. "The mayor's office is under pressure" to reopen lower Manhattan, reported one official who worried that the city's own Department of Environmental Protection felt the air was not suitable to breathe.
Before long, parents of children in the neighborhood were engaged in screaming matches with local officials who had the hapless task of carrying out policies they didn't necessarily support. As it happened, they were all correct in their fears. Class action lawsuits from over 7,000 residents and workers subsequently led to the discovery of documents showing how intense pressure from Mayor Giuliani had indeed led the Department of Health to certify areas in lower Manhattan safe so that they could be reopened for residents and businesses.
Style over Substance
What began with the dismantling of an effective public-health response at Ground Zero later spread to the entire national and local public-health systems. From September 12th, 2001 on, public-health professionals called ever more vigorously for resources to revamp a sagging health infrastructure of hospitals, emergency services, disease-reporting systems, and preventive health care -- in essence, the country's first line of defense against all sorts of health catastrophes, whether caused by terrorism or not.
As state after state faced fiscal crises, what public health departments got was "yo-yo funding," up one year, down the next. What they did not get from the Bush administration were adequate resources to face a more dangerous world -- to make sure we knew when a strange disease pattern was emerging or where increased reports of peculiar symptoms might indicate a terrorist plot. The public-health community never got sufficient equipment to detect higher than expected levels of radiation emanating from a container at some port, nor sufficient lab facilities and trained epidemiologists to track local outbreaks of disease. Instead, it got funding for a high-profile, showcase, mass smallpox-inoculation campaign for a disease that may not even exist on the planet, and ineffective, color-coded public-warning systems that made everyone cynical about any alert that might come from public officials.
In general, administration officials worked doggedly in the public health arena to create great media images that drew attention away from real, if sometimes humdrum, reforms that might have cost money. In the meantime, such public-health basics as laboratories, well-baby clinic care, and inoculation campaigns were quietly drained of money badly needed for a war-gone-wrong in Iraq. Administration cronies with no particular skills or experience in emergency management were put in charge of FEMA and on scientific panels at the Centers for Disease Control. As in other areas, administration officials evidently hoped that nothing revealing would happen on their watch and that they could slide away into history before anyone realized the public's health was in danger.
Then Hurricane Katrina blew into town, allowing the world to see just how unprepared they were. From a public health point of view, Katrina was the dark underside of the 9/11 experience. From lack of emergency-power supplies for hospitals to an inability to collect dead bodies (in some cases for months), administration-managed public health services proved hopeless and helpless in New Orleans -- which increasingly meant anywhere in the U.S. If that was what Katrina could do, what would happen if terrorists actually released a dirty bomb in the middle of Atlanta, Los Angeles, or Houston? Would the public-health community even have the crucial equipment available to detect the nature of such an attack, much less respond quickly? Would anyone be lining up the ambulances, passing out the medications, checking those restaurants and puddles this time around, no less organizing an orderly evacuation of residents?
In the wake of September 11th, the public health community saw its sanest initiatives stifled and its priorities distorted. While money is now less available for the inoculation of babies from the real threats of rubella, mumps, and measles, as hoped-for funds to prevent as many as 350,000 children from getting lead poisoning are no longer on anyone's agenda, as federal funds to support health education have been rescinded, and as (unbelievably enough) money needed to protect U.S. ports from dirty bombs or bioterrorism have all-but-vanished, Katrina victims still wander the nation wondering whether they will be able to see a physician.
For the next 9/11, when it comes to public health, don't think New York, Ground Zero, 2001; think New Orleans, August 29, 2005. Think: "Brownie, you're doing a heck of a job..." Then sit back amid the disaster and wait for the private charities to appear, wait for FEMA to send in the mobile homes.
David Rosner and Gerald Markowitz are the authors of the just published Are We Ready? Public Health Since 9/11, (University of California Press/Milbank Fund). Rosner is Professor of History and Public Health at Columbia University's Mailman School of Public Health. Markowitz is Distinguished Professor of History at John Jay College and CUNY Graduate Center. On September 11th, Markowitz anxiously awaited word from his wife, who worked only a few blocks from the World Trade Center, while Rosner frantically biked toward the collapsing buildings, looking for his daughter whose school was only blocks away.
© Copyright 2006 David Rosner and Gerald Markowitz