Reviews Personal views

Between Chicken Little and the four horsemen of the apocalypse

BMJ 2006; 333 doi: (Published 24 August 2006) Cite this as: BMJ 2006;333:453
  1. Joshua Lipsman (
  1. Westchester County (New York) commissioner of health, USA

    At a medical meeting in the United States this year, a presentation on avian influenza started with two slides of cartoon drawings, the first, of the feckless Chicken Little of “the sky is falling” fame, and the second, of the four horsemen of the apocalypse. As a local health officer, I feel as if these two images represent the poles of my despair over public health emergency planning.

    Tension exists in public health between the rise of public health emergency planning, and our irresistible draw to focus on the real public health problems we face every day. With resources always limited, how do we balance disaster planning with necessary attention to ongoing problems of tobacco, obesity, HIV, maternal/child health, environmental health, and the like? Particularly given the US smallpox vaccination debacle of 2002, we must proceed carefully if we are to sustain our reputation for integrity. I do not wish to be …

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