A Public Mess

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Until the money is made available, some states are taking matters into their own hands. Nebraska passed legislation last September to improve its public-health system, earmarking $6 million from its share of the national tobacco settlement to establish five new health departments that cover 19 of the state's 93 counties. Texas is relying on revenue from the state's telecommunications fund to wire itself for the Health Alert Network. Georgia, which had been given CDC grants to fight such problems as West Nile virus and emerging infections, decided that the best way to do that was to hire a new team of epidemiologists to keep an eye out for all these ills. Such self-sufficiency at the state level will not only make grass-roots disease tracking more efficient but also make local authorities better able to function as a first line of defense in emergencies. That, say health experts, is something they ought to be doing anyway, since it's the states that know the personnel and the resources on the ground better than federal agencies swooping in with a planeload of strangers. "In the final analysis, all response is local," says Dr. Margaret Hamburg, a former New York City health commissioner.

Just as response is local, responsibility--the burden of ensuring that individuals and their families stay healthy--is personal. Seeing to the public weal has always required appealing to the public will. The best bureaucracy in the world can't force wellness on the people it serves. The most it can do is make good health available--providing all the information and resources that people need to take care of themselves. Ultimately, the rest of the caretaking is up to us.

--Reported by David Bjerklie and Andrea Dorfman/New York and Andrew Goldstein/Washington