As recent events have indicated, the U.S. public health system was not prepared to address a national crisis -- and still isn't, says a Tufts expert.

Boston [11.20.01] -- Before September, the biggest concerns most people had about the national public health system centered around health insurance and Medicare benefits. And few realized that long-term problems receiving little attention have left the U.S. vulnerable to a national crisis. But a Tufts expert says the anthrax scare changed that, exposing serious flaws in the U.S. public health system that must be fixed.

   "Certainly, our clumsy performance in response to anthrax can be blamed in part on many years of national neglect of public health capacity -- inadequate budgets and poor preparation for real threats," Tufts' Anthony Robbins -- a public health expert and chairman of the Department of Family Medicine and Community Health at Tufts' Medical School -- wrote in a Boston Globe op-ed.

   As a result, officials from government and public health organizations responded poorly to the recent anthrax scares.

   "We have seen some public health officials, seemingly worried about panicked populations and mass hysteria, try in the first instance to reassure," Robbins wrote in the Globe. "Others have seemed uncertain about what to tell the public."

   While reassurance works in clinical medicine -- when it's part of a discussion between a doctor and patient -- the approach is problematic during a crisis, he wrote.

   And it can be counterproductive over the long term.

   "Public health officials will never be trusted if they are perceived as offering reassurance rather than vigilance," the Tufts expert wrote. "Surely the postal workers understand this lesson."

   According to Robbins, Americans have been led to believe that the biggest threats to their health are their own habits.

   "Opponents of government regulation of hazards -- tobacco, tires, food, workplaces, toxic chemicals, etc. -- have spread the message that it is most frequently Americans who harm their own health by the lifestyles they choose," he wrote.

   As a result, there has been little pressure on the government to strengthen the protections against potential health threats.

   "No wonder Americans no longer appreciate that the government public health programs that assure safe food, water, housing, highways, drugs, vaccines and workplaces are essential in order to protect the health of our population in the face of both ordinary daily threats and the extraordinary threats of terrorism," Robbins wrote in the Globe.

   The flaws must be fixed, especially in light of recent events.

   "There is no doubt that America must rebuild its damaged public health infrastructure," the Tufts expert wrote. "But we must also rebuild a credible public health culture -- distinct from the medical culture of reassurance and treatment -- dedicated to vigilance and protection."