Overview

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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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)

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