Is public health a homeland security issue?

This was one of the first discussion points as part of my ELP course, and creates what I hope will be a good starting point for dialogue on this site.

When asked “what is homeland security” in a post-9/11 world, a lot of different things may come to mind. Terrorism. Border control. Cyber security. Islamic extremism. Trans-national criminal organizations. Immigration. Even Russian meddling in elections.

But do you think “public health”? Maybe bio-terrorism, perhaps. But REAL public health. Immunizations. Outbreaks. Prevention. Disease control. Family planning. Chronic health issues. Do these words evoke the same concerns, the same thoughts, the same drive, that “homeland security” does? Should they?

Lets take a look at some past events and some current events and see if they can help set the stage for determining if public health is a homeland security issue. Start with the past – 100 years ago to be exact. The fall of 1918 saw the first cases of the Spanish Flu in America. The 1918 influenza season started at the high of the First World War, and quickly spread around the world. Considered to be the largest pandemic (in terms of numbers), the global impacts were enormous – Nearly 1 out of every 3 people were affected globally, and estimates are that 10%-20% of people who were sickened died. The global stretch of the impacts of the war only exacerbated the situation. Over 500,000 people in the US died – that’s equivalent to 167+ September 11th attacks…or roughly one every 2 days for the year long flu season.

A more recent event was the Ebola “crisis” of 2014-2016. Ebola has long been known on the African continent; occasional outbreaks would flare up, sicken and kill a few people, and die out just as fast as it appeared. But as global interconnectedness increases, so does the risk of a disease breaking past its traditional boarders. This was the case with the outbreak in Liberia, Guiana, and Sierra Leone. Never before had Ebola cases been seen in the European continent, or anywhere in the Western Hemisphere. The idea that cases could cross the massive distances led to enhanced screening during international travel, monitoring of patients – but not before travelers (and the healthcare workers who cared for them) were stricken in multiple European counties and the United States.

The sad part is, Ebola is not the worst case scenario. While “scary” in nature (I would argue more due to the fact that the disease isn’t well known by the general public) it isn’t nearly as transmissible as other diseases, like another influenza pandemic, or even a novel coronavirus (SARS, MERS). Think about the movie Contagion. While a work of fiction, I think it fairly realistically portrays the threat of a novel virus and the likely response (including the global impacts to life, economy, and social order). Diseases are traveling faster, and mutating faster, than our ability to track and monitor them. And doesn’t that sound like the same problem the military had with combating Al Queda after 9/11, or ISIS more recently? So I ask again – is public health a component of homeland security.

The overarching mission of the US Department of Homeland Security on their website reads: “With honor and integrity, we will safeguard the American people, our homeland, and our values.” Now in my (sometimes simplistic) mind, this presents a clear case for public health needing to be a part of the homeland security spectrum: safeguarding the American people from threats. And yet…is it?

Without delving too much into politics, I want to make an interesting point. The current administration keeps looking to secure funding in the neighborhood of $25 Billion for a US/Mexico border wall to protect the homeland. Yet at the same time, the same administration has put forth cuts to the CDC that would likely require the agency to scale back overseas efforts to detect and stop an outbreak. Are these cuts not antithetical to the overall mission of “homeland security” to protect us, the American populace, here in our homeland?

So again, I ask: is public health a homeland security issue? I would argue that yes, most certainly it is. Emerging infectious diseases are a significant threat to America and our population. So my second question is: why do we look at public health and homeland security through different lenses? This is a question I have a harder time with; theories ranging from “public health isn’t sexy like ‘homeland security’ is,” to the fact that few emergency management and homeland security personnel truly understand the public health world (and few public health professionals truly understand emergency management or homeland security). Even the adoption of the National Health Security Strategy has done little to bridge the gap between these two worlds.

So I would open up the following questions in order to create some discussion in the community:

• Is public health a homeland security issue? Why or why not?
• Why do we look at public health and homeland security differently?
• What can we do (on either a macro/policy or micro/tactical level) to better create integration between these two worlds?

Any conversation below would be well appreciated. I would also welcome suggestions for additional topics!