Redlener Irwin E. author Columbia University. Population and Family Health Columbia University. National Center for Disaster Preparedness Columbia University. Pediatrics Columbia University. National Center for Disaster Preparedness originator text Articles 2008 English In a perfect illustration of our nation's proclivity for postevent crisis response and our resistance to longer term planning and system investment, the nation put a rush order on developing a massive bureaucracy designed to fast track new systems for preventing and responding to terrorism and large scale natural disasters. FEMA and many other agencies were incorporated into the new Department of Homeland Security, billions of dollars were appropriated and, seemingly, a substantial focus on disaster prevention and management was emerging in the aftermath of the attacks on the World Trade Center in New York City. What actually materialized, however, in the frantic push to create new systems, has, so far, failed to provide credible, cost-effective, evidence-based systems of disaster preparedness and response. Overall, I suspect that the government efforts spurred on by the attacks of 9/11 represent not only an extraordinary level of spending, but also a lack of accountability that is virtually unprecedented in recent US history. In fact, after watching—and working among—the efforts to respond effectively to the disasters precipitated by Hurricanes Katrina and Rita, and the subsequent flooding of New Orleans, it is clear that much needs to be done in all aspects of this field. But perhaps no challenge is more pressing than coming to grips with the realities facing families whose "disaster risk profile" is exacerbated by vulnerabilities that include long-term income fragility, social marginalization, or chronic illness. Public health Public administration 75 3 785 792 2008 http://hdl.handle.net/10022/AC:P:8844 NNC NNC 2010-05-25 11:56:14 -0400 2012-02-06 16:42:09 -0500 1340 eng