Strengthening the Fiscal Viability and Independence of Public Health While Responding to Terrorism

  • Date: Nov 18 2003
  • Policy Number: 200323

Key Words: Budget, Community Health Programs, Disasters, Environment, Hospitals, Insurance, Prevention, Security, State Health Services, White House, Federal Health Services, Local Health Services, Sanitation

Observing that in times of national crisis public health programs have suffered as government funds are diverted to national defense and fighting terrorism,1,2 and away from solving existing problems, such as contaminated food and water3 and breakdown in immunization rates4; and

While acknowledging that the American Public Health Association has long supported improved communication between those agencies of government charged with responding to emergencies5,6 we nevertheless recognize that some current proposals advocate such extensive integration between public health departments and police, security agencies and the military,7 that public health infrastructure and personnel could be diverted primarily to providing defense against terrorist attacks8; and

Noting that public health and security entities have different mandates, methodologies and philosophical foundations; and

Noting the limited effectiveness of secondary and tertiary prevention strategies for defending against terrorist attacks,3 especially when compared to the primary prevention strategies advocated in earlier APHA policy opposing war, in particular wars over natural resources9,10; and

Noting that the argument for the shift of domestic funding priorities is predicated on the inevitability of terrorist attacks on the United States, when in fact further attacks are most likely if the United States pursues a policy of pre-emptive war, and might be averted by alternative approaches to international policy;8,10 and

Asserting that all efforts to improve U.S. homeland defenses must protect the civil liberties and human rights of every person in the United States, in particular public employees.

Therefore, APHA

  1. Calls on Congress and the President to abandon any plans to integrate administrations of public health entities with police, intelligence or security agencies.
  2. Calls on Congress and the President to substantially increase core funding for public health infrastructure and personnel to strengthen the capacity of primary public health services as well as balance and strengthen the capacity to react swiftly to any sudden emergency, natural or manmade.
  3. Calls for the passage of legislation at the federal and state levels to protect public health workers from recriminations for refusal to carry out military, police or intelligence tasks which are not properly part of the practice of public health.


  1. Weiss R, Nakashima E. Restoration of broken public health system is best preparation, experts say. Washington Post, September 22, 2001.
  2. APHA Policy Number: LB02-4. Protecting Essential Public Health Functions Amidst State Economic Downturns.
  3. Sidel VW, Cohen HW, Gould RM. Good intentions and the road to bioterrorism preparedness. Am J Public Health 2001;91:716-8.
  4. Brown D. Severe vaccine shortages termed ‘unprecedented;’ Kids’ defenses affected. Washington Post, April 20, 2002, p A01.
  5. APHA Policy Number 9116: Health Professionals and Disaster Preparedness
  6. APHA Policy Number 200016: Prevention, Response, and Training for Emerging and Re-emerging Infectious Diseases, including Bioterrorism.
  7. Hart G, Rudman W, eds. Road Map for National Security: Imperative for Change. The Phase III Report of the U.S. Commission on National Security/21st Century. The United States Commission on National Security/21st Century, February 15, 2001,, accessed Oct. 3, 2001.
  8. Young J. Bioterrorism Readiness More Urgent Than Addressing Uninsured. F-D-C Reports, Vol. 14, No. 207, October 25, 2002. “Bioterrorism preparedness and public health infrastructure strengthening have overtaken the uninsured as America’s top health care priority, former Vice President Al Gore said in remarks at the George Washington University School of Public Health & Health Services Oct. 24. … Gore underscored the threat of bioterrorist attack, which he suggested would increase with an invasion of Iraq, and described the public health system as flawed.”
  9. Policy Number: 9923 WARFARE Opposing War in the Middle East.
  10. Policy Number: 2002-11 Opposing War in Central Asia and the Persian Gulf.

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