A thoughtful, well-researched treatise on the response of the
public-health services to the AIDS crisis. Panem has not set out to
write the definitive history of the AIDS epidemic (for that see
Randy Shilts' And The Band Played On, 1987), but instead focuses
more intently on the role played by the public-health bureaucracy
once the disease was recognized - especially the Public Health
Service as represented by The National Institutes of Health and the
Centers for Disease Control. She points out that both were hampered
by an initial government tack of awareness of the disease, and the
perception that it was "only" a disease found in gay men. By the
time the people in the bureaucracy began working together, swiftly
and smoothly, valuable time had been lost. Panem talks of problems
of coordination and funding, and of communication within the Public
Health Service. The thrust of her book is toward the future, toward
any new, unknown epidemic that might arise: "The next time the
health establishment faces a new disease of unknown cause,
treatment and cure, the search for answers. . .will again be as
agonizing as the disease itself." Among her recommendations:
leadership in a national health emergency should be placed under
one federal official; public health education should begin early in
the crisis; and there should be a good deal of money available,
immediately. Panem covers much of the same ground as Shilts (who is
more interesting and readable when it comes to the gay community's
response to AIDS, for instance, or the media's slowness in taking
up the story). But, although academic, this is a valuable addition
to the AIDS literature, and a thought-provoking proposal for the
future. (Kirkus Reviews)
AIDS is unquestionably the most serious threat to public health in
this century--yet how effective has the United States been in
coping with this deadly disease? This sobering analysis of the
first five years of the AIDS epidemic reveals the failure of
traditional approaches in recognizing and managing this health
emergency; it is an extremely unsettling probe into what makes the
nation ill equipped to handle a crisis of the magnitude of the one
that now confronts us.
Sandra Panem pays particular attention to the Public Health
Service, within which the vast majority of biomedical research and
public health services are organized, including the Centers for
Disease Control and the National Institutes of Health. We learn in
dismaying detail how shortcomings in communication within and among
the many layers of the health establishment delayed management of
the crisis.
She also investigates other problems that surface during a
health emergency, involving issues such as federal budgeting,
partisan politics, bureaucratic bungles, educating the public, the
complications of policymaking, and the vexing role of the press.
Panem makes specific recommendations for a centrally coordinated
federal response to health emergencies, including the creation of a
national health emergency plan.
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