This was a different note a few weeks ago, before Hurricane Katrina laid waste to the Gulf coast. The human and ecological tragedies that we hear of nearly every day now are difficult to comprehend, but certainly we are learning important lessons about what it means to be prepared … and not.

Since September 11, 2001, the U.S. government has made it a priority for communities to "be prepared" for terrorist attacks or natural emergencies. Four years and at least $3.7 billion later,¹ how are we doing? This is not an easy question to answer … "preparedness" connotes the potential to respond appropriately, in a timely manner, with sufficient scale. How does one know if one is "prepared" without having to actually respond to such an emergency and then looking back on one's performance? Does bioterrorism or public health preparedness mean being able to respond well to a TB outbreak or a shortage (and then glut) of flu vaccines or a chemical attack on a ferry or a nuclear accident? These events are all quite different, and the resources required to respond to them are of very different magnitudes and type.

These are the challenges and questions that public health agencies and officials—and their colleagues in law enforcement, medical care, schools, and transportation—have been grappling with across the Northwest and the country. Katrina made these questions much more than theoretical; the need for answers quite terribly real. This issue of Northwest Public Health takes stock of their efforts, progress, and remaining gaps. You can get an inkling of how complex it is to determine our state of preparedness by looking at our Northwest Region at a Glance page, "Preparedness Scorecard 2004," or reading about Montana's efforts to measure its state of readiness (Kuntz, et al.).

Thompson's Viewpoint deals with one of the more complex relationships that affect preparedness, the connection between a trained workforce and a prepared organization or system. On the other hand, the article on hospital preparedness (Warren, et al.) seeks to break down an otherwise overwhelmingly complex challenge, emergency communication, into a few simple tenets.

What's interesting about many of the other articles in this issue is that public health preparedness is not just a big city issue, but rather requires that we attend to potential large-scale emergencies on interstate highways (Conley and Swearingen), across international borders (Turnberg), in suburbia (Denny, et al.), in rural counties (Wangsmo, et al., p. 16, and Yarrow and Lee), and yes, even on university campuses (Reischl, et al.).

Another interesting observation from this issue is that preparedness is not just about the dramatic and manmade. Jones reminds us that the bugs that can hurt us jump from animal to animal and sometimes to man, a morphing we still don't understand well but that could cause greater morbidity and mortality than most imaginable terrorist events. And Snow's article suggests that we still need to be reminded that the front line of public health preparedness is sometimes the most basic of hygienic practices—wash your hands and don't eat from the table on which sick animals were just examined!

Table of Contents

Aaron Katz, Editor-in-Chief
Director, UW Post-Program Initiatives
Packard-Gates Population Leadership Program

¹ Garfield R, State Preparedness for Bioterrorism and Public Health Emergencies (Issue Brief). The Commonwealth Fund, July 2005.