Irwin Redlener was named in May to the new position of associate dean for public health advocacy and disaster preparedness at the Mailman School of Public Health. Dr. Redlener will also direct Mailman’s new National Center for Disaster Preparedness. Dr. Redlener, president and co-founder of the Children’s Health Fund, joined Columbia after serving as president of the Children’s Hospital and director of community pediatrics at Montefiore Medical Center in the Bronx. In Vivo’s Susan Conova discussed with him his hopes for the new position.

Why did you take on the challege of the new National Center for Disaster Preparedness?
The opportunity here at the Mailman School of Public Health came at the right time. I have been a friend and great admirer of the dean, Allan Rosenfield, for many years. We’ve often talked about the possibility of working together ‘some day.’ So, when the offer on the table turned out to be the creation of an entirely new advocacy platform and the development of innovative solutions to large scale challenges, such as terrorism and disaster preparedness, I couldn’t resist.

What’s the country’s current preparedness level for terrorism-related disasters?
We’re in a dangerous situation now – and we should be more prepared than we are. We are just beginning to allocate necessary resources. The agenda for preparedness is still disorganized and we haven’t even defined appropriate benchmarks for what we mean by “preparedness” as a health systems or public health concept. There are major urgent challenges that demand our immediate attention. Clearly, there’s been a great rush to meet these challenges and I understand why, but there needs to be more prospective analysis about how we’re spending the money, what are the priorities and relevant goals for these efforts.

Funds are coming but they’re very slow and there are layers of bureaucracy. The first money for hospital preparedness was released about eight months ago. In New York state it amounted to $40,000 per hospital, which was an extraordinarily inadequate amount to do any substantive preparedness. We don’t know yet what’s going to happen with the second round of funding.

The first thing that has to happen is there must be an in-depth analysis of the critical issues in disaster preparedness. How do we make the most effective use of our resources? We’re looking to create the infrastructure to conduct some of this analysis in the new National Center for Disaster Preparedness. However, because these are enormous tasks, we will need to build collaborations with other public health schools and institutions, public and private.

Are preparedness programs diverting attention from other public health issues?
There’s already evidence that some aspects of the traditional public health agenda are being affected by resource diversion. Local health departments across the country are being told to devote resources to evacuation or quarantine plans and smallpox contingencies. If there’s no additional money or personnel, then people are reassigned to carry out tasks like these.

Preparedness programs must not undermine the focus on the traditional public health agenda, like expanding childhood vaccination programs, HIV/AIDS prevention and the like. I strongly believe that the schools of public health have an invaluable role to play as watchdogs – ensuring an appropriate balance between preparedness and traditional agenda.

How will the new center contribute to preparedness?
The center has several divisions. The Center for Public Health Preparedness, directed by Dr. Steve Morse, is a CDC-funded program that’s been here for two years. It has programs to train public health workers and first responders in response to terrorism and major disasters. This program will be expanded significantly to work with hospitals and health systems.

A second division will focus on preparedness needs of special populations and communities. Our program on pediatric preparedness held a conference in February in Washington that brought 65 experts together and issued a report that details how children respond differently to terrorist weapons than adults. The document is useful for public policy and for people working in hospitals. For example, it gives child-specific dosages for specific agents. But there’s little literature or definitive research on treating children exposed to many of the possible weapons of mass destruction. Antibiotics, for instance, that might be used to treat adults for exposure to certain biological agents may not be formally approved for kids. The report we produced is a consensus of what experts think are the best approaches, given the current state of knowledge. I fully expect that it will be modified as we move forward with more research.

Similar studies and analysis need to happen for other special populations, including the elderly, people with disabilities and others. This will be an important agenda for the new center.

We will also focus on needs of communities. Preparedness information and resources cannot only be directed to health departments and hospitals. We need to involve neighborhood organizations, community-based providers and families. Families want to know what they must do to be prepared for disasters. They want information about smallpox and other possible scenarios. We believe that you can develop a commitment to preparedness that is reasonable and without panic or fundamental change in our way of life.

All this talk about the lack of preparedness is unnerving, yet somehow I haven’t done much to prepare myself. How are other people reacting?
It’s hard to find the right balance between complacency and paranoia. Individuals vary in their comfort level. Many people are unfazed by the threat of bioterrorism, feeling that now we’re experiencing what the rest of the world is already familiar with. Those inclined to think this way, understand that there may well be more acts of terrorism in the United States but we’ll just deal with it when it comes. Others go much further in their quest for personal security and, for instance, may actually move out of the city. For such people, there is a danger of becoming consumed with anxiety and stress.

This range of individual reactions mirrors the challenge we face as a society. We have to decide how much of our resources we're going to put into preparedness – and at what costs to other social programs or balancing the budget. How much do we want to tolerate infringement in personal liberty to get higher levels of security or readiness?

It’s difficult to judge others’ perspectives – with a couple of caveats. First, we must have some level of increased security and preparedness. I don’t want someone who’s complacent about potential terrorism making decisions about preparedness resources. On the other hand, we don’t want paranoid zealots in charge either who will spend or do anything to create a locked-down state of siege in America. Most of us would not pay that price or tolerate significant infringement on the civil rights that are so much part of our national societal contract. We’re truly struggling to find a balance.

What are your goals as associate dean for public health advocacy?
Public health advocacy is an important part of my responsibilities. I have long been concerned about how public health research impacts public policy and opinion. The Mailman School produces an enormous amount of critically important data, analysis and model programs in many areas important to the health and well-being of people in the United States and around the world. For example, we’ve developed education strategies that can reduce HIV transmission. We know a lot about what works, yet we’re all frustrated by the fact that it’s so difficult to turn these strategies into public policy.

I’m interested in developing programs to help researchers influence policy-makers, elected officials, the media, and the public. This may require getting comfortable with settings and strategies that might not be so familiar or comfortable for many academics – like social marketing, working with legislators or dealing with the press. I am pretty certain that we’ll make some progress in all of this, at least enough so some of my colleagues will get turned on by seeing more impact than they might have thought possible from the great work they’re doing. That’s my hope.