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This chapter presents a brief, four-step strategy for practicing duties to help stop harm to life and to human rights. These four steps are: getting information about public-health threats, cooperating with others, evaluating health threats and alternative solutions to them, and engaging in organized action. It is argued that these four steps are best accomplished through piecemeal reform rather than revolution. A number of specific reforms are suggested for which citizens might work to reduce harms to life and to rights to know and to consent.

This chapter examines whether the US is prepared to effectively respond to terrorism and other public health threats. The chapter is organized as follows. Section 11.1 reviews federal efforts to define WMD threats and priorities. Section 11.2 looks at the current national response framework for a coordinated response in four functional areas. Section 11.3 considers the issues in implementing this framework at the state and local levels, with a focus on coordination issues. Section 11.4 assesses the current state of public health preparedness. Federal investments since September 11 have increased the country’s ability to respond to public health emergencies. For example, the influx of bioterrorism funding for expanded laboratory, surveillance, planning, and communication capabilities has served to improve public health preparedness generally. However, the absence of standardized metrics makes it hard to know the current state of preparedness and what remains to be done.

This chapter looks ahead to some of the key threats to the health of the public and the challenges facing a public health system in future. These include climate change and environmental concerns; the need for a concern for health and wellbeing to permeate a far wider range of policies, tasks and activities than at present and to become a priority for those working in fields that would not normally be considered relevant to public health; and the thorny and persistent subject of health inequalities, which, arguably, is more a matter of social justice than health policy. The discussion suggests that a strong and confident public health system will contribute effectively to meeting these challenges. The global economic crisis could also provide an opportunity to find new ways of making progress that does not compromise sustainability.

This chapter illustrates how the public health crises of the 1790s can illustrate the ambiguous nationhood of the early United States and the tension among the states as they attempted to situate themselves within both a national and a global context. Faced with the continuing borderless health threats, the Pennsylvanians—Philadelphians especially—were forced to think about the nature of their relationship with the world beyond the banks of the Delaware River. Philadelphia was after all the center of the quarantine debate that arose from the 1796 Smith Bill. That, in turn, reflected the ways in which interstate conflict over coordinating policy across jurisdictional lines also illuminates the ongoing argument over the place of consent and coercion in achieving consensus among individuals.

This chapter examines the foundational forces that shape health. Even without a pandemic, the United States is faced with public health threats that are shaped by foundational forces. From the political and economic roots of the obesity epidemic, to the social stigma that informs the opioid crisis, to the many structural drivers of climate change, the social, economic, political, and demographic foundations of health are central to the challenges that must be addressed, nationally and globally, in the years to come. Engaging with these forces helped inform the response to COVID-19; they can help in addressing these other challenges as well. And just as a virus can have long-term effects on the body, the pandemic reshaped the societal foundations, with lasting implications for the economy, culture, attitudes towards core issues like race, politics, and more. Whether the experience of the pandemic leads to significant long-term benefits will depend on whether Americans retain the hard lessons of that moment and apply them to foundational forces.